Debating the use of electronic cigarettes for tobacco smoking cessation _ asco annual meeting

The rise of electronic cigarettes (“e-cigs,” “electronic nicotine delivery systems,” or “ENDS”) has provoked vigorous debate within the public health community and among health care providers. Smoking cessation treatment Some view these products with, at best, skepticism of any potential benefits to tobacco cigarette smokers and at worst as a serious threat of undermining the significant reduction in tobacco smoking rates over the past 50 years and providing a gateway to use of combustible tobacco. Hypnotherapy smoking cessation Others view e-cigarettes as a disruptive technology that has the potential to make tobacco smoking obsolete, add to the therapeutic options for treatment of tobacco dependence, and provide public health benefits for years to come.

These divergent views were reflected in open letters sent to the World Health Organization last year, with one group of public health experts emphasizing the potential benefits and harm reduction of e-cigarettes and the other emphasizing the risks to youth and urging more caution.

3 benefits of quitting smoking Although the debate continues, there is limited scientific evidence to support proponents on either side. Smoking cessation training and research programme One major challenge to researchers is the rapidly changing technology in e-cigarettes that frequently outpaces efforts to study them.

Nevertheless, the popularity of e-cigarettes continues to rise, particularly among youth. Benefits of quitting smoking cold turkey The most recent Centers for Disease Control and Prevention report showed e-cigarette use among middle and high school students increasing, with use tripling between 2013 and 2014 (1.1% to 3.9% for middle school students, and 4.5% to 13.4% for high school students). Smoking cessation new drug 1 Over this same time period, tobacco cigarette use dropped from 15.8% to 9.2%. What is the best smoking cessation product This may argue against a gateway effect (i.e., moving from e-cigarettes to smoked tobacco), at least at the current time. Smoking cessation by hypnosis Whether these trends will continue remains to be seen.

As use and knowledge of these products increases among adults, questions posed to health care providers regarding the utility of e-cigarettes for smoking cessation will likely become increasingly common. Uspstf smoking cessation guidelines With respect to e-cigarette efficacy in promoting smoking cessation, data are beginning to trickle in, but the evidence remains unclear. Smoking cessation laser therapy Multiple survey studies have suggested that at least some smokers have had success in quitting or reducing smoking and attenuating craving and withdrawal symptoms. Smoking cessation specialist training 2,3 The most recent Cochrane meta-analysis evaluating e-cigarette data for smoking cessation was notable for how few studies it contained. Laser smoking cessation nj 4 Their review identified just 13 completed studies; two were randomized controlled trials and 11 were cohort studies. Smoking cessation counseling template The authors rated the overall quality of evidence as “low” or “very low” and suggested that further research will greatly influence effect estimates. Cessation of smoking Randomized Controlled Trials

The ASCEND trial was conducted in New Zealand and randomly selected 657 tobacco smokers who wanted to quit smoking to one of three conditions for 12 weeks: nicotine e-cigarette (16 mg/ml cartridge), non-nicotine e-cigarette, or nicotine patch. Quitting smoking by hypnosis 5 Carbon monoxide–validated quit rates at 6 month follow-up were unexpectedly low in all groups and not statistically different (7.3%, 5.8%, and 4.1% in the nicotine e-cigarette, nicotine patch, and placebo e-cigarette groups, respectively). Smoking cessation hypnosis seminars There was a noteworthy difference in the proportion of smokers who reduced cigarette consumption by 50% or more between the e-cigarette and patch users (57% vs. Smoking cessation groups 41%, relative risk [RR] 1.41, 95% CI [1.20, 1.67]).

The ECLAT trial was conducted in Italy and randomly selected 300 tobacco smokers who did not intend to quit smoking to one of three conditions: fixed-dose nicotine e-cigarette (7.2 mg/ml) for 12 weeks, variable-dose nicotine e-cigarette (7.2 mg/ml for 6 weeks, then 5.2 mg/ml for 6 weeks), or non-nicotine e-cigarette for 12 weeks. Benefits of quitting smoking and drinking 6 One-year abstinence rates were higher in the two nicotine e-cigarette groups (13% and 9%) compared with the placebo e-cigarette group (4%), but this difference was not significant. Health benefits of smoking cessation timeline Nicotine e-cigarette users showed a trend that was not statistically significant (25.5% vs. Smoking cessation guidelines 2011 16%, RR 1.30, 95% CI [0.70, 2.44]) toward reducing smoking consumption by 50% or more compared to the placebo group of e-cigarette users. Level 2 smoking cessation training Limitations

