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Electronic cigaretteMay 4 2016

E-cigarettes are likely to be beneficial to public health, a Royal College of Physicians report has concluded. “Smokers can therefore be reassured and encouraged to use them, and the public can be reassured that e-cigarettes are much safer than smoking,” it has said.

The RCP’s Tobacco Advisory Group has written a 200 page report looking at the available evidence and outlined its analysis in the BMJ. It has drawn a number of conclusions about the use of e-cigarettes, including:

  • e-cigarettes are not a gateway to smoking, with UK usage “limited almost entirely to those who are already using, or have used, tobacco”;
  • e-cigarettes do not result in normalisation of smoking with no evidence as yet to suggest otherwise;
  • e-cigarette use is likely to lead to quit attempts that would not otherwise have happened, and in a proportion of these to successful cessation.

However, the report recognises that “the possibility of some harm from long-term e-cigarette use cannot be dismissed due to inhalation of the ingredients other than nicotine, but is likely to be very small, and substantially smaller than that arising from tobacco smoking.”

Addressing concerns that e-cigarettes could ‘re-normalise’ smoking or act as a gateway to tobacco products, the RCP said: “None of these products has to date attracted significant use among adult never-smokers, or demonstrated evidence of significant gateway progression into smoking among young people,” said the RCP. Instead, with smokers quitting by using e-cigarettes, “e-cigarettes can act as a gateway from smoking.

“With appropriate product standards to minimise exposure to the other ingredients, it should be possible to reduce risks of physical health still further. Although it is not possible to estimate the long-term health risks associated with e-cigarettes precisely, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure.”

A number of health charities have commented on the RCP’s call to promote e-cigarettes as a substitute for smoking. Nikki Smith, a senior health information officer at Cancer Research UK, said the RCP report “makes clear, smokers who want to continue using nicotine, or feel they can’t manage without it, can consider e-cigarettes a valid, safer alternative to tobacco.

“Crucially, [the RCP paper] helps tackle a common misconception that e-cigarettes are as harmful as smoking ... this could be an important opportunity for smokers who aren’t planning to stop smoking – or find it very difficult to stop – to switch to a far safer source of nicotine,” she said.

Cancer Research UK, the British Lung Foundation, the Royal Society for Public Health (RSPH) and many others have signed a consensus statement which says: “We all agree that e-cigarettes are significantly less harmful than smoking.”

Dr Samantha Walker of Asthma UK said: “While e-cigarettes are not risk-free, it is encouraging to see this research add to the evidence that they are much safer than tobacco and could help people quit smoking altogether. People with asthma who want to stop smoking should talk to their GP or asthma nurse about all the options available to help them quit. More investment into research is still needed to find out the overall long-term effects of e-cigarettes so that people can make informed decisions about their health.”

The British Heart Foundation has funded research which noted that “e-cigarettes have overtaken licensed nicotine replacement therapies such as NRT, gum or skin patches as the most popular form of support to stop smoking, and they continue to increase in popularity”. Despite 70% of smokers wanting to quit, there are still nearly ten million adults in the UK that smoke.

Dr Mike Knapton, BHF Associate Medical Director, has welcomed the report “which says that e-cigarettes can be an effective aid to potentially reduce harm from smoking and lower the risk of death and disability. There are 2.6 million e-cigarette users in the UK, and many smokers are using them to help quit. Although more research is needed to establish the long term safety of e-cigarettes, they are likely to cause significantly less harm to your health than smoking tobacco.”

The RSPH has similarly welcomed the report, endorsing the view that the evidence base should continue to be monitored, particularly with regard to the long term impact. Shirley Cramer, Chief Executive, RSPH, said: “Whilst we must continue to be vigilant in monitoring the evidence base, we must capitalise on the opportunity presented to us by e-cigarettes and promote them as safer source of nicotine and potential tool for stopping smoking.

Links:

RCP announcement

RCP key recommendations

BMJ announcement

J Britton et al, Tobacco Advisory Group of the Royal College of Physicians. ‘Nicotine without smoke—putting electronic cigarettes in context’. BMJ 2016; 353: i1745. Published April 27 2016

BHF comment

Asthma UK comment

Cancer Research UK comment

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