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, Riccardo Polosa, Jaymin Morjaria, Pasquale Caponnetto, Massimo Caruso, Simona Strano, Eliana Battaglia, Cristina Russo

Abstract

Electronic cigarettes (e-cigs) are marketed as safer alternatives to tobacco cigarettes and have shown to reduce their consumption. Here we report for the first time the effects of e-cigs on subjective and objective asthma parameters as well as tolerability in asthmatic smokers who quit or reduced their tobacco consumption by switching to these products. We retrospectively reviewed changes in spirometry data, airway hyper-responsiveness (AHR), asthma exacerbations and subjective asthma control in smoking asthmatics who switched to regular e-cig use. Measurements were taken prior to switching (baseline) and at two consecutive visits (Follow-up/1 at 6 (±1) and Follow-up/2 at 12 (±2) months). Eighteen smoking asthmatics (10 single users, eight dual users) were identified. Overall there were significant improvements in spirometry data, asthma control and AHR. These positive outcomes were noted in single and dual users. Reduction in exacerbation rates was reported, but was not significant. No severe adverse events were noted. This small retrospective study indicates that regular use of e-cigs to substitute smoking is associated with objective and subjective improvements in asthma outcomes. Considering that e-cig use is reportedly less harmful than conventional smoking and can lead to reduced cigarette consumption with subsequent improvements in asthma outcomes, this study shows that e-cigs can be a valid option for asthmatic patients who cannot quit smoking by other methods.

Figures

Figure 1
Figure 1
(A) Forced expiratory volume (FEV1) at the four timepoints of assessment for all 18 patients; (B) Forced vital capacity (FVC) at the four timepoints of assessment for all 18 patients; (C) Forced expiratory flow (FEF) 25–75 at the four timepoints of assessment for all 18 patients.
Figure 2
Figure 2
Asthma control questionnaire (ACQ) score at the four timepoints of assessment for all 18 patients.
Figure 3
Figure 3
Methacholine PC20 at the four timepoints of assessment.

