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Smoking cessation and E-cigarettes

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Smoking cessation and E-cigarettes

  • a cohort study (n=111,823) found tobacco treatment (pharmacotherapy and/or behavioural support) was associated with a higher prevalence of smoking cessation in dual users of cigarettes and e-cigarettes (29.1% v 19.6% no treatment), suggesting benefit in these individuals (1)
    • prevalence of smoking cessation at 12 months was higher among e-cigarette users (20.8%) compared with non-users (16.8%)
    • among dual users of cigarettes and e-cigarettes, the prevalence of smoking cessation at 12 months was higher among individuals who received tobacco treatment (29.1%) compared with individuals who did not receive tobacco treatment (19.6%)
    • study authors concluded that
      • results suggest that dual users of cigarettes and e-cigarettes benefit from formal tobacco treatment

Effectiveness of E-cigarettes versus nicotine replacement therapy

  • E-cigarettes versus nicotine replacement treatment as harm reduction interventions for smokers who find quitting difficult
    • RCT (n=135) found that e-cigarettes were more effective than nicotine replacement therapy in facilitating validated long-term smoking reduction and smoking cessation (26.5% vs 6.0%; 95% CI 1.6 to 12.4; p=0.005) at 6 months when limited other support was provided (2)
  • analysis of 61 studies (n=16579) suggests there is moderate certainty level evidence that quit rates in people randomised to nicotine electric cigarettes are higher than in patients randomised to nicotine replacement therapy equating to about an additional 3 quitters per 100
    • was moderate-certainty evidence, limited by imprecision, that EC with nicotine increased quit rates at six months or longer compared to non-nicotine e-cigarettes and compared to nicotine replacement therapy

Nicotine e-cigarettes versus non-nicotine e-cigarettes in smoking cessation (3)

  • review of 5 RCTs (n=3253) found that among individuals attempting to quit smoking, nicotine e-cigarettes increased abstinence compared to conventional smoking cessation therapies (RR 1.77; 95% CI, 1.29-2.44) and non-nicotine e-cigarettes (RR 1.56; 95% CI, 1.13-2.15)

E-cigarettes and smoking cessation in pregnancy (4)

  • study found e-cigarettes were more effective than nicotine patches for abstinence at the end of pregnancy (6.8% vs 3.6%, RR 1.93, 95%CI 1.14-3.26) after excluding abstainers using non-allocated products. Adverse events and adverse birth outcomes were similar between arms

Addition of e-cigarettes to standard smoking-cessation counselling and smoking cessation (5)

  • RCT (n=1246) found addition of e-cigarettes to standard smoking-cessation counselling (SCC) resulted in greater abstinence from tobacco use among smokers than SCC alone (28.9% vs 16.3%, RR 1.77; 95% CI, 1.43-2.20) and 59.6% vs 38.5% abstained in 7 days before 6-month visit

NICE state (6):

  • give clear, consistent and up-to-date information about nicotine-containing e-cigarettes to adults who are interested in using them to stop smoking (for example, see the NCSCT e-cigarette guide and Public Health England's information on e-cigarettes and vaping)
  • advise adults how to use nicotine-containing e-cigarettes. This includes explaining that:
    • e-cigarettes are not licensed medicines but are regulated by the Tobacco and Related Products Regulations (2016)
    • there is not enough evidence to know whether there are long-term harms from e-cigarette use
    • use of e-cigarettes is likely to be substantially less harmful than smoking
    • any smoking is harmful, so people using e-cigarettes should stop smoking tobacco completely.
  • Discuss:
    • how long the person intends to use nicotine-containing e-cigarettes for
    • using them for long enough to prevent a return to smoking and
    • how to stop using them when they are ready to do so

  • Ask adults using nicotine-containing e-cigarettes about any side effects or safety concerns that they may experience. Report these to the MHRA Yellow Card scheme, and let people know they can report side effects directly

  • Explain to adults who choose to use nicotine-containing e-cigarettes the importance of getting enough nicotine to overcome withdrawal symptoms, and explain how to get enough nicotine.

A review suggests with respect to acquiring a vaping history (7):

  • be empathetic:
    • young adults may be reluctant to share history of vaping use. Familiarity with vaping terminology, asking in a non-judgmental manner, and asking in a confidential space may help
  • enquire about what vape products and where the patients sources them from:
    • vape products - vape pens commonly contain nicotine or an alternative active ingredient, such as THC (tetrahydrocannabinol) or CBD (cannabidiol)
      • may also inquire about flavorants, or other vape solution additives, that their patient is consuming, particularly if vaping related lung injury is suspected
    • source
      • ask where they source their product from. Sources may include commercially available products, third party distributors, or friends or local contacts.
  • enquire about details of vaping:
    • device
      • what style of device are they using?
    • frequency
      • how many times a day do they use their vape pen (with frequent use considered >5 times a day)? Alternatively, providers may inquire how long it takes to deplete a vape solution cartridge (with use of one or more pods a day considered heavy use)
    • nicotine concentration
      • for individuals consuming nicotine-containing products, clinicians may inquire about concentration and frequency of use, as this may allow for development of a nicotine replacement therapy plan
  • is the patient using other inhaled produced in his/her vaping device?
    • clinicians should ask patients who vape about use of other inhaled products, particularly cigarettes. Further, clinicians may ask about use of water pipes, heat-not-burn devices, THC-containing products, or dabbing
      • concurrent smoking
        • simultaneous use of multiple inhaled products is common among vape users, including concurrent use of conventional cigarettes, water pipes, heat-not-burn devices, and THC-containing or CBD-containing products (7)
          • among those using marijuana products, gathering a history regarding the type of product use, the device, and the modality of aerosol generation may be warranted
        • "dabbing" is the practice of inhaling heated butane hash oil, a concentrated THC wax - which may also be associated with lung injury

Reference:

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