It has also been shown that non-nicotine containing e-cigarettes can help improve the success of quitting attempts showing they are effective in maintaining the aspect of psychological addiction, whilst weaning off the physical addiction.

The recent Cochrane review by Hartmann-Boyce showed that nicotine containing e-cigarettes are better than nicotine free e-cigarettes for promoting cessation. Their use can increase the likelihood of quitting, but often simply leads to a reduction of cigarette use opposed to complete cessation.

Unfortunately, there may be some negative aspects to electronic cigarette use due to the constituents of the liquid which is ‘vaped’ during e-cigarette use. The glycerol and nicotine mix which is inhaled does contain toxic substances which are also found in cigarette smoke. These toxic substances are at a significantly lower concentration than in traditional cigarette smoke, meaning it: may be acceptable to view e-cigarettes as a ‘harm reduction’ device.

At this stage, the mechanism of action and safety of conventional NRT is better understood and should be recommended as the gold standard cessation aid by practitioners. It should be noted that electronic cigarettes may be of some benefit to smokers who are unwilling to quit.

Ultimately, more research is needed into these as a possible adjunct to cessation; however, until this point, electronic cigarettes have not been shown to invoke any serious adverse events.

To ensure we are giving patients gold-standard advice, e-cigarettes should not be viewed as a safe NRT, and only be advised as a risk reduction strategy. Users of electronic cigarettes should therefore be encouraged to eventually stop using them, but their use is (currently) believed to be preferable when compared to smoking conventional cigarettes.