How to Stop Smoking: A Look at the Cochrane Evidence

BY ROBERT WALTON

Vape to quit?

The evidence is stacking up for vaping as an effective way of giving up tobacco. A Cochrane Review Electronic cigarettes for smoking cessation (published September 2021) showed that people using a vape device were probably more likely to stop smoking than those using more conventional forms of nicotine replacement therapy such as sprays, gum, patches or lozenges.

Nicotine replacement therapy has for many years been the gold standard for smoking cessation against which all new treatments were measured. Many researchers were surprised that vaping nicotine turned out to be a more effective way of stopping smoking than other commonly used treatments. Some thought that people would continue to vape as often as they smoked, however this doesn’t seem to be the case. In fact people find vaping helpful for stopping smoking perhaps because it reproduces in part some of the actions and sensations involved in smoking behaviour which the conventional forms of nicotine replacement do not.

Reassuringly the review also found no evidence of a difference in frequency of side effects in those using vape devices compared to people on conventional nicotine replacement although it is not known whether problems may arise from vaping over the longer term.

Nicotine replacement – patches, gum and lozenges

They’re starting to look old fashioned now compared to the trendy new vape devices, but there’s high quality evidence that they work. A Cochrane Review Nicotine replacement therapy versus control for smoking cessation (published May 2018) with information from more than 60,000 people shows that any form of nicotine replacement therapy is better than placebo for stopping smoking. The effects were pretty consistent across all the different forms of nicotine replacement therapy with the rate of quitting about 50% higher with nicotine replacement.

Side effects from the treatment were generally minor such as irritation from the nicotine patches and serious side effects were very rare overall although chest pain was more common in people using nicotine replacement therapy. For conventional forms of nicotine replacement therapy we have long term data on safety including for people at high risk of unwanted effects such as those who already have heart disease and for pregnant women. Although its likely to be very much safer than smoking, vaping hasn’t been around long enough to assess side effects of long term use. In addition to their longstanding track record for satety, patches and lozenges are flexible and can be used at work and in social settings where vaping would not be possible.

In these difficult times another benefit of traditional nicotine replacement therapy is that it remains free of charge in the UK through the NHS smoking cessation services whereas vaping devices and liquids need to be purchased from dwindling household budgets.

Smoking and mental health

Smoking may make you feel better while you’re having a cigarette, but there is new evidence that kicking the habit probably slightly improves your mental health.

A Cochrane Review Smoking cessation for improving mental health (published March 2021) looked at levels of anxiety and depression in people who successfully stopped smoking compared with those that continued. The reviewers found that there was probably a small but important reduction in symptoms. The size of the benefit in mental health is about the same as would be gained by taking antidepressant medication (you can hear about this in the Cochrane Podcast: Does stopping smoking improve mental heath? And it was particularly interesting to see that mental health probably improved after stopping smoking both in people who had problems initially and also in those that didn’t. Or thought they didn’t!

Withdrawal from tobacco may be tough in the first few weeks but there’s light at the end of the tunnel.

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This post was previously published on evidentlycochrane.net and under a Creative Commons license CC BY-ND 4.

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