Use of e-cigs prevents effective tobacco dependency treatment

There is a danger that the debate around e-cigarettes will drown out the work needed to tackle tobacco dependency, warns a leading respiratory physician in a BMJ editorial.

More than three million people in the UK currently vape and the vast majority of people do so in order to cut down or quit their smoking habit, says Dr Nicholas Hopkinson, Reader in Respiratory Medicine, National Heart and Lung Institute, Imperial College London, and Medical Director, British Lung Foundation.

E-cigarettes are now proposed as part of the solution to smoking dependency. However, there is a danger that the popularity of e-cigarettes masks decades of failure to make good use of effective tools to reduce smoking, and the current failure to provide properly funded, comprehensive, evidence based smoking cessation services.

The majority of smokers want to quit, yet provision of smoking cessation treatment, the combination of psychological support and pharmacotherapy, has been and remains inadequate.

Public health budgets continue to be slashed, leading to widespread cuts in smoking cessation services. Although adult smoking rates are now around 15%, there is a danger of complacency, with policy makers thinking that the problem has been solved.

Smoking rates are much higher in poorer people and those with mental health problems and neglect of smoking in these groups is a major driver of health inequality.

“Too often, clinicians consider smoking cessation to be someone else’s problem, or neglect it at the expense of interventions that appear to be more technical or condition specific; witness the relative attention given to the niceties of inhaler selection for COPD, while only around 10% of COPD smokers receive quit smoking treatment.

“A real danger, which must be acknowledged and avoided, is that debate around e-cigarettes drowns out the work needed to implement the full range of tobacco control measures,” says Dr Hopkinson.

PCRS Executive Chair Dr Noel Baxter says: "PCRS supports e-cigarettes as a positive option available to support people to quit tobacco smoking. It is likely that they will never be classified as 100% safe so we must not allow people dependent on tobacco to continue to be exposed to the harms of tobacco whilst the debate about ‘how harmful’ continues."

PCRS believes tackling tobacco dependency is the responsibility of every healthcare professional. The new PCRS practical Guide to Diagnosing and Managing Tobacco Dependency is designed to help healthcare professionals to routinely identify smokers, encourage and support a quit attempt.