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Study will 'give nurses confidence' to recommend e-cigarettes

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Nurses are being urged not to hesitate about recommending e-cigarettes to their patients after a “ground-breaking” UK study found they are one of the most effective ways to kick the habit. 

The clinical trial discovered that vaping was almost twice as successful as nicotine replacement therapies, such as patches and gum, at helping smokers quit.

“Health professionals will feel more comfortable in recommending e-cigarette”

Dunja Przulj 

The findings come after a review in 2015 by Public Health England determined that e-cigarettes were around 95% less harmful than tobacco products.

This latest trial, led by Queen Mary University of London, is said to be the first to test the effectiveness of modern e-cigarettes as a smoking cessation tool. Participants were also given behavioural support.

Study author Dunja Przulj said: “The UK specialist stop smoking services will now be more likely to include e-cigarettes among their treatment options, and health professionals will feel more comfortable in recommending e-cigarettes as a stop-smoking intervention.

“This may ultimately further accelerate the reduction in smoking and in smoking related diseases,” she added.

Funded by the National Institute for Health Research (NIHR), supported by Cancer Research UK and published in the New England Journal of Medicine, the study was set-up to test the long-term effectiveness of new refillable e-cigarettes compared with a range of nicotine replacement treatments.

It saw 886 smokers attend NHS stop smoking services in Tower Hamlets, City of London, Leicester and East Sussex.

“Cigarette smoking is still a major cause of ill health and death in the UK”

Hywel Williams

They were randomly chosen to receive either an e-cigarette, or nicotine replacement treatment of their choice including patches, gum, lozenges, sprays, inhalators, or a combination. Alongside this, the participants received weekly one-on-one behavioural support.

The trial found that 18.0% of vapers were smoke-free after a year, compared to 9.9% of those using other nicotine replacement therapies.

Lead researcher Professor Peter Hajek said this was the first trial to test the efficacy of modern e-cigarettes in helping people stop smoking.

The only previous trial comparing e-cigarettes to nicotine patches used early “cig-a-like” devices with very low nicotine delivery and had no face-to-face contact with the participants.

Professor Hajek added: “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.”

Sophia Lowes, from Cancer Research UK, said the results of the study were “extremely positive”.

She added: “This research should give doctors, nurses, pharmacists and stop smoking service advisers further confidence to recommend e-cigarettes as an effective means of quitting.”

Professor Hywel Williams, director of the NIHR health technology assessment programme, described the study as “groundbreaking”.

He added: “Cigarette smoking is still a major cause of ill health and death in the UK, so this study will provide much needed evidence to help people and policy makers to make informed choices.”

Martin Dockrell, tobacco control lead at Public Health England, said all stop smoking services should now welcome smokers who wanted to quit with the help of an e-cigarette.

“Professionals have been reluctant to recommend their use because of the lack of clear evidence”

Peter Hajek 

The study also found that the e-cigarette participants reported greater decline in incidence of cough and phlegm production after 52 weeks than the other group.

While vapers experienced more throat and mouth irritation (65.4% versus 50.8%), those using nicotine replacement products felt more nausea (37.8% versus 31.4%).

Smokers using e-cigarettes also reported a lower increase in irritability, restlessness and inability to concentrate after the first week of abstinence, compared to those using nicotine replacement tools. 

The researchers recognised that the trial had “several limitations”, including the fact that the product allocation could not be blinded so participants using nicotine replacement could have put less effort into quitting if they saw this route as “inferior”.

But the researchers highlighted that they tried to recruit people with no strong preference. They added that the findings also may not be generalisable to smokers who were less dependent, or to services outside the UK.

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