The e-cigarette is - compared to nicotine patches and chewing gum as well as prescription medication - the most frequently used product by those who wish to give up smoking. This is shown by the "German Survey on Smoking Behaviour" ("DEBRA Study"), which was conducted by the University of Düsseldorf in cooperation with the Federal Ministry of Health. Many smokers hope to finally be smoke-free by switching to the electronic alternative. Are you one of them? In this context, we would like to answer the two most important questions: Can an e-cigarette help me quit smoking? And: Does switching to e-cigarettes make sense at all?
E-cigarette can reduce withdrawal symptoms
Tobacco addiction consists of both physical and psychological dependence and sooner or later leads to a wide variety of withdrawal symptoms when the smoker suddenly stops taking nicotine (see also article: "The first step to quitting smoking - understanding tobacco addiction"). Many smokers who want to stop smoking see the e-cigarette as a suitable method for doing so. But why?
The reasons for this are likely linked to practicality or even suitability for everyday use. E-cigarettes have the advantage that nicotine absorption in the body is much more efficient in contrast to patches or chewing gum and thus better avoids the usual physical withdrawal symptoms. (See also article: "Quitting smoking: methods and their limitations"). In addition, the hand-to-mouth movement is initially retained when an e-cigarette is used as part of a smoking cessation trial.
Whilst the number of studies that have examined the use of these devices in smoking cessation are few, the 2019 publication by Professor Hajek et. al. suggests there is now strong evidence for the first time that e-cigarettes can reduce smoking cravings and tobacco-related withdrawal symptoms.
This is a milestone in evaluating the clinical effectiveness of e-cigarettes as an aid to permanent tobacco cessation.
A total of 886 smokers participated in this clinical trial. The study subjects were divided into two groups. The so-called intervention group received a starter pack consisting of a second-generation e-cigarette and a refill bottle with 18mg of nicotine liquid. The control group used nicotine replacement products (e.g. patches, chewing gum, mouth spray, etc.) for a period of three months. The study participants had the option to combine these products with each other. In addition, both groups received weekly behavioural therapy for at least four weeks.
The results show that the people who used the e-cigarette were twice as successful (18 per cent) in quitting cigarettes than those who received nicotine replacement therapy (9 per cent) when both products were accompanied by behavioural therapy.
Furthermore, the study showed that there were no significant differences between the two groups in terms of respiratory symptoms. In fact, the e-cigarette group was significantly more likely to report a decrease in respiratory symptoms such as cough and mucus production, which were attributed to prior inhalation of tobacco smoke.
Cochrane Review confirms effectiveness of e-cigarette in smoking cessation trial
In 2020, a Cochrane Review analysed the evidence regarding the use of electronic cigarettes for smoking cessation. The review looked at the chances of success for nicotine-containing e-cigarettes compared to other smoking cessation interventions. In addition to the e-cigarette, these include quitting without any aids as well as nicotine-containing replacement therapies such as patches and chewing gum. It also includes behavioural therapy sessions and vaping e-cigarettes without nicotine.
E-cigarette effectiveness
According to the Cochrane scientists, e-cigarettes are effective smoking cessation aids and current evidence suggests that they are more effective and no more harmful than routine nicotine replacement products such as patches and gum.
Thus, the evidence has increased substantially since the last review in 2016. These findings are likely to be of great importance for healthcare professionals and smokers. This is because experience reports and surveys show that a large proportion of smokers have an incorrect assessment of the harmfulness of e-cigarettes.
Safety of e-cigarettes - no serious side effects, but no long-term data either.
In the consolidated analysis of data points from all studies in the Cochrane Review, there was no evidence that people who used nicotine-containing e-cigarettes reported serious health problems compared to people who used nicotine-free e-cigarettes, nicotine replacement therapy or no therapy at all. There is currently no evidence of serious side effects, but long-term data on long-term use of e-cigarettes is pending. Overall, the scientific evidence is that e-cigarettes are not as harmful as conventional cigarettes and that a smoker will benefit from switching to them.
Although the evidence for the use of e-cigarettes in smoking cessation is growing, a recommendation to smokers is still pending in Germany and other European countries. England, on the other hand, is a pioneer. There, the use of e-cigarettes for smoking cessation is already being discussed with smokers and health care professionals and is actively recommended as an effective and safe method.
Conclusion
Until a few years ago, there were not enough studies on the effectiveness of e-cigarettes in smoking cessation to be able to derive a concrete recommendation. However, this has changed following the clinical trial by Hajek et. al. 2019 and the Cochrane Review.
Compared to regular cigarettes, nicotine-containing e-cigarettes lead to much lower exposure to harmful substances and can effectively help people quit smoking.
They also treat physical addiction more effectively than nicotine replacement therapies. But for successful smoking cessation, behavioural addiction must also be addressed. Studies on efficacy and safety support this approach.
Even though long-term data is lacking, from a scientific point of view, switching to e-cigarettes should already bring health benefits. This is because the combination of a more efficient nicotine uptake, temporary retention of the smoking ritual ("hand-to-mouth movement") and a lower pollutant level compared to conventional cigarettes makes the e-cigarette an attractive alternative and is associated with great benefits for smokers.
