E-vaporisers help you stop smoking, but not necessarily stop smoking nicotine

E-vaporisers are an effective aid to stop smoking tobacco cigarettes. However, they do not help to reduce nicotine dependency. This is shown by the results of the world's largest study on this topic, which was conducted by a Swiss-wide interdisciplinary research group led by the University of Bern.

E-vaporisers or e-cigarettes are electrically powered devices that emit nicotine in the form of vapour. In contrast to tobacco cigarettes, they are tobacco-free and produce significantly fewer harmful substances. E-vaporisers are used by tobacco smokers, among others, to quit cigarettes. So far, however, there is insufficient data on how safe e-vaporisers are when they are used over a longer period of time and as part of intensive stop-smoking counselling, as offered in Switzerland. The world's largest study on this topic has now been carried out, involving researchers from the fields of family medicine, pulmonary medicine, toxicology, addiction medicine and epidemiology with five study centres in Switzerland (Bern, Geneva, Lausanne, Zurich, St. Gallen), led by the University of Bern.

Abstinence from tobacco, but nicotine is still consumed

Over a period of six months, a total of 1,246 participants in the two groups were surveyed and clinically examined in the five study centres in German-speaking and French-speaking Switzerland. The adverse health events that occurred during this period were also recorded in detail. This Media Relations 2 Media Relations Hochschulstrasse 6 3012 Bern medien@unibe.ch showed that the addition of e-vaporisers to conventional smoking cessation measures increased the abstinence rate from tobacco smoking by 21%. The abstinence rate from tobacco smoking was 53% in the group with e-vaporisers and 32% in the group without e-vaporisers (67% more abstinence with e-vaporisers compared to no e-vaporisers). However, many people who stopped smoking tobacco stayed with e-vaping and thus with nicotine. Accordingly, nicotine abstinence was lower in this group. The difference was 14% (20% nicotine abstinence in the group with e-vapers compared to 34% in the group without e-vapers).

E-vapers could lead to a reduction in tobacco-related symptoms

In terms of side effects, serious adverse events did not occur more frequently in the group with e-vaporisers than in the group without e-vaporisers. "This speaks in favour of the safety of e-vaporisers in smoking cessation counselling in view of the large scope of the study," says Auer. On the other hand, more mild side effects such as irritated airways were observed. "This can be explained, among other things, by the fact that the nicotine in e-vaporisers irritates the throat more than in conventional cigarettes, which contain additives to alleviate precisely these symptoms," explains Auer. Health problems such as coughing or sputum production were lower in the group with e-vaporisers than in the control group (41% less coughing compared to 34%). "Coughing and sputum production are typical symptoms of smoker's lung. A reduction in these symptoms could indicate that smokers who consistently switch to e-vaporisers and no longer consume tobacco could suffer less from tobacco-related diseases in the long term, even if they continue to use e-vaporisers," explains Martin Brutsche, pulmonologist and head of the study centre in St. Gallen. According to the researchers, however, long-term studies are needed to confirm the health benefits compared to continuing to smoke. "Most smoking-related illnesses are caused by toxic and carcinogenic substances in tobacco and not by nicotine," Martin Brutsche continues.

"Most smokers want to stop smoking tobacco cigarettes, but many are unable to do so even with available, established, scientifically proven smoking cessation products. This is where e-vaporisers could help as part of clinical smoking cessation therapy," adds Isabelle Jacot-Sadowski, who was involved in the Lausanne study centre.

Possible two-stage approach to nicotine addiction

The researchers see a pragmatic approach in recommending e-vapers to smokers instead of leaving them alone with their addiction and the health consequences of their consumption. "By using e-vaporisers, smokers could reduce the risk of tobacco-related diseases until they later decide to stop using nicotine altogether," says Isabelle Jacot-Sadowski. E-vaporisers therefore enable a two-stage approach: first quitting tobacco and then quitting the e-vaporiser, and therefore nicotine.

No easy access to e-steamers recommended

E-vapers are not risk-free. Even though e-vapers release far fewer toxic substances than tobacco cigarettes, they still release carcinogenic substances and nicotine can lead to addictive behaviour, especially among young people. Accordingly, a sharp increase in e-vaping among young people is being observed with concern in many Western countries. "Young people and non-smokers should be breathing fresh air rather than vaping. This is why 3 Media Relations Hochschulstrasse 6 3012 Bern medien@unibe.ch care must be taken to ensure that access to e-vapour devices is adequately regulated," says Auer. The researchers emphasise that the study only investigated the use of e-vaporisers in people willing to quit smoking and in connection with smoking cessation counselling. "We therefore advocate that e-vaporisers could be suggested to smokers as part of stop-smoking advice, but that non-smokers should not have easy access to e-vaporisers, nor to tobacco cigarettes and other nicotine-containing products," explains Auer.

ESTxENDS-Studie, Management: University of Bern in cooperation with Arud as study centre.