References

The evidence keeps piling up: e-cigarettes are definitely safer than smoking. https://tinyurl.com/y76flxyl (accessed 12 February 2019)

British Heart Foundation. Smoking. 2019. https://tinyurl.com/y9l2tmkk (accessed 12 February 2019)

Jensen RP, Luo W, Pankow JF, Strongin RM, Peyton DH. Hidden formaldehyde in e-cigarette aerosols. N Engl J Med. 2015; 372:392-394

National Institute for Health and Care Excellence. Stop smoking interventions and services. 2018. https://www.nice.org.uk/guidance/ng92 (accessed 12 February 2019)

Office for National Statistics. Adult smoking habits in the UK: 2017. 2018. https://tinyurl.com/y2qguxym (accessed 12 February 2019)

Public Health England. E-cigarettes around 95% less harmful than tobacco estimates landmark review. 2015. https://tinyurl.com/ntpao2x (accessed 12 February 2019)

Tobacco smoking and its potential drug interactions. 2019. https://tinyurl.com/y62qx2gd (accessed 12 February 2019)

Shahab L, Goniewicz ML, Blount BC Nicotine, carcinogen, and toxin exposure in long-term e-cigarette and nicotine replacement therapy users: a cross-sectional study. Ann Intern Med. 2017; 166:(6)390-400 https://doi.org/10.7326/M16-1107

Sohal SS, Eapen MS, Naidu VGM, Sharma P. IQOS exposure impairs human airway cell homeostasis: direct comparison with traditional and e-cigarette. ERJ Open Res. 2019; 5:(1)00159-2018 https://doi.org/10.1183/23120541.00159-2018

Smoking cessation in 2019

02 March 2019
Treatments
02 March 2019
Volume 24 · Issue 3

With No Smoking Day taking place on 13 March and people increasingly wanting to manage their own health, it may be the ideal time to encourage patients in your caseload to kick the habit. Tobacco is the leading cause of chronic illness and preventable death worldwide (Ryan et al, 2019), and the risk of heart attacks is doubled in people who smoke compared to that in non-smokers (British Heart Foundation, 2019). Nurses in the community can play a central role in supporting patients to quit smoking and improve their health outcomes.

NICE guidelines

Encouragingly, smokers in Great Britain are on the decline, as an increasing number of people are attempting and succeeding at quitting (Office for National Statistics, 2018). Nonetheless, the overall smoking rates remain high across the globe (Ryan et al, 2019).

According to NICE (2018), every patient who smokes should be advised and encouraged to stop and provided with the necessary support. The latest guidance recommends that health professionals in primary and community care ask patients if they smoke at every opportunity; advise them to quit in a way that is sensitive to the person's preferences and needs; discuss previously used and potential smoking cessation aids; and refer them to their local Stop Smoking service (NICE, 2018).

Additionally, the availability of the following evidence-based stop-smoking interventions is recommended in the guidance (NICE, 2018):

  • Individual and group behavioural support
  • Bupropion
  • Short- and long-acting nicotine replacement therapy (NRT)
  • Varenicline
  • Very brief advice.

    • Very brief advice involves asking the person about both their present and past smoking behaviours; giving them information about the consequences of smoking, as well as those of stopping smoking; and providing advice on the options for support and pharmacotherapy (NICE, 2018).

    How toxic is vaping?

    E-cigarette vaping is not without its risks, but the evidence indicates that e-cigarettes are much safer than conventional cigarettes, or even than chewing tobacco (Public Health England, 2015; Bauld, 2017). A 2017 study funded by Cancer Research UK showed sizeable reductions in carcinogens and other toxic compounds in people who vape but have quit smoking completely, compared with people who smoke cigarettes (Shahab et al, 2017). Studies suggest that vaping is still toxic to the cells in the lungs (Jensen et al, 2015; Sohal et al, 2019), so it should not be taken up as a hobby by non-smokers. Nonetheless, it certainly is not as damaging as smoking tobacco and will most definitely result in health benefits for people who smoke cigarettes.

    Heat-not-burn

    Tobacco heating products, known as ‘heat-not-burn’ products or IQOS, have also surfaced in recent years. However, newly published research suggests that these products are just as harmful as traditional tobacco cigarettes (Sohal et al, 2019). IQOS, a device that heats tobacco, is meant to be a cross between a conventional cigarette and an e-cigarette, as it does not burn to generate aerosol but uses tobacco instead of a liquid (Sohal et al, 2019).

    In their study, Sohal et al (2019) tested exposure to IQOS in vitro and reported that it results in the same damaging effects to human epithelial and smooth muscle cells as traditional tobacco cigarettes. The authors conclude from their data that, like cigarettes, IQOS results in lung damage that can lead to chronic obstructive pulmonary disease, lung cancer and pneumonia, as well as increase the risk of developing asthma.

    Conclusion

    Research and innovation that could lead to improved outcomes are always welcome. However, as Sohal et al (2019) point out, it took more than 50 years to reveal the devastating effects of tobacco smoking to human health. The introduction of smoking devices may help to address some of the public health crises caused by widespread global cigarette smoking, but research suggests that these devices are not without risk, and some are even as harmful (or potentially even more harmful) than conventional cigarettes. It should also be noted that the evidence for these devices is sparse and still being gathered. It will be many years before their long-term impact can be properly investigated, and the early findings should be noted and taken on board in clinical prescribing and advising practice.