References

    1. To T., Stanojevic S., Moores G., Gershon A.S., Bateman E.D., Cruz A.A., Boulet L.P. Global asthma prevalence in adults: Findings from the cross-sectional world health survey. BMC Public Health. 2012;12 doi: 10.1186/1471-2458-12-204.
    1. Polosa R., Knoke J.D., Russo C., Piccillo G., Caponnetto P., Sarva M., Proietti L., Al-Delaimy W.K. Cigarette smoking is associated with a greater risk of incident asthma in allergic rhinitis. J. Allerg. Clin. Immunol. 2008;121:1428–1434. doi: 10.1016/j.jaci.2008.02.041.
    1. Polosa R., Thomson N.C. Smoking and asthma: Dangerous liaisons. Eur. Respir. J. 2013;41:716–726. doi: 10.1183/09031936.00073312.
    1. Polosa R., Russo C., Caponnetto P., Bertino G., Sarva M., Antic T., Mancuso S., Al-Delaimy W.K. Greater severity of new onset asthma in allergic subjects who smoke: A 10-year longitudinal study. Respir. Res. 2011;12 doi: 10.1186/1465-9921-12-16.
    1. Lange P., Parner J., Vestbo J., Schnohr P., Jensen G. A 15-year follow-up study of ventilatory function in adults with asthma. N. Engl. J. Med. 1998;339:1194–1200. doi: 10.1056/NEJM199810223391703.
    1. Tomlinson J.E., McMahon A.D., Chaudhuri R., Thompson J.M., Wood S.F., Thomson N.C. Efficacy of low and high dose inhaled corticosteroid in smokers versus non-smokers with mild asthma. Thorax. 2005;60:282–287. doi: 10.1136/thx.2004.033688.
    1. Chaudhuri R., Livingston E., McMahon A.D., Thomson L., Borland W., Thomson N.C. Cigarette smoking impairs the therapeutic response to oral corticosteroids in chronic asthma. Amer. J. Respir. Crit. Care Med. 2003;168:1308–1311. doi: 10.1164/rccm.200304-503OC.
    1. Tonnesen P., Pisinger C., Hvidberg S., Wennike P., Bremann L., Westin A., Thomsen C., Nilsson F. Effects of smoking cessation and reduction in asthmatics. Nicotine Tob. Res. 2005;7:139–148. doi: 10.1080/14622200412331328411.
    1. Chaudhuri R., Livingston E., McMahon A.D., Lafferty J., Fraser I., Spears M., McSharry C.P., Thomson N.C. Effects of smoking cessation on lung function and airway inflammation in smokers with asthma. Amer. J. Respir. Crit. Care Med. 2006;174:127–133. doi: 10.1164/rccm.200510-1589OC.
    1. Eisner M.D., Yelin E.H., Katz P.P., Shiboski S.C., Henke J., Blanc P.D. Predictors of cigarette smoking and smoking cessation among adults with asthma. Amer. J. Public Health. 2000;90:1307–1311. doi: 10.2105/AJPH.90.8.1307.
    1. Wakefield M., Ruffin R., Campbell D., Roberts L., Wilson D. Smoking-related beliefs and behaviour among adults with asthma in a representative population sample. Aust. N. Z. J. Med. 1995;25:12–17. doi: 10.1111/j.1445-5994.1995.tb00572.x.
    1. Caponnetto P., Russo C., Bruno C.M., Alamo A., Amaradio M.D., Polosa R. Electronic cigarette: A possible substitute for cigarette dependence. Monaldi Arch. Chest Dis. 2013;79:12–19.
    1. Polosa R., Rodu B., Caponnetto P., Maglia M., Raciti C. A fresh look at tobacco harm reduction: The case for the electronic cigarette. Harm Reduct. J. 2013;10 doi: 10.1186/1477-7517-10-19.
    1. Caponnetto P., Campagna D., Cibella F., Morjaria J.B., Caruso M., Russo C., Polosa R. EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: A prospective 12-month randomized control design study. PLoS One. 2013;8 doi: 10.1371/journal.pone.0066317.
    1. Bullen C., Howe C., Laugesen M., McRobbie H., Parag V., Williman J., Walker N. Electronic cigarettes for smoking cessation: A randomised controlled trial. Lancet. 2013;382:1629–1637. doi: 10.1016/S0140-6736(13)61842-5.
    1. Global Initiative for Asthma (GINA) From the Global Strategy for Asthma Management and Prevention. 2012. [(accessed on 17 February 2014)]. Available online:
    1. Juniper E.F., Svensson K., Mork A.-C., Stahl E. Measurement properties and interpretation of three shortened versions of the asthma control questionnaire. Respir. Med. 2005;99:553–558. doi: 10.1016/j.rmed.2004.10.008.
    1. Caponnetto P., Cibella F., Mancuso S., Campagna D., Arcidiacono G., Polosa R. Effect of a nicotine-free inhalator as part of a smoking-cessation programme. Eur. Respir. J. 2011;38:1005–1011. doi: 10.1183/09031936.00109610.
    1. Chalmers G.W., MacLeod K.J., Thomson L., Little S.A., McSharry C., Thomson N.C. Smoking and airway inflammation in patients with mild asthma. Chest. 2001;120:1917–1922.
    1. Pedersen B., Dahl R., Karlstrom R., Peterson C.G., Venge P. Eosinophil and neutrophil activity in asthma in a one-year trial with inhaled budesonide: The impact of smoking. Amer. J. Respir. Crit. Care Med. 1996;153:1519–1529. doi: 10.1164/ajrccm.153.5.8630596.
    1. Lazarus S.C., Chinchilli V.M., Rollings N.J., Boushey H.A., Cherniack R., Craig T.J., Deykin A., di Mango E., Fish J.E., Ford J.G., et al. Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma. Amer. J. Respir. Crit. Care Med. 2007;175:783–790. doi: 10.1164/rccm.200511-1746OC.
    1. Piccillo G., Caponnetto P., Barton S., Russo C., Origlio A., Bonaccorsi A., Maria A.D., Oliveri C., Polosa R. Changes in airway hyperresponsiveness following smoking cessation: Comparisons between Mch and AMP. Respir. Med. 2008;102:256–265. doi: 10.1016/j.rmed.2007.09.004.
    1. Sparrow D., O’Connor G., Colton T., Barry C.L., Weiss S.T. The relationship of nonspecific bronchial responsiveness to the occurrence of respiratory symptoms and decreased levels of pulmonary function: The normative aging study. Amer. Rev. Respir. Dis. 1987;135:1255–1260.
    1. Tashkin D.P., Altose M.D., Connett J.E., Kanner R.E., Lee W.W., Wise R.A. Methacholine reactivity predicts changes in lung function over time in smokers with early chronic obstructive pulmonary disease. The lung health study research group. Amer. J. Respir. Crit. Care Med. 1996;153:1802–1811. doi: 10.1164/ajrccm.153.6.8665038.
    1. Laforest L., van Ganse E., Devouassoux G., Bousquet J., Chretin S., Bauguil G., Pacheco Y., Chamba G. Influence of patients’ characteristics and disease management on asthma control. J. Allerg. Clin. Immunol. 2006;117:1404–1410.
    1. Schatz M., Zeiger R.S., Vollmer W.M., Mosen D., Cook E.F. Determinants of future long-term asthma control. J. Allerg. Clin. Immunol. 2006;118:1048–1053. doi: 10.1016/j.jaci.2006.07.057.
    1. Chaudhuri R., McSharry C., McCoard A., Livingston E., Hothersall E., Spears M., Lafferty J., Thomson N.C. Role of symptoms and lung function in determining asthma control in smokers with asthma. Allergy. 2008;63:132–135.
    1. Farsalinos K.E., Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarettes substitutes: A systematic review. Ther. Adv. Drug Safety. 2014;5:67–86. doi: 10.1177/2042098614524430.
    1. Wong S.L., Shields M., Leatherdale S., Malaison E., Hammond D. Assessment of validity of self-reported smoking status. Health Rep. 2012;23:47–53.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다