GPs should give vaping advice as part of quit smoking attempts, NICE says

GPs and other healthcare professionals should offer advice on vaping as a way to help patients stop smoking, according to draft guidance from NICE.

The updated recommendations, created in collaboration with Public Health England, replace eight previous sets of guidance on prevention and quitting smoking.

NICE said the evidence shows that nicotine-containing e-cigarettes can help people to stop smoking and are similarly effective to other options such as nicotine replacement therapy (NRT).

People should be able to use e-cigarettes to quit smoking if they choose, but should be advised that there is not enough evidence to know whether there are long-term harms, the recommendations state.

Healthcare professionals should advise that e-cigarettes are substantially less harmful than smoking but also that e-cigarettes are not licensed medicines, NICE said in the draft recommendations.

Advice should also be given on where people can find information about e-cigarettes, how to use them correctly and that they should stop smoking completely if they decide to start vaping.

Earlier this year, PHE published an independent report showing that smokers who used vaping as part of a quit attempt have some of the highest success rates.

E-cigarettes were the most popular smoking cessation aid in England in 2020 – used by 27.2%, compared with 15.5% who used over the counter NRT (or 2.7% on prescription), and 4.4% who used varenicline, the report found.

Overall, the expert committee putting together the NICE draft guidance concluded that, when combined with behavioural support, the option of either a combination of short- and long-acting NRT or e-cigarettes were more likely to result in people successfully quitting.

People should also be advised on how to stop using e-cigarettes when they are ready and how to report safety concerns or side effects they may have including through the Yellow Card Scheme, NICE said in the draft document which is out for consultation until the 6 August.

But the recommendations call for more research into both short and long-term health effects from vaping and whether there are specific risks for certain groups such as pregnant women and young people.

In addition, as well as usual support from stop smoking services, pregnant women should be offered vouchers when they can prove they have stopped smoking through carbon monoxide tests.

Voucher rewards should be staggered at least until the end of pregnancy and rewards totalling around £400 have been shown to be effective, NICE said, although services should ensure they cannot be used to purchase products, such as cigarettes or alcohol.

There is some evidence that the pandemic had spurred some people to quit smoking.

Dr Paul Chrisp, director of NICE’S centre for guidelines, said: ‘These draft guideline recommendations are a renewed effort to reduce the health burden of smoking and to encourage and support people to give up smoking.

‘Smoking continues to take a huge toll on the health of the nation and accounts for approximately half the difference in life expectancy between the richest and poorest in society.’

He added: ‘We need to use every tool in our arsenal to reduce smoking rates, including education, behavioural support, financial incentives, and e-cigarettes if people are interested in using them.’

The RCGP said the guidelines are ‘sensible’ and reinforce what many GPs and other healthcare professionals are already doing.

RCGP chair Professor Martin Marshall noted advice about vaping should only be used as a way to stop smoking, and with the intention of stopping vaping eventually.

He said: ‘We would never encourage people who don’t smoke to start vaping. It’s important we continue to build the evidence base around the both short and long-term health effects from e-cigarettes, and we look forward to seeing further research being published.

‘Smoking can have a terrible impact on people’s health, and whatever we can do to help smokers quit, and reduce smoking in society as a whole should be encouraged.’