A meta-analysis evaluates the effectiveness of e-cigarette to help addicts to reduce their tobacco consumption or stop smoking permanently.
An English meta-analysis of McRobbie and colleagues published in the journal Cochrane Collaboration in 2014, acting on the basis of two randomized controlled trials, the effectiveness of electronic cigarettes to help smokers to reduce their consumption or quit. Despite the insufficient number of randomized controlled trials, the electronic cigarette could reduce tobacco consumption and help to stop.
The Study Rationale
Smoking cessation is beneficial for health and wallet smokers. But quitting is not so simple because of a physiological and psychological addiction that is gradually. On a majority of smokers who want to quit, only few succeed long term. Nearly 50% of people who attempt to quit unaided will not.
Behavioral therapies and patches increase the chances of quitting, but their effects do not persist long term. One limitation of these treatments is that they do not take into account the sensory aspect and behavioral ritual of smoking. These rituals became everyday gestures (holding a cigarette in a smoking while taking his coffee) missing for smoking. The electronic cigarette could be a way to overcome this is by cutting brake gradually these automated actions.
The electronic cigarette can it help smokers to stop smoking, or at least reduce it?
The English meta-analysis type McRobbie Cochrane and his colleagues identified two randomized controlled trials testing the effectiveness of Quality of cigarette electronics, ASCEND study (Bullen et al., 2013) and RADIANCE study (Caponnetto et al., 2013). They included respectively 657 and 300 very dependent on nicotine. The endpoints studied were the arrest rates or changes in cigarette consumption for six months or more. The groups with the electronic cigarette were compared to a placebo group given an inactive substance or nicotine patches.
The Non-Pharmacological Intervention (NPI) assessed
Electronic cigarettes have appeared on the market in 2006. Their use may be therapeutic. That is, they can help people who smoke to reduce their smoking or even quit.
The ASCEND trial lasted three months. Electronic cigarettes were broadcasting 16 mg of nicotine per day which corresponds to a small amount compared to cigarettes. Control groups received either nicotine patches composed of 21 mg per day, or electronic cigarettes without nicotine (placebo group). Participants were followed for six months.
The RADIANCE trial lasted three months. Electronic cigarettes broadcast nicotine 7.2 mg or 0 mg per day for the placebo group. Another group used electronic cigarette cartons containing 7.2 mg of nicotine per day for 6 weeks, followed by 5.2 mg of nicotine per day over the next 6 weeks. Participants met 8 times researchers, once early intervention, and then during follow-up visits to 7 where they received their cartridges. Vital signs, carbon monoxide and smoking agenda were monitored at those meetings.
The meta-analysis shows an increase in tobacco use cessation or reduction of rates with the electronic cigarette use compared to placebo without nicotine. There are no differences observed between the effects of electronic cigarettes and nicotine patches to stop smoking.
Despite the small numbers studied and followed a short period, the authors indicate that the use of an electronic cigarette had no deleterious effect on the health of their users.
What it means for Smokers
The number of studies is too limited to conclude definitively that the electronic cigarette is effective in stopping or decreasing cigarette consumption, despite encouraging results.
What it means for Healthcare Professionals
Confronting smokers questions about the effectiveness of the electronic cigarette to stop smoking, health professionals feel an urgent need to know what advice to provide. However, current data on the electronic cigarette does not prove its efficacy and safety to stop or reduce cigarette consumption, despite encouraging results.
What it means for Researchers
This meta-analysis, based on two randomized controlled trials do not support the conclusion about the effectiveness of the electronic cigarette to reduce cigarette consumption rates for those highly dependent on nicotine. The level of evidence is limited because of the number of small clinical trials on this topic. In addition, 90% of participants did not take advantage of the phone and behavioral support that were advised during the procedure. The authors invite us to achieve more methodologically sound clinical trials to test the effectiveness of the electronic cigarette and make its more robust benefits.
What it means for Policymakers
Since the advent of electronic cigarettes on the market in 2006, more and more smokers report using it to reduce their smoking or quit. The lack of studies on the subject does not allow providing irrefutable evidence of effectiveness of the electronic cigarette for that purpose or to conclude that it is safe for the health of consumers.
McRobbie H, Bullen C, Hartmann-Byce J, Hajek P (2014). Electronic cigarettes for smoking cessation and reduction. Cochrane Database of Systematic Reviews, 12, CD010216.
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Same non-pharmacological intervention
To reference this Blog en Sante © article
Ninot G (2015). The electronic cigarette help quit smoking. Blog en Sante, A58.
© Copyright 2015 Gregory Ninot. All rights reserved.