Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints

Background: Smoking reduction remains a pivotal issue in public health policy, but quit rates obtained with traditional quit-smoking therapies remain disappointingly low. Tobacco Harm Reduction (THR), aiming at less harmful ways of consuming nicotine, may provide a more effective alternative. One promising candidate for THR are electronic cigarettes (e-cigs). The aim of this study was to investigate the efficacy of second-generation e-cigs both in terms of acute craving-reduction in the lab and in terms of smoking reduction and experienced benefits/complaints in an eight-month Randomized Controlled Trial (RCT).

Published: 29 October 2014

Positive: Yes

Link to publication: http://www.mdpi.com/1660-4601/11/11/11220/htm

Dr Farsalinos comments on the study: http://www.ecigarette-research.com/web/index.php/2013-04-07-09-50-07/2014/186-ecig-rct

Authors

Karolien Adriaens
Dinska Van Gucht
Paul Declerk
Frank Baeyens


Summary

Abstract

: Background: Smoking reduction remains a pivotal issue in public health policy, but quit rates obtained with traditional quit-smoking therapies remain disappointingly low. Tobacco Harm Reduction (THR), aiming at less harmful ways of consuming nicotine, may provide a more effective alternative. One promising candidate for THR are electronic cigarettes (e-cigs). The aim of this study was to investigate the efficacy of second-generation e-cigs both in terms of acute craving-reduction in the lab and in terms of smoking reduction and experienced benefits/complaints in an eight-month Randomized Controlled Trial (RCT).

Design: RCT with three arms.

Methods: Participants (N = 48) unwilling to quit smoking were randomized into two e-cig groups and one control group. During three lab sessions (over two months) participants, who had been abstinent for four hours, vaped/smoked for five minutes, after which we monitored the effect on craving and withdrawal symptoms. eCO and saliva cotinine levels were also measured. In between lab sessions, participants in the e-cig groups could use e-cigs or smoke ad libitum, whereas the control group could only smoke. After the lab sessions, the control group also received an e-cig. The RCT included several questionnaires, which repeatedly monitored the effect of ad libitum e-cig use on the use of tobacco cigarettes and the experienced benefits/complaints up to six months after the last lab session.

Results: From the first lab session on, e-cig use after four hours of abstinence resulted in a reduction in cigarette craving which was of the same magnitude as when a cigarette was smoked, while eCO was unaffected. After two months, we observed that 34% of the e-cig groups had stopped smoking tobacco cigarettes, versus 0% of the control group. After five months, the e-cig groups demonstrated a total quit-rate of 37%, whereas the control group showed a quit rate of 38% three months after initiating e-cig use. At the end of the eight-month study, 19% of the e-cig groups and 25% of the control group were totally abstinent from smoking, while an overall reduction of 60% in the number of cigarettes smoked per day was observed (compared to intake). eCO levels decreased, whereas cotinine levels were the same in all groups at each moment of measurement. Reported benefits far outweighed the reported complaints.


Conclusion

Conclusion: In a series of controlled lab sessions with e-cig naïve tobacco smokers, second generation e-cigs were shown to be immediately and highly effective in reducing abstinence induced cigarette craving and withdrawal symptoms, while not resulting in increases in eCO. Remarkable (>50 pc) eight-month reductions in, or complete abstinence from tobacco smoking was achieved with the e-cig in almost half (44%) of the participants.

Continuer la lecture de Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints

Tobacco harm reduction: The need for new products that can compete with cigarettes

Highlights
• Tobacco harm reduction aims to reduce illness and death caused by smoking tobacco.
• The medical and regulatory consensus is that nicotine itself is relatively safe.
• Snus use in Sweden provides strong evidence in support of harm reduction.
• E-cigarettes are seen by many smokers as an attractive alternative to cigarettes.
• Regulated, safer nicotine alternatives may substantially improve public health.

