New evidence published in the Cochrane Library demonstrates that using e-cigarettes to stop or reduce smoking found high certainty that quit rates were higher in people than those who used nicotine replacement therapy. There was moderate certainty evidence that nicotine e-cigarettes are more effective than zero nicotine e-cigarettes.

What is the Cochrane Tobacco Addiction Review Group?

The work of the Cochrane Tobacco Addiction Review Group are views and opinions expressed of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, the NHS, or the Department of Health. 

Cochrane gathers and combines the best evidence from research to determine the benefits and risk of treatments by systematically reviewing the available evidence with a strong emphasis on quality assessment. The methods are considered gold-standard and help healthcare providers, patients, carers, researchers, funders, policy makers and guideline developers improve their knowledge and make decisions. 

What is Nicotine Replacement Therapy?

Nicotine Replacement Therapy, or NRT, is a nicotine dependence treatment pathway that helps people stop smoking. It is one of several treatments available to you according to the NHS that can help beat addiction and reduce withdrawal symptoms. It is described as a medicine that provides the user with a low level of nicotine without tar, carbon monoxide, and other harmful substances present when tobacco is combusted and inhaled. 

It is argued to help reduce withdrawal effects like mood swings and cravings that can occur when you stop smoking. NRTs can come in many forms, such as skin patches, chewing gum, inhalers that look like plastic cigarettes, tablets, oral strips, lozenges, and even nasal or mouth sprays. 

There is no evidence that any single version of NRT is more effective than another, but there is good evidence that using a combination of NRT is more effective than a single product.

Who can use Nicotine Replacement Therapy?

The NHS state most people can use NRTs. These include adults and children over 12 years of age – although children under 18 should not use the lozenges without getting medical advice first, pregnant women – your doctor may suggest NRT if they think it would help you quit; read more about stopping smoking in pregnancy breastfeeding women – your doctor can advise you how to do this safely.

What studies have been made to-date in the Cochrane Library?

In a study representative of 22,052 that uses robust randomised controlled trials (RCTs) reported abstinence from cigarettes at six months or longer. There were 78 studies in total, of which 40 were RCTs. There were 34 studies conducted in the US and 16 conducted in the UK.  

How effective are nicotine e-cigarettes compared zero nicotine e-cigarettes?

The results found that an additional four quitters per 100 when comparing nicotine e-cigarettes to nicotine replacement therapy with high certainty evidence. This ultimately means that people who choose to use nicotine e-cigarettes, or vapes, are more likely to stop smoking for at least six months than using gum, strips, or patches and the like. 

How effective are nicotine e-cigarettes compared zero nicotine e-cigarettes?

There remains moderate certainty evidence that using e-cigarettes with nicotine increase quit rates at six months or longer when compared to zero nicotine e-cigarettes. In absolute terms, this could lead to an additional seven quitters per 100.

What else can be gleaned from the latest Cochrane Library update?

None of the included studies detected serious adverse events considered possibly related to e-cigarette use. The most commonly-reported adverse effects were mouth or throat irritation, headache, cough, and nausea, which tended to go away with continued use. There is no clear evidence of harm from nicotine e-cigarettes when used to quit smoking. To note, the longest follow-up was two years, and the overall number of studies was small.