09 Oct

New Australian Trial Will Test E-Cigarettes

Although they appeared on the Australian market about six years ago, it is only now that the first Australian clinical trial of electronic cigarettes as a quit-smoking tool has been announced. While they are popular with users, the government and a number of public health experts are cautious about electric cigarettes.

The e-cigarette is a battery-operated device that is used to quit smoking. It simulates the effect of tobacco smoke by heating up a liquid which turns to vapour and is then inhaled by the user. Some models look exactly like a real cigarette, but many are larger and of a different colouration.

Even though electronic cigarettes have not been approved as a therapeutic product, they are legally available in Australia, and are popular with people wishing to quit smoking.

Whereas in the United Kingdom where electric cigarettes are included in official quit smoking guidelines, the Australian federal government does not support their use as a quitting aid because they have not yet been evaluated by the Therapeutic Goods Administration.

Recently the federal Department of Health and Ageing announced that it had “commissioned a regulatory impact statement on options for further regulation of electronic nicotine delivery systems (including electronic cigarettes) and smokeless tobacco products” [1].

Some public health experts have also expressed their concern about e-cigarettes. Dr Steve Hambleton of the Australian Medical Association said that he was concerned about the insufficient evidence of the benefits of electric cigarettes, the lack of regulation, and the possibility that they might serve as an “entry into smoking not necessarily as an exit from smoking” [1].

Similarly, Professor Simon Chapman, a lecturer in public health at the University of Sydney, said that e-cigarettes which mimic the “smoking performance” of cigarettes might reinforce the appeal of smoking [1].

Even so, the scientific research on the effectiveness and safety of electronic cigarettes is promising. In August 2012, the Onassis Cardiac Surgery Centre in Greece reported that it had found that electric cigarettes had no adverse effect on the functioning of the cardiovascular system. One of the researchers, Dr Konstantinos Farsalinos, stated that “substituting tobacco with electronic cigarettes may be beneficial to health” [2]. An article published in the September 2012 issue of the journal Addiction reported that e-cigarettes enhanced quitting motivation, lowered cravings for tobacco cigarettes, and greatly lowered the exposure to toxins in non-smokers [3]. Another study, whose results were published in the BMC Public Health journal in 2011, found that there was a substantial decrease in cigarette consumption in people who used electric cigarettes over a six month period. More than half of the 40 experiment participants either quit smoking altogether or more than halved their cigarette consumption [4].

Now it seems that the Australian government wants the facts about e-cigarettes. Dr Coral Gartner, a research fellow at the Centre for Clinical Research at the University of Queensland, will soon commence a federal government-funded trial with 1600 smokers to test the effectiveness of e-cigarettes as a long-term substitute for tobacco cigarettes.
Dr Gartner rejected calls to ban electronic cigarettes, but argued that they should be regulated with the same restrictions as tobacco cigarettes, because the quality and safety of different devices was highly variable.

“If a large enough proportion of the smoking population find them to be an acceptable substitute, it might be possible to encourage smokers to move to e-cigarettes with the longer-term aim of phasing out conventional cigarettes, which are the most harmful nicotine product and kill half of all long-term users,” she said [1].

[1] Asher Moses, “Experts wary of e-cigarettes as test run looms”, The Sydney Morning Herald, 4 March 2013.
[2] Dr Konstantinos Farsalinos, “Electronic cigarettes do not damage the heart: First-hand smoke, second-hand smoke or electronic cigarettes”, 2012 European Society of Cardiology Congress, 25 August 2012.
[3] Wagener T L, Siegel M & Borrelli B (2012) Electronic cigarettes: Achieving a balanced perspective, Addiction, Volume 107, Issue 9, 1545-1548.
[4] Polosa R, Caponnetto P, Morjaria J B, Papale G, Campagna D & Russo C (2011) Effect of an electronic nicotine delivery device (e-cigarette) on smoking reduction and cessation: A prospective 6-month pilot study, BMC Public Health, Volume 11: 786.