How to stop smoking: a look at the Cochrane evidence

In this blog for people wanting to stop smoking, Robert Walton, a very general practitioner, looks at Cochrane evidence to help you start your new smoke-free life. 

Page updated on 17 November 2022 to include new evidence on e-cigarettes from the living systematic review Electronic cigarettes for smoking cessation (updated November 2022).

Take-home points

Nicotine replacement therapy is an effective way to stop smoking. It's also free of charge through NHS smoking cessation services People using vape devices are more likely to quit than those using conventional nicotine replacement Side effects of nicotine replacement are rare. There’s no evidence of a difference in side effects between using conventional forms of nicotine replacement and vaping, but it is not known whether problems may arise from vaping over the longer term New evidence shows that stopping smoking is probably beneficial to mental health


Vape to quit?

The evidence is stacking up for vaping as an effective way of giving up tobacco.  A Cochrane Review Electronic cigarettes for smoking cessation (most recently updated in November 2022) showed (with high quality evidence) that people using a vape device were more likely to stop smoking than those using more conventional forms of nicotine replacement therapy such as sprays, gum, patches or lozenges.

Nicotine replacement therapy has for many years been the gold standard for smoking cessation against which all new treatments were measured.  Many researchers were surprised that vaping nicotine turned out to be a more effective way of stopping smoking than other commonly used treatments.  Some thought that people would continue to vape as often as they smoked, however this doesn’t seem to be the case.  In fact people find vaping helpful for stopping smoking perhaps because it reproduces in part some of the actions and sensations involved in smoking behaviour which the conventional forms of nicotine replacement do not.

Common side effects reported by those using nicotine e‐cigarettes were throat or mouth irritation, headache, cough and feeling sick. These effects reduced over time as people continued using nicotine e‐cigarettes. Reassuringly the review also found no evidence of a difference in frequency of side effects in those using vape devices compared to people on conventional nicotine replacement although it is not known whether problems may arise from vaping over the longer term.

Nicotine replacement – patches, gum and lozenges

They’re starting to look old fashioned now compared to the trendy new vape devices, but there’s high quality evidence that they work.  A Cochrane Review Nicotine replacement therapy versus control for smoking cessation (published May 2018) with information from more than 60,000 people shows that any form of nicotine replacement therapy is better than placebo for stopping smoking.  The effects were pretty consistent across all the different forms of nicotine replacement therapy with the rate of quitting about 50% higher with nicotine replacement.

Side effects from the treatment were generally minor such as irritation from the nicotine patches and serious side effects were very rare overall although chest pain was more common in people using nicotine replacement therapy.  For conventional forms of nicotine replacement therapy we have long term data on safety including for people at high risk of unwanted effects such as those who already have heart disease and for pregnant women.  Although its likely to be very much safer than smoking, vaping hasn’t been around long enough to assess side effects of long term use.  In addition to their longstanding track record for satety, patches and lozenges are flexible and can be used at work and in social settings where vaping would not be possible.

In these difficult times another benefit of traditional nicotine replacement therapy is that it remains free of charge in the UK through the NHS smoking cessation services whereas vaping devices and liquids need to be purchased from dwindling household budgets.

Smoking and mental health

Smoking may make you feel better while you’re having a cigarette, but there is new evidence that kicking the habit probably slightly improves your mental health.

A Cochrane Review Smoking cessation for improving mental health (published March 2021) looked at levels of anxiety and depression in people who successfully stopped smoking compared with those that continued.  The reviewers found that there was probably a small but important reduction in symptoms.  The size of the benefit in mental health is about the same as would be gained by taking antidepressant medication (you can hear about this in the Cochrane Podcast: Does stopping smoking improve mental heath? And it was particularly interesting to see that mental health probably improved after stopping smoking both in people who had problems initially and also in those that didn’t.  Or thought they didn’t!

Withdrawal from tobacco may be tough in the first few weeks but there’s  light at the end of the tunnel.

