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== Studies/papers ==
== Studies/papers ==
2023: [https://www.tandfonline.com/doi/full/10.1080/17476348.2023.2167716 Health impact of e-cigarettes and heated tobacco products in chronic obstructive pulmonary disease: Current and emerging evidence] '''Morjaria JB, Campagna D, Caci G, O'Leary R, Polosa R. doi: 10.1080/17476348.2023.2167716. Epub ahead of print. PMID: 36638185.'''


=== 2023: [https://www.tandfonline.com/doi/full/10.1080/17476348.2023.2167716 Health impact of e-cigarettes and heated tobacco products in chronic obstructive pulmonary disease: Current and emerging evidence] '''Morjaria JB, Campagna D, Caci G, O'Leary R, Polosa R. doi: 10.1080/17476348.2023.2167716. Epub ahead of print. PMID: 36638185.''' ===
* Compared with conventional cigarettes, HTPs and ECs offer substantial reduction in exposure to toxic chemicals and have the potential to reduce harm from cigarette smoke when used as tobacco cigarette substitutes. In this review, we examine the available clinical studies and population surveys on the respiratory health effects of ECs and HTPs in COPD patients.
* Compared with conventional cigarettes, HTPs and ECs offer substantial reduction in exposure to toxic chemicals and have the potential to reduce harm from cigarette smoke when used as tobacco cigarette substitutes. In this review, we examine the available clinical studies and population surveys on the respiratory health effects of ECs and HTPs in COPD patients.
* As many COPD smokers prefer to smoke, conventional cigarette substitution should be considered as a valuable solution to the persistent problem of smoking, and combustion-free nicotine delivery technologies should be weight as a component of this strategy.
* As many COPD smokers prefer to smoke, conventional cigarette substitution should be considered as a valuable solution to the persistent problem of smoking, and combustion-free nicotine delivery technologies should be weight as a component of this strategy.
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* This review article highlights the need for large, carefully designed, adequately controlled, long- term follow-up clinical trials to assess the true potential of combustion-free nicotine delivery technologies for sustained smoking cessation and reducing risk of harm from smoking, particularly among smokers with chronic obstructive pulmonary disease (COPD).
* This review article highlights the need for large, carefully designed, adequately controlled, long- term follow-up clinical trials to assess the true potential of combustion-free nicotine delivery technologies for sustained smoking cessation and reducing risk of harm from smoking, particularly among smokers with chronic obstructive pulmonary disease (COPD).


2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549158/ COPD smokers who switched to e-cigarettes: health outcomes at 5-year follow up]
=== 2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549158/ COPD smokers who switched to e-cigarettes: health outcomes at 5-year follow up] ===


2021: [https://link.springer.com/article/10.1007/s11739-021-02674-3 Health outcomes in COPD smokers using heated tobacco products: a 3-year follow-up]
* Those in the EC user group achieved a marked decline in cigarette smoking or abstinence. COPD EC users had a significant diminution in COPD exacerbations; with the mean (±SD) exacerbation rate falling from 2.3 (±0.9) at baseline to 1.1 (±1.0) at 5 years (''p'' < 0.001), whereas no significant changes were observed in the control group.
* Patients were evaluated prospectively for their measurements of respiratory exacerbations, spirometric indices, quality of life using the COPD assessment tool (CAT), 6-min walk distance (6MWD), as well as conventional cigarette consumption.
* Significant and constant improvements in lung function, CAT scores and 6MWD were reported in the EC user group over the 5-year observation period compared with the reference group (''p'' < 0.05).


2022: [https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-021-00284-0 Electronic cigarettes as a harm reduction strategy among patients with COPD: protocol for an open-label two arm randomized controlled pilot trial]
=== 2021: [https://link.springer.com/article/10.1007/s11739-021-02674-3 Health outcomes in COPD smokers using heated tobacco products: a 3-year follow-up] ===


=== 2022: [https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-021-00284-0 Electronic cigarettes as a harm reduction strategy among patients with COPD: protocol for an open-label two arm randomized controlled pilot trial] ===
* A harm reduction approach with the goal of achieving CC switching may be a more pragmatic approach, making EC use particularly appropriate with COPD [25]. EC represent a potentially effective harm reduction tool that is safer than smoking CC [18, 23, 24]. Smokers with COPD, however, tend to be older and may have a higher level of addiction to nicotine than the average smoker and the feasibility and preliminary effectiveness of an EC harm-reduction strategy in a COPD population has not been explored.  
* A harm reduction approach with the goal of achieving CC switching may be a more pragmatic approach, making EC use particularly appropriate with COPD [25]. EC represent a potentially effective harm reduction tool that is safer than smoking CC [18, 23, 24]. Smokers with COPD, however, tend to be older and may have a higher level of addiction to nicotine than the average smoker and the feasibility and preliminary effectiveness of an EC harm-reduction strategy in a COPD population has not been explored.  
* Our study protocol has a few limitations. First, as a pilot study the protocol is not powered to detect small differences in CPD or CAT Scores between the NRT and EC arms. Second, CAT Score is not the gold standard for the assessment of respiratory health.
* Our study protocol has a few limitations. First, as a pilot study the protocol is not powered to detect small differences in CPD or CAT Scores between the NRT and EC arms. Second, CAT Score is not the gold standard for the assessment of respiratory health.
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