An international review published today finds e-cigarettes are 70 per cent more effective in helping smokers quit than nicotine replacement therapy. The findings come as public health charity Action on Smoking and Health (ASH) publishes figures showing e-cigarette uptake dropped in 2020 compared to 2019. The charity warns that unfounded concerns about health risks from e-cigarettes may mean thousands of smokers who could benefit from switching completely are missing the chance.
The review, produced by Cochrane, examined the best quality evidence on e-cigarettes for quitting smoking from around the world. They found that e-cigarettes were 70 per cent more effective at helping smokers quit than the use of nicotine replacement therapy, currently the most commonly used medication to help smokers quit.
These important findings reinforce existing evidence and strengthen the case for more smokers to be encouraged to use these products to help them quit. However, data from ASH from their annual survey with YouGov found that in March 2020 there were 3.2m e-cigarette users in Great Britain, down from 3.6m in 2019. Almost all users are smokers or ex-smokers with use among never smokers very low.
The charity points to a disappointing stagnation in the numbers of smokers who are using e-cigarettes given their proven impact on helping smokers quit. There has been little growth in the rate at which smokers use e-cigarettes since 2014. In 2020, 17.4 per cent of smokers were using an e-cigarette; almost unchanged from 2014, when 17.6 per cent reported current use. Unfounded concerns about the relative safety of e-cigarettes are a likely cause – just 39 per cent of smokers in Great Britain correctly believe vaping is less harmful than smoking in 2020.
Vaping is much less harmful than continuing to smoke, with the Cochrane Review finding little evidence of short-term harms. However, as people are now using products longer term, continued research is needed to understand what, if any, risks there might be in the long term.
Deborah Arnott, chief executive of ASH, said, “About a third of smokers have never even tried an e-cigarette and less than 20 per cent are currently using one. If many more smokers could be encouraged to give e-cigarettes a go, the latest evidence indicates that many more might successfully quit.
“Health professionals have an important role to play. They can give smokers the confidence to try an e-cigarette, by letting them know that they can help them manage cravings and that they are a much safer alternative than continuing to smoke.”
Nick Hopkinson, reader in respiratory medicine at Imperial College London and chair of ASH said, “I see people every day in clinic whose lungs are damaged by smoking – many have tried to quit repeatedly but have not been able to. E-cigarettes can help those who might otherwise struggle to quit successfully. I would urge colleagues throughout the NHS to join me in encouraging those smokers who could benefit to try using an e-cigarette. The more smokers we can get to quit today, the fewer people will be in our clinics and hospitals tomorrow.”
Ruth Sharrock, respiratory consultant at Queen Elizabeth Hospital, Gateshead said, “I see patients in clinic and on the wards, who are battling the complications of smoking related diseases every day. Many have never tried using e-cigarettes, despite there being growing evidence that this might be a more successful way to reduce harm from tobacco for smokers who have failed with other quit methods. I urge them to try to switch and reassure them that the risks are vastly reduced compared to the fact that half of cigarette smokers die from a smoking related disease. E-cigarettes have a valuable place in our armoury at tackling tobacco related disease.”
Case studies
Ralph, 58, Surrey:
Ralph has been smoking since his early teens when he would club together his lunch money to skip school and smoke. He said, “I’ve smoked more or less continuously since then. I managed to stop for three months in 1994 but otherwise I’ve mostly just increased the amount I smoke.”
This year Ralph decided to make a change to help him manage his health as he gets older and improve his diabetes. He got in touch with his local stop smoking service, as well as starting to use an e-cigarette again. He first tried one a few years ago but it hadn’t worked for him while he was still smoking.
Ralph said, “I’ve found one with a sealed capsule works for me. It doesn’t leak, it’s quite small and unobtrusive and doesn’t produce loads of vapour. It just gives me a little nicotine hit when I need it. It’s not the same as smoking but it does give you something to do with your hands.”
One You Surrey, the local stop smoking service, really helped Ralph and he has been smoke-free since May 20, with no intention of going back. The service provides nicotine replacement therapy free to some smokers.
He comments, “The service has been really important. I was able to try lots of different nicotine products, so I’ve also used patches, gum and lozenges. These things can be expensive but with a service you can try them out and find what works for you.”
As a 60 a day smoker, Ralph has used both NRT and e-cigarettes to help him quit and credits both with allowing him to stop. He started on a high nicotine strength liquid, but he found the taste of the high strength product unpleasant – so switched down to 12mg and is now on 3mg, hoping to drop down to 0mg in the future.
“I use it as a crutch, and when I’m used to not smoking, I hope I’ll give up the vape too; I don’t want to use it forever.”
Ralph says he’d recommend quitting to anyone and wishes he’d done it years ago, “I felt better almost immediately, not getting out of breath and so forth. I used to cough all the time, a deep unpleasant cough, and now that’s gone. I can also smell and taste things I didn’t use to be able to which means I’m using less salt in my food.”
His improving tastebuds have made him more discerning about his choice of drinks, “I used to make a virtue over having no favourite fizzy drink but since I stopped smoking, I can suddenly taste the difference! So, my recommendation would be a diet ginger beer.”
“I’m absolutely confident about staying quit. I’m not going to be taking up marathons, but this is making me healthier and I’m not going back.”
Charlotte, 26, Tameside:
Charlotte had tried to quit several times before using an e-cigarette in her successful quit attempt last year. Charlotte had used nicotine replacement therapy in previous attempts, patches and the oral spray, but with both, she only managed to quit for a few days at a time – she just didn’t find it satisfying.
Charlotte smoked her last cigarette on September 30, 2019 and took up vaping the very next day. “I didn’t know where to start, what I needed to buy or how it all worked. I popped down to my local store and they gave me all the information that I needed.”
Charlotte and her partner both intended to quit at some point but her partner, who had been smoking for 10-12 years, was keen that his quit take place on his own terms, and told Charlotte that he wouldn’t be following in her footsteps. However, seeing how well Charlotte got on with the e-cigarette, he bought his own vaping starter kit four days later and neither of them have ever looked back.
Charlotte is still vaping one year on but has not gone back to smoking. Before the pandemic hit, she was considering reducing the nicotine level she uses but following lockdown decided she had enough on her plate and prioritised not going back on the cigarettes.
Charlotte’s reason for wanting to quit came from seeing her nan and auntie suffer as a result of long-term smoking. Both had been diagnosed with COPD and were blighted by chest infections.
“It worried me to see them out of breath and hear the rattle as they breathed. I wanted to avoid that happening to me.”
Amongst the myriad of benefits Charlotte has experienced, she’s also managed to avoid getting any chest infections since the early days of her quit attempt, and she’s been able to achieve more in the gym.
“I go to the gym five days a week and it seemed like within no time after becoming smoke-free I was able to achieve more than when I smoked. I would always struggle with the cardio exercises, quickly getting out of breath, but soon after quitting I felt much more at home on the treadmill.”