Switching to E-cigarettes as Harm Reduction Among Individuals With Chronic Disease Who Currently Smoke: Results of a Pilot Randomized Controlled Trial

Introduction:
This text provides an overview of a pilot randomized controlled trial (RCT) examining the impact of switching to electronic cigarettes (ECs) on harm reduction and decreased combustible cigarette (CC) use in patients with chronic obstructive pulmonary disease (COPD), asthma, coronary artery disease (CAD), and peripheral artery disease (PAD). The study aims to estimate EC-related reduction in CPD at 3 months, estimate the effect of ECs on reductions in chronic illness symptoms, and determine the feasibility and acceptability of an EC intervention for CC harm reduction among a population with chronic illness.

Key Points:

* The study is a two-arm, open-label RCT comparing the impact of standard care (NRT + counseling) versus EC + counseling on reduction in CPD and chronic illness symptoms over a 3-month intervention period with follow-up at 6 months.
* Participants were randomized into one of two study arms, counseling with standard care (NRT) or counseling with intervention (EC), using a minimization strategy.
* Participants randomized to the intervention arm were provided with a supply of NJOY "Daily" ECs and instructed to replace CCs with ECs as much as possible. Participants randomized to the standard-of-care arm were provided with a supply of NRT patches and lozenges or gum and instructed to reduce their CC consumption.
* Both study arms received six counseling sessions delivered by telephone with a licensed mental health counselor trained in motivational interviewing and smoking cessation treatment.
* The primary study outcome measures were change in number of self-reported CPD from baseline and change in chronic illness symptom severity at 3 months.
* The study found that participants in both arms reduced their CPD from baseline to 3 months, with no significant difference between the two arms. However, COPD patients in the EC arm showed a significant reduction in CAT scores at 3 months.
* The study also found that the intervention was feasible and acceptable, with high rates of recruitment, enrollment, retention, and treatment satisfaction.

Main Message:
The findings from this pilot RCT suggest that ECs may be a safer alternative for chronic condition patients using CCs and warrant further research on expected smoking cessation/reduction among individuals who use ECs. The observed reduction in CPD and improvement in respiratory symptoms suggest that switching to ECs appears feasible and acceptable among those with chronic diseases. These results support further exploration of switching to ECs as a harm reduction strategy among CC users who have been unsuccessful at quitting by other means.

Mahathi Vojjala, Elizabeth R Stevens, Andrew Nicholson, Tucker Morgan, Aayush Kaneria, Grace Xiang, Olivia Wilker, Rachel Wisniewski, Irina Melnic, Omar El Shahawy, Kenneth I Berger, Scott E Sherman, Switching to E-cigarettes as Harm Reduction Among Individuals With Chronic Disease Who Currently Smoke: Results of a Pilot Randomized Controlled Trial, Nicotine & Tobacco Research, Volume 27, Issue 1, January 2025, Pages 36–45, https://doi.org/10.1093/ntr/ntae158