BELLARMINE UNIVERSITY, LOUISVILLE, KY Electronic Cigarettes and Smoking Cessation Sarah Boone,...

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes and Smoking Cessation

Sarah Boone, Carolyn Little, Clay Owens, Jeremy Randolph, Genny

Tibbs

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Objectives

• Analyze Smoking in Kentucky

• List Methods of Smoking Cessation

• Acute Effects of Electronic Cigarettes

• Review the Evidence of Related Studies

• Compare Use of Electronic Cigarettes and Nicotine Patches

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Smoking in KY

http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2010/states/kentucky/

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Smoking in KY

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Smoking in KY

http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2010/states/kentucky/

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Smoking Cessation

• 80% of smokers who attempt cessation relapse within in first month of quitting

• 3-5% remain abstinent at 6 months (Polosa, BMC Public Health, 2011)

• Common Methods: – Electronic cigarettes – Nicotine Patches – Oral Medication – “Cold Turkey”

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes

Westenberger, FDA, 2009

P: Smokers

I: Electronic Cigarettes

C: Nicotine Patches

O: Smoking Cessation

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Acute Effects of E-Cigarettes

Vansickel, American Association for Cancer Research, 2010

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Acute Effects of E-Cigarettes

• 32 tobacco cigarette smokers

• Four products:– Own brand cigarette, “NPRO” electronic

cigarettes, “Hydro” electronic cigarettes, or sham

• Outcome Measures: – Heart rate, plasma nicotine content,

Tiffany Drobes Questionnaire of Smoking Urges Brief

Vansickel, American Association for Cancer Research, 2010

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Acute Effects of E-Cigarettes

• Results:

– Own brand increased plasma nicotine, CO concentration and heart rate

– NPRO EC, Hydro EC, and sham smoking did not

– Both EC exposed users to no nicotine or CO

– Both EC didn’t increase heart rate

– Both EC increased subjective ratings of acceptability

Vansickel, American Association for Cancer Research, 2010

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Acute Effects of E-Cigarettes

• Conclusion:

– Neither electronic cigarettes exposed users to measurable levels of nicotine or CO

– Both suppressed nicotine/tobacco abstinence symptom ratings

Vansickel, American Association for Cancer Research, 2010

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes & Smoking Cessation

Polosa, BMC Public Health, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes & Smoking Cessation

• Methods:

– 5 visits: baseline and four follow up visits at week 4, 8, 12, and 24

– Baseline Measurements: • Demographics and detailed smoking history • Level of carbon monoxide in exhaled breath

(eCO)

– 4 week supply of 7.4 mg nicotine cartridges given

– Max use of 4 cartridges/day

Polosa, BMC Public Health, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes & Smoking Cessation

Reducers Heavy Reducers

Quitters Smoking Failure

50% reduction in number of

cig/day compared to

baseline 

80% reduction in number of

cig/day compared to

baseline

Smoking abstinence at

24 weeks

< 50% reduction in number of

cig/day compared to

baseline

Polosa, BMC Public Health, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes & Smoking Cessation

• Results: – 50% reduction shown in 13/40 subjects– Combined sustained 50% reduction and

smoking abstinence in 22/40 (p≤0.001)• Conclusions:

– Reduction in cigarette smoking with e-cigarettes may increase motivation to quit

– Gradual reductions in cigarette smoking can increase cessation

Polosa, BMC Public Health, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Case Series on Smoking Cessation Utilizing E-cigs

Caponnetto, Journal of Medical Case Reports, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Case Series on Smoking Cessation Utilizing E-cigs

• Three chronic smokers (two male, one female)

• Severe dependence to nicotine– Fagerstrom Test of Nicotine Dependence

(FTND)– Exhaled Breath Carbon Monoxide

Concentration (eCO)

• Previous cessation efforts (patches & group counseling)

Caponnetto, Journal of Medical Case

Reports, 2011.

