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Longitudinal studies suggest e-cigarettes to be no more effective than already existing smoking cessation product

by Andrew H.Y. Lee, BA, Brian J. Stater, MD, Lanny Close, MD, and Rahmatullah Rahmati, MD •

Trio Best PracticeTRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.

Background

Electronic nicotine delivery systems (ENDS; commonly known as electronic cigarettes or e-cigarettes) have been commercially available in the United States since 2007, yet recently have generated substantial controversy as their use and availability expands. ENDS are battery-operated devices designed to resemble traditional cigarettes that heat and vaporize nicotine-containing solutions. Each device contains a microelectrical circuit, activated by inhaling through a mouthpiece that vaporizes a propylene glycol–nicotine solution and delivers it to the user, an act often termed vaping. They are ubiquitously available commercially, sold from vendors ranging from the local corner gas station and drug store to the Internet marketplace. ENDS do not depend on combustion, meaning that the user and bystanders are theoretically not exposed to many of the harmful compounds and particulate matter produced by traditional cigarettes.

Recently, there has been a drastic increase in usage and awareness of ENDS, largely as a result of shrewd, aggressive marketing. Although ENDS are marketed as a safer and healthier alternative to conventional cigarettes, much remains unknown. The long-term safety data on ENDS is scant and inconsistent, and there is a lack of internationally certified manufacturing sites. Whereas some public health officials have embraced ENDS as a potential pathway to smoking reduction or cessation, other experts are concerned that ENDS could undermine a decades-long public health campaign to denormalize and stigmatize smoking. These experts are concerned that ENDS could maintain nicotine addiction by deterring smokers from utilizing proven cessation tools, thus acting as a gateway to future smoking and increasing nicotine addiction among youth.

As physicians primarily involved in the treatment of head and neck malignancies, otolaryngologists have a particular responsibility in guiding patients toward effective methods of tobacco cessation. Furthermore, evidence-based recommendations on the efficacy of ENDS in smoking cessation will be paramount for sound policy development.

Best Practice

Although nonlongitudinal studies and anecdotal evidence may routinely tout the benefits of ENDS, longitudinal studies suggest ENDS to be no more effective than already existing smoking cessation products. Furthermore, the long-term safety profile of these products remains unknown. The dearth of high-quality randomized control trials directly comparing the efficacy of ENDS compared to traditional smoking cessation fails to match the rapidly growing awareness and use of ENDS in the public sphere (Laryngoscope. 2015;125:785-787).