Published: 10 November 2013

Positive:

Link to publication: http://www.sciencedirect.com/science/article/pii/S0306460313003729

Authors

Karl Olov Fagerström
Kevin Bridgman


Summary

Over the last 50 years, the concept of tobacco harm reduction has been well established. It is now understood that nicotine itself is not very harmful and nicotine replacement therapy products have been widely used as an aid to quit, reduce to quit or temporarily abstain from smoking for many years. The popularity of the unlicensed electronic cigarette has increased despite an unknown risk profile and snus use in Sweden provides strong evidence in support of a harm reduction strategy. The regulatory environment around harm reduction has changed in the UK and is continuing to evolve across the globe. The need for more appealing, licensed nicotine products capable of competing with cigarettes sensorially, pharmacologically and behaviourally is considered by many to be the way forward. The significant positive impact on public health that could be gained from encouraging people to switch from cigarettes to licensed medicinal nicotine products cannot be ignored.


Conclusion

N/A

Continuer la lecture de Tobacco harm reduction: The need for new products that can compete with cigarettes

Prevalence and characteristics of e-cigarette users in Great Britain: Findings from a general population survey of smokers

Highlights
• There is now near universal awareness of e-cigarettes.
• Use is common among smokers.
• Quarter of all smokers unsure as to whether they are less harmful than cigarettes.
• E-lites – a brand that delivers a low dose of nicotine – is the most popular.
• Users have higher SES, smoke more heavily and have attempted to quit recently.

Published: 11 March 2014

Positive:

Link to publication: http://www.sciencedirect.com/science/article/pii/S0306460314000744

Authors

Jamie Brown
Robert West
Emma Beard
Susan Michie
Lion Shahab
Ann McNeill


Summary

Background

E-cigarettes may be effective smoking cessation aids and their use by smokers has been growing rapidly. It is important to observe and assess natural patterns in the use of e-cigarettes whilst experimental data accumulates. This paper reports the prevalence of e-cigarette awareness, beliefs and usage, including brand choice, and characterises the socio-demographic and smoking profile associated with current use, among the general population of smokers and recent ex-smokers.

Methods

Data were obtained from 3538 current and 579 recent ex-smokers in a cross-sectional online survey of a national sample of smokers in Great Britain in November and December 2012. Differences between current and recent ex-smokers in the prevalence of e-cigarette awareness, beliefs and usage were examined and the socio-demographic and smoking profile associated with current use of e-cigarettes was assessed in a series of simple and multiple logistic regressions.

Results

Ninety-three percent of current and recent ex-smokers (n = 3841) were aware of e-cigarettes. Approximately a fifth (n = 884) were currently using e-cigarettes, whilst just over a third (n = 1507) had ever used them. Sixty-seven percent of the sample (n = 2758) believed e-cigarettes to be less harmful than cigarettes; however, almost a quarter (n = 994) remained unsure. Among both current and recent ex-smokers, the most popular reasons for using were health, cutting down and quitting (each > 80%) and 38% used the brand ‘E-lites’. Among current smokers who were aware of but had never used e-cigarettes, approximately half (n = 1040) were interested in using them in the future. Among current smokers, their use was associated with higher socio-economic status (OR = 1.48, 95%CI = 1.25–1.75), smoking more cigarettes (OR = 1.02, 95%CI = 1.01–1.03) and having a past-year quit attempt (OR = 2.82, 95%CI = 2.38–3.34).


Conclusions

There is a near universal awareness of e-cigarettes and their use appears to be common among smokers in Great Britain although a quarter of all smokers are unsure as to whether e-cigarettes are less harmful than cigarettes. E-lites – a brand that delivers a low dose of nicotine – is the most popular. E-cigarette users appear to have higher socio-economic status, to smoke more cigarettes per day and to have attempted to quit in the past year.


