Effectiveness and tolerability of electronic cigarette in real-life: a 24-month prospective observational study

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Electronic cigarettes (e-Cigarette) are battery-operated devices designed to vaporise nicotine that may aid smokers to quit or reduce their cigarette consumption. Research on e-Cigarettes is urgently needed to ensure that the decisions of regulators, healthcare providers and consumers are evidence based. Here we assessed long-term effectiveness and tolerability of e-Cigarette used in a ‘naturalistic’ setting. This prospective observational study evaluated smoking reduction/abstinence in smokers not intending to quit using an e-Cigarette (‘Categoria’; Arbi Group, Italy). After an intervention phase of 6 months, during which e-Cigarette use was provided on a regular basis, cigarettes per day (cig/day) and exhaled carbon monoxide (eCO) levels were followed up in an observation phase at 18 and 24 months. Efficacy measures included: (a) ≥50 % reduction in the number of cig/day from baseline, defined as self-reported reduction in the number of cig/day (≥50 %) compared to baseline; (b) ≥80 % reduction in the number of cig/day from baseline, defined as self-reported reduction in the number of cig/day (≥80 %) compared to baseline; (c) abstinence from smoking, defined as complete self-reported abstinence from tobacco smoking (together with an eCO concentration of ≤10 ppm). Smoking reduction and abstinence rates were computed, and adverse events reviewed. Of the 40 subjects, 17 were lost to follow-up at 24 months. A >50 % reduction in the number of cig/day at 24 months was shown in 11/40 (27.5 %) participants with a median of 24 cig/day use at baseline decreasing significantly to 4 cig/day (p = 0.003). Smoking abstinence was reported in 5/40 (12.5 %) participants while combined >50 % reduction and smoking abstinence was observed in 16/40 (40 %) participants at 24 months. Five subjects stopped e-Cigarette use (and stayed quit), three relapsed back to tobacco smoking and four upgraded to more performing products by 24 months. Only some mouth irritation, throat irritation, and dry cough were reported. Withdrawal symptoms were uncommon. Long-term e-Cigarette use can substantially decrease cigarette consumption in smokers not willing to quit and is well tolerated.

Read more here; http://link.springer.com/article/10.1007/s11739-013-0977-z

E-cigarettes may help people quit smoking regular cigarettes: study says…

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Even among study participants with no intention of quitting smoking, using e-cigs led to a decrease in traditional cigarette use or in some cases quitting regular cigs entirely, Italian researchers found in what they say is the first clinical trial to explore the use of e-cigarettes as a quitting tool.
A man smokes an e-cigarette, a device that delivers a vaporized puff of nicotine.

ROBIN UTRECHT/AFP/GETTY IMAGES

A man smokes an e-cigarette, a device that delivers a vaporized puff of nicotine.

In a trial of e-cigarettes among Italian smokers with no desire to quit using tobacco at the outset, up to 13 percent of participants were not smoking regular cigarettes at all a year later.

Though the study was not billed as a smoking-cessation test, more than half of participants cut down on tobacco soon after they started using the e-cigarettes. And the percentage who quit smoking entirely by the end rivals results achieved with medications, the authors note in the journal PLOS ONE.

“I think the main message of the study is that we can use these products as an extraordinary tobacco control tool,” Dr. Riccardo Polosa, the new study’s senior author from the University of Catania, told Reuters Health.

“This really is the first clinical trial that’s ever been reported on electronic cigarettes. There has been survey evidence and anecdotal reports, but this is the first serious study,” said Dr. Michael Siegel, who studies e-cigarettes but wasn’t involved in the new research.

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E-cigarettes were first introduced in China in 2004. The battery-powered devices let users inhale nicotine-infused vapors, which don’t contain the harmful tar and carbon monoxide in tobacco smoke.

While past studies have looked at the use of e-cigarettes, the new study is the first to follow hundreds of smokers for an entire year. It did not, however, compare the devices to traditional nicotine replacement therapies, such as gum or patches.

To see how many e-cigarette users would cut down or quit smoking cigarettes without any encouragement, the researchers recruited 300 people between June 2010 and February 2011. All were current smokers who stated they had no intention of quitting in the near future. Each participant was then randomized into one of three groups.

One group received e-cigarettes along with cartridges containing 7.2 milligram (mg) of nicotine. Another group also received the devices and 7.2 mg nicotine cartridges, but later in the study they were switched to 5.4 mg nicotine cartridges. And a third group got e-cigarettes and cartridges containing only tobacco flavor but no nicotine.

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Each participant received enough supplies to last three months and went to regular checkups throughout the year.

At the end of the study, 13 percent of the group that first received the highest-dose nicotine cartridges was no longer smoking. That compared to 9 percent of those who were in the reduced-nicotine group and 4 percent in the group without nicotine.

