E-cigarettes could help smoking cessation in hospitals

Friday, February 23, 2018

E-cigarettes could be helpful for smoking cessation in hospitals

Research published today in the New Zealand Medical Journal indicates electronic cigarettes, used as an alternative form of nicotine replacement, are well tolerated by alcoholics admitted to hospital for detoxification and could be helpful for curbing smoking during hospital stays.

The study, led by Dr Penelope Truman from Massey University’s School of Health Sciences, with community specialist detox nurse Moira Gilmour and physician Dr Geoffrey Robinson from the Capital and Coast District Health Board, carried out a survey of more than 40 patients at Kenepuru Hospital in Porirua, in two cohorts between 2013 and 2016.

Dr Truman says very similar reductions in smoking were observed, whether patients were offered electronic cigarettes or conventional nicotine-replacement therapies (NRT) such as patches or gum.

“This small acceptability trial showed no significant problems with the use of electronic cigarettes within a hospital setting and suggests they could be helpful in the management of patients who smoke,” Dr Truman says.

Alcoholics who were also smokers were offered the option of using an electronic cigarette as well as, or instead of, conventional nicotine replacement therapy to help them stop smoking while in hospital.

“The electronic cigarettes proved more popular than standard nicotine-replacement therapy and were at least as effective,” Dr Truman says. “Using electronic cigarettes for smoking substitution or reduction while in hospital is an option for improved patient management that should be explored further.”

The study groups were drawn from alcohol-dependent patients consuming a mean of 20 standard drinks per day, admitted for an expected five or six days for medically-supported alcohol withdrawal. These patients often present with a range of health issues related to their alcohol dependence, including liver disease, nutritional deficiencies and other organ damage.

“Depression and anxiety disorders are common in this group, which also has high rates of tobacco dependence. In this study, two groups of patients were recruited. The first [July 2013-April 2014] were offered standard nicotine-replacement therapy, such as patches and gum. They were asked to keep written records of their daily smoking and their use of NRT while they were in the ward and to comment on their experience of NRT,” Dr Truman says.

The second group (May 2014-Feb 2016) were given access to an e-cigarette with the option of NRT also. They were permitted to smoke the e-cigarette inside the ward, meaning they didn’t have to leave their room. They recorded their use of e-cigarettes and NRT, and on day three or four of their stay, a blood sample was taken to measure nicotine levels.

Ms Gilmour says cigarette smoking and smoking cessation have long been problematic for patients presenting for withdrawal from alcohol. This is also apparent for those patients admitted to psychiatric units.

“In recent years, evidence-based research and proactive support through nicotine-replacement therapy, has seen smoking banned from public places such as hospitals. Stopping smoking was an added stressor for patients admitted to the withdrawal unit with physiological or physical complexities from other substances. Staff also felt stressed in trying to manage the risks associated with patients leaving the ward to smoke.

“Having an alternative to routine NRT was found to be more acceptable to this patient group and supported the DHB’s non-smoking policy. This was seen to reduce stress of both patients and staff, as patients were happy to remain on the ward while using the e-cigarette. This had a positive effect on treatment, and there was an increase in patients’ confidence to continue to work on reducing cigarette smoking once back in the community,” Ms Gilmour says.

The paper, entitled “Acceptability of electronic cigarettes as an option to replace tobacco smoking for alcoholics admitted to hospital for detoxification” was published in the New Zealand Medical Journal today (Friday February 23).

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