Counseling Patients on the Use of Electronic Cigarettes

Published: January 2015

Positive: No

Link to publication:



Jon O. Ebbert, MD, MS
Amenah A. Agunwamba, ScD, MPH
Lila J. Rutten, PhD, MPH


Electronic cigarettes (e-cigarettes) have substantially increased in popularity. Clear evidence about the safety of e-cigarettes is lacking, and laboratory experiments and case reports suggest these products may be associated with potential adverse health consequences. The effectiveness of e-cigarettes for smoking cessation is modest and appears to be comparable to the nicotine patch combined with minimal behavioral support. Although a role for e-cigarettes in the treatment of tobacco dependence may emerge in the future, the potential risk of e-cigarettes outweighs their known benefit as a recommended tobacco treatment strategy by clinicians. Patients should be counseled on the known efficacy and potential risks of e-cigarettes.


Clinicians are ethically obligated to promote smoking cessation using evidence-based treatment strategies. Smokers will ask about e-cigarettes, and we must be prepared to offer appropriate counseling. With the evidence available to date, clinicians must be circumspect in recommending e-cigarettes for use by cigarette smokers interested in quitting smoking for the following reasons:

1. They are not demonstrably superior to FDA-approved medications for smoking cessation.

2. They may not be effective for smoking cessation and dual use (ie, using e-cigarettes and continuing to smoke) will prolong exposure to tobacco.

3. They are not FDA-approved for the treatment of tobacco dependence.

4. Short-term safety data suggest they may cause airway reactivity.

5. The long-term health risk of exposure to e-cigarette constituent chemicals is unknown.

6. No regulatory oversight, such as requirements for good manufacturing practices, is currently in place for e-cigarette devices or e-juice.

More clinical safety data and increased product reliability and regulation are needed before e-cigarettes can assume a place in the standard clinical approaches to the treatment of tobacco dependence.

Full text: __www.mayoclinicproceedings.org_article_S0025-6196(14)00989-6_fulltext