Doctors have an “ethical obligation” to consider e-cigarette use for patients who are having trouble giving up smoking, experts suggest

A review of the latest scientific evidence on e-cigarettes, by UNSW Conjoint Associate Professor Colin Mendelsohn, has been published in the Internal Medicine Journal of the Royal Australian College of Physicians.

Based on the growing body of data supporting the effectiveness of e-cigarettes in smoking cessation means, it suggests they should be recommended as a less harmful alternative to traditional cigarettes.

This is particularly pertinent for patients who have repeatedly tried and failed to kick the habit using existing treatments.

A/Prof Mendelsohn cites recent studies of US and UK populations – where e-cigarettes are legal and widely available – which have demonstrated that vaping is associated with higher success rates of quitting smoking than among non-users.

The highest success rates occurred with newer e-cigarette models and daily use of nicotine e-liquid, rather than intermittent use.

Meanwhile a 2016 report by the Royal College of Physicians in the UK concluded that the health risk from long-term vaping was unlikely to exceed 5% of the harm from smoking tobacco.

Another study found vaping results in a dramatic reduction in carcinogens and other toxicants measured in the blood and saliva of e-cigarette users, compared with tobacco smokers.

Other research cited in A/Prof Mendelsohn’s review found that smokers who switch to vaping have significant health improvements, including improvements in asthma, chronic obstructive pulmonary disease, blood pressure, cardiovascular health, lung function and pneumonia risk.

“Medical practitioners have a duty of care to provide the best possible management at each encounter,” says A/Prof Mendelsohn, of the UNSW School of Public Health and Community Medicine.

“Withholding a legitimate treatment option that could prevent a life-threatening illness is a breach of that obligation.

“For patients who have repeatedly failed to quit smoking with conventional strategies an e-cigarette is a legitimate, evidence-based option for reducing harm. Their use could lead to substantial improvements in public health in Australia,” he says.

His comments follow the presentation of Australia’s Health, Aged Care and Sport Committee’s report on the Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia.

While the committee overall recommended the retention of the ban on nicotine use in e-cigarettes in Australia, the Committee’s chair, federal member for North Sydney Trent Zimmerman, also issued a dissenting report in which he recommends that nicotine be legitimised in e-cigarettes.

This minority report says allowing people who have repeatedly tried to quit tobacco to use nicotine in e-cigarettes could save “many thousands of lives”.

It recommended the devices should be made available as a consumer good.

The main report found that from a public health perspective, four key questions need to be asked regarding the health impacts of e-cigarettes: whether they help reduce the number of people smoking tobacco; their long-term health effects; would the legalisation of nicotine in e-cigarettes act as a gateway to nicotine use for non-smokers; and is the use of e-cigarettes less harmful than the use of tobacco products.

“The view of almost all Australian public health organisations that contributed to the inquiry is that there is currently insufficient evidence to prove that E‑cigarettes are an effective smoking cessation tool,” it stated.

“In Australia between 2013 and 2016, the smoking rate has not declined significantly for the first time in decades, despite very high cigarette prices, plain packaging and strict tobacco control laws,” says A/Prof Mendelsohn.

“However, in countries where which support vaping, smoking rates are continuing to fall, faster than ever, in some cases.”

But vaping should not replace smoking as a long-term activity, he warns.

After quitting smoking, it is preferable for people to aim to cease vaping, within three to six months if possible, but long-term use of e-cigarettes is safer than relapsing to smoking, he says.