Continuer la lecture de Prevalence and characteristics of e-cigarette users in Great Britain: Findings from a general population survey of smokers

Characterisation of mainstream and passive vapours emitted by selected electronic cigarettes

Electronic cigarettes have achieved growing popularity since their introduction onto the European market. They are promoted by manufacturers as healthier alternatives to tobacco cigarettes, however debate among scientists and public health experts about their possible impact on health and indoor air quality means further research into the product is required to ensure decisions of policymakers, health care providers and consumers are based on sound science. This study investigated and characterised the impact of ‘vaping’ (using electronic cigarettes) on indoor environments under controlled conditions using a 30 m3 emission chamber. The study determined the composition of e-cigarette mainstream vapour in terms of propylene glycol, glycerol, carbonyls and nicotine emissions using a smoking machine with adapted smoking parameters. Two different base recipes for refill liquids, with three different amounts of nicotine each, were tested using two models of e-cigarettes. Refill liquids were analysed on their content of propylene glycol, glycerol, nicotine and qualitatively on their principal flavourings. Possible health effects of e-cigarette use are not discussed in this work. Electronic cigarettes tested in this study proved to be sources for propylene glycol, glycerol, nicotine, carbonyls and aerosol particulates. The extent of exposure differs significantly for active and passive ‘vapers’ (users of electronic cigarettes). Extrapolating from the average amounts of propylene glycol and glycerol condensed on the smoking machine filter pad to the resulting lung-concentration, estimated lung concentrations of 160 and 220 mg m−3 for propylene glycol and glycerol were obtained, respectively. Vaping refill liquids with nicotine concentrations of 9 mg mL−1 led to vapour condensate nicotine amounts comparable to those of low-nicotine regular cigarettes (0.15–0.2 mg). In chamber studies, peak concentrations of 2200 μg m−3 for propylene glycol, 136 μg m−3 for glycerol and 0.6 μg m−3 for nicotine were reached. Carbonyls were not detected above the detection limits in chamber studies. Particles in the size range of 20 nm to 300 nm constantly increased during vaping activity and reached final peak concentrations of 7 × 106 particles L−1. Moreover, the tested products showed design flaws such as leakages from the cartridge reservoirs. Possible long term effects of e-cigarettes on health are not yet known. E-cigarettes, the impact of vaping on health and the composition of refill liquids require therefore further research into the product characteristics. The consumers would benefit from harmonised quality and safety improvements of e-cigarettes and refill liquids.

Published: 13 October 2014

Positive:

Link to publication: http://www.sciencedirect.com/science/article/pii/S1438463914000972

Authors

Otmar Geiss
Ivana Bianchi
Francisco Barahona
Josefa Barrero-Moreno


Summary

Electronic cigarettes (e-cigarettes) have become increasingly popular since their introduction onto the European market in 2005. Use in Great Britain, for example, more than doubled from 2.7% of vapers in 2010 to 6.7% in 2012 (Dockrell et al., 2013).

They are frequently advertised by manufacturers as a healthier alternative to tobacco cigarettes (Ayers et al., 2011) and a smoking cessation tool, and have become a popular substitute for traditional tobacco because of indoor smoking restrictions on traditional tobacco cigarettes (Etter and Bullen, 2011).

Uncertainties about their impact on health and indoor air quality have caused debate among scientists and public health experts. Concerns most frequently relate to product safety in terms of product design, exposure to toxic products, potential for abuse (including dual use with tobacco products), use by young people and effectiveness in helping smokers to quit smoking tobacco cigarettes (Noel et al., 2011).

Although some studies have indicated that they are less harmful than smoking regular tobacco cigarettes (Caponetto et al., 2013 and Wagener et al., 2012), e-cigarettes and refill liquids nonetheless require further research into the detail and composition of the products, as will be required under the newly revised Tobacco Product Directive (2014/40/EU), to ensure that the decisions of policymakers, health care providers and consumers are based on sound science (Etter et al., 2011).

Only a few studies have reported on the impact of e-cigarette vaping on indoor air quality (passive vaping).Schripp et al. (2013) found that volatile organic compounds (VOCs) and ultrafine particles (UFP) were released from an e-cigarette while actively vaping in an 8 m3 emission chamber. Schober et al. (2014)reported on VOC, particle and polycyclic aromatic hydrocarbons (PAHs), carbonyls and metals releases into a real office environment. This study also monitored the effect of vaping on FeNO release and the urinary metabolite profile. McAuley et al. (2012) compared the effects of e-cigarettes vapour and cigarette smoke on indoor quality. In this study, vapours were generated using a smoking machine and were collected in a sampling bag for analysis. Fuoco et al. (2014) analysed e-cigarette generated aerosols in terms of particle number concentrations and size distribution.

