Subscribe to RSS
DOI: 10.1055/a-2194-5666
Die E-Zigarette – Mittel zur Tabakentwöhnung?
The e-cigarette – means of smoking cessation?Zusammenfassung
Tabakentwöhnung in Deutschland Nachdem der Tabakkonsum über mehrere Jahre rückläufig war, zeigt sich aktuell eine Stagnation bzw. ein Wiederanstieg der Rauchenden in Deutschland. Die Ursachen erscheinen vielfältig, wie z. B. Belastungen durch die Pandemie mit der sozialen Isolation, steigende Lebenshaltungskosten und Krieg in Europa. Bei einem weiterhin stark verbreiteten Tabakkonsum in der deutschen Bevölkerung wird eine evidenzbasierte Tabakentwöhnung nur selten durchgeführt.
Gesundheitsrisiken der E-Zigarette Nach neueren Studien sind E-Zigaretten an der Pathogenese von Lungenerkrankungen, Herz- und Gefäßschädigungen beteiligt. Zudem wirken ihre Inhaltsstoffe auch karzinogen. Klinische Untersuchungen zum dauerhaften Konsum liegen aber bisher nicht vor.
Wie wirksam ist die E-Zigarette bei der Tabakentwöhnung? E-Zigaretten als Konsumentenprodukt sind den in Leitlinien empfohlenen Nikotin-Ersatzpräparaten und suchthemmenden Medikamenten nicht überlegen. Im therapeutischen Setting sind sie etwas besser wirksam als Nikotin-Ersatzpräparate. Sie werden aber meistens dauerhaft konsumiert und verstetigen so die Nikotinabhängigkeit. Ihr Konsum erhöht die Rückfallgefahr zum Tabakrauchen.
Evidenzbasierte Tabakentwöhnung ambulant und stationär Trotz der verschiedenen neuen Ansätze, wie Internet-basierte Angebote, App etc., sind Gespräche und Pharmakotherapie der Goldstandard und wirksamer als jede Therapie für sich allein.
Abstract
After several years of declining tobacco consumption, the number of smokers in Germany is currently stagnating or rising again. The reasons seem to be manifold, e. g. stress caused by the pandemic with social isolation, rising cost of living and war in Europe.
With tobacco use still widespread in the German population, evidence-based tobacco cessation is rarely implemented.
According to recent studies, e-cigarettes are involved in the pathogenesis of lung disease, cardiac and vascular damage. In addition, their ingredients also have carcinogenic effects. However, clinical studies on long-term use are not yet available.
E-cigarettes as a consumer product are not superior to nicotine replacement products and addiction-reducing medications recommended in guidelines. In the therapeutic setting, they are slightly more effective than nicotine replacement products. However, they are usually consumed continuously and thus perpetuate nicotine dependence. Their use increases the risk of relapse to tobacco smoking.
Despite the various new approaches, such as Internet-based offerings, app, etc., talks and pharmacotherapy are the gold standard and more effective than any therapy on its own.
Publication History
Article published online:
21 November 2023
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Rigotti NA, Kruse GR, Livingstone-Banks J. et al. Treatment of Tobacco Smoking: A Review. JAMA 2022; 327 (06) 566
- 2 Kotz D, Batra A, Kastaun S. Smoking Cessation Attempts and Common Strategies Employed. Dtsch Ärztebl Int 2020;
- 3 Brenner H, Mons U. Krebs: Große Potenziale der Prävention. Dtsch Ärztebl 2019; 116 (4).
