BACKGROUND: About 10% of Dutch people who undertake a serious attempt to quit smoking use the e-cigarette as a smoking cessation aid. However, using an e-cigarette leads to damage to the respiratory and cardiovascular systems. Many former smokers also continue to use the e-cigarette permanently. The revision (2024) of the Dutch Guideline on Tobacco and Nicotine Addiction, based on scientific evidence and expert opinion, has formulated a recommendation for all Dutch healthcare professionals on whether or not to recommend the e-cigarette as smoking cessation support.
METHODS: Various databases were systematically searched for guidelines, systematic reviews and RCTs. The scientific evidence found was assessed using the GRADE methodology for guideline development. In addition, a working group of 20 healthcare professionals and patient representatives took into account other considerations based on their practical experiences. This process and the resulting recommendations were reviewed and approved by 25 professional and other organisations.
RESULTS: The quality of the evidence was ‘moderate’ to ‘very low’. In its assessment, the working group attached great importance to the fact that patients remain exposed to harmful substances by inhaling the vapour of the e-liquid. Moreover, switching to the e-cigarette temporarily or permanently maintains both nicotine addiction (physical) and smoking behaviour (psychological). It can also lead to a relapse to tobacco products. The final recommendation is that e-cigarettes are not recommended as smoking cessation support, unless a smoker has already made several unsuccessful quit attempts and expresses a clear desire to use the e-cigarette in the next attempt.
CONCLUSIONS: Abroad, e-cigarettes are regulated in various ways. In the Netherlands, the health care system is reluctant to use e-cigarettes as a smoking cessation aid for health and ethical reasons. Also, the Dutch healthcare has (yet) insufficient experience in adequately integrating the e-cigarette into (behavioural) smoking cessation programmes, so other ways of smoking cessation are preferred.