Other studies have focused on safety and quality aspects of refill liquids. They reported inconsistent levels of nicotine (Goniewicz et al., 2013) and nicotine impurities (Trehy et al., 2011, Etter et al., 2013 and Hutzler et al., 2014) among batches/brands. Williams et al. (2013) described the possibility of metals, or chemicals from plastics in the delivery system, leaching into the vapour before inhalation. Behar et al. (2014)identified toxicants in cinnamon-flavoured e-cigarette refill liquids.

This study proposes a systematic approach to characterise e-cigarette emissions under controlled conditions using a smoking machine with adapted smoking parameters for the generation of vapours from well characterised refill-liquids. The impact of vaping on the indoor environment was investigated introducing the generated vapours into a 30 m3 walk-in emission chamber operated under defined conditions (temperature, relative humidity and ventilation rate). The composition of e-cigarette mainstream vapours in terms of propylene glycol, glycerol, low molecular carbonyls and nicotine emissions was determined applying an adapted standardised smoking protocol for regular cigarettes. Two models of e-cigarettes were used in this study, differing primarily by the way in which refill liquids are evaporated. In order to cover the widest range possible, two very different base recipes for the refill liquid, each with three different amounts of nicotine, were used for the emission testing. Possible health effects of e-cigarette use are not discussed in this work.


Conclusion

Electronic cigarettes tested in this study proved to be sources of propylene glycol, glycerol, nicotine, carbonyls and aerosol particulates. The extent to which people could be passively exposed to these depends on the ventilation rate, room size, indoor climate, room equipment and number of e-cigarettes in use. In addition to exposure to toxicants, consideration must also be given to the generally perceived air quality in microenvironments where vaping is permitted (independently of its toxicity). Sensory assessment of the acceptability of air quality or odour intensity by a human panel could answer this question and should be further explored.

In addition to considering exposure to second-hand vapour, this study shows that active vapers inhale relatively high concentrations of propylene glycol, glycerol, aerosol particulates and certain carbonyls. This exposure might require further toxicological evaluation.

Possible long term effects of e-cigarettes health are not yet known. E-cigarettes, the impact of vaping on health and the composition of refill liquids require therefore further research into the product characteristics. For the benefit of consumers, quality and safety requirements of e-cigarettes and refill liquids should be harmonised.


Continuer la lecture de Characterisation of mainstream and passive vapours emitted by selected electronic cigarettes

A systematic review of health effects of electronic cigarettes

Highlights
No firm conclusions can be drawn on the safety of electronic cigarettes.
The findings in the 76 studies were often inconsistent and contradictory.
Serious methodological problems were identified and there is no long-term follow-up.
In 34% of the articles the authors had a conflict of interest.
Electronic cigarettes can hardly be considered harmless.

Published: 16 October 2014

Positive: No

Link to publication: http://www.sciencedirect.com/science/article/pii/S0091743514003739

Authors

Charlotta Pisingera
Martin Døssingb


Summary

Objective

To provide a systematic review of the existing literature on health consequences of vaporing of electronic cigarettes (ECs).

Methods

Search in: Pub Med, EMBASE and CINAHL. Inclusion criteria: Original publications describing a health-related topic, published before 14 August 2014. PRISMA recommendations were followed. We identified 1101 studies; 271 relevant after screening; 94 eligible.

Results

We included 76 studies investigating content of fluid/vapor of ECs, reports on adverse events and human and animal experimental studies. Serious methodological problems were identified. In 34% of the articles the authors had a conflict of interest. Studies found fine/ultrafine particles, harmful metals, carcinogenic tobacco-specific nitrosamines, volatile organic compounds, carcinogenic carbonyls (some in high but most in low/trace concentrations), cytotoxicity and changed gene expression. Of special concern are compounds not found in CCs, e.g. propylene glycol. Experimental studies found pulmonary obstruction after short-term exposure. Reports on short-term adverse events were often flawed by selection bias.


