Switching from cigarettes to heated tobacco systems in unmotivated COPD patients is associated with fewer exacerbations.

Doctors monitored a range of indicators: the frequency of COPD exacerbations, spirometry data (a key method for assessing lung function), and the results of two tests reflecting daily well-being. One of these was the COPD Assessment Test (CAT), an internationally recognized tool consisting of questions about symptoms and the impact of the disease on daily life. In addition, study participants completed an exercise test, in which doctors measured the distance they could walk in 6 minutes: this reflects physical endurance and exercise tolerance in real-world conditions.

In patients who were not motivated to quit smoking completely and who fully or partially replaced cigarettes with heated tobacco systems, the number of severe exacerbations decreased by approximately 40% annually compared to baseline. For people with COPD, an exacerbation is a sharp deterioration in their condition, requiring emergency medical care and often hospitalization. The authors emphasize that this magnitude of risk reduction is comparable to the results of standard drug therapy for exacerbations typically prescribed for COPD (inhaled corticosteroids and combination therapies). In other words, even without changing the treatment regimen, switching from cigarettes to heated tobacco systems produced additional clinical benefits.

No less telling is what the doctors failed to find. Those who switched to smoke-free products showed no significant improvement in spirometric parameters—primarily, forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC). This is understandable: in COPD, some structural damage to the airways is irreversible, and no amount of replacing tobacco products with less harmful ones will restore lung function.

However, an important point is that no further deterioration in these indicators was observed. Moreover, in some patients, doctors recorded a "downgrading" of COPD according to the GOLD classification (an international scale that divides the disease into four levels—from mild to extremely severe—based on spirometry and symptoms). This means that some patients, after switching to ESNT, effectively "moved" into a milder disease category, which in practical terms means a reduction in the severity of symptoms and a lower risk of complications.

Quitting smoking completely is the best health choice for any smoker. However, given that many COPD patients find quitting extremely difficult even with existing therapies, replacing cigarettes with less harmful, non-combustible products can be a "downward spiral" in risk. This study highlights precisely this pragmatic context for harm reduction.

The authors note that larger, longer-term prospective studies are needed to draw definitive conclusions. However, the consistent improvements seen in COPD patients over three years make the current results clinically significant.