Ep 113 – Vaping: an update

Quitting smoking is the single most important thing a smoker can do to improve their health, and with the right combination of support, medication and determination, individuals can successfully overcome their nicotine addiction and enjoy a smoke-free life. For many, quitting smoking completely can be a challenge due to the addictive nature of nicotine, but various strategies and treatments are available to help support patients who are trying to stop smoking. Benefits are immediate, both in the short- and long-term, and it is never too late to stop smoking. The rise in e-cigarette use has contributed to increased numbers of smokers quitting their tobacco, but e-cigarette use in younger people has caused significant concerns. In this episode, which is an update to episode 51, Dr Roger Henderson provides an overview of vaping, and the pros and cons of e-cigarette use.

Key references

1. NICE guideline [NG209]. https://www.nice.org.uk/guidance/ng209.
2. Office for Health Improvements & Disparities. https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update/nicotine-vaping-in-england-2022-evidence-update-main-findings.
3. Lindson N, et al. Cochrane Database Syst Rev. 2024;1:CD010216. doi: 10.1002/14651858.CD010216.pub8.
4. Hopkinson NS, et al. Thorax. 2024;79:662-669.doi: 10.1136/thorax-2023-220569.
5. American College of Cardiology. 2024. https://www.acc.org/About-ACC/Press-Releases/2024/04/01/21/51/study-links-e-cigarette-use-with-higher-risk-of-heart-failure.

Patient resources

• NHS. https://www.nhs.uk/better-health/quit-smoking/.
• NHS. https://www.nhs.uk/live-well/quit-smoking/nhs-stop-smoking-services-help-you-quit/.
• Cancer Research UK. https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/smoking-and-cancer/how-do-i-stop-smoking.
• Action on smoking and health. https://ash.org.uk/resources/view/leaflet-for-service-users-quitting-smoking.

Key take-home points

• Smoking is still the leading cause of premature death and preventable illness in England, with around 80,000 smoking-related deaths per year.
• One person dies every 6 seconds somewhere on Earth from smoking.
• Each cigarette smoked takes 11 minutes off that smoker’s life.
• Almost 500,000 NHS hospital admissions each year are due to smoking – approximately 4% of all admissions.
• Around 14% of the UK population smoke.
• Receiving support from a healthcare professional increases the likelihood that a smoker will make an attempt to quit.
• Over 40% of smokers in England want to quit, but most who try without support are likely to fail.
• Smokers are up to 3-times more likely to quit when offered specialist support compared with willpower alone.
• Smoking tobacco is an embedded behaviour; therefore, the best outcomes for smoking cessation are achieved when pharmacotherapy and psychological support are combined.
• A combination of behavioural support and pharmacotherapy increases the likelihood that smokers will quit compared with those offered less support or advice alone.
• Combination nicotine-replacement therapy (NRT) is 25% more effective compared with the use of a single NRT product.
• Tobacco harm reduction is a key concept.
• The first e-cigarette went on sale in China in 2004.
• All e-cigarettes have three basic elements: a battery, which heats up a coil or atomiser, turning the flavoured e-liquid or juice into a vapour, which is then inhaled.
• E-liquid comprises four ingredients: vegetable glycerine, propylene glycol, nicotine and flavouring. Some liquids do not contain nicotine.
• People using e-cigarettes should stop smoking tobacco completely, because any smoking is harmful.
• The evidence suggests that e-cigarettes are substantially less harmful to health than smoking but are not risk free.
• Since 2021, the proportion of 11- to 18-year-olds vaping has been greater than those smoking. In 2023, 8% of that age group vape regularly; of 4.5 million people in Britain who vape, 11% are aged 18 to 24.
• Although it is illegal to sell vaping products to people aged under 18, many young people can buy these easily from sellers who do not enforce the law.
• Adolescents can also be heavily influenced by social media platforms and influencers, along with intensive marketing campaigns promoting brightly coloured, highly flavoured and cheap disposable vapes.
• The sale of nicotine vaping products to under 18s is prohibited across the UK but children appear to be able to easily obtain illegal vapes, which often contain high levels of lead, nickel and chromium.
• The health advice regarding vaping appears to be clear: young people and anyone of any age who has never smoked should not vape.
• Vaping using regulated and licensed products can be extremely effective in helping adult smokers successfully quit smoking as part of an orchestrated quit attempt involving healthcare professionals, and it should be viewed in the same way as any other type of nicotine replacement therapy. However, they are inappropriate to be used in any form in children whose lungs and brains are still developing.
• Research just published online in the respiratory journal Thorax suggests that the more time spent on social media, the greater the likelihood that children and young people will smoke and/or vape.
• A US study published in April 2024 found that vapers are 19% more likely to suffer from heart failure than those who have never used e-cigarettes.