Conclusions

Due to many methodological problems, severe conflicts of interest, the relatively few and often small studies, the inconsistencies and contradictions in results, and the lack of long-term follow-up no firm conclusions can be drawn on the safety of ECs. However, they can hardly be considered harmless.


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Particulate Metals and Organic Compounds from Electronic and Tobaccocontaining Cigarettes: Comparison of Emission Rates and Secondhand Exposure

Particulate metals and organic compounds from electronic and tobacco-containing cigarettes: comparison of emission rates and secondhand exposure

Published: 22 August 2014

Positive: No

Link to publication: http://pubs.rsc.org/en/content/articlelanding/2014/em/c4em00415a#!divAbstract

Authors

Arian Saffari, Nancy Daher, Ario Ruprecht, Cinzia De Marco, Paolo Pozzi, Roberto Boffi, Samera H. Hamad, Martin M. Shafer, James J. Schauer, Dane Westerdahle and Constantinos Sioutas


Summary

In recent years, electronic cigarettes have gained increasing popularity as alternatives to normal (tobacco-containing) cigarettes. In the present study, particles generated by e-cigarettes and normal cigarettes have been analyzed and the degree of exposure to different chemical agents and their emission rates were quantified. Despite the 10-fold decrease in the total exposure to particulate elements in e-cigarettes compared to normal cigarettes, specific metals (e.g. Ni and Ag) still displayed a higher emission rate from e-cigarettes. Further analysis indicated that the contribution of e-liquid to the emission of these metals is rather minimal, implying that they likely originate from other components of the e-cigarette device or other indoor sources. Organic species had lower emission rates during e-cigarette consumption compared to normal cigarettes. Of particular note was the non-detectable emission of polycyclic aromatic hydrocarbons (PAHs) from e-cigarettes, while substantial emission of these species was observed from normal cigarettes. Overall, with the exception of Ni, Zn, and Ag, the consumption of e-cigarettes resulted in a remarkable decrease in secondhand exposure to all metals and organic compounds. Implementing quality control protocols on the manufacture of e-cigarettes would further minimize the emission of metals from these devices and improve their safety and associated health effects.


Conclusion

Analysis of secondhand emissions from a popular and widely-used e-cigarette brand indicated a very large reduction of particle-phase emissions compared to normal tobacco-containing cigarettes in a real-life setting. BC and particle-phase PAHs, deleterious chemical species present in high concentrations in tobacco smoke, were not detected in e-cigarette’s aerosol. Emission rates of organic compounds (including alkanes and organic acids) as well as total emission of inorganic elements and metals were also significantly reduced (more than100 times for organics and 10 times for elements) in e-cigarettes compared to normal cigarettes. Analysis of elemental emissions indicated the presence of toxic metals (such as Ni, Zn and Ag) in e-cigarette’s aerosol, with Ni and Ag having higher indoor emission rates compared to normal cigarettes. Moreover,analysis of nicotine indicated that secondhand particle-phase nicotine accounted for about 0.02% of the total nicotine generation and emission during e-cigarette vaping. Based on our results, use of e-cigarettes from a public health perspective appears to be an improvement compared to normal tobacco-containing cigarettes, as exposure to most of the toxic and/or undesirable chemical species was found to be much lower than that for normal cigarettes. However, considering the lack of regulation on the manufacturing process of e-cigarettes, there appears to be a potential for utilization of toxic material (such as metals) in e-cigarettes, which could lead to their emission in e-cigarette’s vapor and aerosol.1,13Implementing quality control regulations on the design and manufacturing process of e-cigarettes is therefore necessary to prevent potential utilization of non-desirable material in e-cigarettes and e-liquids.


