Topic
Smoking cessation
Pharmacotherapy, e-cigarettes, and the cardiovascular safety question.
What the evidence shows
Stopping smoking is still the most effective thing in respiratory medicine. A cessation programme that succeeded in only one in five participants nonetheless reduced all-cause mortality over 14.5 years (Lung Health Study) — an effect no inhaler has approached.
E-cigarettes outperform nicotine replacement for one-year abstinence, 18.0% against 9.9%, when both are supported behaviourally (TEC). The finding usually quoted without its companion is that most successful quitters were still vaping at a year; whether that is durable harm reduction or substituted dependence, this trial cannot say.
Does stopping smoking change mortality?
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| Lung Health Study | 2005 | Smoking cessation programme | A cessation programme that worked for one in five participants still reduced all-cause mortality over 14.5 years |
E-cigarettes for cessation
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| TEC | 2019 | E-cigarettes | E-cigarettes nearly doubled one-year quit rates compared with nicotine replacement |
Key references
Guidelines, standards and reviews for this topic.
- Electronic Cigarettes and Smoking Cessation
- Farber HJ, Conrado Pacheco Gallego M, Galiatsatos P, et al. Harms of Electronic Cigarettes: What the Healthcare Provider Needs to Know. Ann Am Thorac Soc 2021 Apr;18(4):567-572. PMID 33284731
- Prochaska JJ. The public health consequences of e-cigarettes: a review by the National Academies of Sciences. A call for more research, a need for regulatory action. Addiction 2019 Apr;114(4):587-589. PMID 30347473
- Guidelines
- Leone FT, Zhang Y, Evers-Casey S, et al. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020 Jul 15;202(2):e5-e31. PMID 32663106
- Long-term effects of smoking cessation interventions
- Cho ER, Brill IK, Gram IT, et al. Smoking Cessation and Short- and Longer-Term Mortality. NEJM Evid 2024 Mar;3(3):EVIDoa2300272. PMID 38329816
Studies not yet summarised
On the reading list for this topic and awaiting a full record. Listed here so nothing is hidden.
- Combination therapy
- Baker TB, Piper ME, Smith SS, et al. Effects of Combined Varenicline With Nicotine Patch and of Extended Treatment Duration on Smoking Cessation: A Randomized Clinical Trial. JAMA 2021 Oct 19;326(15):1485-1493. PMID 34665204
- Walker N, Parag V, Verbiest M, et al. Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial. Lancet Respir Med 2020 Jan;8(1):54-64. PMID 31515173
- Electronic Cigarettes and Smoking Cessation
- Halpern SD, Harhay MO, Saulsgiver K, et al. A Pragmatic Trial of E-Cigarettes, Incentives, and Drugs for Smoking Cessation. N Engl J Med 2018 Jun 14;378(24):2302-2310. PMID 29791259
- Single drug
- Transdermal nicotine for smoking cessation. Six-month results from two multicenter controlled clinical trials. Transdermal Nicotine Study Group. JAMA 1991 Dec 11;266(22):3133-8. PMID 1956099