MILAN — Use of electronic cigarettes as a tool to quit smoking conventional cigarettes increased threefold between 2012 and 2014 among surveyed Europeans, while use of medically approved smoking cessation therapies declined, researchers reported here.

The percentage of smokers using conventional nicotine replacement therapy (NRT) declined from 14.6% to 12.2% from 2012 to 2014, according to the surveys of more than 10,000 Europeans. At the same time, smoking cessation attempts involving a healthcare professional or smoking cessation clinic visit declined from 6.7% to 5.0% of respondents.

 

But experimentation with e-cigarettes for the purposes of quitting smoking increased markedly, with 11% of smokers reporting it in 2014, compared with 3.7% in 2012, said Constantine Vardavas, MD, PhD, of the University of Crete, Greece.

Vardavas told MedPage Today that the low rate of healthcare professional involvement is a “significant concern.”

Vardavas was one of several researchers to present studies examining e-cigarette usage and safety this week at the European Respiratory Society International Congress.

In a separate study, Vardavas and colleagues analyzed more than 100 e-cigarette liquids commonly sold in Europe, finding all but one of the products to have at least one substance classified by the United Nations as a potential health risk.

Roughly 25% of samples contained cyclopentanolone and 9% contained a-ionone. Both have been classified as chemicals that may cause allergy or asthma symptoms or breathing difficulties if inhaled. Menthol was present in 43% of the samples and ethyl vanillin was present in 16.5%. Both additives are classified as “able to cause respiratory irritation,” Vardavas noted.

 

A recent European Commission directive on electronic cigarettes noted that “except for nicotine, only ingredients are used in the nicotine-containing liquid that do not pose a risk to human health in the heated and unheated form.”

“We think the respiratory irritants we found may be a breach of this legislation,” Vardavas said. “We also think users should be aware that e-cigarettes may contain respiratory irritants.”

A third presentation, reporting results from a survey of more than 30,000 randomly selected adults in Sweden, bolstered earlier findings showing users of e-cigarettes to be more likely to be current cigarette smokers than former or never smokers.

About 10% of respondents said they only smoked conventional cigarettes, while 0.6% said they only used e-cigarettes, and 1.2% said they used both.

E-cigarette use was more common among current cigarette smokers, with around 10% reporting current vaping. Just 1% of former smokers and 0.6% of non-smokers surveyed reported current e-cigarette use.

Not surprisingly, cigarette smokers and dual smoker/vapers were the most likely to report respiratory symptoms, including persistent cough, productive cough, and wheezing.

Just over 25% of non-smokers reported experiencing respiratory symptoms, compared to 34% of e-cigarette-only users, 46% of cigarette smokers, and 56% of dual cigarette and e-cigarette users.

Behavioral scientist Linnea Hedman of Sweden’s Umea University, who presented the findings, said the data on smoking and e-cigarette dual users could be interpreted in several ways.

“It could be that they’re turning to e-cigarettes when they’re in places like cafes and restaurants where they cannot smoke conventional cigarettes, or it could be that they’re using e-cigarettes in the hopes of quitting smoking,” she noted.

In a press briefing held Sunday afternoon at the ERS conference, Hedman said the findings from her research team and others suggest that dual users may not be all that interested in using e-cigarettes to give up smoking.

 

“E-cigarette use was most common among (current) smokers,” she said, adding that while e-cigarettes are increasingly being promoted for smoking cessation, many current smokers may be using them instead for convenience.

She added that the newly reported data on e-cigarette use does not address the long-term impact of greater e-cigarette use.

“The question remains, will e-cigarettes increase the burden of respiratory conditions in the future or will they contribute to smoking cessation?” she said. “Only prospective studies following this group of individuals will be able to answer that question.”

• Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner