Smoke-Free Solutions Deserve a Place in COPD Awareness Month

---

Key Points:

• COPD Awareness Month: November marks National COPD Awareness Month, launched to raise awareness of chronic obstructive pulmonary disease, a leading cause of death in the U.S. Ironically, groups leading these campaigns – including the COPD Foundation and American Lung Association (ALA) – continue opposing tobacco harm reduction (THR) tools that could lower COPD risk by eliminating smoke.

• Smoke, Not Nicotine: The World Health Organization identifies smoking as a major cause of COPD, yet continues to reject harm reduction. Research shows it is smoke – not nicotine – that causes the greatest harm, as burning tobacco releases 7,000+ chemicals, including 69 known carcinogens.

• Harm Reduction Evidence: Studies increasingly show that switching from cigarettes to e-cigarettes, heated tobacco, or oral nicotine products can reduce COPD flare-ups and improve respiratory health. These tools help smokers lower toxic exposure and manage symptoms when quitting isn’t possible.

• Key Research Findings:

  • A 2018 study found COPD patients who switched to e-cigarettes had fewer exacerbations over three years.

  • A 2020 five-year follow-up confirmed sustained reductions in flare-ups.

  • A 2021 study on heated tobacco users showed fewer COPD attacks and improved breathing, exercise tolerance, and quality of life.

  • A 2022 Japan analysis found declines in COPD hospitalizations after heated tobacco adoption.

  • A 2024 Italian review concluded both e-cigarette and heated tobacco users experienced fewer exacerbations and improved symptoms than smokers.

  • A 2025 Cochrane review found no short-term adverse effects from nicotine pouches and lower toxicant exposure than cigarettes.

• FDA Recognition: The U.S. FDA has authorized 20 nicotine pouch products, finding they present lower risks of cancer and other diseases than smoking or traditional smokeless tobacco.

• Public Health Contradictions: Despite mounting evidence, the ALA and COPD Foundation still warn against all nicotine use – even citing “irreversible lung damage” from vaping – while ignoring FDA-authorized products proven to reduce harm.

• Funding Bias: The CDC Foundation, another COPD Awareness Month partner, receives funding from Michael Bloomberg’s $1.6 billion global tobacco control campaign, promoting flavor bans and tax hikes that limit adult access to harm-reduction tools.

• Policy Takeaway: Smokers deserve accurate information and access to safer, smoke-free products. Organizations claiming to fight COPD should embrace harm reduction, not reject it. Denying adults these alternatives keeps them tied to the most dangerous nicotine product of all – the cigarette.

---

November is National COPD Awareness Month, a U.S. public health observance aimed at raising awareness of chronic obstructive pulmonary disease. While the exact year of its launch is unclear, the awareness campaign gained traction around 2008, when COPD was identified as the third leading cause of death in the United States. Ironically, organizations such as the CDC Foundation and the American Lung Association (ALA) lead awareness efforts each November, yet both continue to attack tobacco harm reduction products that can help lower COPD risk by eliminating the smoke produced by conventional tobacco and nicotine products.

According to the World Health Organization, which also rejects tobacco harm reduction, smoking is “one of the leading causes” of COPD. Globally, an estimated 392 million people live with the disease, with nearly three-quarters residing in low- and middle-income countries. In the United States, smoking remains a major risk factor, but the Centers for Disease Control and Prevention notes that about one-fourth of adults with COPD have never smoked. Researchers have understood for decades that it is the smoke – not the nicotine – that causes the greatest harm from tobacco. When burned, cigarettes emit more than 7,000 chemicals, including at least 69 known carcinogens. Reducing or eliminating smoke while still providing nicotine has been shown to help smokers quit and dramatically cut exposure to toxic chemicals.

An expanding body of research indicates that smokers who switch to lower-risk products – such as e-cigarettes, heated tobacco, or oral nicotine – experience fewer COPD flare-ups and improved quality of life. COPD is a progressive, nonreversible lung disease caused by the narrowing and destruction of the airways and air sacs in the lungs. Over the past two decades, researchers have studied whether tobacco harm reduction tools can help slow symptom progression among adults who are unable or unwilling to quit smoking. While more long-term research is needed, results to date are promising.

A 2018 longitudinal study followed COPD patients using e-cigarettes over three years and found that, although lung function did not change, e-cigarette use coincided with significant reductions in COPD exacerbations. A 2020 five-year follow-up study confirmed a sustained decline in flare-ups, concluding that e-cigarette use may improve both objective and subjective COPD outcomes. Similar improvements have been observed among smokers who switch to heated tobacco products. A 2021 three-year study reported a substantial decrease in annual COPD exacerbations among heated tobacco users, along with improvements in respiratory symptoms, exercise tolerance, and quality of life. A 2022 population-level analysis in Japan found that COPD hospitalizations declined following the introduction of heated tobacco, though the authors emphasized the need for replication in other countries.

A 2024 review by the Italian Society of Internal Medicine, which evaluated literature published between 2013 and 2023, found that switching to e-cigarettes led to fewer COPD exacerbations and improved symptoms compared to continued smoking, while heated tobacco use after switching was also associated with reduced exacerbations and symptom improvement. Although there are no direct studies on COPD outcomes among smokers who transition to oral nicotine products, emerging evidence shows these products significantly reduce exposure to harmful combustion byproducts that contribute to COPD. A 2025 Cochrane Review of nicotine pouch studies found no short-term adverse effects among smokers who used them, while emphasizing the need for more long-term data. The U.S. Food and Drug Administration has authorized 20 nicotine pouch products for marketing, concluding that the research showed lower levels of harmful chemicals than cigarettes or most smokeless tobacco products and that the authorized pouches present a lower risk of cancer and other serious diseases.

These findings should be recognized during COPD Awareness Month, as the development and use of smoke-free alternatives represents one of the most meaningful opportunities to prevent and manage COPD. Yet the very organizations leading COPD awareness efforts continue to spread misinformation about these products. In 2019, the ALA declared that “no one should use e-cigarettes or any tobacco product” and claimed that vaping causes “irreversible lung damage and disease.” In 2024, it reiterated those claims, citing “evolving evidence” of e-cigarette harm while ignoring the FDA’s scientific authorizations of heated tobacco and oral nicotine products.

The CDC Foundation, which also participates in COPD Awareness Month campaigns, has become an active player in the tobacco harm reduction debate. It tracks e-cigarette and nicotine pouch sales and youth usage trends, publishing reports largely funded by Michael R. Bloomberg’s global tobacco control initiatives. The Foundation is one of five partners in Bloomberg Philanthropies’ nearly $1.6 billion global tobacco control campaign, and its reporting consistently emphasizes youth use and supports restrictive policies such as flavor bans and higher excise taxes as indicators of progress.

Policymakers should view these organizations’ claims with skepticism. Groups that claim to want to reduce the burden of smoking-related disease cannot continue obstructing access to innovations that dramatically reduce that burden. As the nation observes COPD Awareness Month, it is essential that smokers are not denied access to safer alternatives and are not confined to the most lethal product of all – the combustible cigarette.

Nothing in this analysis is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101.