Electronic Cigarettes as Good as Patch for Quitting Smoking

Neil Canavan

September 09, 2013

BARCELONA, Spain — Electronic cigarettes are as effective as the patch when it comes to helping smokers overcome the cravings of nicotine addiction, suggests the first randomized study of its kind.

The work, presented here at the European Respiratory Society (ERS) 2013 Annual Congress, and simultaneously published online in the Lancet, demonstrates that smokers using e-cigarettes and those using the patch are able to abstain from smoking in equal proportions after 6 months.

Chris Bullen, MD, director of the National Institute for Health Innovation at the University of Auckland in New Zealand, and his team compared 3 approaches to smoking cessation in 657 smokers. Participants actively trying to quit were randomly assigned to active e-cigarettes that contained 16 mg of nicotine, placebo e-cigarettes with no nicotine, or patches that contained 21 mg of nicotine.

After randomization, study participants were instructed to use the assigned method for 1 week prior to their quit date, and for 12 weeks thereafter. During the study period, all participants were offered behavioral support. The researchers assessed sustained abstinence from cigarettes 6 months after the quit date.

Overall, 5.7% of participants remained cigarette-free at 6 months. Treatment success was highest with the active e-cigarettes, followed by the patches, and lowest with the placebo e-cigarettes; however, these differences were not statistically significant.

Table. Percentage of Smokers Who Successfully Quit

Treatment Group Successful Cessation, %
E-cigarettes (n = 292) 7.3
Nicotine patches (n = 292) 5.8
Placebo e-cigarettes (n = 73) 4.1


When the researchers analyzed cigarette consumption and evaluated the benefit of cutting down instead of quitting, the results were statistically significant. More participants in the active e-cigarette group than in the patch group had reduced consumption by at least half at 6 months (57% vs 41%). Differences in addiction and withdrawal scores were also significant between the 2 active-treatment groups (= .018)

There were no differences in adverse events in the 3 groups.

However, the success seen with the active e-cigarette did come with some interesting caveats. "At 6 months, more than a third of the people in that group who had quit smoking were still using the e-cigarettes," Dr. Bullen reported.

For those in the e-cigarette cohort who didn't manage to quit, about 30% now use both. This is certainly a concern.

"This suggests that they substituted e-cigarettes for their nicotine supply. I suppose you could argue that this is a bad thing, that you're maintaining nicotine dependence, but at least it is better than having the person continue to smoke," he said. "However, for those in the e-cigarette cohort who didn't manage to quit, about 30% now use both. This is certainly a concern, and more research is needed in the area of dual use."

If a person uses e-cigarettes to successfully quit smoking but is still using them a year later, is that a problem? Gareth Jones, MD, from the Liverpool Heart and Chest Hospital in the United Kingdom, told Medscape Medical News that a smoker who successfully quits should certainly be congratulated. "But I would be obligated to mention that I don't know what these devices will do to the lungs in the long term. As yet, there is no clear evidence on which to base an opinion. Ideally, I'd want you to quit using the e-cigarette as well, as long as it didn't mean you would go back to using real cigarettes."

The dearth of solid data is partially explained by the nature of the product. "The problem in the United Kingdom is that there is no standard e-cigarette," Dr. Jones explained. "A recent study by the World Health Organization showed that even e-cigarettes manufactured by the same company have widely variable components. There are regulations coming in the United Kingdom in 2016 that will require safety and efficacy data, but until then, we really don't know what you're inhaling."

Outgoing ERS president Francesco Blasi, MD, emphasized that more data are needed to gauge the effects of the long-term use of e-cigarettes.

"This study is an important first step in looking at the safety and efficacy of these devices," he told Medscape Medical News. "This is exactly what we want — the ERS wants more science in this regard. They've shown that in the short term, e-cigarettes are as effective as the nicotine patch, and that the safety seems good. But we need larger studies on the long-term use of e-cigarettes, because we just don't know what will happen."

And there need to be some answers soon, Dr. Blasi pointed out. "These products now sell all over the world. We have a lot of consumers using this kind of device, particularly in Europe, so the ERS strongly advocates that the European Parliament consider this issue."

He noted that the Parliament's environment and heath committee will vote on recommendations to regulate e-cigarettes as medicinal products on October 8.

In the United States, the Centers for Disease Control and Prevention (CDC) has reported that middle- and high-school students more than doubled their use of e-cigarettes from 2011 to 2012.

Those data were published in the September 6 issue of the Morbidity and Mortality Weekly Report. Officials at the CDC and the US Food and Drug Administration plan to continue surveillance and research of e-cigarette use, including its potential as a gateway to more conventional tobacco products and its long-term health effects.

Dr. Bullen reports having done research for the Ruyan brand of e-cigarettes (the e-cigarettes used in this study were the Elusion brand). Dr. Blasi and Dr. Jones have disclosed no relevant financial relationships.

European Respiratory Society (ERS) 2013 Annual Congress: Abstract P1047. Presented September 8, 2013.


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