Complete study: Particulate metals and organic compounds from (study in pdf)

Particulate (additional information on the study in pdf)

Metal and Silicate Particles Including Nanoparticles Are Present in Electronic Cigarette Cartomizer Fluid and Aerosol

The filament, a nickel-chromium wire, was coupled to a thicker copper wire coated with silver. The silver coating was sometimes missing. Four tin solder joints attached the wires to each other and coupled the copper/silver wire to the air tube and mouthpiece. All cartomizers had evidence of use before packaging (burn spots on the fibers and electrophoretic movement of fluid in the fibers). Fibers in two cartomizers had green deposits that contained copper. Centrifugation of the fibers produced large pellets containing tin. Tin particles and tin whiskers were identified in cartridge fluid and outer fibers. Cartomizer fluid with tin particles was cytotoxic in assays using human pulmonary fibroblasts. The aerosol contained particles >1 µm comprised of tin, silver, iron, nickel, aluminum, and silicate and nanoparticles (<100 nm) of tin, chromium and nickel. The concentrations of nine of eleven elements in EC aerosol were higher than or equal to the corresponding concentrations in conventional cigarette smoke. Many of the elements identified in EC aerosol are known to cause respiratory distress and disease.

Published: 20 March 2013

Positive: No

Link to publication: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0057987

Reply from Dr Siegel: http://tobaccoanalysis.blogspot.be/2013/04/metals-in-electronic-cigarette-vapor.html

Authors

Monique Williams
Amanda Villarreal
Krassimir Bozhilov
Sabrina Lin
Prue Talbot


Summary

We tested the hypothesis that EC aerosol contains metals derived from various components in EC.

Cartomizer contents and aerosols were analyzed using light and electron microscopy, cytotoxicity testing, x-ray microanalysis, particle counting, and inductively coupled plasma optical emission spectrometry.


Conclusions

The presence of metal and silicate particles in cartomizer aerosol demonstrates the need for improved quality control in EC design and manufacture and studies on how EC aerosol impacts the health of users and bystanders.


 

Complete study: Metal and Silicate Particles Including Nanoparticles Are Present in Electronic Cigarette Cartomizer Fluid and Aerosol (pdf)

Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study

Vape Vs NRTs Vs cold turkey. 20% cessation with vape, 10% with NRTs

Published: 12 May 2014

Positive: Yes

Link to publication: http://onlinelibrary.wiley.com/doi/10.1111/add.12623/pdf

Link to press release (FR): http://www.pourquoidocteur.fr/La-e-cigarette-fait-la-preuve-de-son-efficacite-pour-arreter-de-fumer–7757.html

Authors:

Jamie Brown

Emma Beard

Daniel Kotz

Susan Michie

Robert West


Summary

Background and Aims

Electronic cigarettes (e-cigarettes) are rapidly increasing in popularity. Two randomized controlled trials have suggested that e-cigarettes can aid smoking cessation, but there are many factors that could influence their real-world effectiveness.

This study aimed to assess, using an established methodology, the effectiveness of e-cigarettes when used to aid smoking cessation compared with nicotine replacement therapy (NRT) bought over-the-counter and with unaided quitting in the general population.

Design and Setting

A large cross-sectional survey of a representative sample of the English population.

Participants

The study included 5863 adults who had smoked within the previous 12 months and made at least one quit attempt during that period with either an e-cigarette only(n=464), NRT bought over-the-counter only (n=1922) or no aid in their most recent quit attempt (n=3477).

Measurements

The primary outcome was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including nicotine dependence.

Findings

E-cigarette users were more likely to report abstinence than either those who used NRT bought over-the-counter [odds ratio (OR)=2.23, 95% confidence interval(CI)=1.70–2.93, 20.0 versus 10.1%] or no aid (OR=1.38, 95% CI=1.08–1.76, 20.0 versus 15.4%). The adjusted odds of non-smoking in users of e-cigarettes were 1.63 (95% CI=1.17–2.27) times higher compared with users of NRT bought over-the-counter and 1.61 (95% CI=1.19–2.18) times higher compared with those using no aid


Conclusion

Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence


Continuer la lecture de Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study

Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit

We reviewed available research on the use, content and safety of electronic cigarettes (EC), and on their effects on users, to assess their potential for harm or benefit and to extract evidence that can guide future policy.