More information

NHS Better Health Quit Smoking

Evidently Cochrane blogs (you can see the key messages here and click the links to go to the blogs):

Quitting smoking: which types of behavioural support work best to help people stop?

Quitting smoking is one of the best things someone who smokes can do to improve their health There are many types of behavioural support available and studies suggest that: Behavioural interventions for smoking cessation can help people quit smoking for 6 months or longer Receiving counselling or guaranteed monetary rewards for quitting are most likely to help Behavioural interventions are not likely to be harmful  

Smoking and COVID-19

Smoking and coronavirus (COVID-19): time to quit

Smoking increases the risk of getting acute respiratory infections and of being more severely affected, as does exposure to second-hand smoke. The Cochrane Special Collection, COVID-19: Effective options for quitting smoking during the pandemic, pulls together evidence including Cochrane Reviews on nicotine replacement, behavioural support such as telephone, internet and text messaging programmes, and gradual quitting. The Cochrane Reviews in the Special Collection focus on interventions which do not rely on in-person support, or face-to-face contact with health practitioners.

Stop suddenly or cut down first?

What is the best way to stop smoking – should I stop suddenly or cut down first?

Many people would like to reduce the amount of cigarettes they smoke before stopping smoking completely. There is evidence that cutting down the amount of cigarettes smoked before trying to stop completely could help as many people to stop as quitting smoking abruptly. If you want to cut down to quit then seeking support from a health professional and using either fast-acting nicotine replacement therapy or varenicline whilst you are reducing could increase your chances of success. 

Quitting smoking in pregnancy

What helps women to quit smoking while pregnant?

Quitting smoking when pregnant is the best thing you can possibly do for your own health and your baby’s health There are many types of support available, and studies suggest that: Receiving counselling support and incentives or rewards for quitting are most likely to help Education and getting feedback via a smokalyzer or other similar device probably help Nicotine replacement therapy (NRT) combined with behavioural support may help women to stop smoking in later pregnancy more than behavioural support alone

References [pdf] 

Join in the conversation on Twitter with @rtwalton123 @CochraneUK or leave a comment on the blog.

Please note, we cannot give specific medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.

Robert Walton reports grants from NIHR Health Technology Asessment, grants from NIHR Programme Grants for Applied Research, personal fees and other from TTS Pharma,  outside the submitted work;  In addition, Dr. Walton has a patent WALTON R, MCKINNEY E, MARSHALL S, MURPHY M, WELSH K, others. GENETIC INDICATORS OF TOBACCO CONSUMPTION. Patent number: 2001038567. Filed date: 24 Nov 2000. Publication date: 01 Jun 2001  with royalties paid to gNostics, and a patent Tucker MR, Walton R, Matthews H, Miskin A. Method and Kit for Assessing a Patient’s Genetic Information, Lifestyle and Environment Conditions, and Providing a Tailored Therapeutic Regime. Patent number: US20110251243 A1. Application number: US 12/944,372. Filed date: 11 Nov 2010. Publication date: 13 Oct 2011  issued to None.

How to stop smoking: a look at the Cochrane evidence by Robert Walton

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

4 Comments on this post

  1. Embarking on a journey towards a smoke-freelife is a commendable decision that requires support and evidence-based strategies. Robert Walton, a seasoned general practitioner, delves into Cochrane evidence to guide individuals in their quest to quit smoking.

    Victor Conrad Mercer / Reply
  2. This article can prove a good one for those who want to stop smoking.

    Vapeorizer / Reply
  3. […] If you or anyone you know wants to see facts on vaping and other methods of quitting smoking with links to evidence to back this up, visit the site here – evidently Cochrane – how to stop smoking. […]

    New Cochrane Blog – Easy Access To Evidence Based Research – Vaping & Smoking Biz Solutions Vendor / Reply
  4. […] If you or anyone you know wants to see facts on vaping and other methods of quitting smoking with links to evidence to back this up, visit the site here – evidently Cochrane – how to stop smoking. […]

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