Robust Evidence Shows Vaping Works Best

Cochrane runs a project that looks at the findings from the body of research evidence about electronic cigarettes, and it’s certain that a paper published this month will feature in future iterations of its systematic review. Researchers from Bern, Lausanne, Geneva, Zurich, St. Gallen, Basel, Fribourg and at the Hôpital Pitié–Salpêtrière in Paris released a paper for peer review in the New England Journal of Medicine that emphatically demonstrates ecigs worked to help smokers quit tobacco.

Didn’t the Hôpital Pitié–Salpêtrière feature in a previous article about vaping?
Wow, what a great memory. Yes, two doctors at the Hôpital Pitié–Salpêtrière in Paris were the first to note links between nicotine use and hospital admissions during the Covid pandemic. They found that although smokers were more likely to have worse outcomes if they were admitted to hospital for treatment for Covid, nicotine users were less likely to suffer from life-threatening episodes and be admitted in the first place. Their findings sparked a flurry of research looking at whether nicotine could be used in a preventative capacity. But this is not related to the study featured in this article, it simply confirms that they have a open view on nicotine use.

So, what is this latest piece of research about?
An impressive twenty-one doctors worked together to produce “Electronic Nicotine-Delivery Systems for Smoking Cessation”. They were aware that a huge number of smokers have claimed anecdotally that vaping helped them to quit smoking. They also knew that there was now a solid body of research now to support those claims but believed that more “evidence regarding the efficacy and safety of these systems is needed.”

So, they set up their multicentre randomised control trial.

What is a randomised control trial?
A randomised control trial, otherwise known by its initials ‘RCT’, is a piece of research where the subjects are split into groups randomly. One of the groups experience the thing that is being tested – in this case they would be using vapes – while the other group receive the control measure that the outcomes will be judged against. RCTs are accepted as a gold standard in evidence gathering because they reduce the likelihood of bias creeping in and are most likely to rigorously determine if a cause-and-effect relationship exists.

What did the researchers do?
The team obtained the voluntary services of 1246 participants. Each one of these people were smokers which, in practice, meant they had been smoking at least five cigarettes a day over the previous year and agreed that they wanted to quit smoking. In addition, they all agreed that they wanted to set a date to quit smoking within three months of joining the programme.

What did this group receive to help them quit smoking?
The first group were given access to free vape starter kits, free eLiquid, and the facility of smoking-cessation support counselling. The group were also told that they were able to use traditional nicotine replacement products such as sprays, gum, and patches if they wanted to – but they would have to pay for those.

And what about the other group?
The control group also received ac cess to smoking-cessation support counselling, but they were also given a voucher that could be used for anything, including sprays, gum and patches.

What measurements did the research team make?
All 622 adults in the first group and the 624 adults in the control group were tested for the presence of carbon monoxide or by-products in their urine that would indicate they were still smoking, and this biochemical analysis validated any claims they’d given up smoking. This testing works because vaping does not produce any carbon monoxide or anywhere near the same level of by-products in the urine.
The team also recorded self-reported abstinence from any nicotine products including cigarettes, vapes, sprays, gum, and patches.
Finally, they recorded any side effects from switching from smoking to ecig use, including any breathing issues or possible adverse events to eLiquids.

And what were the results from the randomised control trial?
·9% of the electronic cigarette group successfully gave up smoking during the study
·3% of the control group successfully gave up smoking during the study
This rose by the end of the project to 59.6% in the vaping group and 38.5% in the control group

How have the results been greeted?
Three British-based experts in this field have commented on the findings.
Dr Jamie Hartmann-Boyce, Director of the Evidence-Based Healthcare at Oxford University’s Nuffield Department of Primary Care Health Sciences, said that the study was “well-conducted, independent and robust”.
She added that it “clearly shows that nicotine e-cigarettes can help people to stop smoking. It adds to a strong and consistent body of evidence supporting the use of nicotine e-cigarettes as a stop smoking aid.”

Dr Sarah Jackson, the Principal Research Fellow at University College London’s (UCL) Tobacco and Alcohol Research Group, agreed that the “well-conducted trial” adds to the growing evidence supporting what we know about vaping and how it helps adult smokers to quit tobacco use.

She explained that the results clearly demonstrate: “People who received free e-cigarettes and e-liquids plus usual care were 77% more likely to quit smoking for at least six months than those in the control group (usual care).”
She added that the team’s assessment of the safety of using e-cigarettes “should provide further reassurance to people who smoke and healthcare professionals that e-cigarettes can be used as an effective tool for stopping smoking without substantial risks to health.”

Finally, Professor Lion Shahab, Professor of Health Psychology and Co-Director of the UCL Tobacco and Alcohol Research Group, University College London (UCL), said that the “high-quality” study is yet another that demonstrates “e-cigarettes are an effective smoking cessation aid, nearly doubling cessation rates compared with existing treatment.”
Professor Shahab noted that as the study took place in Central Europe it confirmed that the impact of vapes as seen in the UK is being replicated in countries with different attitudes to vaping and legal frameworks.
Even though some still try to claim that vaping doesn’t work for smokers, the research findings are becoming overwhelming that it does.