The ground-breaking review article “Health impact of e-cigarettes and heated tobacco products in chronic obstructive pulmonary disease: Current and emerging evidence” published in Expert Review of Respiratory Medicine discusses existing and future options for COPD smokers who have difficulty quitting smoking. It also systematically reviews the current literature about e-cigarettes and heated tobacco products. The article is authored by CoEHAR researchers of the University of Catania together with British respiratory physicians at Guy’s & St Thomas’ Hospitals in London.
Catania, 17 January 2023 – Chronic obstructive pulmonary disease (COPD) is a common chronic lung disease characterised by respiratory symptoms and progressive airflow limitation due to inflammatory responses in the airways/lungs in response to protracted exposure to smoke toxicants. Globally, there are more than 65 million people affected by this disease, with more than 3 million patients with COPD in Italy alone. COPD kills. COPD is the third leading cause of global death, causing more than 3 million deaths every year.
Slowing down disease progression, reducing respiratory exacerbations, and improving quality of life are unmet needs in the management of patients with COPD. Cessation of smoking is the only proven method known to improve morbidity and mortality, but it is discouraging that most smoking cessation schemes do not seem to work for the vast majority of COPD smokers and that many COPD patients continue smoking despite their symptoms.
Considered that only limited information is available about the health impact of combustion-free nicotine delivery alternatives in COPD, a research team of CoEHAR (Center of Excellence for the Acceleration of HArm Reduction) led by its founder professor Riccardo Polosa, authored this state-of-the-art review article to carefully identify and critically appraise the existing evidence from human studies on the respiratory health effects of ECs/HTPs substitution for COPD patients who smoke. The primary goal is to provide clinicians with evidence on the health effects of ECs/HTPs substitution to inform their recommendations and plans and to promote health literacy in COPD patients who are using or intending to use ECs/HTPs with a specific focus on existing evidence on their respiratory health.
Tobacco harm reduction is required as an alternative to the “quit or die” scenario.
“Patients with COPD who are having difficulty at stopping smoking should consider substituting conventional cigarettes with combustion-free nicotine delivery alternatives such as e-cigarettes (ECs), and heated tobacco products (HTPs). Although not risk-free, it is acknowledged that these products release far less toxic emissions compared to combustible cigarettes – says corresponding author, Professor Riccardo Polosa.
“Our state of the art review is an important reference for those interested in the impact of smoking, smoking cessation and smoking substitution in COPD – add Polosa – The article also includes specific recommendations for COPD patients who smoke and expert opinion on future prospective”.
Preliminary findings from prospective clinical studies are promising, but more high quality work is necessary to quantify the relative risk of using these emerging technologies compared to cigarette smoking, to accurately establish product quality and safety in absolute terms, and to assess health effects in COPD patients.
This review article highlights the need for large, carefully designed, adequately controlled, long- term follow-up clinical trials to assess the true potential of combustion-free nicotine delivery technologies for sustained smoking cessation and reducing risk of harm from smoking, particularly among smokers with chronic obstructive pulmonary disease (COPD). Appropriate outcomes of these studies should include, among others, changes in lung function, respiratory symptoms, health-related quality of life, exacerbations of COPD, physical functional ability, thoracic imaging (e.g. high-resolution computed tomography) as well as readily accessible biomarkers associated with the severity and progression of this disease.