Reduction of bronchial response to mannitol after partial switch from conventional tobacco to electronic cigarette consumption

Respir Med. 2021 Mar;178:106324. doi: 10.1016/j.rmed.2021.106324. Epub 2021 Feb 1.


Background: Regarding the multiple health effects of e-cigarettes, there are insufficient data on potential effects on bronchial reactivity (BHR). In the present study, we assessed the impact of a switch from conventional to e-cigarettes on BHR under realistic conditions over a period of 3 months.

Methods: Sixty subjects who declared to reduce or stop their tobacco consumption by inhalation of nicotine-containing liquids via e-cigarette, and 20 volunteers participating in a stop-smoking program were included. Data was analysed using parametric and non-parametric statistical procedures. Spirometry, determinations of exhaled carbon monoxide (eCO) and nitric oxide (FeNO), provocation testing with mannitol as an indirect bronchial stimulus, and cotinine measurements were used to investigate BHR and nicotine abstinence.

Results: BHR to mannitol significantly decreased in the group using e-cigarettes and nicotine-containing liquids over a period of three months in this real-life setting. Participants reduced their tobacco consumption to about 25% or lower, confirmed by a reduction in eCO. Changes in lung function and FeNO were small and not statistically significant, and changes in the stop-smoking group were similar to those in the e-cigarette group.

Conclusion: The reduction in BHR that can be expected after a reduction of cigarette consumption was not abolished by the concomitant use of e-cigarettes. Whether the decrease in BHR observed after 3 months is maintained when using e-cigarettes over longer time periods or has an individual prognostic value, must be clarified in long-term studies.

Keywords: Bronchial reactivity; Lung function; Smoking cessation; e-cigarettes.

MeSH terms

  • Bronchi / physiology*
  • Bronchi / physiopathology
  • Bronchial Provocation Tests / methods*
  • Carbon Monoxide / metabolism
  • Electronic Nicotine Delivery Systems*
  • Female
  • Humans
  • Lung / physiology*
  • Male
  • Mannitol / pharmacology*
  • Nitric Oxide / metabolism
  • Smoking Cessation / methods*
  • Spirometry
  • Surveys and Questionnaires
  • Time Factors
  • Tobacco Smoking / adverse effects*
  • Vaping*


  • Nitric Oxide
  • Mannitol
  • Carbon Monoxide