Skip to main content

Advertisement

SpringerLink
Log in

Electronic Cigarettes for Smoking Cessation

  • Ischemic Heart Disease (D Mukherjee, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Electronic cigarettes (e-cigarettes) are novel vaporising devices that, similar to nicotine replacement treatments, deliver nicotine but in lower amounts and less swiftly than tobacco smoking. However, they enjoy far greater popularity than these medications due in part to their behaviour replacement characteristics. Evidence for their efficacy as cessation aids, based on several randomised trials of now obsolete e-cigarettes, suggests a modest effect equivalent to nicotine patch. E-cigarettes are almost certainly far less harmful than tobacco smoking, but the health effects of long-term use are as yet unknown. Dual use is common and almost as harmful as usual smoking unless it leads to quitting. Population effects, such as re-normalising smoking behaviour, are a concern. Clinicians should be knowledgeable about these products. If patients who smoke are unwilling to quit or cannot succeed using evidence-based approaches, e-cigarettes may be an option to be considered after discussing the limitations of current knowledge.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Warner KE. Cost effectiveness of smoking-cessation therapies. Interpretation of the evidence-and implications for coverage. Pharm Econ. 1997;11:538–49.

    CAS  Google Scholar 

  2. Fagerstrom K, Hughes J. Varenicline in the treatment of tobacco dependence. Neuropsychiatr Dis Treat. 2008;4:353–63.

    PubMed  PubMed Central  Google Scholar 

  3. Stead L, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2011;11:CD000146.

    Google Scholar 

  4. Fiore MC, Schroeder SA, Baker TB. Smoke, the chief killer—strategies for targeting combustible tobacco use. N Engl J Med. 2014;370:297–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Adkison SE, O’Connor RJ, Bansal-Travers M, Hyland A, Borland R, Yong H-H, et al. Electronic nicotine delivery systems: international tobacco control four-country survey. Am J Prev Med. 2013;44:207–15.

    PubMed  PubMed Central  Google Scholar 

  6. Abrams DB. Promise and peril of e-cigarettes: can disruptive technology make cigarettes obsolete? JAMA. 2014;311:135–6. This article provides an excellent overview of the potential benefits and harms of e-cigarettes at individual and population levels and has provoked a debate suggesting that e-cigarettes may have a role in tobacco control.

    CAS  PubMed  Google Scholar 

  7. McQueen A, Tower S, Sumner W. Interviews with “vapers”: implications for future research with electronic cigarettes. Nicotine Tob Res. 2011;13:860–7.

    PubMed  Google Scholar 

  8. Noel JK, Rees VW, Connolly GN. Electronic cigarettes: a new ‘tobacco’ industry? Tob Control. 2011;20:81.

    PubMed  Google Scholar 

  9. Grana RA, Ling PM. “Smoking revolution”: a content analysis of electronic cigarette retail websites. Am J Prev Med. 2014;46:395–403.

    PubMed  PubMed Central  Google Scholar 

  10. Regan AK, Promoff G, Dube SR, Arrazola R. Electronic nicotine delivery systems: adult use and awareness of the ‘e-cigarette’ in the USA. Tob Control. 2013;22:19–23.

    PubMed  Google Scholar 

  11. Tan ASL, Bigman CA. E-cigarette awareness and perceived harmfulness: prevalence and associations with smoking-cessation outcomes. Am J Prev Med. 2014;47:141–9. doi:10.1016/j.amepre.2014.02.011.

    PubMed  PubMed Central  Google Scholar 

  12. King BA, Alam S, Promoff G, Arrazola R, Dube SR. Awareness and ever use of electronic cigarettes among U.S. Adults, 2010–2011. Nicotine Tob Res. 2013;15:1623–7. doi:10.1093/ntr/ntt013.

    PubMed  Google Scholar 

  13. Zhu SH, Gamst A, Lee M, Cummins S, Yin L, Zoref L. The use and perception of electronic cigarettes and snus among the U.S. population. PLoS One. 2013;8:e79332. doi:10.1371/journal.pone.0079332. The article provides recent survey data on e-cigarette use drawing on a robust sample of the US population.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Grana RA. Electronic cigarettes: a new nicotine gateway? J Adolesc Health. 2013;52:135–6.

