Reacción a "Reactions to a study on the use of e-cigarettes for smoking cessation"

Electronic cigarettes, also known as vapers, are devices equipped with an electrical heating element that heats a liquid containing propylene glycol, glycerine, additives and often nicotine, to generate an aerosol that is inhaled like cigarette smoke. The global market for these devices, marketed as consumer products, has been growing rapidly over the last decade and was worth more than 20 billion euros in 2022. 

The paper just published in the New England Journal of Medicine shows the results of a clinical trial comparing quit rates of smoking and other nicotine products in a group of 1,246 smokers of five cigarettes a day or more, who were randomly assigned to two groups. Subjects in the control group received behavioural treatment over an eight-week period that included information on the use of different smoking cessation medications, while the intervention group was also provided with free e-cigarettes and liquids to be used for a period of six months. After this time, the proportion of subjects who remained smoke-free in the intervention group was significantly higher than that observed in the control group. However, the proportion of participants who, at the end of the follow-up period, had not used any nicotine products (in the form of tobacco, e-cigarettes or medication) for at least one week was higher in the control group than in the experimental group. 

The results of this study add to those of other research that, under the conditions of a clinical trial, suggest that e-cigarettes could improve the results of conventional smoking cessation treatment. A high proportion of smokers who quit smoking continue to use nicotine-containing e-cigarettes regularly after six months, in contrast to the usual case of nicotine-containing drug therapy, where drug treatment is withdrawn before this time is reached. Thus, the potential help of e-cigarettes for smoking cessation contrasts with the risks of continued use in terms of potential relapse or the long-term harmful effects of nicotine and other toxic components of the aerosols emitted by these devices. Moreover, even in the case of smoking cessation medications, it is difficult for the benefits obtained under the demanding conditions of a clinical trial to be observed also in real-life conditions, where many smokers present more complex clinical situations and cannot access intensive professional support. 

The circumstances under which e-cigarettes are made accessible to the population in our environment, where large multinational tobacco companies are involved in the promotion and marketing of some of the most successful products, have also favoured the use of these devices among young people and adolescents, exposing them to a higher risk of developing nicotine addiction, favouring the progression towards the use of conventional tobacco products and thus undermining the progress that is needed to reduce the enormous burden of disease and mortality caused by tobacco worldwide.