Chest physicians split on pros and cons of e-cigarettes

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Patients are asking their chest physicians about using e-cigarettes to quit smoking, but those physicians are divided about whether the products do more harm than good, according to a Yale-led study. The finding demonstrates the need for more research on e-cigarettes that will help physicians counsel their patients who smoke.

Since the invention of e-cigarettes in the early 2000s, experts have disagreed about their role in smoking cessation and reducing harms from smoking. While some experts believe that e-cigarettes are simply a tool for getting consumers — particularly youth — addicted to nicotine, others view them as a potential alternative for smokers who struggle to quit with traditional cessation therapies.

To get a handle on the opinion of chest physicians, Stephen Baldassarri, M.D., and his co-authors conducted a survey of members of the American College of Chest Physicians. The survey asked about the providers’ experiences with e-cigarette users and their opinion about the products.

Of the nearly 1,000 respondents, the vast majority, 88%, reported that their patients had inquired about e-cigarettes, and one-third said at least some of their patients use the products. “Physicians are likely to encounter this in their practice,” said Baldassarri, a clinical fellow in pulmonary medicine.

More respondents than not — 41% compared with 21% —disagreed with the notion that patients could improve their health by switching from tobacco smoking to e-cigarettes. However, the physicians were split about whether e-cigarettes promoted smoking cessation.

“Although very few of the respondents thought that e-cigarettes were more harmful than smoking, many were not convinced that switching from smoking to e-cigarette use would improve a patient’s health,” he noted.  “There was also a clear divide among the survey respondents regarding whether the products should be used as a smoking cessation aid.”

This divergence in opinion about e-cigarettes, which mirrors results from prior surveys, points to the need for more research. While most providers would agree that they do not want nonsmokers or youth adopting e-cigarettes, questions remain about the risks and benefits for traditional smokers.

“Further research into these products is going to be critical for providing the evidence base for physicians to make appropriate recommendations for their patients who smoke,” he said.

Other study authors are Geoffrey L. Chupp, Frank T. Leone, Graham W. Warren, and Benjamin A. Toll.

The study was supported by the Section of Pulmonary, Critical Care, and Sleep Medicine at Yale School of Medicine, and the National Heart, Lung, and Blood Institute.

Toll receives funding as an expert witness in litigation filed against the tobacco industry. Chupp received grants or speaking fees from NIH, Genetech, Glaxo Smith Kline, Astra Zeneca/Medimmune, Mannkind, and Boston Scientific. 

Citation: Journal of Smoking Cessation

Read the study.

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