E-cigarettes more effective than nicotine replacement to stop smoking

Long-term effects of vaping are still unknown, but smoking causes 55,000 cancer deaths in the UK every year, and is leading cause of premature death and disability

Electronic cigarettes containing nicotine are better than traditional nicotine replacement therapies (NRT) like gum and patches in helping people quit smoking, suggests the latest Cochrane Review.

The World Health Organisation (WHO) says that approximately 22.3% of the global population uses tobacco, making smoking an important global health issue. Quitting reduces the risk of disease, including lung cancer and heart attacks, but it’s not easy.

While NRTs are safe, effective and widely used, “high certainty evidence” suggests nicotine e-cigarettes are more likely to help people quit for at least six months, with 8-12% of people quitting using nicotine e-cigarettes, compared to 6% using NRTs. They also led to higher quit rates than non-nicotine e-cigarettes or no stop-smoking intervention.

The Cochrane Tobacco Addiction Group (TAG) and Cancer Research UK conduct a monthly “living systematic review”, analysing the most reliable scientific studies available. This latest review includes 78 studies, an increase of 22 since 2021.

“For the first time, this has given us high certainty evidence that e-cigarettes are even more effective at helping people to quit smoking than traditional nicotine replacement therapies,” explains Dr Jamie Hartmann-Boyce, Associate Professor, University of Oxford and editor ofCochrane TAG.

E-cigarettes are misunderstood he says, which may discourage some people from using them to stop smoking. E-cigarettes heat a liquid with nicotine, flavourings and other chemicals which users ‘vape’, so they aren’t exposed to the same disease-causing chemicals as smoking conventional cigarettes.

“Evidence shows that nicotine e-cigarettes carry only a small fraction of the risk of smoking.”

But they’re not risk-free and shouldn’t be used by non-smokers, adds Dr Nicola Lindson, University Research Lecturer, University of Oxford and Cochrane TAG’s Managing Editor: “Evidence shows that nicotine e-cigarettes carry only a small fraction of the risk of smoking. In our review, we did not find evidence of substantial harms caused by nicotine-containing electronic cigarettes when used to quit smoking.”

Studies comparing nicotine e-cigarettes to NRTs found significant side effects were rare; short-to-medium-term effects included throat or mouth irritation, headache, cough, and feeling nauseous; these effects diminished over time.

However, research is needed into the long-term effects of using nicotine e-cigarettes and of newer e-cigarettes which offer better nicotine delivery than earlier models.

“We welcome this report which adds to a growing body of evidence showing that e-cigarettes are an effective smoking cessation tool,” says Michelle Mitchell, Chief Executive, Cancer Research UK. “While the long-term effects of vaping are still unknown, the harmful effects of smoking are indisputable – smoking causes around 55,000 cancer deaths in the UK every year.”

Smoking is the single biggest driver in the difference in life expectancy in England, with people from more deprived backgrounds more likely to smoke, and at a younger age.

Professor Nicholas Hopkinson, Professor of Respiratory Medicine and Honorary Consultant Physician, National Heart and Lung Institute, Imperial College said, “There are still more than six million people in the UK who smoke, and these findings strongly support making e-cigarettes available as one of the options to help them to quit.”

Ending smoking could more than halve the cancer inequality gap in England say Cancer Research UK, who are requesting that the government deliver on its smoke-free 2030 ambition to reduce the number of smokers to less than 5% of the adult population. This action could prevent thousands of cancers, reduce the cancer inequality gap and prevent the next generation from suffering a lifetime of addiction.