- Former smokers who use vapes or HTPs report lung symptom levels similar to people who have never smoked
- Findings suggest these nicotine alternatives do NOT worsen respiratory health when used as substitutes for smoking
- The longer someone had smoked, the worse their respiratory symptoms were likely to be
- Researchers approved powerful new tool to test for even minor respiratory symptoms in former smokers
Former smokers – whether they quit altogether or switch to vapes or heated tobacco products (HTP) – report significantly fewer respiratory symptoms than current smokers, a new Italian study has found.
The research, published in the journal BMC Public Health, found that former smokers who use vapes or HTPs report lung symptom levels similar to people who have never smoked. The findings suggest that these nicotine alternatives do not worsen respiratory health when used as substitutes for smoking.
The study said: “The scores of former smokers are similar to those not using these products, and lower than smokers’, suggest[ing] that HTPs and e-cigarettes do not add materially to respiratory symptoms when smokers stop smoking.”
New tool to test and compare respiratory symptoms
Researchers set out to validate the Italian version of the Respiratory Symptom Experience Scale (IT-RSES), a powerful and sensitive new tool to detect and measure even early signs of breathing issues in smokers before disease is diagnosed.
After translation into Italian, they used the IT-RSES via phone interview with 750 Italian participants across five tobacco use groups. These were: never-smokers, former smokers not using alternative products, HTP users, vape users, and continuing smokers. The tool compared symptoms across the groups, while taking into account the participants’ age and the number of years they had smoked.
The study said: “Cigarette smoke exposes smokers to toxic chemicals that are products of combustion and that contribute to pulmonary (and other) harms of smoking. The aerosol from non-combustible products [such as vapes and HTPs] do not contain these combustion products.
“Biomarker data demonstrate that, compared to smoking, these products reduce users’ exposure to many toxicants, including not only carcinogens and cardiovascular toxicants, but also respiratory toxicants, suggesting that switching to such products would improve respiratory symptoms.
“Nevertheless, since these products are inhaled, it is important to assess their impact on respiratory symptoms. ”
More time smoking = worse lung symptoms
It found that IT-RSES scores “correlated significantly” with how many years a person had been smoking (i.e. the longer someone had smoked, the worse their respiratory symptoms were likely to be).
The study said: “As expected, because chronic smoking leads to respiratory symptoms, in the groups with a history of smoking, there was a high correlation between IT-RSES scores and the number of years the participant had smoked, even independent of current tobacco use status.”
It also, predictably, found higher scores in smokers compared to never-smokers.
Most notably, former smokers, HTP users and vape users all had lower scores than smokers and were not significantly different from each other.
A growing body of evidence
Italian respiratory physician Riccardo Polosa said: “This study adds to the growing body of evidence showing that quitting smoking – or switching to less harmful products – can bring measurable health benefits, even in the short term. The IT-RSES gives clinicians and researchers a much-needed tool to track these improvements reliably.”
The researchers concluded that the IT-RSES is a reliable and useful tool “for assessing respiratory symptoms in smokers, and former smoker[s] who stopped smoking and were using e-cigarettes or HTPs.”
“Assessment of respiratory symptoms in smokers and former smokers is of clinical and research relevance,” the study said. “However, there is currently a dearth of specific tools available for this purpose, and none in languages other than English.
“While many instruments are available for assessing clinically significant symptoms in those already diagnosed with various diseases, it is useful to have a tool for assessing respiratory symptoms in more general samples of smokers and former smokers.”
The latest findings follow an evidence review in March that found vaping is not scientifically linked with severe respiratory issues among people who have never smoked.
The review of 12 studies in the U.S, led by professors from the University of Catania in Italy, found that eight reported no significant association between vaping and symptoms such as COPD, chronic bronchitis, emphysema, or asthma.
The remaining five studies reported at least one significant link – but the researchers concluded the methodologies used in four of these were “not robust.”
