The buzz surrounding e-cigarettes is loud and confusing. While the manufacturers of these products — and some health professionals as well — tout them as a way to help people quit smoking, others say the science just isn’t there to make that recommendation.
A recent study out of Harvard Medical School suggests proceeding with caution before adding e-cigs to the stop smoking arsenal. When researchers compared patients in a stop smoking study who did and did not use these products, they found the quit rate was significantly higher among those who didn’t — 27 percent vs. just 10 percent.
What do respiratory therapists tell their patients about e-cigs? We asked, and you answered.
Just say no
Most therapists we talked to came down squarely against any use of e-cigs in tobacco cessation.
“We do not use them nor have we even considered them as a healthy alternative,” said Michele Hale, BEd, RRT, CPFT, from Fisher-Titus Medical Center in Norwalk, OH. “We are trying to change behaviors, and feel this is not a choice that promotes best practice for our patient’s welfare.”
Martine Eon, BS, RRT, RRT-NPS, RPSGT, a lung health specialist with MaineHealth in Portland, ME, agrees.
“I have not seen one well-done study demonstrating that e-products were an effective tool for tobacco independence,” she said. “So no, I would not recommend them for this purpose.”
As is the facilitator of the Freedom From Smoking program at Baptist Health in Little Rock, AR, Rita Newman, BA, RRT, NCTTP, never recommends e-cigs to her patients, citing the lack of science supporting the practice and reports of pneumonia from inhaling the water vapor and metal flecks from the battery that heats the fluid, which can be seen on chest x-rays.
She’s also concerned about reports suggesting people who use e-cigs are more likely to become dual users—e-cigs plus traditional cigs.
“I definitely do not recommend using e-cigarettes to help quit smoking,” Newman said.
Chrissy Acker, RRT, from Northwest Texas HealthCare System in Amarillo, TX, echoes those sentiments. She never recommends e-cigs to her patients, and if they are already using them, she tries to help them see why they shouldn’t.
“As a respiratory therapist, I have had patients shut down and end up on mechanical ventilation from using them,” Acker said.
Judy Kochmanski, BSRC, RRT, works in home care through a nursing agency in New York and was selected to be a part of their tobacco cessation program, which also uses Freedom From Smoking.
“We had a pharmacist come and talk about chemicals in e-cigs and how they are unregulated and they include many bad chemicals beyond nicotine, including unregulated amounts of formaldehyde for some brands,” she said. “Needless to say we do not recommend the use of e-cigs for quitting.”
Robert Johnson, MS, RRT, respiratory care manager at the University of Alabama Hospital in Birmingham, offers a very practical reason why no one should be initiating e-cigs with patients who are still in the hospital.
“We were just talking about this question yesterday in response to EC.02.01.03 EP4, ‘Smoking materials are removed from patients receiving respiratory therapy,’” said Johnson, referring to the new Joint Commission standard. “I brought up my concerns about any device that burns or heats up the delivered substances.”
A limited role
While the prevailing opinion is no, never ever use e-cigs, a few of the therapists we spoke with do see a very limited role.
Michael Hess, BS, RRT, RPFT, chronic lung disease coordinator at Western Michigan University in Kalamazoo, says the e-cig question comes up fairly frequently in discussions he has with his patients seeking to kick the habit.
“I’m a firm believer that knowledge is power, so when they ask, I tell them the truth: We don’t know what the long-term effects are, there’s no solid evidence that they can help people quit, and there’s new data coming out all the time that is often contradictory to whatever study came out the week before,” Hess said.
But he does consider them as a therapy of last resort in patients who have failed to quit again and again using proven methods like nicotine replacement therapy (NRT), counseling, and cognitive behavioral therapy.
When he does, he follows guidance from the American Cancer Society (ACS), which has issued a position statement saying that switching to e-cigs is preferable to continuing with traditional cigarettes. Also per the ACS, he stresses to his patients that they must make a full switch rather than continue to use both products at the same time.
“Once that’s done, we start talking about titrating the nicotine dose and tracking ‘puffs,’ as people often tend to just do a few sets of puffs and then move on,” Hess said. ”This self-limiting effect may well be part of the risk-mitigation feature of e-cigs.”
Harriette Janssen, RRT, and her colleagues at Ascension St. Elizabeth Hospital in Appleton, WI, where she serves as coordinator of cardiac and pulmonary rehab, recently met with the 1-800-QUIT-NOW group, which receives tax dollars in 28 states to help people quit smoking.
“Nationally, they have pretty successful outcomes in that 23 percent of referrals are actually smoke-free one year later,” she said. The program, which offers free NRT and support information worth more than $200 to people who make a quit attempt, has verbiage on e-cigs that her hospital plans to follow.
“We will begin using their recommendation of, ‘the long-term effects of e-cigarettes are currently unknown, however, they may be safer than the 6,000 chemicals that are in tobacco products,’” Janssen said.
Susan Rinaldo Gallo, MEd, RRT, CTTS, FAARC, an Epic training specialist at Duke Health in Durham, NC, says her hospital forbids the use of e-cigs for inpatients. Clinicians recommend NRT and provide education on its proper use instead, and they advise patients to continue on NRT when they go home too.
But she does see a role for these products outside of the acute care hospital.
“I think e-cigs should be used in an outpatient program if the patient wants them or if other methods have failed,” she said. “E-cigs decrease the harm as compared to traditional cigarettes.”
Clearly, more research is needed to determine what value — if any — e-cigarettes add to tobacco cessation. Until then, the takeaway from these RTs is, proceed with caution — if you decide to go there at all.
Smoking Cessation Resources
Are you looking for resources to help your patients stop smoking? Check out the AARC’s Tobacco Resources for tips and tools.