Does Vaping Cause COPD?

vaping

Introduction

Chronic obstructive pulmonary disorder (COPD) is a term used to describe a group of progressive lung diseases that are the result of heavy smoking. COPD dramatically reduces airflow throughout the airways, causing extreme difficulty breathing and a plethora of secondary issues for the patient. This results in drastically reduced quality of life as the disease progresses, and very often, death. COPD is a result of long-term deterioration and destruction of sensitive lung tissue, estimated to become one of the leading causes of death by 2030 [1].

39% of the 15 million U.S. adults with COPD continue to smoke, increasing the speed at which their COPD progresses [2]. Vaping is often considered a more healthful alternative to smoking conventional tobacco, particularly so for those with smoking-associated diseases like COPD.

lung disease

COPD Risk Factors

The risk factors most commonly associated with COPD are:

Exposure to tobacco smoke

Smoking tobacco is inextricably linked to the development and exacerbation of COPD. The more you smoke, and the longer you smoke for, the more likely you will develop COPD.

tobacco

Asthmatic smokers

Smokers with asthma, a disease of chronic inflammation of the airways, have an even higher risk of developing COPD.

Long term exposure to chemicals, fuel fumes and dust

Occupational or long term exposure to chemical fumes, burning fuel and dust particles increases your risk of developing COPD.

Genetics

Only one rare genetic disorder is known to dramatically increase the chances of COPD, known as alpha1 antitrypsin (AAT) deficiency. Scientists do not yet understand why some smokers get COPD and others do not, suggesting genetics may influence COPD onset.

aat

COPD Symptoms

COPD is currently an incurable disease that often results in death, with an average age of onset of 40 years [3]. Early symptoms include shortness of breath, wheezing and increased heart rate. As the disease progresses, symptoms develop to blueness of the fingers and lips (cyanosis), swelling in the feet and ankles, inability to finish a meal due to shortness of breath, a frequent requirement for oxygen, and drastically reduced quality of life. COPD is categorised into four stages of severity, based on the patient’s ability to forcefully exhale air in one second, known as forced expiratory volume (FEV1).

Vaping and COPD

COPD and smoking are linked. Studies have shown that 20-30% of smokers will develop COPD symptoms, and smoking accounts for as many as 8 out of 10 related COPD deaths [4]. Given the role of smoking in COPD, and the failure of smokers with COPD to ever fully quit smoking, vaping could provide a valuable asset and smoke-free alternative for patients with COPD. However, as with any new technology, very little research on the long term effects of vaping has been published.

lungs

Research indicates that the uptake of vaping by current and former smokers with COPD is substantial – people vaping with COPD are looking for in-depth research in this area [5].

So how could vaping affect people with COPD?

The potential damaging effects of vaping has been a relatively simple task to research due to the very basic composition of e-cigarette vapour, compared to the thousands of compounds found in tobacco smoke. The most abundant components of e-liquid are widely considered as safe. The particle size of e-cigarette vapour however, is a little more problematic. E-cigarette vapour particles are the correct size to penetrate the lungs and airways at very high levels, leading to irritation and a potentially harmful effect.

A recent study has investigated if vaping can make COPD worse over a two-year period. For COPD patients who fully or partially replaced tobacco with vaping, respiratory exacerbations were halved, and improved general health and physical activity status was reported [6]. This early data strongly suggests that if you have COPD, replacing smoking with vaping has a very positive effect on COPD symptoms.

ecigarettes

So, will vaping help your COPD? This recent research showing an improvement in overall health also confirms observations from an internet-based survey of 1,190 COPD patients who replaced cigarettes with vaping [7]. Over 75% of respondents reported improvement of their symptoms after changing to vaping, compared only 0.8% that experienced a negative effects from vaping on their COPD. The most positive result of all, was the discovery that 20% of respondents were able to stop their routine COPD medications, through replacing smoking with vaping.

The use of e-cigarettes has now been widely established to be 95% less damaging than smoking tobacco in individuals without lung diseases [8,9, 10]. For those with COPD who smoke, evidence combined from new clinical trials and patient feedback suggests an overwhelmingly positive response from patients with COPD who replace tobacco with vaping.

Could Vaping Cause COPD?

Inhaling e-cigarette vapour will be more harmful than complete cessation of smoking and vaping. Research published earlier this year investigated the effects of vaping on alveolar macrophages (lung cell cultures). Scientists discovered that vaping treatment speeds up the death of lung cells by 50-fold, implying vaping has the potential to trigger diseases like COPD later in life [11]. However, how relevant these results are to vaping in vivo (in real life) is questionable – it is incredibly difficult to replicate a physiologically complex act like smoking in cells growing in a laboratory.

research

Summary

Interestingly, the COPD foundation has little to say on vaping and COPD, with no information or material available on their website on the topic. This suggests that although the strikingly positive results are out from initial clinical trials and patient surveys, patient foundations and trusted information providers are yet to take a side on whether vaping can help COPD. As always, it is best to consult your doctor or physician on advice about vaping and COPD to understand the risks associated with this habit. Clinical trials into vaping and COPD remain ongoing across the U.S., Europe and Australasia [12].

Sources

1. WHO World Health Statistics 2008. PDF available from: http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf?ua=1. [Accessed 2018 September 27].

2. Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease Among Adults—United States, 2011. Morbidity and Mortality Weekly Report 2012;61(46):938–43 [accessed 2018 September 28].

3. https://statistics.blf.org.uk/copd
[accessed 2018 September 27]

4. Institute of Medicine. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. Washington: National Academy of Sciences, Institute of Medicine, 2009 [accessed 2018 September 28]

5. Kruse GR, Kalkhoran S, Rigotti NA. Use of electronic cigarettes among U.S. adults with medical comorbidities. Am J Prev Med. 2017;52(6):798–804

6. Polosa R, Morjaria JB, Caponnetto P, et al. Evidence for harm reduction in COPD smokers who switch to electronic cigarettes. Respir Res. 2016;17(1):166.

7. Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V. Characteristics, perceived side effects and benefits of electronic cigarette use: a worldwide survey of more than 19,000 consumers. Int J Environ Res Public Health. 2014;11(4):4356–4373.

8. Nicotine without Smoke. Tobacco Harm Reduction: A Report of the Tobacco Advisory Group of the Royal College of Physicians.London: Royal College of Physicians; 2016.

9. McNeill A, Brose LS, Calder R, Hajek P, McRobbie H. E-Cigarettes: An Evidence Update. A Report Commissioned by Public Health England. London: Public Health England; 2015. (Contract No.: PHE Publications Gateway Number: 2015260).

10. Nutt DJ, Phillips LD, Balfour D, et al. Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res. 2014;20(5):218–225.

‪11. Scott A, Lugg ST, Aldridge K, et al. Pro-inflammatory effects of e-cigarette vapour condensate on human alveolar macrophages‬.‪ Thorax Published Online First:13 August 2018. doi: 10.1136/thoraxjnl-2018-211663‬

12. Clinical Trials into COPD and E-cigarette usage. https://clinicaltrials.gov/ct2/results?cond=Copd&term=E-cigarette&cntry=&state=&city=&dist= [Accessed 2018 September 27].

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