How do vapes compare with NRTs?

Latest Cochrane Review finds vapes are more effective than traditional nicotine replacement therapy (NRT) in helping people quit smoking 

Studies on the effectiveness and safety of vaping to help people quit smoking are coming out in increasing numbers. In assessing the available evidence, few compare with the integrity and regard held for Cochrane. Cochrane is a global independent network of researchers, professionals, patients and carers and their reviews are internationally recognized as the highest standard in evidence-based healthcare.

The recently published Cochrane Review has found the strongest evidence yet that people are more likely to quit smoking for at least six months using nicotine e-cigarettes or vapes than using nicotine replacement therapies (NRTs) such as patches and gums.  The review concluded there was no clear evidence of harm detected in the overall small number of studies reviewed. Note that these results only reflect data that was collected over 2 years, with the longest study follow-up being at the 2 year mark.

So let’s find out more about what the recently published in-depth Cochrane Review on vaping for smoking cessation determined about vaping as a tool to quit smoking.

What outcomes does the Cochrane Review look at?

The Cochrane Review analysed 78 studies involving over 22,000 people. Of the 78 studies 40 were randomised controlled trials (RCTs), which are the gold standard format for studies in safety and efficacy of new treatments.

The two key outcomes reviewed were:

1/ how many people successfully quit smoking for six months or longer using vapes (otherwise known as electronic cigarettes), and

2/ how many people experienced unwanted side-effects from using vaping as a quit tool.

Comprehensive reviews such as this equip healthcare providers and regulators with information that is essential in generating safety regulations and medical guidance for using vaping as a tool to help people quit smoking.

What were the results from the Cochrane Review of vaping to quit smoking?

The Cochrane Review found there is “high certainty evidence that nicotine e-cigarettes are more effective than traditional nicotine replacement therapy (NRT) in helping people quit smoking”.

The review found people are more likely to quit smoking by using nicotine e‐cigarettes than using nicotine replacement therapy (6 studies, 2378 people) with between 9 to 14 people out of 100 who vape likely to remain cigarette-free after 6 months compared to 6 out of 100 people using NRT such as gums and patches.

The review also found that fewer people had success going cold turkey or only using behavioural support as a tool to quit smoking. For every 100 people attempting to quit with no additional help, only an estimated 4 followed through long-term. 

Key adverse events of vaping in short-to-medium term

The Cochrane Review showed low numbers of reported unwanted effects in the studies comparing nicotine vapes to nicotine replacement treatment. The key adverse effects noted in the Cochrane Review in the short-to-medium term (up to 2 years) were irritation in the throat or mouth, headache, cough and nausea. However, these effects appeared to diminish over time. 

Other adverse effects that people recorded when switching to vaping included dizziness, increased heart rate, shortness of breath and sleep disturbances. In most instances, these  effects dissipated within a few days to a week of beginning vaping.

The Cochrane Review “did not detect any clear evidence of harm” from vapes when used to quit smoking, however the longest follow-up was 2 years, and the overall number of studies was small.

Long-term effects of vaping

The Cochrane Review did not provide analysis for unwanted effects of vaping beyond 2 years of use. Scientific knowledge and understanding of the long-term health effects of vaping is still limited with further research required. Vaping is not risk free and some research indicates long-term vaping can result in negative effects on the cardiovascular system as well as similar deleterious effects on the lungs as seen in smoking.

Supporting you to quit smoking 

Crucial to the success of quitting smoking is your sense of agency and the freedom to discover which quit tools work for you in the long run.  Whether you are trying to quit for the first time or the fiftieth time, there are many tools for helping you quit.  

It is important to recognise nicotine vaping products are prescription items and should be used under the guidance of a medical practitioner and if you experience any unwanted effects, speak to your healthcare provider. 

If you have tried other smoking cessation products in the past but did not succeed in quitting and would like to know if vaping is an option for you, Help Me Stop can discuss options with you. Complete your virtual consult for review by an authorised prescriber of nicotine who will determine if you’re eligible for treatment and, if you are approved, a nicotine vape prescription will be written for you.

PLEASE NOTE: Vaping products are used as second-line tools and may be useful for those who have not successfully quit smoking using first line treatments such as approved nicotine replacement therapies (NRT) or prescription medications such as Zyban and Champix. Long-term vaping and dual-use (smoking and vaping concurrently) is not recommended and should be avoided.  Regular review and monitoring by your regular GP is advised along your smoking cessation journey.