Respiratory System


Effect of Smoking Abstinence and Reduction in Asthmatic Smokers Switching to Electronic Cigarettes: Evidence for Harm Reversal

Riccardo Polosa, Jaymin Morjaria, Pasquale Caponnetto, Massimo Caruso, Simona Strano, Eliana Battaglia, Cristina Russo
International Journal of Environmental Research and Public Health
Published online: May 2014

The e-cig may help smokers with asthma to reduce their cigarette consumption or remain abstinent and hence reduce the burden of smoking-related asthma symptoms. The positive findings observed with e-cigs allows us to advance the hypothesis that these products may be valuable for smoking cessation and/or tobacco harm reduction also in asthma patients who smoke.

By substantially reducing number of cigarettes smoked per day and exposure to their hazardous toxicants, e-cigs may not only improve asthma symptoms and pulmonary function but may also confer an overall health advantage in smokers with asthma [13]. Therefore, e-cig use in asthmatic smokers unable or unwilling to quit should be exploited as a safer alternative approach to harm-reversal (i.e., specific reversal of asthma-related outcomes) and, in general, to harm-reduction (i.e., overall reduction of smoke-related diseases).


Evidence for harm reduction in COPD smokers who switch to electronic cigarettes

Riccardo Polosa, Jaymin Bhagwanji Morjaria, Pasquale Caponnetto, Umberto Prosperini, Cristina Russo, Alfio Pennisi, Cosimo Marcello Bruno
Respiratory Research
Published online: 16 Dec 2016

Conclusion: “These findings suggest that ECs use may aid smokers with COPD reduce their cigarette consumption or remain abstinent, which results in marked improvements in annual exacerbation rate as well as subjective and objective COPD outcomes.” 

Changes in the Frequency of Airway Infections in Smokers Who Switched ToVaping: Results of an Online Survey

Joanna Astrid Miler, Bernhard Mayer, Peter Hajek
Published online: 16 Dec 2016

Results: “Altogether 941 responses were received. Overall, 29% of responders reported no change in respiratory symptoms, 5% reported worsening, and 66% reported an improvement (95% CI=62.9-69.0).” 

Changes in breathomics from a 1-year randomized smoking cessation trial of electronic cigarettes

Davide Campagna, Fabio Cibella, Pasquale Caponnetto, Maria Domenica Amaradio, Massimo Caruso, Jaymin B. Morjaria, Mario Malerba, Riccardo Polosa
BMC Pneumonia
Published online: 20 Jun 2016

Conclusion: “Smokers invited to switch to electronic cigarettes who completely abstained from smoking showed steady progressive improvements in their exhaled breath measurements and symptom scores. FeNo and eCO normalization is highly supportive of improved respiratory health outcomes and adds to the notion that quitting from tobacco smoking can reverse harm in the lung.” 

Respiratory infections and pneumonia: potential benefits of switching from smoking to vaping

Davide Campagna, Maria Domenica Amaradio, Mark F. Sands, Riccardo Polosa
Published online: 12 Apr 2016

Also, given that the propylene glycol in EC aerosols is a potent bactericidal agent, switching from smoking to regular vaping is likely to produce additional lung health benefits.

In conclusion, smokers who quit by switching to regular ECs use can reduce risk and reverse harm from tobacco smoking. 

Innovation in the e-vapour category is likely not only to further minimise residual health risks, but also to maximise health benefits.


E-cigarettes in patients with COPD: current perspectives

Morjaria JB, Mondati E, Polosa R
Published online: 1 Nov 2017

Conclusion: “Although ECs are not risk free, they are much less harmful than conventional tobacco smoking. The emerging clinical evidence suggests that ECs are unlikely to raise significant health concerns for the respiratory tract under normal conditions of use, even in smokers with pre-existing lung disease. In particular, recent studies in COPD and chronic asthma suggest that substitution of conventional tobacco cigarettes for ECs can ameliorate subjective and objective disease-related outcomes and exacerbation rates as well as improving success in abstaining from smoking long term.” 

Reduced biological effect of e-cigarette aerosol compared to cigarette smoke evaluated in vitro using normalized nicotine dose and RNA-seq-based toxicogenomics

Linsey E. Haswell, Andrew Baxter, Anisha Banerjee, Ivan Verrastro, Jessica Mushonganono, Jason Adamson, David Thorne, Marianna Gaça, Emmanuel Minet
Published online: 18 Apr 2017

Here, we assessed the transcriptional response of a primary 3D airway model acutely exposed to e-cigarette aerosol and cigarette (3R4F) smoke.

