FPIN's Clinical Inquiries
Electronic Cigarettes for Smoking Cessation
Am Fam Physician. 2021 Jan 1;103(1):53-54.
Are electronic cigarettes (e-cigarettes) effective for tobacco cessation in adults?
e-Cigarettes with nicotine can be used to encourage smoking cessation, but continued use after cessation may be a risk factor for relapse. (Strength of Recommendation [SOR]: B, based on a meta-analysis of two low-quality randomized controlled trials [RCTs].) e-Cigarettes with nicotine used for smoking cessation are more effective than e-cigarettes without nicotine (9% vs. 4% off cigarettes at six months). Nicotine e-cigarettes are more effective at one year than other forms of nicotine replacement (18% vs. 9.9% off cigarettes at one year), although 80% of abstinent patients will continue e-cigarette use. (SOR: B, based on a large RCT.)
A 2016 systematic review and meta-analysis evaluated the effect of using e-cigarettes to help patients who smoke achieve long-term smoking cessation.1 The study included two RCTs with 662 adults from New Zealand and Italy interested in smoking cessation and compared e-cigarettes with nicotine to e-cigarettes without nicotine (placebo). Patients using e-cigarettes abstained from smoking for at least six months at a higher rate than those using placebo e-cigarettes (9% vs. 4%, respectively; relative risk [RR] = 2.29; 95% CI, 1.05 to 4.96).1 There were no serious adverse effects related to e-cigarette use.1 The authors rated the overall quality of the evidence as low, with high risk of selection bias.
A 2019 pragmatic RCT with 886 patients from the United Kingdom who smoked cigarettes and were interested in quitting evaluated the one-year effectiveness of e-cigarettes with nicotine compared with other forms of nicotine replacement for smoking cessation. Patients had a median age of 41 years, and they smoked a median of 15 cigarettes per day. During randomization, researchers provided patients with an e-cigarette device and one 30-mL bottle of nicotine vaporizing fluid or three months of the nicotine replacement
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Referencesshow all references
1. Hartmann-Boyce J, McRobbie H, Bullen C, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016;(9):CD010216....
2. Hajek P, Phillips-Waller A, Przulj D, et al. A randomized trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med. 2019;380(7):629–637.
3. Gomajee R, El-Khoury F, Goldberg M, et al. Association between electronic cigarette use and smoking reduction in France. JAMA Intern Med. 2019;179(9):1193–1200.
4. American Cancer Society position statement on electronic cigarettes. Accessed December 4, 2020. https://www.cancer.org/healthy/stay-away-from-tobacco/e-cigarette-position-statement.html
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