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Some e-cigarette users may struggle to quit smoking

[March 27, 2018] (Reuters Health) - Smokers who say they want to kick the habit might have an easier time if they don’t use e-cigarettes, a U.S. study suggests.

Researchers tested two smoking cessation approaches for 1,357 adult smokers who were hospitalized and expressed a desire to quit. Patients were randomly assigned to receive a free supply of an approved smoking cessation aid or to join a control group that could call a phone hotline for cessation advice.

Overall, 28 percent of participants occasionally used e-cigarettes within three months after discharge.

Six months after they left the hospital, about 10 percent of people who reported using e-cigarettes over the first three months after discharge had successfully quit smoking traditional cigarettes, compared with 27 percent of those not using e-cigarettes, lab tests found.

While this study wasn’t designed to prove whether or how e-cigarettes might directly impact the chance of smoking cessation, it does suggest that occasional e-cigarette use, which was common among study participants, may not help this effort, said lead study author Dr. Nancy Rigotti, a researcher at Harvard Medical School and director of the Tobacco Research and Treatment Center at Massachusetts General Hospital in Boston.

“The study is consistent with the hypothesis that smokers need to use e-cigarettes regularly and daily and switch completely from cigarettes to e-cigarettes for them to have the greatest chance of help,” Rigotti, who has received research funding from Pfizer, maker of the smoking-cessation drug Chantix, said by email.

Big U.S. tobacco companies are all developing e-cigarettes. The battery-powered gadgets feature a glowing tip and a heating element that turns liquid nicotine and flavorings into a cloud of vapor that users inhale.

When e-cigarettes contain nicotine, they can be addictive like traditional cigarettes. Even without nicotine, earlier research suggests that flavorings and other ingredients in e-liquids used for vaping could be linked to serious breathing problems.

A big question about e-cigarettes, namely, whether they’re safe or at least safer than traditional cigarettes, isn’t answered by the current study.

Many smokers who attempt to quit fail, regardless of what cessation aid they try, and a separate study offers fresh evidence that even medications aren’t a fool-proof tool.

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For this study, researchers randomly assigned 302 smokers hospitalized with heart problems to receive either varenicline (Chantix) or a placebo pill for 12 weeks, in addition to counseling.

One year later, lab tests showed that about 40 percent of the participants quit smoking with varenicline, compared with 29 percent with placebo, researchers report in the Canadian Medical Association Journal.

“These patients are at high risk for recurrent cardiovascular events (e.g., heart attacks, unstable angina, and mortality) if they continue to smoke,” said lead study author Sarah Windle of Jewish General Hospital in Montreal.

While some previous research has linked varenicline to an increased risk of heart or psychiatric problems, the current study didn’t find these side effects.

“Our findings suggest that varenicline is efficacious and safe for smoking cessation in this important patient population,” Windle said by email.

“Of the first-line treatments used for smoking cessation, which also include various forms of nicotine replacement therapy and the prescription medication bupropion, varenicline is the most effective,” said Robert Reid of the University of Ottawa Heart Institute. Reid, author of an accompanying editorial, has received fees from Pfizer, maker of varenicline, and Johnson and Johnson, maker of various nicotine replacement products.

One advantage of the drug is that it dulls the effect of nicotine in the brain, making cigarettes less pleasurable. Nicotine replacement therapies, or e-cigarettes containing nicotine, may help reduce withdrawal by delivering smaller amounts of nicotine than traditional cigarettes, Reid said by email.

“The vast majority of smokers have made multiple quit attempts, with and without assistance and generally have some idea about how they respond to the currently available treatments,” Reid added. “There is strong evidence that using these treatments, combined with behavioral support, makes it significantly more likely that smokers will be able to achieve long-term abstinence from tobacco.”

SOURCES: http://bit.ly/2pH27f9 Annals of Internal Medicine, online March 26, 2018, and http://bit.ly/2pJ2xSh Canadian Medical Association Journal, online March 26, 2018.

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