Based on equivalent or higher nicotine delivery, an acute exposure to e-cigarette aerosol had a reduced impact on gene expression compared to 3R4F smoke exposure in vitro.

Therefore, we can conclude that the data strongly supports the adverse effect of acute exposure to cigarette smoke on MucilAir™ cells with functional enrichment for cancer, inflammation and fibrosis genes. In contrast, RNA-seq-based toxicogenomics showed a reduced impact of e-cigarette aerosols acute exposure on MucilAir™ cells compared with 3R4F reference cigarette at equivalent or higher dose of nicotine exposure.

Electronic cigarette vapor alters the lateral structure but not tensiometric properties of calf lung surfactant

Rebecca J. Przybyla, Jason Wright, Rajan Parthiban, Saeed Nazemidashtarjandi, Savas Kaya, Amir M. Farnoud
Published online: 17 Nov 2017

While both e-cigarette vapor and conventional cigarette smoke affect surfactant lateral structure, only cigarette smoke disrupts surfactant interfacial properties. The surfactant inhibitory compound in conventional cigarettes is tar, which is a product of burning and is thus absent in e-cigarette vapor.


Health effects in COPD smokers who switch to electronic cigarettes: a retrospective-prospective 3-year follow-up

Polosa R, Morjaria JB, Prosperini U, Russo C, Pennisi A, Puleo R, Caruso M, Caponnetto P
Published online: 28 Aug 2018

Conclusion: “The present study suggests that EC use may ameliorate objective and subjective COPD outcomes and that the benefits gained may persist long-term. EC use may reverse some of the harm resulting from tobacco smoking in COPD patients.” 


The effect of e-cigarette aerosol emissions on respiratory health: a narrative review

Riccardo Polosa, Renée O’Leary, Donald Tashkin, Rosalia Emma, Massimo Caruso
Published online: 2 Aug 2019

Expert opinion: There is growing evidence to support the relative safety of E-Cigarette (EC) emission aerosols for the respiratory tract compared to tobacco smoke. Public Health England estimated, on the basis of a review of 185 studies, that vaping an e-cigarette is likely to be at least 95% less harmful than smoking a regular cigarette. In 2016, the Royal College of Physicians reaffirmed this figure, estimating the risk of long-term inhalation of e-cigarette aerosol to be unlikely to exceed 5% of the risk associated with long-term cigarette smoking. This review article shows that although some potential effects on respiratory cell types can be shown in vitro, and low levels of chronic irritation of the respiratory tract can be anticipated at certain levels of vaping, these effects are much less than those of smoking. The clinical evidence confirms that ECs are unlikely to raise significant health concerns for the respiratory tract under normal conditions of use. Former smokers using and smokers intending to use ECs as a substitute for smoking should receive correct information about residual risks and potential benefits of these products. Promoting further access to ECs may offer an opportunity to reduce or prevent some of the otherwise inevitable burden of respiratory morbidity and mortality caused by tobacco smoking

In an Expert Review in Respiratory Medicine article published about 7 years ago [Caponnetto P, Campagna D, Papale G, et al. The emerging phenomenon of electronic cigarettes. Expert Rev Respir Med. 2012 Feb; 6(1):63–74.., we discussed several important research developments and future avenues for e-cigarette science. In the authors’ view, those expert opinions have been substantiated by the growing body of evidence. We therefore reiterate our prediction that EC use is the most effective method of substituting tobacco cigarettes for those smokers who are unable or unwilling to quit and we are now confident that current vaping products are much less harmful than conventional cigarettes as well as earlier EC designs.


Benefits of e-cigarettes in smoking reduction and in pulmonary health among chronic smokers undergoing a lung cancer screening program at 6 months

Claudio Lucchiari, Marianna Masiero, Ketti Mazzocco, Giulia Veronesi, Patrick Maisonneuve, Costantino Jemos, Emanuela Omodeo Salè, Stefania Spina, Raffaella Bertolotti, Gabriella Pravettoni
Published online: Apr 2020

The study is a double-blind randomized controlled trial. Two hundred and ten smokers were randomized into three groups: nicotine e-cigarette (8 mg/mL nicotine concentration), nicotine-free e-cigarettes (placebo), and control with 1:1:1 ratio. All participants received a 3 months cessation program that included a cognitive-behavioural intervention aimed at supporting people in changing their behaviour and improving motivation to quit.

