Electronic cigarettes have gained attention as an aid to smoking cessation, and some experts consider them an option alongside established treatments. Guidance remains cautious, however, because these products are not advised for pregnant or breastfeeding women or minors.

With limited robust clinical evidence on nicotine e-cigarettes, the French-speaking Society for Smoking Cessation convened an internal expert panel to assess the available data and determine whether a consensus could be reached. The findings were published in Archives of Public Health.

The panel used a fast-track Delphi method to evaluate whether experts could reach an agreement on key statements about nicotine e-cigarettes. In two rounds, experts rated every statement on a 1-9 agreement scale, with higher scores indicating stronger agreement. After reviewing the aggregated feedback from the full expert panel, they could adjust their ratings, and each proposal was re-evaluated and rescored. Over a total period of 40 calendar days, consensus was defined as a median score of 7 or more on the 1-9 scale, with an interquartile range ≤ 3.

The 87 participating experts were drawn from varied clinical backgrounds; although not all were physicians, they had extensive hands-on experience in tobacco-dependence care.

Expert Consensus

The main proposals agreed upon regarding the role of e-cigarettes in smoking cessation are as follows.

• E-cigarettes are an appropriate cessation option and can replace pharmacotherapy or be used with nicotine treatment when suitable conditions are met, including adequate nicotine dosing, appropriate liquid choice, and a limited duration of use.
• When paired with pharmacotherapy, clinicians should ideally explain the benefits and limitations of each option with input from trained specialists.
• If withdrawal symptoms occur during e-cigarette use, increasing the nicotine dose is recommended instead of adjusting the power of the device. The concurrent use of conventional cigarettes should be temporary, with complete cessation as the goal of treatment.
• E-cigarettes may be appropriate for individuals with psychiatric disorders or other substance use disorders and for those with chronic obstructive pulmonary disease, coronary artery disease, or hospitalization.

No consensus has emerged for minors, pregnant women, breastfeeding women, or people in the preoperative or postoperative period. Experts advised pregnant or breastfeeding women who already vape to continue when the risk for relapse is high.

A strong agreement supports the need for national guidance that defines the role of e-cigarettes in cessation and specifies monitoring for adverse effects. Short-term effects, such as oral irritation, headache, cough, and nausea, are well described, whereas long-term effects remain uncertain because of limited follow-up.

Experts also agreed that future guidance should differentiate between e-cigarettes made by tobacco companies and those made by independent manufacturers.

The panel did not reach a consensus on where these products should be sold. Retail outlets offer wide access but little expert support, whereas pharmacies provide professional counseling but have limited availability.

The authors reported an increasing acceptance of e-cigarettes as a cessation tool and highlighted the challenge for health authorities in helping smokers quit while also protecting nonsmokers, particularly young individuals, for whom vaping may function as an entry point to smoking.

This story was translated from Univadis France, part of the Medscape Professional Network.