- 4 E-cigarettes are harmful to health. Accessed August 13, 2022 at: https://www.who.int/news/item/05–02–2020-e-cigarettes-areharmful-to-health
- 5 Batra A, Kiefer F, Andreas S. et al. S3 Guideline “Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment” – Short Version. Eur Addict Res 2022; 1-19
- 6 Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) in Zusammenarbeit mit medizinischen Fachgesellschaften und Organisationen: Deutsche Gesellschaft für Innere Medizin , (DGIM), Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung (DGK), Deutsche Gesellschaft für Angiologie – Gesellschaft für Gefäßmedizin (DGA). et al. Empfehlungen zum Umgang mit der elektronischen Zigarette (E-Zigarette). Pneumologie 2022; 76 (07) 473-478
- 7 Staff J, Kelly BC, Maggs JL. et al. Adolescent electronic cigarette use and tobacco smoking in the Millennium Cohort Study. Addiction 2022; 117 (02) 484-494
- 8 St Helen G, Liakoni E, Nardone N. et al. Comparison of Systemic Exposure to Toxic and/or Carcinogenic Volatile Organic Compounds (VOC) during Vaping, Smoking, and Abstention. Cancer Prev Res Phila Pa 2020; 13 (02) 153-162
- 9 Schäfer M, Steindor M, Stehling F. et al. EVALI (E-cigarette or vaping product use associated lung injury): First case report of an adolescent in Europe. Pediatr Pulmonol 2021; 56 (05) 1274-1275
- 10 Jonas A. Impact of vaping on respiratory health. BMJ 2022; 378: e065997
- 11 Davis LC, Sapey E, Thickett DR. et al. Predicting the pulmonary effects of long-terme-cigarette use: are the clouds clearing?. Eur Respir Rev 2022; 31 (163)
- 12 Gotts JE, Jordt SE, McConnell R. et al. What are the respiratory effects of e-cigarettes?. BMJ 2019; 366: l5275
- 13 Neczypor EW, Mears MJ, Ghosh A. et al. E-Cigarettes and Cardiopulmonary Health: Review for Clinicians. Circulation 2022; 145 (03) 219-232
- 14 Münzel T, Hahad O, Kuntic M. et al. Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes. Eur Heart J 2020; 41 (41) 4057-4070
- 15 Biondi-Zoccai G, Sciarretta S, Bullen C. et al. Acute Effects of Heat-Not-Burn, Electronic Vaping, and Traditional Tobacco Combustion Cigarettes: The Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking (SUR – VAPES) 2 Randomized Trial. J Am Heart Assoc 2019; 8 (06) e010455
- 16 Fetterman JL, Keith RJ, Palmisano JN. et al. Alterations in Vascular Function Associated With the Use of Combustible and Electronic Cigarettes. J Am Heart Assoc 2020; 9 (09) e014570
- 17 Berlowitz JB, Xie W, Harlow AF. et al. E-Cigarette Use and Risk of Cardiovascular Disease: A Longitudinal Analysis of the PATH Study (2013–2019). Circulation 2022; 145 (20) 1557-1559
- 18 Mravec B, Tibensky M, Horvathova L. et al. E-Cigarettes and Cancer Risk. Cancer Prev Res (Phila Pa) 2020; 13 (02) 137-144
- 19 Bracken-Clarke D, Kapoor D, Baird AM. et al. Vaping and lung cancer – A review of current data and recommendations. Lung Cancer 2021; 153: 11-20
- 20 Pisinger C, Rasmussen SKB. A Systematic Review Comparing the Health Effects of Dual Use of Electronic and Conventional Cigarettes with Health Effects of Exclusive Smoking of Conventional Cigarettes. Research Square 2022;
- 21 Hartmann-Boyce J, McRobbie H, Lindson N. et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2020; 10: CD010216
- 22 Wang RJ, Bhadriraju S, Glantz SA. E-Cigarette Use and Adult Cigarette Smoking Cessation: A Meta-Analysis. Am J Public Health 2021; 111 (02) 230-246
- 23 Hedman L, Galanti MR, Ryk L. et al. Electronic cigarette use and smoking cessation in cohort studies and randomized trials: A systematic review and meta-analysis. Tob Prev Cessat 2021; 7: 62
- 24 Thomas KH, Dalili MN, López-López JA. et al. Comparative clinical effectiveness and safety of tobacco cessation pharmacotherapies and electronic cigarettes: a systematic review and network meta-analysis of randomized controlled trials. Addict Abingdon Engl 2022; 117 (04) 861-876
- 25 Hanewinkel R, Niederberger K, Pedersen A. et al. E-cigarettes and nicotine abstinence: a meta-analysis of randomised controlled trials. Eur Respir Rev 2022; 31 (163) 210215
- 26 Barufaldi L, Guerra R, de Albuquerque R deC. et al. Risk of smoking relapse with the use of electronic cigarettes: A systematic review with meta-analysis of longitudinal studies. Tob Prev Cessat 2021; 7: 1-10
- 27 Chen R, Pierce JP, Leas EC. et al. Effectiveness of e-cigarettes as aids for smoking cessation: evidence from the PATH Study cohort, 2017–2019. Tobacco Control 2023; 32: e145-e152
- 28 Jha P, Ramasundarahettige C, Landsman V. et al. 21st-Century Hazards of Smoking and Benefits of Cessation in the United States. N Engl J Med 2013; 368 (04) 341-350
- 29 Wu AD, Lindson N, Hartmann-Boyce J. et al. Smoking cessation for secondary prevention of cardiovascular disease. Cochrane Tobacco Addiction Group, ed. Cochrane Database Syst Rev 2022; 2022 (08)
- 30 Taylor GM, Lindson N, Farley A. et al. Smoking cessation for improving mental health. Cochrane Tobacco Addiction Group, ed. Cochrane Database Syst Rev 2021; 2021 (03)
- 31 Cartmell KB, Dismuke CE, Dooley M. et al. Effect of an Evidencebased Inpatient Tobacco Dependence Treatment Service on 1-Year Postdischarge Health Care Costs. Med Care 2018; 56 (10) 883-889