The Emerging Phenomenon of Electronic Cigarettes

Pasquale Caponnetto; Davide Campagna; Gabriella Papale; Cristina Russo; Riccardo Polosa

Disclosures

Expert Rev Resp Med. 2012;6(1):63-74. 

In This Article

Electronic Cigarettes: Potential for Smoking Cessation

Current smoking cessation interventions can increase the chance of quitting in committed smokers who are already motivated and prepared to stop smoking,[30] but a broader range of interventions are needed in order to bring more smokers into treatment and increase the numbers who are motivated to make quit attempts. Although not formally regulated as a pharmaceutical product, the positive preliminary clinical experience with these products could be confirmed and expanded in classic smoking-cessation trials of smokers motivated to quit.

The most common smoking-cessation method is nicotine replacement, which aims to address nicotine dependence.[31] Its primary mechanism of action is to partially replace the nicotine formerly obtained from tobacco smoking, aiding smoking cessation by attenuating the reinforcing effects of nicotine delivered via tobacco, and therefore reducing the severity of withdrawal symptoms and cravings.[32] Approved nicotine replacement therapies do not completely control all symptoms of withdrawal because the available delivery systems do not reproduce the rapid and high levels of nicotine achieved through tobacco use.[33,34] Differences in formulations (nicotine lozenge, gum, patch, nasal spray and inhaler) could have a distinct impact upon either withdrawal symptoms or urges to smoke, but there is little direct evidence that one nicotine product is more effective than another, perhaps with the only exception being the nicotine nasal spray.[35] It is possible that the electronic cigarette may deliver aerosolized nicotine in a more efficient manner.

Moreover, efficacy with nicotine-replacement therapies, as for all antismoking medications, is modest because it addresses only the physical component of smoking (i.e., nicotine addiction), and is unlikely to resolve the psychological components (cognitive, social and behavioral, including handling, holding and puffing a cigarette) associated with smoking.[36,37] When the smoker stops smoking, those rituals are no longer there, but the need for the ritual still exists and this is an important cause of relapse. Given that both nicotine- and smoking-related cues appear to control cigarette craving and withdrawal symptoms, electronic cigarettes – by supplying nicotine and by mimicking the rituals associated with cigarette smoking – may be used as an efficient smoking cessation tool.[12,27,28] Also, when we bear in mind that nicotine per se does not cause much risk when separated from inhaling smoke, switching to the electronic cigarette equates to quitting in exposure terms.

Results from recent surveys support the idea that electronic cigarettes may be effective in helping smokers quit. In a large internet survey of 3587 electronic cigarette users,[10] most respondents (up to 96%) reported that the electronic cigarette helped them quit or reduce their smoking. They also stated that electronic cigarettes were used to avoid relapse. Most ex-smokers in the sample (79%) feared they might relapse to smoking if they stopped using the electronic cigarette. Heavner et al. enrolled 303 users, most of whom lived in the USA (72%) or Europe (21%), via email and links on various blogs and forums.[212] The online survey was conducted by a UK electronic cigarette company and the data was evaluated by independent university researchers. Most (79%) were using electronic cigarettes as a complete replacement for smoking, with another 17% using them as a partial replacement. Health improvements were reported for general health (91%), smoker's cough (97%) and ability to exercise (84%), and none reported that these were worse. In the survey of Siegel et al., the prevalence of smoking abstinence among the 222 electronic cigarettes users was of 31% at 6 months.[38] Of those using the elecronic cigarette more than 20-times per day, 70% were nonsmokers at 6 months. Goniewicz et al. surveyed 257 users in Poland to investigate patterns of use.[39] Of the 170 users who completed the survey, 83% were regular smokers when they began using elecronic cigarettes and 66% declared they were not smoking. Almost all (98%) used their electronic cigarettes every day. Nicotine levels used ranged from zero nicotine (3%) to higher than 16 mg per cartridge (25%), with 41% using 8–16 mg per cartridge.

These findings indicate that electronic cigarettes may be an effective aid to smoking cessation, and therefore merits further evaluation for this purpose.

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