After 6 months about 20% of the entire sample stopped smoking. Participants who used e-cigarettes with nicotine smoked fewer tobacco cigarettes than any other group after 6 months.

Our data add to the efficacy and safety of e-cigarettes in helping smokers reducing tobacco consumption and improving pulmonary health status.

Pulmonary health, assessed with self-reported measures, clinical evaluations and the Leicester Cough Questionnaire, improved in participants who stopped smoking compared to their own baseline. Moreover, participants in this group [nicotine e-cigarettes] showed the lowest level of exhaled carbon monoxide, and the lowest level of dependence compared to the nicotine-free e-cigarette and control conditions.

E-Cigarettes and Respiratory Disease: A Replication, Extension, and Future Directions

Donald S. Kenkel, Alan D. Mathios, Hua Wang
Published online: Jul 2020

The statistical associations between e-cigarette use and respiratory disease are driven by e-cigarette users who are also current or former smokers of combustible tobacco. 

A striking feature of the data is that almost all e-cigarette users were either current or former smokers of combustible tobacco.

Among respondents who had never smoked combustible tobacco, we find no evidence that current or former e-cigarette use is associated with respiratory disease.

Exclusive E-Cigarette Users Report Lower Levels of Respiratory Symptoms Relative to Dual E-Cigarette and Cigarette Users

Rachel N Cassidy, PhD, Jennifer W Tidey, PhD, Suzanne M Colby, PhD
Published online: 8 Aug 2020

Findings suggest that differences in respiratory symptoms between dual and exclusive e-cigarette users appear to be attributable to combustible cigarette smoking, rather than more intense or frequent e-cigarette use across groups.

Investigation on the Antibacterial Activity of Electronic Cigarette Liquids (ECLs): A Proof of Concept Study

Virginia Fuochi, Massimo Caruso, Rosalia Emma, Aldo Stivala, Riccardo Polosa, Alfio Distefano, Pio M Furneri
Current Pharmaceutical Biotechnology
Published online: 6 Jun 2020

Our results have shown that flavours considerably enhance antibacterial activity.

This study provides important evidence that should be taken into consideration in further investigative approaches, to clarify the different sensitivity of the various bacterial species to e-liquids, including the respiratory microbiota, to highlight the possible role of flavours and nicotine. 

COPD smokers who switched to e-cigarettes: health outcomes at 5-year follow up

Ricardo Polosa, Jaymin B Morjaria, Umberto Prosperini, Barbara Busà, Alfio Pennisi, Mario Malerba, Marilena Maglia, Pasquale Caponnetto
Published online: 10 Oct 2020

The present study suggests that EC use may ameliorate objective and subjective COPD outcomes, and that the benefits gained appear to persist long term. EC use for abstinence and smoking reduction may ameliorate some of the harm resulting from tobacco smoking in COPD patients.


MRI Shows Lung Perfusion Changes after Vaping and Smoking

Sylvia Nyilas, MD, PhD • Grzegorz Bauman, PhD • Insa Korten, MD, PhD • Orso Pusterla, MSc, PhD • Florian Singer, MD, PhD • Michael Ith, PhD • Cindy Groen•Anna Schoeni, PhD • Johannes T. Heverhagen, MD, PhD • Andreas Christe, MD • Nicolas Rodondi, MD, MAS•Oliver Bieri, PhD • Thomas Geiser, MD • Reto Auer, MD, MAS • Manuela Funke-Chambour, MD • Lukas Ebner, MD
Published online: 5 Apr 2022

In conclusion, short-term perfusion changes after use of electronic nicotine delivery systems and tobacco smoke expo-sure can be sensitively detected by functional MRI. Perfusion impairment at MRI did correlate with ventilation inhomo-geneity (lung clearance index) and was altered after tobacco smoking. Lung ventilation at MRI showed no changes after ex-posure to nicotine. These preliminary results suggest that MRI indexes may be considered as a noninvasive test to complement pulmonary function testing in this setting.