Action on Smoking and Health. Use of e-cigarettes (vapes) among adults in Great Britain. 2021. (accessed 3 February 2022)

The role of e-cigarettes in treating tobacco dependence. 2019. (accessed 3 February 2022)

Bowler RP, Hansel NN, Jacobson S Electronic Cigarette Use in US Adults at Risk for or with COPD: Analysis from Two Observational Cohorts. J Gen Intern Med. 2017; 32:(12)1315-1322

Bozier J, Rutting S, Xenaki D, Peters M, Adcock I, Oliver BG. Heightened response to e-cigarettes in COPD. ERJ Open Res. 2019; 5:(1)00192-2018

British Lung Foundation. Estimating the economic burden of respiratory illness in the UK. 2017. (accessed 3 February 2022)

CASP. CASP - Critical Appraisal Skills Programme. 2021. (accessed 3 February 2022)

Ferrari M, Zanasi A, Nardi E Short-term effects of a nicotine-free e-cigarette compared to a traditional cigarette in smokers and non-smokers. BMC Pulm Med. 2015; 15

Fineout-Overholt E, Johnston L. Teaching evidence based practice: asking searchable, answerable clinical questions. Worldviews Evid Based Nurs. 2005; 2:(3)157-160

Gee RE, Boles WR, Smith DG. E-Cigarettes: A Public Health Threat, Not a Population Health Intervention. Am J Public Health. 2021; 111:(2)224-226

Global Initiative for Chronic Obstructive Lung Disease. 2021 Report. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2021. (accessed 3 February 2022)

Gotts JE, Jordt SE, McConnell R, Tarran R. What are the respiratory effects of e-cigarettes?. BMJ. 2019; 366

Hartmann-Boyce J, McRobbie H, Lindson N Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2020; 10:(10)

Higham A, Bostock D, Booth G, Dungwa JV, Singh D. The effect of electronic cigarette and tobacco smoke exposure on COPD bronchial epithelial cell inflammatory responses. Int J Chron Obstruct Pulmon Dis. 2018; 13:989-1000

Marczylo T. How bad are e-cigarettes? What can we learn from animal exposure models?. J Physiol. 2020; 598:(22)5073-5089

McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Rev. 2014; (12)

National Institute for Health and Care Excellence. Stop smoking interventions and services. 2018. (accessed 3 February 2022)

National Institute for Health and Care Excellence. Tobacco: preventing uptake, promoting quitting and treating dependence. 2021. (accessed 7 February 2022)

Palamidas A, Tsikrika S, Katsaounou PA Acute effects of short term use of ecigarettes on Airways Physiology and Respiratory Symptoms in Smokers with and without Airway Obstructive Diseases and in Healthy non smokers. Tob Prev Cessat. 2017; 3

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

Polosa R, Morjaria JB, Prosperini U Health effects in COPD smokers who switch to electronic cigarettes: a retrospective-prospective 3-year follow-up. Int J Chron Obstruct Pulmon Dis. 2018; 13:2533-2542

Polosa R, Morjaria JB, Prosperini U COPD smokers who switched to e-cigarettes: health outcomes at 5-year follow up. Ther Adv Chronic Dis. 2020; 11

Public Health England. Cost of smoking to the NHS in England: 2015. 2017. (accessed 4 February 2022)

Public Health England. Vaping in England. 2020 evidence update summary. 2020. (accessed 3 February 2022)

Royal College of General Practitioners. RCGP Position Statement on the use of electronic nicotine vapour products (E-Cigarettes). 2017. (accessed 3 February 2022)

COPD - Symptoms, diagnosis and treatment. 2021. (accessed 3 February 2022)

Xie Z, Ossip DJ, Rahman I, Li D. Use of electronic cigarettes and self-reported chronic obstructive pulmonary disease diagnosis in adults. Nicotine Tob Res. 2020a; 22:(7)1155-1161

Xie W, Kathuria H, Galiatsatos P Association of Electronic Cigarette Use With Incident Respiratory Conditions Among US Adults From 2013 to 2018. JAMA Netw Open. 2020b; 3:(11)

How safe are e-cigarettes for patients with COPD? A systematic review

02 March 2022
Volume 33 · Issue 3


The use of e-cigarettes has risen rapidly in recent years. Joanne Brook and Dr Mary Turner performed a systematic review to identify if e-cigarettes are appropriate for patients with COPD


A high smoking-related burden is placed on health services in diagnosing, treating and managing associated long-term illnesses such as chronic obstructive pulmonary disease (COPD). While there are many smoking cessation options available, the use of e-cigarettes has risen rapidly.


To identify if the promotion of e-cigarettes is an appropriate intervention for patients with COPD.


A systematic process was used to search databases and identify research papers detailing the effects of e-cigarettes on pulmonary health outcomes in COPD; analysis identified five main themes.


Eight papers were reviewed. Findings support current clinical guidance endorsing the use of e-cigarettes for smoking cessation; however, COPD patients may be at greater risk of inflammatory responses, exacerbation, disease progression and worsening general health.


The effects of e-cigarettes are not fully understood, but they are not risk-free. More evidence is needed about both the short and long-term impact of their use in this cohort.

Smoking is one of the main causes of chronic lung disease (Royal College of General Practitioners (RCGP), 2017). As more people are diagnosed with COPD, not only is the financial burden placed on health services increasing, but a rise in workload has been noted, particularly in primary care settings where a large proportion of COPD care is delivered (British Lung Foundation, 2017; Public Health England (PHE), 2017).

Hand-held vaping devices or e-cigarettes began to emerge as an alternative nicotine replacement therapy (NRT) around 2015. As e-cigarettes do not contain tobacco and other harmful toxins found in cigarettes, it is believed they help reduce lung disease and smoking-related deaths (Hartmann-Boyce et al, 2020). With the National Institute for Health and Care Excellence (NICE) guidance (2018; 2021) and the RCGP (2017) recommending healthcare professionals (HCPs) discuss the use of e-cigarettes as a means to quit smoking, their popularity has risen. However, there is now a rising trend of smokers using e-cigarettes in addition to conventional cigarettes in the long-term (Action on Smoking and Health (ASH), 2021).

Register now to continue reading

Thank you for visiting Practice Nursing and reading some of our peer-reviewed resources for general practice nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • New content and clinical newsletter updates each month