Chronic obstructive pulmonary disease (COPD) is intricately linked to smoking. It’s estimated around 80% of cases of COPD are caused by smoking, and it’s one of the most important ways smoking causes death and disease. It might not be the first smoking-related condition you think of, but it’s right up there with lung cancer and heart disease as one of the major risks of smoking.
With all of this in mind, the impact of vaping on COPD risk and the effect of switching on smokers with COPD are two crucial areas for research to look at. A new study from Professor Riccardo Polosa and his team does just that, covering a massive three years of data from a group of smokers with COPD who switched to vaping, and comparing their results with smokers who didn’t switch. The researchers found that vaping “may reverse some of the harm resulting from tobacco smoking in COPD patients.” For smokers interested in making the switch to vaping, the study offers more excellent news.
What is COPD?
COPD is a broad term that covers many different specific conditions, including emphysema, bronchitis and non-reversible asthma. Doctors group the conditions together because they are all progressive lung diseases. This means you increasingly struggle to breathe as the condition progresses. Most sufferers are over 40 years old and have a history of smoking, and it’s estimated to affect about one in five smokers. As the condition progresses, sufferers may struggle to perform simple tasks like climbing a flight of stairs or walking to the mailbox without feeling breathless and exhausted. COPD is currently incurable and it is the third leading cause of death in the US. The World Health Organization estimates that it will also be the third leading cause of death worldwide by 2030.
Presently, the only strategy to reduce the impact of COPD and improve the prognosis of sufferers is to stop smoking. However, many COPD sufferers struggle to quit, and this is why the researchers investigated the potential impact of vaping: it could be a pragmatic solution to the problem, although likely not an absolutely ideal one.
The Study: What They Did
The researchers recruited two groups of smokers. One group consisted of 22 smokers with COPD who switched to vaping at the start of the study period. The researchers matched these smokers with another group of 22 smokers who didn’t switch to vaping, so they could compare their results to see if vaping had an impact on their conditions. The smokers were followed up with each year for a total of three years, with the results from the first two years first being reported a couple of years ago in a separate study.
What They Found: COPD Sufferers Who Switched to Vaping Saw Improvements
The researchers looked at several indicators of how the patients were progressing at each follow-up visit. These included their relevant symptoms, the number of cigarettes they smoked per day, the number of serious exacerbations of their condition (requiring treatment or a hospital visit) in the past year, standard lung function tests, their scores on a COPD health questionnaire and (for patients who agreed and were able to) the distance they could walk in six minutes. If these measures improved (for example, fewer exacerbations and a longer walking distance), this signifies an improvement in their COPD.
Vaping Helps COPD Sufferers Smoke Less Per Day
Firstly, the researchers noted a substantial reduction in the number of cigarettes smoked per day in the COPD sufferers who started vaping. At the first visit, they smoked an average of 22 cigarettes per day, which fell to just 2 per day after a year and continued to drop to an average of 1.5 per day by the third year. At the three-year mark, 13 of the 22 smokers who started vaping had completely quit smoking. In contrast, the control group continued to smoke the same number of cigarettes per day throughout the study.
COPD Sufferers Who Switched Had Fewer Exacerbations of Their Condition
The patients with COPD who switched to vaping had significantly fewer exacerbations of their condition at each of the three follow-up visits. The number of exacerbations declined from an average of 2.3 at the first visit to 1.3 at the three-year follow-up, which was a statistically significant improvement. In comparison, the control group saw no reductions in exacerbations, despite being at a similar rate of 2.1 at the beginning of the study. The difference between the groups at the end of the study was statistically significant. Notably, the vapers who also continued to smoke (dual users) also saw a significant decrease in their number of exacerbations over the three-year period.
Switchers Improved on COPD Questionnaire and Six Minute Walking Distance
The scores on the COPD questionnaire also significantly improved for the group who switched to vaping. In comparison, there was no improvement in the control group. By the third visit, the switching group’s score had improved by 5.5 points on the questionnaire, from around 20 to 15, compared to the control group scores, which remained at around 20 throughout. Again, both the dual users and the full switchers showed consistent improvements.
Scores on the six minute walking distance test weren’t available for all participants, but there was a significant difference between the groups after three years. For the switchers, their walking distance improved by a median of 70 meters, but for the control group the distance actually decreased by 7.5 meters.
Is Vaping a Good Harm Reduction Strategy for COPD Patients?
The overall results of the study suggest plenty of benefits for smokers with COPD who switch to vaping. While the researchers didn’t see an improvement on lung function tests, they took the fact that their conditions didn’t get worse as a positive sign. Many advanced COPD patients continue to suffer reduced lung function like this. This is often true even if they quit smoking and remain completely abstinent from all forms of nicotine.
The remainder of the measures investigated in the study did show improvements. The researchers point to the reduction in exposure to carbon monoxide as the cause for this. Experts expect improvements in these cases, given that e-cigarette vapor doesn’t contain carbon monoxide, or many other harmful constituents of smoke. The fact that vapers who also continued to smoke showed similar improvements in their condition is likely because they reduced their smoking substantially, by over 75% of their baseline level. To be clear, it is the reduction in smoking that causes the improvements, rather than an effect of vaping itself.
The researchers conclude:
“[Vaping] may be exploited as a less harmful strategy to potentially halt or reverse COPD-related outcomes and, in general, to reduce the risk of smoking-related diseases or the harm from smoking-associated comorbidities. While the sample size in our study was relatively small, the results of this study may provide preliminary evidence that long-term use of [e-cigarettes] is unlikely to result in substantial health concerns in COPD patients.”
Overall, the study is really positive news for the potential of vaping for COPD patients who still smoke. While complete abstinence might be preferable, this isn’t always possible. In these cases, vaping might be able to make a substantial difference where nothing else could.