Since there was no control group of smokers who got no e-cigarettes at all, it’s hard to know how many would have quit smoking on their own by the end of a year, experts noted.

Siegel, a professor at the Boston University School of Public Health, said he would expect about 2 percent of the participants to quit within a year if they weren’t involved in a study.

RELATED: SMOKERS SEE E-CIGS AS A WAY TO BREAK HABIT: SURVEY

However, Polosa’s team also found that between 9 and 12 percent of people in each of the nicotine-cartridge groups had reduced the amount they smoked by at least half.

“The study is very positive in that it shows if you smoke even a low- or medium-strength e-cigarette, you can get some increased quitting and decreased smoking,” Dr. Murray Laugesen, a tobacco and nicotine researcher who was not involved with the new study, told Reuters Health.

“It also has to be acknowledged that these are good results in people who had no intention of quitting,” said Laugesen, a public health medicine specialist at Health New Zealand Ltd in Christchurch. He is also involved in an e-cigarette clinical trial and hopes to present the results in September.

Siegel told Reuters Health that what’s attractive about e-cigarettes is they can not only provide the nicotine that smokers crave without other harmful substances, they allow people to mimic their traditional smoking behavior.

RELATED: E-CIGARETTES GAIN VISIBILITY, BUT EXPERTS DISAGREE ON SAFETY

Researchers said that’s one reason why e-cigarettes might turn out to be a better form of nicotine replacement therapy than patches and gums, but there’s no data yet to prove it.

“I think that’s why they… found the people who actually got no-nicotine electronic cigarettes had some sort of quitting behavior… But obviously the people who got the nicotine and the high dose of nicotine did the best. Clearly having the nicotine and device structure is ideal,” Siegel said.

But he cautioned that more research is needed – especially on the long-term safety of e-cigarettes and how the devices stack up against traditional smoking cessation methods.

“My advice to people is to try the traditional therapy first. But I think electronic cigarettes are for people who have tried and failed nicotine replacement therapy, which is, sadly, most people,” Siegel added.

Read more: http://www.nydailynews.com/life-style/health/e-cigarette-study-hints-quit-aid-potential-article-1.1381914#ixzz2dIfKk2I3

The Laguna Beach City Council on Tuesday rejected a proposed ban on electronic cigarettes.

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City Manager John Pietig recommended adding e-cigarettes to the city’s ordinance restricting the use in public of tobacco and other plants or weeds that are smoked. The proposed amendment is consistent with the council’s long-standing desire to protect the public from secondhand smoke and to discourage the unhealthy habit of smoking, according to Pietig’s summary.

“The secondhand vapor from an e-cig is no more harmful than the water vapor rising out of a cup of coffee,” said Laguna Beach resident Peter French, regional vice president of Life LLC. “We sell health and wellness products. One of those products happens to be the electronic cigarette.”

E-cigarettes are battery-operated devices that generally contain cartridges filled with nicotine, flavors and other chemicals, according to a July 22, 2009, news release from theU.S. Food and Drug Administration provided by Tom Kiklas, president and co-founder of the Tobacco Vapor Electronic Cigarette Assn.

FDA tests have detected dipropylene glycol in the cigarettes, but an Environmental Protection Agency release, also provided by Kiklas, states that studies conducted up to the testing limit established by the agency have shown dipropylene glycol not to be carcinogenic.

“I am not convinced that e-cigarettes are dangerous,” said Councilman Steven Dicterow, who voted to reject a ban.

Councilwoman Toni Iseman, the council’s most avid advocate of smoking bans as a person who is made ill by secondhand smoke, said she once sat next to a smoker puffing on an e-cigarette and could not smell anything.

“A secondary [e-cig] benefit is not dropping cigarette butts on the ground, and we could possibly be helping someone quit smoking,” Iseman said.

Mayor Kelly Boyd, who quit smoking after being diagnosed with cancer but still sneaks the occasional puff, said a golfing buddy of his smokes electronic cigarettes and has cut back on tobacco products.

French compared the addictive quality of nicotine to that of caffeine.

“Nicotine has gotten a bad reputation over the years based on the company it keeps,” French said. “Wrapped up in a traditional cigarette, nicotine is surrounded by thousands of chemicals, more than 60 of which are absolutely carcinogenic and many of which are more addictive than nicotine itself.”

French said that since 2008, his sales have shown that thousands of people have moved away from traditional cigarettes.

“This is because it is an easy, effective and safe nicotine delivery system without other harmful chemicals, including tar and carbon monoxide,” French said. “This technology should be embraced and celebrated, not vilified and feared out of ignorance. “

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