E-Cigarettes and Smoking Cessation

A new study has found that e-cigarettes are comparable to nicotine patches in terms of helping patients quit smoking, and preliminary data show that e-cigarettes seem to be just as safe as nicotine patches.¹

E-cigarettes differ from traditional cigarettes in that e-cigarettes do not contain tobacco. Instead, e-cigarettes contain liquid nicotine, which is turned into a vapor and inhaled.

The myriad harms of smoking are well-established. As reminded by The American College of Obstetricians and Gynecologists (ACOG), ob/gyns are in a unique position to offer smoking cessation counseling to patients. In a committee opinion, ACOG advised that brief behavioral counseling paired with smoking cessation aids can help patients quit smoking-or at least get them thinking about it.²

ACOG also reminds clinicians that smoking cessation counseling is reimbursable. Most health care plans consider 3 to 10 minutes of counseling intermediate and more than 10 minutes of counseling intensive and reimburse accordingly.

The use of e-cigarettes as a smoking-cessation tool is controversial, mainly because the long-term effects of the toxins found in nicotine vapor are unknown. In addition, e-cigarettes are not regulated by the FDA. More research is needed to establish what role, if any, e-cigarettes should play in tobacco control and to better understand their benefits and harms. The available evidence, however limited, is promising.

In this new study, 292 people received a 13-week supply of commercially available e-cigarettes, with each containing about 16 mg of nicotine; 292 people received a 13-week supply of nicotine patches, and 73 people received placebo (nicotine-free) e-cigarettes. After the initial 13 weeks, a 3-month follow-up ensued.

At 6 months, 5.7% of participants were completely abstinent from smoking. The e-cigarette group had the highest proportion of abstainers (7.3% vs 5.8% and 4.1% for the nicotine-patch group and placebo group, respectively), although the differences between study groups were not significant.

Of those unable to quit after 6 months, 57% of those in the e-cigarette group reduced their daily consumption of cigarettes by at least half, compared with 41% in the nicotine patch group. A third of participants in the e-cigarette groups (both nicotine and placebo) were still using the devices at 6 months. In the nicotine-patch group, only 8% of participants were still using the patches at 6 months.

There were no differences in adverse health events overall or in serious adverse events between study groups. This finding suggests that the safety of e-cigarettes is similar to that of nicotine patches, explained the study authors.

Considering that safety data for e-cigarettes is scarce and that the devices are unregulated, it would be best not to recommend e-cigarettes. If patients ask, however, study data is available.

Pertinent Points:
- E-cigarettes, with or without nicotine, are a modestly effective tool to help smokers quit.
- The profile of e-cigarettes in terms of achievement of smoking abstinence is similar to that of nicotine patches.
- More research is needed to establish the overall health benefits and harms of e-cigarettes and their role in tobacco control.

References:

1. Bullen C, Howe C, Laugesen M, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 9 September 2013. doi:10.1016/S0140-6736(13)61842-5.
2. American College of Obstetricians and Gynecologists. Committee opinion no. 503: tobacco use and women’s health. Obstet Gynecol. 2011;118:746-750.