    PubMed  Google Scholar 

  15. Corey C, Wang B, Johnson SE, Apelberg B, Husten C, King BA, et al. Cancer-related news from the CDC: electronic cigarette use among middle and high school students. Oncol Times. 2013;35:36.

    Google Scholar 

  16. Zhu S-H, Sun JY, Bonnevie E, Cummins SE, Gamst A, Yin L, et al. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Tob Control. 2014;23:iii3–9.

    PubMed  Google Scholar 

  17. Brown CJ, Cheng JM. Electronic cigarettes: product characterisation and design considerations. Tob Control. 2014;23:ii4–10.

    PubMed  Google Scholar 

  18. Etter J-F. Electronic cigarettes: a survey of users. BMC Public Health. 2010;10:231.

    PubMed  PubMed Central  Google Scholar 

  19. Vickerman KA, Carpenter KM, Altman T, Nash CM, Zbikowski SM. Use of electronic cigarettes among state tobacco cessation quitline callers. Nicotine Tob Res. 2013;15:1787–91. doi:10.1093/ntr/ntt061.

    PubMed  Google Scholar 

  20. Pepper JK, Brewer NT. Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review. Tob Control. 2013. doi:10.1136/tobaccocontrol-2013-051122.

  21. Benowitz NL. Nicotine addiction. N Engl J Med. 2010;362:2295–303.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Wullner U, Gundisch D, Herzog H, Minnerop M, Joe A, Warnecke M, et al. Smoking upregulates alpha4beta2* nicotinic acetylcholine receptors in the human brain. Neurosci Lett. 2008;430:34–7.

    PubMed  Google Scholar 

  23. Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2012;11:CD000146.

    PubMed  Google Scholar 

  24. Bullen C, McRobbie H, Thornley S, Glover M, Lin R, Laugesen M. Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tob Control. 2010;19:98–103.

    CAS  PubMed  Google Scholar 

  25. Eissenberg T. Electronic nicotine delivery devices: ineffective nicotine delivery and craving suppression after acute administration. Tob Control. 2010;19:87–8.

    PubMed  Google Scholar 

  26. Vansickel AR, Eissenberg T. Electronic cigarettes: effective nicotine delivery after acute administration. Nicotine Tob Res. 2013;15:267–70.

    CAS  PubMed  Google Scholar 

  27. Goniewicz ML, Kuma T, Gawron M, Knysak J, Kosmider L. Nicotine levels in electronic cigarettes. Nicotine Tob Res. 2013;15:158–66.

    CAS  PubMed  Google Scholar 

  28. Zhang Y, Sumner W, Chen D-R. In vitro particle size distributions in electronic and conventional cigarette aerosols suggest comparable deposition patterns. Nicotine Tob Res. 2013;15:501–8.

    CAS  PubMed  Google Scholar 

  29. Etter JF, Bullen C. Saliva cotinine levels in users of electronic cigarettes. Eur Respir J. 2011;38:1219–20.

    CAS  PubMed  Google Scholar 

  30. Williams M, Talbot P. Variability among electronic cigarettes in the pressure drop, airflow rate, and aerosol production. Nicotine Tob Res. 2011;13:1276–83.

    PubMed  Google Scholar 

  31. Schroeder MJ, Hoffman AC. Electronic cigarettes and nicotine clinical pharmacology. Tob Control. 2014;23:ii30–5.

    PubMed  Google Scholar 

  32. Hua M, Yip H, Talbot P. Mining data on usage of electronic nicotine delivery systems (ENDS) from YouTube videos. Tob Control. 2013;22:103–6.

    PubMed  Google Scholar 

  33. Farsalinos KE, Spyrou A, Tsimopoulou K, Stefopoulos C, Romagna G, Voudris V. Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices. Sci Rep. 2014;4:4133.

    PubMed  PubMed Central  Google Scholar 

  34. Vansickel AR, Weaver MF, Eissenberg T. Clinical laboratory assessment of the abuse liability of an electronic cigarette. Addiction. 2012;107:1493–500.