In combining the data from the two studies, nicotine e-cigarette use was associated with higher abstinence rates than placebo e-cigarette use (RR 2.29, 95% CI [1.0, 4.96]) and increased likelihood of reducing cigarette consumption by at least 50% (RR 1.31, 95% CI [1.02, 1.68]), but these effects were relatively small. Laser treatment for smoking cessation 4 Importantly, these trials had several limitations. What does a smoking cessation nurse do First, they were single-center studies and used early-generation e-cigarette products that are likely now considered obsolete. Smoking cessation antidepressant drugs Nicotine delivery from the e-cigarette was likely low, if present at all, and guidance for use of the products was limited. Free smoking cessation hypnosis downloads Second, low levels of behavioral and pharmacologic support were provided, and the ECLAT study involved only individuals who were not motivated to quit. Drugs for smoking cessation Third, because of unexpectedly low overall quit rates in the ASCEND trial, the sample size may have been underpowered to detect differences between groups. Smoking cessation drugs canada Advising Patients on E-Cigarette Use

ASCO and the American Association for Cancer Research recently issued a joint statement on electronic nicotine delivery systems. Smoking cessation benefits 2,3 The statement concluded that there are currently insufficient safety and efficacy data to recommend e-cigarettes for use by the general population or for patients with cancer for smoking cessation. Benefits of smoking cessation Other key recommendations in the statement included: (1) additional research on e-cigarettes, including assessment of health impact, understanding patterns of use, and determining what role e-cigarettes have in tobacco smoking cessation; (2) product regulation at the federal, state, and local level to ensure appropriate reporting of product ingredients, childproof caps on liquids, and warning labels on products and their advertisements; (3) prohibition of child-friendly flavors; and (4) prohibiting e-cigarette use in places where tobacco smoking is prohibited.

Given the limited evidence available, what should we tell our patients who want to use e-cigarettes as a means to quit smoking tobacco? First and foremost, we should praise the patient for expressing interest in quitting smoking, and we must not discourage a quit attempt, regardless of whether we agree with the patient’s approach.

Second, we should educate patients about the U.S. Laser for smoking cessation Food and Drug Administration–approved therapies for tobacco dependence that are proven to be effective, and we should strongly recommend these treatments as first-line: nicotine replacement therapy (patch, gum, lozenge, inhaler, and nasal spray), varenicline, bupropion, and various combinations of these medications. Definition of smoking cessation We should inquire about prior experiences patients have had with these approved therapies, and we should try to identify and remove previous barriers to treatment. National smoking cessation With adequate dosing and the combination of multiple medications, patients who had previous unsuccessful attempts to quit using approved therapies may, in fact, respond to approved therapy and achieve abstinence. What is the best smoking cessation aid Behavioral counseling should also be added to the patient’s treatment plan whenever possible, as the combination of behavioral and pharmacotherapy is superior to either modality alone.

Third, we must identify patients who have truly not had success with approved therapies during multiple quit attempts, who are adamantly unwilling to use them, or who insist on e-cigarette use. Laser smoking cessation vancouver We must educate these patients about the currently limited state of knowledge about e-cigarettes, while still emphasizing that quitting tobacco smoking is the highest priority. Cold laser smoking cessation We should inform these patients that e-cigarettes are not harmless and are not currently regulated by the U.S. Laser smoking cessation treatment Food and Drug Administration. Smoking cessation training nhs We must also emphasize that e-cigarettes have not been around long enough to know the long-term effects, nor has there been sufficient evidence to establish their efficacy in promoting smoking cessation. B c smoking cessation program With those caveats, it is reasonable to support a patient’s attempt to quit tobacco smoking using e-cigarettes in specific circumstances. Quit smoking cessation For instance, patients may come to you having initially quit smoking tobacco by using e-cigarettes. Benefits of quitting smoking after 3 years In such a case, it is important to praise the patient, and to advise them on weaning off of the e-cigarette, which they can begin doing by gradually lowering the e-cigarette’s nicotine content. Quitting smoking hypnosis effectiveness Although the ultimate goal is making our patients completely smoke and vape free, we must always emphasize that abstinence from tobacco smoking is the highest priority.

About the Authors: Dr. Benefits of quitting smoking now Baldassarri is a research and clinical fellow in Pulmonary and Critical Care Medicine at Yale School of Medicine. What does smoking cessation mean Dr. Quit smoking cessation nation Herbst is Ensign Professor of Medicine (Medical Oncology) and Professor of Pharmacology and chief of medical oncology at Yale Cancer Center and Smilow Cancer Hospital at Yale-New Haven. Smoking cessation hypnosis audio He is also the associate director for translational research and translational working group leader, Thoracic Oncology Program, at Yale Cancer Center. Best smoking cessation programs Dr. Smoking cessation therapy Toll is associate professor of Public Health Services and chief of Tobacco Cessation and Health Behaviors of the Hollings Cancer Center at the Medical University of South Carolina and lecturer in psychiatry at the Yale School of Medicine.