One of the
most pressing unanswered questions in public health has been "Do
e-cigarettes actually help smokers quit?"
The first,
large rigorous assessment now answers this question.
A study,
published Wednesday in the New England Journal of Medicine, found that
e-cigarettes were nearly twice as effective as conventional nicotine
replacement products, like patches and gum, for quitting smoking, reports New
York Times. The success rate was 18% among the e-cigarette group, compared to
9.9% among those using traditional nicotine replacement therapy.
The study
was conducted in Britain and funded by the National Institute for Health
Research and Cancer Research UK. For a year, it followed 886 smokers
assigned randomly to use either e-cigarettes or traditional nicotine
replacement therapies. Both groups also participated in at least four weekly
counseling sessions, an element regarded as critical for success.
E-cigarettes
provide the nicotine smokers crave without the toxic tar and carcinogens that
come from inhaling burning tobacco. But, it is still not approved as smoking
cessation tools.
Doctors up
till now were reluctant to recommend their use because of the lack of
clear evidence from randomized controlled trials. This is now likely to change.
The New
England Journal devoted much of its current issue to e-cigarettes, publishing
two editorials and a letter, and the collection embodies the tangled public
health debate over the devices. One editorial — written by
Belinda Borrelli, a behavioral health expert and Dr. George T. O’Connor, a
pulmonologist — pumped the brakes on inclinations to embrace e-cigarettes.
The editorial
recommended that e-cigarettes be taken up when other cessation approaches,
including behavioral counselling have failed; that patients use the lowest dose
of nicotine possible and that health care providers establish a clear timeline
for
e-cigarette use.
e-cigarette use.
The clinical
trial took place from May 2015 to February 2018. Because the smokers were
recruited at the clinics, they were already predisposed to quitting, a feather
on the scale that could slightly have affected results. The participants were
typically middle-aged, smoked between half a pack and a pack a day and had
already tried quitting.
Because
self-reports of smoking abstinence are not considered reliable, researchers
measured the quantities of carbon monoxide in the participants’ breath, a more
precise validation. Higher quit rates and compliance among e-cigarette users
could be additionally explained because those subjects expressed more
satisfaction with the devices than did the other group with their products.
Some
researchers hypothesize that because a body takes in only the amount of
nicotine it needs to maintain a certain level, high-nicotine products could
have the advantage of delivering that power punch with fewer puffs, decreasing
the amount of harmful aerosol a vaper would inhale.
(Source: New
York Times)
|
NEJM
Abstract
A
randomized trial of e-cigarettes vs nicotine-replacement therapy
Hajek P,
Phillips-Waller A, Przulj D, et al. N Engl J Med. 2019 Jan 3. Epub ahead of
print
Background: E-cigarettes
are commonly used in attempts to stop smoking, but evidence is limited
regarding their effectiveness as compared with that of nicotine products
approved as smoking-cessation treatments.
Methods: We
randomly assigned adults attending U.K. National Health Service stop-smoking
services to either nicotine-replacement products of their choice, including
product combinations, provided for up to 3 months, or an e-cigarette starter
pack (a second-generation refillable e-cigarette with one bottle of nicotine
e-liquid [18 mg per milliliter]), with a recommendation to purchase further
e-liquids of the flavor and strength of their choice. Treatment included
weekly behavioral support for at least 4 weeks. The primary outcome was
sustained abstinence for 1 year, which was validated biochemically at the
final visit. Participants who were lost to follow-up or did not provide
biochemical validation were considered to not be abstinent. Secondary
outcomes included participant-reported treatment usage and respiratory
symptoms.
Results: A
total of 886 participants underwent randomization. The 1-year abstinence rate
was 18.0% in the e-cigarette group, as compared with 9.9% in the
nicotine-replacement group (relative risk, 1.83; 95% confidence interval
[CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence,
those in the e-cigarette group were more likely than those in the
nicotine-replacement group to use their assigned product at 52 weeks (80% [63
of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth
irritation was reported more frequently in the e-cigarette group (65.3%, vs.
51.2% in the nicotine-replacement group) and nausea more frequently in the
nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The
e-cigarette group reported greater declines in the incidence of cough and
phlegm production from baseline to 52 weeks than did the nicotine-replacement
group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for
phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group
differences in the incidence of wheezing or shortness of breath.
Conclusions: E-cigarettes
were more effective for smoking cessation than nicotine-replacement therapy,
when both products were accompanied by behavioral support.
(Funded by
the National Institute for Health Research and Cancer Research UK; Current
Controlled Trials number, ISRCTN6047760)
|
Dr KK
Aggarwal
Padma
Shri Awardee
President
Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group
Editor-in-Chief IJCP Publications
President
Heart Care Foundation of India
Past
National President IMA
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