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Patients with asthma with difficulty quitting may benefit from electronic cigarette use

Electronic cigarettes may be a stopgap measure for patients with asthma who smoke, have difficulty with cessation and frequently relapse, according to a recent evidence-based guide published in Annals of Allergy & Immunology.

“Smoking cessation should be strongly encouraged in patients with asthma who smoke, and they should be offered effective personalized strategies. In addition to pharmacotherapy and behavioral support, other options should be made available to manage smokers who frequently relapse and for those who are unable or unwilling to quit,” Riccardo Polosa, MD, PhD, from the Centro per la Prevenzione e Cura del Tabagismo at Azienda Ospedalieroe-Universitaria in Catania, Italy, and colleagues wrote. “A realistic alternative is to encourage these smokers to switch to [electronic cigarettes], a much less harmful source of nicotine.”

Polosa and colleagues performed a review of PubMed for articles containing information about patients with asthma, smoking cessation, electronic cigarettes, tobacco harm reduction and tobacco harm reversal, according to the abstract. They identified data that showed vapor toxicology with electronic cigarettes was 96% less harmful than combustible cigarettes and contained fewer tobacco smoke toxicants and carcinogens. Although there are limited data to suggest respiratory health gains in patients with electronic cigarettes, the researchers cited a retrospective clinical survey that showed improved forced expiratory volume in 1 second and forced vital capacity among other measurements when reducing combustible tobacco use or switching to electronic cigarettes. Further, patients in a different, online survey who switched to electronic cigarettes from combustible tobacco showed an improvement in asthma symptoms in 65.4% of cases, with only 1.1% of patients showing worsening symptoms after switching to electronic cigarettes.

However, the researchers were careful to only recommend electronic cigarettes as an alternative when other methods of cessation have not succeeded.

“The argument for [electronic cigarettes] must be framed within the correct context,” Polosa and colleagues wrote. “[Electronic cigarettes] represent an option for harm reduction in existing smokers. With any emerging behavior associated with exposure to inhalational agents, there is legitimate cause for concern and a need for study of potential harm. However, this potential risk must be taken in the context of the known harm of cigarette smoking in populations with and without asthma.” – by Jeff Craven

Disclosure: Polosa reports grant funding from Pfizer and Boehringer-Ingelheim, lecture fees from Novartis and GlaxoSmithKline and other funding from the IMI-JU for European project on severe asthma.