Electronic cigarettes in smoking cessation

Background: Tobacco use is the most prevalent preventable cause of death in the United States, accounting for approximately 20% of all deaths each year. Despite available treatment options, many smokers still experience multiple failed quit attempts indicating a need for development of novel therapies. When the electronic cigarette (e-cigarette) was introduced to the United States' market in 2007, patients began to discuss its possible use as the newest form of nicotine replacement therapy (NRT). Methods: A PubMed search was performed for the following terms: “Electronic cigarettes, e-cigarettes, and smoking cessation”. A manual search of references from articles found was performed to identify additional relevant articles. Results: Most evidence surrounding use of e-cigarettes for smoking cessation is found in self-reports and user surveys. One study looking at short-term effects of e-cigarettes on desire to smoke found a decreased desire in subjects inhaling from both nicotine-containing and placebo e-cigarettes. Three studies from Italy looked at natural reduction of cigarette use when subjects were allowed to freely use e-cigarettes. All three studies showed a natural reduction indicating potential efficacy for e-cigarette use in smoking cessation. A recently published randomized controlled trial was unable to prove superiority of e-cigarettes over transdermal nicotine patches for smoking cessation. Conclusions: A few studies have explored the possibility of replacing tobacco cigarettes with e-cigarettes to facilitate a natural reduction in use and have shown minimal positive results in a population not intending to quit. A recent randomized controlled trial comparing e-cigarettes with nicotine patches for smoking cessation was unable to prove superiority. Until these products are regulated and efficacy can be shown with well-designed studies, e-cigarettes are not a viable treatment for use in smoking cessation or as nicotine replacement therapy.