Catania, May 2, 2025 – Smokers who quit—either entirely or by switching to alternatives such as e-cigarettes or heated tobacco products—report significantly fewer respiratory symptoms compared to those who continue smoking. These are the findings of a new study led by the CoEHAR (Center of Excellence for the Acceleration of Harm Reduction) at the University of Catania.
“Switching from cigarettes to reduced-risk alternatives like e-cigarettes and heated tobacco products can lead to real improvements in respiratory symptoms,” said Prof. Pasquale Caponnetto, lead author of the study. “This is a critical step forward in tobacco harm reduction strategies.”
Among former smokers, those using combustion-free products reported respiratory symptom levels comparable to those of never-smokers. The results suggest that such alternatives do not worsen respiratory health when used as substitutes for combustible cigarettes.
A key element of the study was the validation of the Italian version of the Respiratory Symptom Experience Scale (IT-RSES), a sensitive clinical tool designed to detect early signs of respiratory distress in smokers. “Until now, there was no validated tool in Italian to assess subtle but important respiratory symptoms in smokers,” said co-author Dr. Graziella Chiara Prezzavento. “The IT-RSES fills this gap and opens new opportunities for clinical monitoring and public health research.”
“These findings add to the growing body of evidence that quitting smoking—or switching to less harmful products—can result in measurable health benefits, even in the short term,” added Prof. Riccardo Polosa, senior author of the study and founder of CoEHAR. “The IT-RSES provides clinicians and researchers with a much-needed instrument to reliably monitor these improvements.”
International collaboration was also central to the study, as highlighted by co-author Dr. Saul Shiffman of the University of Pittsburgh: “The Italian version of the RSES mirrors the performance of the original English tool, confirming that respiratory symptom assessment is relevant and applicable across languages and cultures. It is an important step toward international research comparability.”
The study reinforces the potential role of non-combustion nicotine products—such as vaping devices and heated tobacco—in reducing health risks for adult smokers, and underscores the importance of validated tools for measuring respiratory outcomes in harm reduction research.