    PubMed  PubMed Central  Google Scholar 

  35. Dawkins L, Turner J, Hasna S, Soar K. The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition. Addict Behav. 2012;37:970–3.

    PubMed  Google Scholar 

  36. Dale LC, Hurt RD, Offord KP, Lawson GM, Croghan IT, Schroeder DR. High-dose nicotine patch therapy. Percentage of replacement and smoking cessation. JAMA. 1995;274:1353–8.

    CAS  PubMed  Google Scholar 

  37. Buchhalter AR, Acosta MC, Evans SE, Breland AB, Eissenberg T. Tobacco abstinence symptom suppression: the role played by the smoking-related stimuli that are delivered by denicotinized cigarettes. Addiction. 2005;100:550–9.

    PubMed  Google Scholar 

  38. Brody AL, Mandelkern MA, Costello MR, Abrams AL, Scheibal D, Farahi J, et al. Brain nicotinic acetylcholine receptor occupancy: effect of smoking a denicotinized cigarette. Int J Neuropsychopharmacol. 2009;12:305–16.

    CAS  PubMed  Google Scholar 

  39. Hajek P, McRobbie H, Gillison F. Dependence potential of nicotine replacement treatments: effects of product type, patient characteristics, and cost to user. Prev Med. 2007;44:230–4. doi:10.1016/j.ypmed.2006.10.005.

    CAS  PubMed  Google Scholar 

  40. Berlin I, Anthenelli RM. Monoamine oxidases and tobacco smoking. Int J Neuropsychopharmacol. 2001;4:33–42.

    CAS  PubMed  Google Scholar 

  41. Carpenter CM, Wayne GF, Connolly GN. The role of sensory perception in the development and targeting of tobacco products. Addiction. 2007;102:136–47.

    PubMed  Google Scholar 

  42. Wagener TL, Meier E, Hale JJ, Oliver ER, Warner ML, Driskill LM, et al. Pilot investigation of changes in readiness and confidence to quit smoking after e-cigarette experimentation and 1 week of use. Nicotine Tob Res. 2014;16:108–14.

    CAS  PubMed  Google Scholar 

  43. Etter JF, Bullen C. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Addiction. 2011;106:2017–28.

    PubMed  Google Scholar 

  44. Grana RA, Popova L, Ling PM. A longitudinal analysis of electronic cigarette use and smoking cessation. JAMA Int Med. 2014;174:813–4.

    Google Scholar 

  45. Caponnetto P, Cibella F, Mancuso S, Campagna D, Arcidiacono G, Polosa R. Effect of a nicotine-free inhalator as part of a smoking-cessation programme. Eur Respir J. 2011;38:1005–11.

    CAS  PubMed  Google Scholar 

  46. Caponnetto P, Polosa R, Russo C, Leotta C, Campagna D. Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series. J Med Case Rep. 2011;5:585.

    PubMed  PubMed Central  Google Scholar 

  47. Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effect of an electronic nicotine delivery device (e-cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health. 2011;11:786.

    PubMed  PubMed Central  Google Scholar 

  48. Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, Polosa R: EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS One. 2014; 8. doi: 10.1371/journal.pone.0066317. This article is the first published randomized trial of an e-cigarette

  49. Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet. 2013;382:1629–37. This article is the most widely cited randomized trial of an e-cigarette for smoking cessation.

    PubMed  Google Scholar 

  50. Dockrell M, Morison R, Bauld L, McNeill A. E-cigarettes: prevalence and attitudes in Great Britain. Nicotine Tob Res. 2013;15:1737–44. doi:10.1093/ntr/ntt057.

    PubMed  PubMed Central  Google Scholar 

  51. Brown J, Beard E, Kotz D, Michie S, West R. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction. 2014. doi:10.1111/add.12623. This article provides first-time population data from the UK, indicating that e-cigarettes have cessation potential.

  52. West R. Smoking in England. http://www.smokinginengland.info/latest-statistics/. Accessed 25 July 2014. Fascinating new data from the UK on the possible role of e-cigarettes in reducing population smoking prevalence.

