Q: My son has been unsuccessful trying to quit smoking on his own, but he is resistant to using nicotine patches or taking pills. What's your opinion about e-cigarettes to help with smoking cessation?
A: Users of electronic cigarettes (e-cigarettes) inhale an aerosol created by heating nicotine, flavorings and other substances. There is general agreement that vaping (the term often used to describe use of e-cigarettes) is safer than smoking cigarettes. However, vaping can cause mouth or throat irritation, nausea, and coughing, and the long-term effects are unknown.
Although unproven, there may be health benefits to a smoker who gives up smoking even if they become a long-term vaper instead.
A new study compares vaping with other common nicotine replacement approaches to help smokers quit. The findings support the idea that vaping may be helpful.
Researchers recruited nearly 900 people who wanted to quit smoking, randomly assigning half to receive e-cigarettes and the other half to receive other nicotine replacement products (including nicotine patches and gum). All study participants received weekly individual counseling for four weeks.
After one year:
--Eighteen percent of those assigned to vaping had stopped smoking; only 10 percent of those using other nicotine-replacement therapy had quit.
--Among successful quitters, 80 percent of those in the e-cigarette group were still vaping; only 9 percent of those in the nicotine-replacement group were still using those products.
--Reports of cough and phlegm production dropped more in the e-cigarette group.
So, while e-cigarette use was associated with nearly twice the rate of smoking cessation, more than 80 percent of smokers entering this study continued to smoke.
The-cigarettes used in this study contained much lower levels of nicotine than found in some common brands used in the US (such as Juul). The importance of this difference is unclear, but a higher nicotine level could contribute a higher rate of addiction to e-cigarettes.
You should encourage your son to try the best studied smoking cessation strategies:
--behavioral therapy, such as individual counseling
--nicotine replacement therapy, such as a long-acting nicotine patch and short-acting nicotine gum
--medications to reduce the urge to smoke, such as varenicline (Chantix) or bupropion (Zyban).
While I think concerns about vaping are appropriate (especially regarding use among youth), this study demonstrates that it could help people quit smoking. Vaping could get approval from the FDA as a smoking cessation aid, but even if that happens, it should not be the first choice given how much is still unknown.
Ultimately, we'll need good studies to assess the long-term safety of vaping, to confirm that when used to aid smoking cessation we aren't just replacing one bad habit with another.
(Robert H. Shmerling, M.D., is associate professor of Medicine at Harvard Medical School and clinical chief of Rheumatology at Beth Israel Deaconess Medical Center in Boston. For additional consumer health information, please visit www.health.harvard.edu.)