Barcelona, Spain - Electronic cigarettes are as effective as the patch when it comes to helping smokers overcome the cravings of nicotine addiction, suggests the first randomized study of its kind.
The work, presented here at the European Respiratory Society (ERS) 2013 Annual Congress and simultaneously published online in the Lancet, shows that smokers using electronic cigarettes and those using the patch were able to abstain from smoking in equal proportions after six months.
Dr Chris Bullen (University of Auckland, New Zealand) and his team compared three approaches to smoking cessation in 657 smokers. Participants actively trying to quit were randomly assigned to active e-cigarettes that contained 16 mg of nicotine, to placebo e-cigarettes with no nicotine, and to patches that contained 21 mg of nicotine.
After randomization, study participants were instructed to use the assigned method for one week prior to their quit date and for 12 weeks thereafter. During the study period, all participants were offered behavioral support. The researchers assessed sustained abstinence from cigarettes six months after the quit date.
Overall, 5.7% of participants remained cigarette-free at six months. Treatment success was highest with the active e-cigarettes, followed by the patches, and lowest with the placebo e-cigarettes; however, these differences were not statistically significant.
Percentage of smokers who successfully quit
|
Treatment |
Percentage |
|
Electronic cigarettes (n=292) |
7.3 |
|
Nicotine patches (n=292) |
5.8 |
|
Placebo electronic cigarettes (n=73) |
4.1 |
When the researchers analyzed cigarette consumption and evaluated the benefit of cutting down instead of quitting, the results were statistically significant. More participants in the active electronic cigarette group than in the patch group had reduced consumption by at least half at six months (57% vs 41%). Differences in addiction and withdrawal scores were also significant between the 2 active-treatment groups (p=0.018)
There were no differences in adverse events in the three groups.
However, the success seen with the active electronic cigarette did come with some interesting caveats. "At six months, more than a third of the people in that group who had quit smoking were still using the e-cigarettes," Bullen reported.
"This suggests that they substituted e-cigarettes for their nicotine supply. I suppose you could argue that this is a bad thing, that you’re maintaining nicotine dependence, but at least it is better than having the person continue to smoke," he said. "However, for those in the e-cigarette cohort who didn’t manage to quit, about 30% now use both. This is certainly a concern, and more research is needed in the area of dual use."
For those in the e-cigarette cohort who didn’t manage to quit, about 30% now use both. This is certainly a concern, and more research is needed in the area of dual use.
If a person uses electronic cigarettes to successfully quit smoking but is still using them a year later, is that a problem? Dr Gareth Jones (Liverpool Heart and Chest Hospital, UK) said in an interview that a smoker who successfully quits should certainly be congratulated. "But I would be obligated to mention that I don’t know what these devices will do to the lungs in the long term. As yet, there is no clear evidence on which to base an opinion. Ideally, I’d want you to quit using the e-cigarette as well, as long as it didn"t mean you would go back to using real cigarettes."
The dearth of solid data is partially explained by the nature of the product. "The problem in the United Kingdom is that there is no standard e-cigarette," Jones explained. "A recent study by the World Health Organizationshowed that even e-cigarettes manufactured by the same company have widely variable components. There are regulations coming in the United Kingdom in 2016 that will require safety and efficacy data, but until then, we really don’t know what you’re inhaling."
Outgoing ERS president Dr Francesco Blasi (University of Milan, Italy) emphasized that more data are needed to gauge the effects of the long-term use of electronic cigarettes.
"This study is an important first step in looking at the safety and efficacy of these devices," he said. "This is exactly what we want—the ERS wants more science in this regard. They’ve shown that in the short term, e-cigarettes are as effective as the nicotine patch and that the safety seems good. But we need larger studies on the long-term use of e-cigarettes, because we just don’t know what will happen."
And there need to be some answers soon, Blasi pointed out. "These products now sell all over the world. We have a lot of consumers using this kind of device, particularly in Europe, so the ERS strongly advocates that the European Parliament consider this issue."
He noted that the parliament’s environment and heath committee will vote on recommendations to regulate e-cigarettes as medicinal products on October 8.
In the US, the Centers for Disease Control and Prevention report in the September 6, 2013 issue of the Morbidity and Mortality Weekly Report that middle- and high-school students more than doubled their use of electronic cigarettes between 2011 and 2012. The CDC and the US Food and Drug Administration officials plan to continue surveillance and research of electronic cigarette use, including its potential as a gateway to more conventional tobacco products and its long-term health effects.
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