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Case Series on Smoking Cessation Utilizing E-cigs

• Results:

– Cessation status following the usage of E-cigs• No relapse 6 months following study

– Reduction in eCO– Variation in E-cig composition

• Regulation?

• Limitation – Small sample sizeCaponnetto, Journal of Medical Case Reports, 2011.

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Comparison: Nicotine Patch Therapy

Myung et al. 2007, Am J Health-Syst Pharm

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Comparison: Nicotine Patch Therapy

• Study:– Meta-analysis of studies investigating

efficacy of nicotine patches vs. placebo.

• Purpose:– Assess current literature– Determine an odds ratio for smoking

cessation Myung et al. 2007, Am J Health-Syst Pharm

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Comparison: Nicotine Patch Therapy

• Methods:– 16 RCT’s – Total subjects: 9,457

• 6,084 nicotine group• 3,373 placebo group

• Results of Meta-analysis:

Pooled OR (odds ratio) for 16 studies was 1.79

http://www.nyc.gov/html/doh/html/pr2007/pr036-07.shtml

Myung et al. 2007, Am J Health-Syst Pharm

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes for Smoking Cessation

Bullen, Nat Inst Health Innov, 2013

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes for Smoking Cessation: A Randomized Controlled

Trial

• Purpose:– To assess whether E-cigarettes containing

nicotine were more effective for smoking cessation than nicotine patches

• Methods:– 657 subjects were selected for the study– Randomized by computerized block

randomization– 4:4:1 ratio

Bullen, Nat Inst Health Innov, 2013

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes for Smoking Cessation: A Randomized Controlled

Trial

• Procedures:

– Subjects used respective smoking cessation products for 12 weeks before a specific “quitting day”

– The primary outcome measured was smoking abstinence six months after “quitting day”

– Verified by self-report and carbon monoxide measurement

Bullen, Nat Inst Health Innov, 2013

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Electronic Cigarettes for Smoking Cessation: A Randomized Controlled

Trial

• Results:

– Abstinence rates after six months• Nicotine E-cigarette 7.3%• Nicotine Patches 5.8%• Placebo E-cigarette 4.1%

– Study was underpowered due to low abstinence rates and could not conclude if E-cigarettes were superior to nicotine patches or placebo Bullen, Nat Inst Health Innov, 2013

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Summary Smoking Cessation

Electronic Cigarettes • Levels of nicotine or eCO

were reduced• Suppressed

nicotine/tobacco abstinence symptom ratings

• Highest rates of abstinence after six months

• Greater success rates with “rituals” of smoking

Nicotine Patch • Odds ratio for sustained

abstinence after 1 year: 1.79 (compared to placebo)

• Lowest rates of abstinence after six months

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Additional Resources

• Stop Smoking Classes Louisville – http://www.louisvilleky.gov/health/iwantto/

stopsmokingclasses.htm

• Norton Healthcare Smoking Cessation Program– http://www.nortonhealthcare.com/smoking

• Kentucky Cabinet for Health & Family Services – http://chfs.ky.gov/dph/mch/hp/tobacco.htm

BELLARMINE UNIVERSITY, LOUISVILLE, KY

ReferencesBullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N. Electronic cigarettes for smoking cessation: a randomised controlled trial. Nat Inst Health Innov. 2013; 13:1-9.

Caponnetto P, Polosa R, Russo C, Leotta C, Campagna D. Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series. Journal of Medical Case Reports. 2011; 5: 585.

Myung SK, Yoo KY, Oh SW, et al. Meta-analysis of studies investigating one-year effectiveness of trasdermal nicotine patches for smoking cessation. Am J Health-Syst Pharm.2007; 64: 2471.

Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health. 2011; 11:786-797. doi:10.1186/1471-2458-11-786.

Vansickel AR, Cobb CO, Weaver MF, Eissenberg TE. A clinical laboratory model for evaluating the acute effects of electronic “cigarettes”: nicotine delivery profile and cardiovascular and subjective effects. Amer Assoc Cancer Res. 2010; 19: 1945-1953.