Published: 31 July 2014

Positive: Yes

Link to publication: http://onlinelibrary.wiley.com/doi/10.1111/add.12659/abstract

Authors

Peter Hajek
Jean-François Etter
Neal Benowitz
Thomas Eissenberg
Hayden McRobbie


Summary

EC aerosol can contain some of the toxicants present in tobacco smoke, but at levels which are much lower. Long-term health effects of EC use are unknown but compared with cigarettes, EC are likely to be much less, if at all, harmful to users or bystanders. EC are increasingly popular among smokers, but to date there is no evidence of regular use by never-smokers or by non-smoking children. EC enable some users to reduce or quit smoking.


Conclusion

Allowing EC to compete with cigarettes in the market-place might decrease smoking-related morbidity and mortality. Regulating EC as strictly as cigarettes, or even more strictly as some regulators propose, is not warranted on current evidence. Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to EC as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use.


Continuer la lecture de Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit

Effectiveness and tolerability of electronic cigarette in real-life: a 24-month prospective observational study

This prospective observational study evaluated smoking  reduction/abstinence in smokers not intending to quit using an e-Cigarette (‘Categoria’; Arbi Group, Italy).

Published 20 July 2013

Positive: Yes

Link to publication: http://link.springer.com/article/10.1007%2Fs11739-013-0977-z

Authors

  • Riccardo Polosa,
  • Jaymin B. Morjaria,
  • Pasquale Caponnetto,
  • Davide Campagna,
  • Cristina Russo,
  • Angela Alamo,
  • MariaDomenica Amaradio,
  • Alfredo Fisichella

 

Summary

Electronic cigarettes (e-Cigarette) are battery-operated devices designed to vaporise nicotine that may aid smokers to quit or reduce their cigarette consumption. Research on e-Cigarettes is urgently needed to ensure that the decisions of regulators, healthcare providers and consumers are evidence based. Here we assessed long-term effectiveness and tolerability of e-Cigarette used in a ‘naturalistic’ setting. This prospective observational study evaluated smoking reduction/abstinence in smokers not intending to quit using an e-Cigarette (‘Categoria’; Arbi Group, Italy). After an intervention phase of 6 months, during which e-Cigarette use was provided on a regular basis, cigarettes per day (cig/day) and exhaled carbon monoxide (eCO) levels were followed up in an observation phase at 18 and 24 months. Efficacy measures included: (a) ≥50 % reduction in the number of cig/day from baseline, defined as self-reported reduction in the number of cig/day (≥50 %) compared to baseline; (b) ≥80 % reduction in the number of cig/day from baseline, defined as self-reported reduction in the number of cig/day (≥80 %) compared to baseline; (c) abstinence from smoking, defined as complete self-reported abstinence from tobacco smoking (together with an eCO concentration of ≤10 ppm). Smoking reduction and abstinence rates were computed, and adverse events reviewed.


 

Conclusion

Of the 40 subjects, 17 were lost to follow-up at 24 months. A >50 % reduction in the number of cig/day at 24 months was shown in 11/40 (27.5 %) participants with a median of 24 cig/day use at baseline decreasing significantly to 4 cig/day (p = 0.003). Smoking abstinence was reported in 5/40 (12.5 %) participants while combined >50 % reduction and smoking abstinence was observed in 16/40 (40 %) participants at 24 months. Five subjects stopped e-Cigarette use (and stayed quit), three relapsed back to tobacco smoking and four upgraded to more performing products by 24 months. Only some mouth irritation, throat irritation, and dry cough were reported. Withdrawal symptoms were uncommon. Long-term e-Cigarette use can substantially decrease cigarette consumption in smokers not willing to quit and is well tolerated.


Continuer la lecture de Effectiveness and tolerability of electronic cigarette in real-life: a 24-month prospective observational study