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Editorial Smoking Cessation
The E-cigarette – a New Tool to Aid
Department of Chest Diseases, University of Liège, Belgium
T his editorial shows that, despite controversies in the public health community and among professionals regarding the role of
e-cigarettes as an aid to stopping smoking, and although the potential health risks of long-term use of nicotine are unknown, modern
devices should be regarded more as a solution than a problem. Clinicians, owing to the high morbidity and mortality of smoking
should include e-cigarettes as efficient tools to help smokers to quit smoking or at least as a substitute for cigarettes. Effort is needed to
improve knowledge about this tool.
Keywords Smoking cessation, e-cigarettes, tobacco harm
reduction Disclosure: Pierre Bartsch has no conflicts of interest to
declare in relation to this article. No funding was received
for the publication of this article.
Authorship: All named authors meet the International
Committee of Medical Journal Editors (ICMJE) criteria
for authorship of this manuscript, take responsibility
for the integrity of the work as a whole, and have
given final approval for the version to be published.
Open Access: This article is published under the
Creative Commons Attribution Noncommercial License,
which permits any non-commercial use, distribution,
adaptation and reproduction provided the original
author(s) and source are given appropriate credit.
Received: 31 January 2017
A new social phenomenon has occurred since the end of the first decade of the 21st century,
namely, the rise of the electronic cigarette (e-cig) also called the electronic nicotine delivery
system (ENDS). The two names are not strictly equivalent, as the latter implies the presence
As a lung physician confronted daily with the difficult challenge of smoking cessation, in this article,
I will consider only the nicotine-containing devices. This is a social issue as neither pharmaceutical
industry, nor the tobacco industry predicted that e-cigs would become so popular in the absence
of big advertising campaigns. The first models looked like cigarettes (cigalikes) and appeared more
as gadgets than as a possible tool for smokers wanting to quit smoking. The inventor, a Chinese
person named Hon Lik was nevertheless pushed to design a product delivering nicotine without
dangerous components, after witnessing his father dying from a lung cancer. We do not know if
this pharmacist and engineer was aware of Russel’s claim that ‘people smoke for nicotine but they
die from tar’. 1
Published Online: 14 April 2017
Citation: EU Respiratory & Pulmonary Diseases,
2017;3(1):19–20 Corresponding Author: Pierre Bartsch, Domaine
Universitaire du Sart, Tilman B35 4000, Liège, Belgium.
Health professionals were not the initiators of this way of stopping or reducing smoking, the
initiative came from the population of smokers itself. The Public Health community, all over
the world, was, and still is, very reluctant to endorse the practice. The ideological reason is an
opposition to the concept of harm reduction itself. Tobacco harm reduction (THR) is considered by
opponents as compromising smoking cessation constituting a gateway to smoking among non-
smoking adolescents. The real-world situation is the 80% failure of abstinence with the current
approved treatments of nicotine dependence in the general population. So if electronic cigarettes
are at least as efficient as nicotine patches for smoking cessation, we should utilise them for this
indication, if they are proven to be not at all, or much less dangerous for health, which seems to
be the case. 2
Many surveys show that a number of users who quit will continue to ‘vape’, which is considered
a safer way, not to smoke, but to vaporise nicotine. For those people, we are in the THR situation
A more scientific reason to contest the place of e-cigs in smoking cessation is still the absence
of large randomised controlled trials. The Cochrane Review on the subject 3 states that electronic
cigarettes may have the same efficacy as the nicotine patch, and with a short time use of up to
two years, not seeming to be deleterious for human health.
Today, if cigalikes (first generation e-cigarettes) are no longer regarded as nicotine substitutes, this
is not the case for the second and, mostly, third generation e-cigs, which deliver nicotine to the
brain almost as fast as a classical cigarette. 4 A population study of smokers, not using smoking
cessation help from health professionals (HP), showed a much better success with e-cigs, than
with nicotine replacement therapy (NRT) such as patches bought over the counter.
Therefore, when a HP is confronted to a smoker unable or unwilling to quit after using
licensed medicines, it is mandatory to encourage the use of last-generation electronic cigarettes.
This is a challenge not only for lung physicians, cardiologists, oncologists and other specialists,
TOU CH MED ICA L MEDIA