Recent years have seen a massive increase in regulations in countries all around the world against e-cigs in some kind of mistaken belief that they are damaging to the health of the public, however it is vital to bear in mind the amount of damage that e-cigs can actually prevent, especially for smokers who are most at-risk.
Asthma sufferers are most likely to experience a worsening of their condition through smoking, with a more rapid decline in lung function resulting in corticosteroid treatments failing to work so well. Switching to vaping instead of smoking tobacco can potentially reduce the suffering of those with asthma, however previously there was no research which could support this theory.
Now, a new study into the improvements experienced by smokers with asthma who have either partially or completely switched to vaping, has been published by Professor Riccardo Polosa. While the sample of people used in this study is relatively small, the evidence overwhelmingly shows that asthmatic smokers show significant improvements following making the switch, and this implies that vaping is likely to be a suitable alternative to smoking for those who find that they are unable to give up nicotine completely.
A Summary Of The Study
Data was taken from 18 smokers with asthma who had made the switch to vaping during two clinic visits during late 2012 and 2013. Both the baseline and the pre-baseline data was then used to demonstrate that the changes experienced did not form part of a pre-existing trend from before the patient began vaping.
Several tests and questionnaires were carried out including questionnaires into asthma control, tests for airway hyper-responsiveness and spirometry tests, and notes were taken of any exacerbations to their condition.
Following one year, significant improvements were able to be observed in asthma control as well as improvements in the spirometry data and a better response to the airway hyper-responsiveness tests. These were noted not only in those who had completely made the switch to vaping but also in those who were still dual-users.
Out of the 18 participants, 10 had completely quit smoking by vaping, while the 8 dual users had cut the amount of cigarettes they consumed on average each day, cutting the numbers down to 3.9 from 22.4 over the course of the year. However the purpose of this study was not to determine whether e-cigs were effective in assisting the cessation of smoking in asthmatic patients.
None of the participants in the study required admittance to a hospital or intensive care unit at any time during the period of the study, and overall the amount of exacerbation showed a decrease, however this was not considered to be a significant difference. The only side effects reported related to a dry mouth and some throat irritation.
The benefits which were observed in the conditions of the participants were reasonably expected to be in direct relation to stopping smoking as opposed to vaping itself, however this research does suggest that e-cigarettes can be well-tolerated by asthmatics.
Both the small size of the sample and the retrospective reporting during this study can be considered to be limitations, however the findings do appear to agree with the knowledge that already exists about the health benefits of reducing or quitting smoking for asthma sufferers.
Studying Asthmatics Who Vape or Dual-Use – What The Study Actually Did
During the study, researchers reviewed the medical records of asthma sufferers who were regular attendees at outpatient clinics. In the end, they identified 18 smokers with asthma (7 female, 11 male) who had reported that they had switched either entirely or partially to vaping during a minimum of two follow-up visits, who could become participants in this research project. Between September 2012 and December 2013, the selected patients attended the outpatient clinic to receive treatment as they usually would. All had either a mild or moderate case of asthma. Baseline visits were identified for each patient from when they were still smoking tobacco, and records were obtained from the visit that they had made before this baseline visit in order to establish that the condition of the patients was stable (i.e. showing no improvement before the time of the baseline visit). The follow up visits took place at around 6 months and a year after the baseline visit took place and at each one the patients were assessed again in order to determine if and how their condition had changed. In order to assess any changes an asthma questionnaire was used to note any exacerbation experienced in the patient’s condition, in conjunction with a spirometry test on the patient’s lung function, and some patients also underwent airway hyper-responsiveness tests.
Out of the 18 participants, 10 had switched completely to e-cigs while 8 were dual users. Before the study, all of the patients were smoking roughly 20 cigarettes each day. In the beginning, the participants started out vaping cig-a-likes, however they then switched to advanced PVs, and by the time the study finished they had been vaping for between 10 and 14 months. The measurements of their lung function, the results of their hyper-responsiveness tests and their questionnaire scores at both the baseline and the pre-baseline testing stages showed that before the baseline was taken their conditions had shown neither worsening nor improvement.
What The Study Showed – Asthmatics Enjoy Positive Outcomes From Both Dual-Use And Single Vaping
At the follow up six months after beginning the study, one of the lung function parameters as well as the asthma questionnaire scores had shown an improvement in all of the participants, and both single and dual users experienced similar improvements. After one year, there had been significant improvements in all of the measured asthma outcomes for both single and dual users, excepting the measurements taken among the single users of the amount of air which can be exhaled by the patient.
Over the study period, no participant required admittance to either a hospital or intensive care unit and overall, the amount of exacerbations was reduced when compared to the measurement taken at baseline. However this change was not statistically significant and this means that chance variation cannot be completely ruled out. Despite this, during the research period, none of the participants experienced an acute increase in their symptoms such as wheezing or coughing, and no adverse reactions linked to vaping were reported except for the occasional complaint of a dry mouth or throat irritation.
