From the Guidelines
Vaping and e-cigarette use pose significant health risks and should be avoided, as they can lead to nicotine dependence, cardiovascular problems, and respiratory issues, among other complications, as evident from recent studies 1. The latest information on the risks of vaping and e-cigarette use highlights the importance of advising individuals, especially those with diabetes, to avoid these products altogether. Key points to consider include:
- E-cigarettes contain harmful substances, including nicotine, volatile organic compounds, and heavy metals, which can damage lung tissue and lead to severe respiratory distress 1.
- Nicotine addiction is a major concern, particularly among youth, as e-cigarettes often deliver higher concentrations of nicotine than traditional cigarettes, and can harm brain development, which continues until about age 25 1.
- Emerging research suggests potential links to cardiovascular problems, including increased heart rate, blood pressure, and risk of heart attack, as well as possible connections to chronic lung disease and cancer 1.
- Dual use with traditional cigarettes is common and may compound health risks rather than reduce them, emphasizing the need for evidence-based cessation methods 1.
- For those trying to quit smoking, FDA-approved cessation methods like nicotine replacement therapy, bupropion, or varenicline are recommended instead of vaping, as they have been shown to be effective in reducing tobacco use and improving health outcomes 1. Some of the key recommendations for healthcare providers include:
- Advising all patients not to use cigarettes and other tobacco products or e-cigarettes 1.
- Including smoking cessation counseling and other forms of treatment as a routine component of diabetes care after identification of tobacco or e-cigarette use 1.
- Assessing the level of nicotine dependence and providing special considerations for patients who may gain weight after smoking cessation, as this weight gain does not diminish the substantial cardiovascular benefit realized from smoking cessation 1.
From the Research
Risks of Vaping and E-Cigarette Use
- The use of e-cigarettes has been growing dramatically in the US and globally across populations 2
- E-cigarettes have varying amounts of toxicants, nicotine, and carcinogens, putting users at risk for lung diseases and COVID-19 similar to smokers 2
- Most governing bodies have not approved e-cigarettes as a smoking cessation tool, but suggest that they may help those who have failed conventional smoking cessation treatments to quit combustible tobacco and nicotine in the short term 2
Comparison with Traditional Smoking Cessation Methods
- Nicotine replacement therapy (NRT) has been available since 1982 and has been shown to increase smoking cessation rates by approximately 1.5- to 2-fold after 12 months 3
- Bupropion, an inhibitor of the neuronal uptake of noradrenaline and dopamine, is effective for smoking cessation and its effectiveness is improved by a moderate level of counselling 3
- Varenicline, a partial agonist at nicotinic alpha4beta2 receptors, has been shown to be as effective as, or more effective than, bupropion for smoking cessation 3, 4, 5
Effectiveness of Different Treatments
- A systematic review and multiple treatment meta-analysis found that all therapies, including high-dose NRT, combination NRT, bupropion, and varenicline, offered treatment benefits over controls, but the benefits of treatments over standard-dose NRT were not retained in the long term, except for varenicline 4
- A randomized trial found that bupropion, NRT, and their combination had similar effectiveness for smoking cessation, but bupropion may be more beneficial for smokers with a history of depression 6
- A comparative effectiveness trial found that varenicline and combination NRT had significant effects on candidate mediators of early abstinence, including craving, positive smoking expectancies, withdrawal symptoms, and quitting motivation 5