  53. Zeller M, Hatsukami D. The strategic dialogue on tobacco harm reduction: a vision and blueprint for action in the US. Tob Control. 2009;18:324–32.

    PubMed  Google Scholar 

  54. Foulds J, Veldheer S, Berg A. Electronic cigarettes (e-cigs): views of aficionados and clinical/public health perspectives. Int J Clin Pract. 2011;65:1037–42.

    CAS  PubMed  Google Scholar 

  55. Kralikova E, Novak J, West O, Kmetova A, Hajek P. Do e-cigarettes have the potential to compete with conventional cigarettes? A survey of conventional cigarette smokers’ experiences with e-cigarettes. Chest. 2013;18:12–2842.

    Google Scholar 

  56. Lechner WV, Tackett AP, Grant DM, Tahirkheli NN, Driskill LM, Wagener TL. Effects of duration of electronic cigarette use. Nicotine Tob Res. 2014. doi:10.1093/ntr/ntu061.

  57. US Department of Health Education and Welfare: Smoking and health: report of the Advisory Committee to the Surgeon General of the Public Health Service. In Public Health Service Publication Washington: US Department of Health, Education and Welfare, Public Health Service. 1964.

  58. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004;328:1519.

    PubMed  PubMed Central  Google Scholar 

  59. Benowitz NL, Hansson A, Jacob P. Cardiovascular effects of nasal and transdermal nicotine and cigarette smoking. Hypertension. 2002;39:1107–12.

    CAS  PubMed  Google Scholar 

  60. Kimmel SE, Berlin JA, Miles C, Jaskowiak J, Carson JL, Strom BL. Risk of acute first myocardial infarction and use of nicotine patches in a general population. J Am Coll Cardiol. 2001;37:1297–302.

    CAS  PubMed  Google Scholar 

  61. Joseph AM, Norman SM, Ferry LH, Prochazka AV, Westman EC, Steele BG, et al. The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease. N Engl J Med. 1996;335:1792–8.

    CAS  PubMed  Google Scholar 

  62. Benowitz NL, Gourlay SG. Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy. J Am Coll Cardiol. 1997;29:1422–31.

    CAS  PubMed  Google Scholar 

  63. Cheng T. Chemical evaluation of electronic cigarettes. Tob Control. 2014;23:2013–051482. This article provides an account of findings from a systematic literature review of the chemical constituents of e-cigarettes.

    Google Scholar 

  64. Pellegrino RM, Tinghino B, Mangiaracina G, Marani A, Vitali M, Protano C, et al. Electronic cigarettes: an evaluation of exposure to chemicals and fine particulate matter (PM). Ann Ig. 2012;24:279–88.

    CAS  PubMed  Google Scholar 

  65. Callahan-Lyon P. Electronic cigarettes: human health effects. Tob Control. 2014;23:ii36–40. This article provides an account of findings from a systematic literature review of the health effects of e-cigarettes.

    PubMed  Google Scholar 

  66. Bjartveit K, Tverdal A. Health consequences of smoking 1–4 cigarettes per day. Tob Control. 2005;14:315–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Bullen C, Whittaker R, McRobbie H, Fagerstrom K. A clinical imperative: assisting patients who smoke to reduce their risk of cardiovascular disease. Prev Cardiol. 2007;10:5–9.

    CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Chris Bullen declares he has received in-kind support from the manufacturer of a smoking cessation medication for giving a guest lecture but has no other conflict of interest.

Human and Animal Rights and Informed Consent

This article contains reference to studies the author conducted with human participants, all who gave informed consent and were conducted with appropriate ethical review. No animal subjects were involved in studies performed by the author.

Author information

Authors and Affiliations

  1. National Institute for Health Innovation, School of Population Health, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand

    Christopher Bullen

Authors
  1. Christopher Bullen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher Bullen.

Additional information

This article is part of the Topical Collection on Ischemic Heart Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bullen, C. Electronic Cigarettes for Smoking Cessation. Curr Cardiol Rep 16, 538 (2014). https://doi.org/10.1007/s11886-014-0538-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-014-0538-8

Keywords

Search

Navigation