Vapes beat patches and gum for quitting smoking, major review finds

Nicotine vapes help more people stop smoking than nicotine patches and gum, according to an updated review of the evidence by the Cochrane collaboration, published as thousands of people across England try to quit during Stoptober.

The evidence

Cochrane reviews are regarded as among the most reliable summaries of medical evidence. This one is a "living" review, updated as new studies are published. The latest version includes 80 randomised controlled trials involving 29,861 people, nine of them new in this update.

• There was high-certainty evidence that nicotine e-cigarettes led to more people quitting than nicotine replacement therapy such as patches and gum: about four extra quitters for every 100 people.
• Nicotine e-cigarettes also did better than e-cigarettes without nicotine, with about two extra quitters per 100 people.
• They also appeared to do better than behavioural support alone or no support, although the researchers were less confident about that comparison because of possible bias in some studies.

The researchers found no evidence that using e-cigarettes to quit smoking increased the risk of serious harm, but said longer-term research is still needed.

"Substantially less harmful than smoking"

"We have very strong evidence that regulated nicotine e-cigarettes are substantially less harmful than smoking," said the review's senior author, Dr Jamie Hartmann-Boyce. "Based on the consistency of the findings here, it's clear that they are a proven and viable option for people wishing to quit traditional cigarettes."

The lead author, Dr Nicola Lindson of the University of Oxford, said: "Quitting smoking is hard, and a lot of people who smoke will have tried many times to quit smoking and been unsuccessful. Although nicotine vapes are unlikely to be completely risk-free, they are less harmful than smoking, and that is the most important comparison to make for people who are still smoking tobacco."

The warnings

The findings apply only to regulated nicotine e-cigarettes. Illegal products, and vapes containing other substances such as THC, may carry very different risks. "Unlicensed e-cigarettes are potentially dangerous, with issues including unstable batteries and harmful chemicals," Dr Hartmann-Boyce said. In the UK, legal vapes must be notified to the medicines regulator, the MHRA.

Vaping is not risk-free, and health bodies including the World Health Organization warn about nicotine addiction, particularly among children and young people. The researchers say vapes are best seen as a step away from smoking rather than a final destination, and that people who do not smoke should not start vaping.

Why it matters

Smoking remains the world's leading cause of preventable disease and death. The World Health Organization says it kills more than seven million people a year, including 1.6 million non-smokers exposed to second-hand smoke.

Help to quit in Birmingham

Stoptober, the NHS campaign that encourages people to stop smoking for 28 days in October, is based on research showing that people who manage to quit for 28 days are five times more likely to quit for good. Free help is available from local stop smoking services, from pharmacists and GPs, and through the free NHS Quit Smoking app. Using stop smoking support alongside a quitting aid gives smokers the best chance of success.