E-cigarettes may be more effective than NRT for smoking cessation

Refillable e-cigarettes are more effective than nicotine-replacement therapy (NRT) for smoking cessation when combined with behavioural support, according to a study published in the New England Journal of Medicine (2019;380:629–37).

 The study authors randomised 886 adults attending NHS stop-smoking services to their choice of NRT product or combination of products (including patches, gum, lozenges and sprays), provided for up to three months, or to an e-cigarette starter pack (comprising a refillable e-cigarette with one bottle of nicotine e-liquid 18mg/ml), with a recommendation to purchase further e-liquids of their choice. All participants also received weekly behavioural support for at least four weeks.

The primary outcome was sustained abstinence for one year, which was achieved in 18% of participants in the e-cigarette group and 9.9% in the NRT group (relative risk 1.83; p<0.001). Participants in the e-cigarette group also reported less withdrawal, discomfort and craving. Among those who achieved sustained abstinence, those in the e-cigarette group were more likely to use their product at the one-year mark than those in the NRT group (80% vs 9%). In terms of adverse effects, throat or mouth irritation was reported more frequently in the e-cigarette group and nausea more frequently in the NRT group. The e-cigarette group reported a lower incidence of cough and phlegm production at one year, but there were no significant differences in the incidence of wheezing or shortness of breath.

Meanwhile, according to an independent report from King’s College London commissioned by PHE, regular use of e-cigarettes among young people remains low and has plateaued among adults. Although quitting smoking remains the main reason for vaping, just over a third of all current smokers have never tried e-cigarettes. Furthermore, only 4.1% of quit attempts through stop-smoking services in England are made using e-cigarettes, despite this being an effective approach. The report recommends that stop-smoking services should do more to encourage smokers who want to quit with the help of e-cigarettes.



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