LAUSR

According to global tobacco control, nine out of 28 European Union countries have legislated Electronic cigarettes (ECs) as medicines or consumer products. Furthermore, several countries have licensed ECs to be prescribed as medicines. Nevertheless, no EC medical device is currently available in the market. First-generation ECs devices deliver less nicotine than late-generation ones. These contain larger liquid reservoirs and higher voltage batteries and can deliver as much nicotine as conventional cigarettes. As the EC technology evolves rather rapidly, research studies may be easily outdated once a new EC product has been launched. An illustrative example is the randomized trial led by Hajek et al. in the United Kingdom (UK) and recently published in the prestigious NEJM. Participants were smokers motivated to quit recruited from the UK stop-smoking services. Smokers were randomized to either use (i) combined Nicotine Replacement Therapy (NRT) products of their choice or (ii) to switch to an e-cigarette starter pack. Notably, during the trial, there was a need to substitute the EC device because it was discontinued from the market. The limitations of this trial have been discussed elsewhere. However, it is worthy to highlight that three quarters of the participants had previously used NRT (74.9%), while less than half (41.5%) had used ECs. Most UK smokers have already attempted to quit smoking. This may explain the low 1-year abstinence rates, both in the EC arm (18%) and in the NRT arm (9.9%). Moreover, it should be highlighted that daily adherence to NRT was rather low (10.3%; n = 46) and it was monitored only for a short period (4 weeks). Information on combined NRT medication (schedule and dosing) is lacking in the manuscript. Nevertheless, 44 patients on NRT achieved smoking abstinence at one-year follow-up (9.9%). Robust research is the fundament of smoking cessation national guidelines. They clearly state that the best treatment is a combination of behavioural support and medication. More intensive support and follow-up over time are crucial to achieve the best success rates.