Lung cancer

TSANZ says new evidence strengthens case against vaping for smoking cessation

Wednesday, 25 Nov 2020


Respiratory experts have urged parliament not to ease access to electronic cigarettes, saying new evidence has confirmed that vaping has little benefit in tobacco smoking cessation and harms the lungs.

Professor Matthew Peters, Professor of Respiratory Medicine, Macquarie University, Sydney, has told a parliamentary inquiry into tobacco harm minimisation the ‘plausible’ assumption that e-cigarettes would be effective at in helping smokers quit has now been shown to be untrue.

The former president of TSANZ said papers released in the last few weeks – such as the ITC Four Country Smoking and Vaping Survey – show that vaping does not improve rates of discontinued smoking.

And a six year follow up study of smokers by Italian researchers has found no difference in smoking-related events and markers of general health between those who continued to smoke, dual users and those who quit smoking after switching to vaping.

But of equal concern is the finding that vaping may add to harms of smoking through dual use, said Professor Peters, who is Co-Chair of the TSANZ Electronic Cigarettes Working Party.

He noted that a “massive review” by Tom Wills of studies that covered two million people found that electronic cigarette use increased the risks, symptoms and complications of asthma and COPD by 39% to 49%.

“So it is clear in terms of the health harms we are talking about the safest option is to be a nonsmoker and a nonvaper,” he said.

“However, in Australia and elsewhere the most common pattern is dual use. This is not harm reduction. Dual use is a harm accentuation. That is now clear. Theory has been replaced by evidence.”

Professor Peters added that while some smokers were able to quit while using e-cigarettes, they should only be seen as a last resort.

“The Thoracic Society believes that smokers who failed standard approaches and would only countenance a quit attempt in conjunction with electronic cigarette use should be able to do so, but with a defined product that is proven to be safe and effective,” he said.

“Outside this particular construct, some of these which were once assumed or considered plausible are now untrue: that e-cigarettes would be effective at a community level in helping smokers quit; that, by commencing electronic cigarettes in parallel with smoking, a smoker might be launched on a pathway to smoking cessation; that using e-cigarettes after smoking cessation would prevent relapse; and that switching in total or in part would lead to harm reduction.”

He said that advocates of e-cigarettes could not deny use was increasing among young people, particularly with the flavoured products being marketed.

“[They] should spend more time talking to parents, schoolteachers and school counsellors. I have with me  … a sample of four beautiful products—very berry, orange soda, mango and julep—all seized from a year 12 formal at a prominent Sydney school last Thursday. Parents and teachers will tell you this is dramatically increasing. Teachers do not need this in this year of COVID.”

The inquiry heard from several other healthcare leaders, including AMA president Dr Omar Khorshid, who said they did not support a harm reduction role for e-cigarettes.

However some leading figures in tobacco control research, such as Professor Ron Borland, of the University of Melbourne, said they supported a limited role for vaping in smoking cessation.

Professor Borland said he did not believe there was a gateway theory about vaping as encouraging young people to start smoking, and there was an unmet need for lower risk alternatives to tobacco smoking for the many people who still can not quit using current nicotine replacement products.

“It appears to me that we are not going to solve the problem without the use of better pharmacological aids, and it’s my view at the moment that the most promising of those available at the moment are some of the new vaping products. Currently, they’re not good enough to switch the majority of smokers away from smoking, but they clearly are helping more than previous interventions have been able to,” he said.

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