A new study has shown that when combined with one-on-one behavioural therapy, e-cigarettes are nearly twice as effective in helping people to quit smoking than relying on traditional nicotine-replacement products such as patches and gums.

The results of the new research, targeted at almost 900 long-term smokers seeking help from the NHS to quit the habit, has already been hailed as a landmark achievement by public health experts in the UK—many of whom now believe that e-cigarettes have already helped bring down the smoking rate and should be included in adult anti-smoking efforts.

“This study should reassure policymakers and health professionals -- mainly beyond the UK -- who have until now been hesitant to recommend e-cigarettes for smoking cessation on the basis that there was a lack of high-quality trial evidence,” said Jamie Brown, who serves as deputy director of the Tobacco and Alcohol Research Group at University College London.

“We need to help as many people as possible to give themselves the best chance of success by using aids like e-cigarettes each time they try to stop smoking,” Paul Aveyard, a professor of behavioural medicine at the University of Oxford, said in a response to the study.

However, there was less acceptance of the study results in the United States, as there is concern that the nicotine present in vaping devices is equally addictive and can lead to smoking habits in children.

“The US Food and Drug Administration has not found any e-cigarette to be safe and effective in helping smokers quit,” said Jennifer Hobbs Folkenroth, senior director of tobacco at the American Lung Association. “We only support methods that are FDA approved and regulated.”

Dr. Scott Gottlieb, FDA Commissioner, had recently announced a crackdown on what he termed an “epidemic” of e-cigarette use among teenagers—as there has been an increasing number of children in the United States who are becoming addicted to e-cigarettes.

“E-cigarettes have volatile organic compounds, cancer causing chemicals, and flavourings that have been linked to lung disease,” said Borelli, director at the Centre for Behavioural Science Research at Boston University.

“Let's not say e-cigarettes are a magic pill to help people quit smoking without having all of the information.”

Researcher at Queen Mary University of London, Professor Peter Hajek, led a randomised controlled trial to determine whether e-cigarettes—such as V2 Cigs UK—were a better tool to help peoplequit smoking than nicotine replacement therapy.

“E-cigarettes were almost twice as effective as the 'gold standard' combination of nicotine replacement products,”said Professor Hajek in a statement.

“Health professionals have been reluctant to recommend their [e-cigarette] use because of the lack of clear evidence from randomized controlled trials. This is now likely to change.”

Their research was published in the New England Journal of Medicine and the subjects—mostly middle-aged smokers—were randomly assigned to two groups.  One group received the traditional nicotine replacement of their choice, such as patches, lozenges, sprays, inhalators, gum or a combination of products for three months. The second group received an e-cigarette starter pack and received adequate encouragement to purchase future supplies, selecting e-juice strengths and flavours of their own choice.

All the groups were also given one-on-one behavioural support each week for four weeks and received biochemical tests at the end of the year to ensure they had quit smoking. The results at the end of a one-year abstinence period showed that 18%of the vapers (79 people) were no longer smoking, in comparison to about 10% of the others (44 people) in the traditional nicotine replacement group.

This study is the first trial to make a comparison of licensed quitting aids with e-cigarettes, which are not licensed for medical use—therefore, testing the “efficacy of modern e-cigarettes in helping smokers quit”.  According to the lead researcher, he believes that the results could change the advice smokers are given.

“Although a large number of smokers report that they have quit smoking successfully with the help of e-cigarettes, health professionals have been reluctant to recommend their use because of the lack of clear evidence from randomised controlled trials. This is now likely to change,” Hajek said.

For those using e-cigarettes, they experienced a much lower rate of early problems smokers experience when trying to quit the habit, such as irritability and inability to concentrate. However, vapers reported more throat and mouth irritation, while nicotine replacement therapy users reported more nausea.

Additionally, nearly 80% of those using e-cigarettes were still vaping at the end of the year, whereas about 9% of the other group were still using traditional nicotine replacement therapy.

“I think one can see it as potentially problematic and also potentially beneficial,” said Hajek. “There are both sides to it and I think the beneficial side is stronger. The negative one is they are still using something, and e-cigarettes are unlikely to be totally safe.”

“They are unlikely to have more than about 5% of the risks of smoking but there is still some risk and if using it for one year means that they are using it for 30 years and if that generates some health risk then they would be better off not using it.”

“Now the positive aspect is that we know from studies of nicotine replacement therapy that some heavy smokers need that crutch for longer to protect them from relapse.”

“They will get quite a bit of benefit in that they will avoid feeling miserable and having urges to smoke and feeling there is something missing in their life and they will not put on weight, which these types of heavy smokers do, which puts them at risk of diabetes and so on,” he continued.

Many scientists in the UK and Public Health England involved in tobacco research have applauded the study, noting the potential of e-cigarettes to help people quit.

“This landmark research shows that switching to an e-cigarette can be one of the most effective ways to quit smoking, especially when combined with face-to-face support. All stop-smoking services should welcome smokers who want to quit with the help of an e-cigarette,” said Martin Dockrell, tobacco control lead at Public Health England.

“Smokers trying to quit have been choosing e-cigarettes over other types of support for some time. The research indicates that health professionals and Stop Smoking services should reach out to smokers who want to use e-cigarettes and support them in making this life-changing step,” said Prof Ann McNeill from Kings College London.

According to Professor Robert West from University College London the study was “of huge significance. It provides the clearest indication yet that e-cigarettes are probably more effective than products such as nicotine gum and patches. It fits previously published trend data showing an increase in quit success rates in England and the US linked to more people using e-cigarettes.”

“They biochemically verified smoking outcomes. They did rigorous data analysis, they had long-term outcomes. They let people choose their e-liquid, they let people choose their nicotine replacement therapy. And it was conducted in the real world,” said Borrelli.

However, they all agreed that more research is necessary into the long-term potential harms of e-cigarettes usage.