Dr Laura Crotty Alexander Discusses the Potential of e-Cigarette Use for Smoking Cessation

Nicotine replacement therapy can help with smoking cessation, but there are dangers of using e-cigarettes, said Laura Crotty Alexander, MD, ATSF.

Laura Crotty Alexander, an associate professor of medicine at the University of California, San Diego, discusses some of the potential benefits and harms of e-cigarette use for smoking cessation. Crotty Alexander is also the section chief of pulmonary critical care at the Veterans Affairs San Diego Healthcare System.


What would you say to studies that have shown e-cigarettes can help with smoking cessation?

I think most of us who work in the area of pulmonary medicine and who have all of these patients who have never been able to quit smoking, that a lot of us thought that e-cigarettes would be helpful in that way. But the first 2 generations of devices really had limited delivery of nicotine. So smokers did not get the same hit, so to speak, when they would use one of those devices. That earlier data really showed that they were not helpful in smoking cessation. In fact, smokers who added them in became dual users of conventional tobacco and e-cigarettes. There was concern that it was actually driving the nicotine addiction to be worse, sort of emphasizing it, by allowing people to vape nicotine in places where they were not allowed to smoke conventional tobacco. A lot of people feel comfortable vaping in their own home and their own car, because it doesn't have as much of a smell. That was very concerning.

But then the third- and fourth-generation devices really cranked up the nicotine content, and they deliver nicotine to the bloodstream much more similarly and sometimes even at a higher rate than conventional tobacco. The most recent meta-analysis that came out of the University of California, San Francisco really shows that in a randomized controlled trial fashion, if you give a smoker an e-cigarette who's trying to quit, they do look like they can help with smoking cessation in that specific setting. That is exciting. There's always another need for nicotine replacement therapy. Maybe they can be useful on that front.

But the bottom line is that we have FDA-approved nicotine replacement therapies, the patch, the gum, the inhaler, lozenges, all these different things that work really well for cessation and are safe. Because they've already been tested in humans, we know that their health effects are safer than smoking tobacco. But for e-cigarettes, they have a lot more chemicals in those aerosols relative to these other nicotine replacement therapies. We're talking about usually on the order of 50 to 120 chemicals in an e-cigarette aerosol that's being taken in along with the nicotine. It's just more dangerous as a physician, saying “Do no harm.” It's really hard for me to advise a patient to use an e-cigarette, without telling them it could also cause all these other problems. You could stay addicted to nicotine by the use of the e-cigarette and you might develop these other health effects from the use of an e-cigarette. Yes, we're in a different place now than we were several years ago with e-cigarettes. We understand them a bit more. They continue to evolve, but there are still dangers of using them, and we have a lot more work to do to figure out exactly what those are.

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