The asthmatic smoker represents a distinct disease phenotype, with increased susceptibility of exacerbations and poor asthma-specific health. Increased disease severity and marked impairment in asthma control is more frequently reported in people with asthma who have smoked more than 20 pack years. Most studies show an accelerated decline in lung function and increased airflow obstruction and even worse, asthma patients who smoke appear to have a reduced response to anti-asthma drugs, compared to asthmatics who do not smoke.

Although quitting smoking can reverse the negative impact of tobacco smoke on asthma symptoms and lung function, many smokers will keep smoking, because when given only the options of smoking or completely giving up nicotine, many will not give it up.

The group hypothesized that electronic cigarettes could not only assist asthmatic smokers to quit, but they could also contribute to harm reversal of subjective and objective asthma outcomes.

The research group investigated changes in the health status and respiratory function of 18 smokers with mild to moderate asthma who quit smoking by switching to daily electronic cigarette use. Baseline measurements were taken prior to switching and were compared with those obtained at 6, 12, and 24 months follow-up visits.

Long-term monitoring of respiratory symptoms, lung function, airway hyper-responsiveness, asthma control, asthma exacerbations and tobacco consumption in daily electronic cigarette users with asthma is of great importance to patients, consumers, manufacturers, health professionals and policy makers. “Significant improvements in respiratory symptoms and lung function have been consistent” - noted the lead author of the study, Prof Riccardo Polosa - with similar positive results being reported in dual users, that is, those who smoked and vaped simultaneously".

Polosa says that switching to daily use of electronic cigarettes may ameliorate clinical, functional and therapeutic outcomes for many asthma patients who smoke and that beneficial effects persist in the long-term. According to the researchers, the use of electronic cigarettes can even reverse the damage caused by tobacco smoke in asthma patients who smoke. Of note, deterioration in methacholine PC20, lung function, ACQ scores and exacerbation rates was noted in the two patients who relapsed to exclusive tobacco smoking.

Quitting smoking is an essential step for asthma patients, crucial for the effective treatment of their disease. However it is not always easy for them. In these cases, a less harmful alternative to tobacco smoking can be a valid option. This evidence-based notion that substitution of conventional cigarettes with electronic cigarettes is unlikely to raise significant respiratory concerns can improve counselling between physicians and their asthmatic patients, who are using or intend to use electronic cigarettes.