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First trial shows e-cigarettes are more effective than nicotine patches and gum for quitters

Currently, 10% of Irish ex-smokers use e-cigarettes.

Image: Shutterstock/Sergei Domashenko

E-CIGARETTES ARE MORE effective than other nicotine replacement treatments, such as patches and gum, at helping smokers to quit, according to the results of a recent clinical trial.

The study led by Queen Mary University of London, which involved almost 900 smokers who also received additional behavioural support, found that 18% of e-cigarette users were smoke-free after a year, compared to 9.9% of participants who were using other nicotine replacement therapies.

The trial – funded by the National Institute for Health Research and Cancer Research UK – was set-up to test the long-term efficacy of newer refillable e-cigarettes compared with a range of nicotine replacement treatments. 

However, e-cigarettes are still not recommended to smokers who wish to quit by the HSE. 

According to lead researcher, Professor Peter Hajek from Queen Mary University of London, this is the first trial to test the efficacy of modern e-cigarettes in helping smokers quit.

“E-cigarettes were almost twice as effective as the ‘gold standard’ combination of nicotine replacement products,” Hajek said.

Although a large number of smokers report that they have quit smoking successfully with the help of e-cigarettes, health professionals have been reluctant to recommend their use because of the lack of clear evidence from randomised controlled trials. This is now likely to change.

According to the study’s authors, the only previous trial comparing e-cigarettes to nicotine patches used early ‘cig-a-like’ e-cigarettes with very low nicotine delivery, had no face-to-face contact, and found low efficacies for both treatments.

A spokesperson for Queen Mary University confirmed to TheJournal.ie that the study received “no funding from e-cigarette manufacturers and no author has any links with any tobacco or e-cigarette manufacturers”. 

Not a recommended cessation tool

In Ireland, 17% of smokers who have tried to quit in the past year and 30% of those who have successfully quit smoking, currently use e-cigarettes. 

The Healthy Ireland Survey 2018 reported that 20% of the population are smokers, but the prevalence of smoking has declined from 23% in 2015 to 20% in 2018. 

The survey also found that 44% of all who have smoked in the past 12 months have made an attempt to quit during that period. Almost half (42%) of those who have successfully quit smoking in the past 12 months did so through willpower alone, and 41% used e-cigarettes. 

Currently, 10% of Irish ex-smokers use e-cigarettes. 

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At present, government policy notes the evidence regarding the safety of e-cigarettes and their effectiveness as a cessation tool is insufficient to recommend them to those who wish to quit smoking. 

The Department of Health commissioned HIQA to conduct a health technology assessment last year, which included an assessment of e-cigarettes.

It reported similar conclusions regarding the insufficiency of robust research evidence to inform decisions regarding the use of e-cigarettes as a smoking cessation tool.  

The most commonly observed side effects of e-cigarette use in clinical trials and surveys are that of temporary throat and respiratory irritation and dry cough.
E-cigarettes are unlikely to be harmless, and long-term use may increase the risk of chronic obstructive pulmonary disease, lung cancer, and possibly cardiovascular disease, as well as some other diseases also associated with smoking.

The HSE has said that in line with advice from HIQA, e-cigarettes are not recommended or prescribed as a smoking cessation tool. 

“The current HSE position regarding use of e-cigarettes reflects this current government policy. There are a range of policy and legislative issues regarding e-cigarettes and health to be considered by the Department of Health and it is important that the situation regarding the safety, health impacts and potential role of e-cigarettes as supports to help people quit smoking is monitored,” a HSE spokesperson said. 

Mixed signals

When it came to the clinical trial, it found that while e-cigarettes were the most effective when it came to quitting smoking, the rate of continuing e-cigarette use was fairly high, which the authors say could be “problematic”. 

The rate of continuing e-cigarette use was fairly high. This can be seen as problematic if e-cigarette use for a year signals ongoing long-term use, which may pose as-yet-unknown health risks.

The trial also found that there were mixed signals regarding the effects of e-cigarettes on the respiratory system. More participants in the e-cigarette group than in the nicotine-replacement group reported breathing issues.  

During the trial, 886 smokers attended UK National Health Service stop smoking services (in Tower Hamlets, City of London, Leicester and East Sussex) and were randomised to receive either a nicotine replacement treatment of their choice (including patches, gum, lozenges, sprays, inhalators) or an e-cigarette starter pack.

Every participant then received weekly one-on-one behavioural support for at least four weeks, with expired air carbon monoxide monitoring.

In addition to e-cigarettes being almost twice as effective, the researchers found that:

  • E-cigarette participants reported a greater decline in the incidence of a cough and of phlegm production after 52 weeks. 
  • E-cigarette participants experienced less severe urges to smoke at 1 and 4 weeks post-quit date.
  • They also reported a lower increase in irritability, restlessness and inability to concentrate after the first week of abstinence, compared to those in the nicotine replacement trial.

The researchers add that the reason e-cigarettes were found to be more effective than other nicotine replacement therapies could be primarily because they allow better tailoring of nicotine dose to individual needs, but also because they provide some of the behavioural aspects of smoking cigarettes.

“The findings may not be generalisable to smokers who are less dependent, or to first generation ‘cig-a-like’ e-cigarettes, and further trials are needed to determine whether the results generalise outside the UK services,” the study concluded. 

Source: HSE Ireland/YouTube

The HSE has recommended its QUIT service as a “safe and effective smoking cessation tool”. 

“People who smoke that are interested in using these services and who use or plan to use e-cigarettes are welcomed and supported to develop a smoking cessation plan which best fits their needs and preferences,” a HSE spokesperson said. 

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Adam Daly

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