From the Guidelines
The most appropriate response is A. asthma exacerbation risk. Switching from conventional cigarettes to e-cigarettes would likely increase this patient's risk of asthma exacerbations. E-cigarettes contain irritants and chemicals that can trigger bronchospasm and airway inflammation in individuals with asthma, as noted in the 2025 standards of care in diabetes 1. This is particularly concerning for this patient who already has poorly controlled asthma, evidenced by her three emergency department visits for asthma exacerbations in the past six months.
Some key points to consider in this patient's case include:
- The patient's history of asthma and recent exacerbations, which suggest that her respiratory health is already compromised
- The potential for e-cigarettes to worsen respiratory conditions, despite containing fewer carcinogens than traditional cigarettes
- The importance of complete smoking cessation in improving asthma control and reducing exacerbations, as well as providing additional benefits for diabetes management and overall health
- The availability of evidence-based approaches to smoking cessation, such as nicotine replacement therapy, prescription medications like varenicline or bupropion, and behavioral counseling, which can be tailored to the patient's specific needs and medical history
According to the 2025 standards of care in diabetes, individuals with diabetes should be advised to avoid vaping and using e-cigarettes, either as an approach to stop smoking combustible cigarettes or as a recreational drug 1. Instead, this patient would benefit from a complete smoking cessation program using evidence-based approaches. Complete smoking cessation would likely improve her asthma control, reduce exacerbations, and provide additional benefits for her diabetes management and overall health, as supported by the 2020 standards of medical care in diabetes 1.
Key benefits of smoking cessation for this patient include:
- Improved asthma control and reduced risk of exacerbations
- Better management of diabetes and reduced risk of complications
- Improved overall health and reduced risk of cardiovascular disease
- Potential for improved weight management and reduced risk of weight-related health problems, as weight gain after smoking cessation is often temporary and does not diminish the substantial cardiovascular benefits realized from smoking cessation 1.
From the Research
Smoking Cessation and E-Cigarettes
The patient is considering switching to e-cigarettes to improve her health. Based on the available evidence, this change would most likely increase her:
- Asthma exacerbation risk
Rationale
Studies have shown that e-cigarettes can worsen asthma symptoms and increase the rate and severity of exacerbations in asthmatics who use them regularly 2. Additionally, evidence suggests that many e-cigarette compounds might contribute to the pathogenesis of asthma, and lung function seems to deteriorate with the use of e-cigarettes in this population 2.
Alternative Options
Instead of switching to e-cigarettes, the patient could consider other evidence-based treatments for smoking cessation, such as:
- Nicotine replacement therapy (NRT)
- Varenicline
- Bupropion
- Combination NRT These interventions have been shown to be effective in helping people quit smoking and may be more suitable for the patient's needs 3, 4, 5.
Important Considerations
It is essential to note that e-cigarettes pose several potential health risks, including exposure to heavy metals and toxicants, and nicotine poisoning 6. Furthermore, the long-term health effects of e-cigarettes are unknown, and their use is associated with increased risk of subsequent cigarette and marijuana use in youth 6.