Smokers who switch to vaping see improved respiratory health

A new paper in Nicotine and Tobacco Research, published by Oxford University Press, finds that people who switch from smoking cigarettes to vaping see improved respiratory health, but people who begin consuming electronic cigarettes while continuing to smoke regular cigarettes do not report improved respiratory symptoms.

Adults increasingly use electronic cigarettes to try to quit smoking because of the perceived reduced risk. But while vaping reduces exposure to toxic chemicals, it has been unclear whether switching from cigarettes to e-cigarettes results in a reduction of the respiratory problems—like wheezing and coughing—common in regular cigarette smokers.

Researchers here used data from the Population Assessment of Tobacco and Health (PATH) study, a national longitudinal measure of tobacco use in the United States performed by the National Institutes of Health. The investigators here observed adult participants between 2013 and 2019 who reported smoking cigarettes exclusively at the beginning of the investigation and reported a baseline cough or wheeze.

The researchers divided the subjects into four groups: those who transitioned from exclusive cigarette smoking to quitting nicotine altogether, those who switched from cigarette smoking to vaping exclusively, those who continued to smoke cigarettes only, and those who kept smoking and also began vaping.

Completely switching from cigarettes to e-cigarettes led to a moderate increase in the resolution of wheeze symptoms compared with persistent smoking. However, there were lower rates of respiratory symptom resolution among those transitioning to vaping while maintaining or increasing their smoking. Among 5,210 subjects with a baseline cough, 3,362 (65%) saw their coughs go away. Of the 5,367 people who reported a baseline wheeze, the researchers observed that 2,862 (53%) saw improvements. Switching from cigarettes to e-cigarettes exclusively resulted in significantly reduced wheezing but not cough resolution. Transitioning to both smoking and vaping (vs. just continuing to smoke cigarettes) was not associated with respira­tory improvement overall or even among participants who reduced their cigarette smoking intensity.

The researchers note that the rates of symptom resolu­tion were 14% lower (for cough) and 15% lower (for wheeze) among those who switched to dual use and maintained or increased their smoking intensity; those who started using electronic cigarettes while continuing to smoke the same number of regular cigarettes saw their wheeze and coughing get worse.

Switching from smoking cigarettes to quitting nicotine altogether was, perhaps unsurprisingly, associated with the best improvements in both coughs and wheezing.

The paper, “Association of cigarette–e-cigarette transitions with respiratory symptom resolution,” is available (at midnight on November 12^th) at https://doi.org/10.1093/ntr/ntae224.