Potential smoking cessation aid

A 2010 study in New Zealand compared the use of a nicotine inhaler with an e-cigarette to aid smoking cessation.4 The study determined that the use of an e-cigarette in smoking cessation is extremely similar to the use of a nicotine inhaler. This was due to the similar delivery method of nicotine and the option to specify a predetermined amount based on user preference.4 However, unlike the nicotine inhaler, the e-cigarette is not an approved smoking cessation device.4 A more recent study completed in 2013 studied 300 subjects to focus on the efficiency and safety of using electronic cigarettes as a tobacco cigarette substitute for a 12-month period.26 The researchers found that the use of electronic cigarettes decreased tobacco cigarette consumption and elicited tobacco abstinence without causing significant side effects (i.e., elevated heart rate, blood pressure, weight gain).26 In several surveys, e-cigarette users have reported that electronic cigarettes are effective for assisting with smoking cessation.10,11,27 The American Heart Association position states that there is insufficient evidence to recommend e-cigarettes as a primary smoking cessation aid and maintains that it is reasonable to support a patients’ desire to use e-cigarettes for smoking cessation when initial conventional tobacco cessation treatment has failed or when the patient refuses conventional treatment.2

Discussion

A few small studies indicate that electronic cigarettes can assist with smoking cessation and produce less negative effects on the body when compared with conventional tobacco cigarettes.4,26,28 However, data are available only for short-term use, and no larger rigorous long-term studies have been completed. With the long-term smoking cessation rates and health effects unknown, further research is in high demand.


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Conclusion

When confronted with a patient’s questions about e-cigarette use, the PCP must consider patient preferences, the patient’s current circumstances, and previous attempts at smoking cessation to determine the best recommendations for each individual patient. Preliminary evidence suggests that although e-cigarettes are not considered healthy by any means, they may be the lesser of two evils when compared with traditional tobacco cigarettes. The majority of patients who inquire about electronic cigarettes are searching for healthier lifestyles. Therefore, providers should make it clear that electronic cigarettes cannot be considered healthy, and they are not regulated by the FDA but may provide some health benefits for patients depending on their personal smoking habits. As research related to e-cigarettes and their efficacy as smoking cessation aids expands, PCPs should critically evaluate the results to best counsel patients to make healthy lifestyle choices.

Cara N. Wilt, MS, RN, AGNP-BC, is an adult and gerontological primary care nurse practitioner, Emergency Department, University of Maryland Medical Center in Baltimore. Laura W. Koo, MS, RN, FNP-BC, is an assistant professor, Department of Organizational Systems and Adult Health, University of Maryland Baltimore School of Nursing.

References

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