While this research is unable to provide evidence for how effective e-cigs are for stopping smoking, the rate observed in quitting completely and the substantial reduction of cigarette consumption should still be noted. 10 participants stopped smoking completely by using vaping as an alternative, and across the entire sample, the number of tobacco cigarettes smoked each day decreased on average to 1.7 after one year from 21.9 at the baseline assessment. When it comes to dual users, the number of cigarettes smoked each day dropped to 3.9 each day after one year which was down from 22.4 daily.
What Does The Study Mean?
The improvements that were observed during this study are generally assumed to be as a result of either stopping or drastically cutting down on smoking rather than being an effect directly attributable to vaping itself. This finding, therefore, is fairly expected since improvements in lung function after quitting smoking have been observed previously in other studies. This improvement is probably because of the inflammatory effect that cigarette smoke has on the airways, or possibly due to the impact smoking may have on asthma medications’ effectiveness. These explanations may also explain the improvements were were observed with regards to airway hyper-responsiveness.
The hyper-responsiveness improvements could well offer clinical benefits, and the improvement which was observed in the scores of the asthma control questionnaire is also considered to be clinically relevant, however the results regarding general lung function were not, and this is due to the fact that although the lung function improvements were statistically significant, the sample was deemed to be too small to count. This shows that improvements took place, however this is not likely to translate into a notable clinical improvement.
When taking into account that all of the other measures of outcomes showed an improvement following the patient making the switch to vaping, the research team observed that there was no change in the amount of condition exacerbations and they assumed that the reason for this was due to the fact that exacerbation was relatively rare in this group of sufferers since their cases of asthma were only mild or moderate, thus leaving little room to show any improvement when it comes to this area, and it would certainly be especially difficult to define any such improvement in this group considering the small size of the sample.
One ongoing concern about e-cigs is that those who smoke as well as vape may not experience as much of a benefit as might be imagined by simply cutting down the amount of cigarettes smoked daily, however in this study, it was revealed that the observed improvements in those patients who were dual users in fact were pretty much identical to the results from those who had made the switch to vaping entirely. Furthermore, one of the outcome measures actually showed a more rapid improvement in those patients who were dual users, and this is thought to be because the dual users actually reduced their level of smoking more than the single users since they had been heavier smokers on average than those asthma patients who had managed to quit successfully. This, in turn, allowed these patients more opportunity to show a greater improvement in their measurements after they reduced their smoking. Of course, their consumption of cigarettes was reduced dramatically (on average from around 20 cigarettes a day to around 5 daily after 6 months), and this ought to be considered when thinking about how this could be applied to other dual users.
A key element of this study is the implication that it has for smokers with asthma, who, regardless of their medical condition, appear to be generally disinterested in quitting the habit for good. While the sample here effectively selected themselves (i.e. they chose to start vaping themselves rather than being randomly assigned e-cigs) the result of the research does reveal that e-cigs seem to be an effective way for asthmatics to try to quit. This led the researchers to speculate that the most probable cause of this is the combination of the physical and behavioural elements of using e-cigarettes (i.e. the provision of nicotine together with the familiar hand to mouth movement that they would use in smoking).
Although the authors of the study could not be certain that using e-cigs led to the patients’ positive outcomes, it was possible to say that none of the patients reported any harm from making the switch to vaping, and therefore this suggests that asthmatic smokers can tolerate vaping well. This led them to conclude that those asthmatic smokers who are either unwilling or unable to stop smoking should be offered e-cigarettes as an alternative safe approach which can also reverse the harm caused by smoking and reduce further harm being caused.
It is important to note, however, that this research is of a preliminary nature, and further studies which are more rigorously controlled are required in order to confirm the benefits which have been observed here. The study’s main limitations are the small size of the patient sample and much of the reporting’s retrospective nature. Overall, it is hard in cases of research such as this to establish a causal relationship, and information which has been recorded by the various medical professionals can be different in their quality. It is also possible that there was a chance of some recall bias when symptoms were reported, for example the patient forgetting some minor symptom, and also that the patients were self-reporting their own abstinence from tobacco smoking. Yet despite these limitations, this research does offer a positive finding which will almost certainly be strengthened in the future by further studies as there are known to be benefits associated with quitting smoking and vaping is also known to be comparatively safe.
As regulators, journalists and politicians are currently trying to make us believe that e-cigs could be a threat to our public health, research such as this continues to show that there are likely to be major benefits associated with switching to vaping. Future studies which look at the same outcomes but which are more rigorously controlled will almost certainly supply further compelling evidence, however the initial findings of this research appear to fit with the existing knowledge we have on this subject, and the results even from this small project show that we have good reason to believe that smokers with asthma who make the switch to vaping are likely over time to see a great improvement in their medical condition.