A lively pro-con session on e-cigarettes sparked discussion on their role in smoking cessation and public health during the European Respiratory Society (ERS) Congress 2025 taking place in Amsterdam, Netherlands, with experts presenting contrasting perspectives on benefits, risks, and policy implications.
The speakers discussed whether the potential benefits of e-cigarettes in reducing tobacco use outweigh the risks of exposing the lungs to additional metals and chemicals through vaping. They also considered if tighter regulation could help establish e-cigarettes a useful cessation tool while preventing misuse, or if problems such as dual use with regular cigarettes and uptake among people who have never smoked are serious enough to warrant banning them entirely.
Evidence Supporting E-Cigarettes
Hayden McRobbie, PhD, professor of population health at Queen Mary University London, UK, argued that e-cigarettes can be an effective tool for smoking cessation when appropriately regulated. He referenced his work on a review of electronic cigarettes for smoking cessation and other trials, noting that e-cigarettes consistently demonstrated higher quit rates than nicotine replacement therapy (NRT).
He explained how e-cigarettes deliver nicotine by heating a liquid to produce an inhalable aerosol, with newer products offering nicotine delivery that more closely approximates cigarettes. While acknowledging that e-cigarettes are “not harmless,” McRobbie emphasized that they expose users to far fewer toxicants than combustible tobacco.
Randomized controlled trial data showed that e-cigarettes increased quit success compared with NRT. Evidence comparing e-cigarettes with varenicline remains limited, but McRobbie argued that they remain a reasonable cessation aid, particularly for smokers who have struggled with other methods.
“That’s where regulation comes in: we can at least try and bring some sort of quality standards to this imperfect situation, as this currently is. We don’t have a medicinal e-cigarette. No one’s put that through medical licensing. It would be an advantage, perhaps, if there was, but would we use it?…Selling it only in pharmacies [is an option]—which is a way that the Australian government has now moved to. That is certainly something that if we were starting again, maybe that’s a way that we could better regulate the supply of e-cigarettes,” he explained.
McRobbie addressed potential risks, including links between vaping and respiratory illness, as well as the 2019 outbreak of lung injuries in the US, which were traced to tetrahydrocannabinol-containing devices rather than standard nicotine products. He concluded by encouraging access to evidence-based smoking cessation support and warning against policies that discourage smokers from switching to less harmful alternatives.
Evidence Questioning E-Cigarettes
Following McRobbie, Aslı Görek Dilektaşlı, MD, PhD, a professor of pulmonary medicine at Uludağ University in Bursa, Turkey, offered a more critical perspective. She noted that while global tobacco use has declined, the introduction of e-cigarettes in some countries has not accelerated reductions in smoking prevalence.
Dilektaşlı highlighted the addictive properties of nicotine, its potential cardiovascular effects, and emerging evidence of cytotoxicity from e-cigarette flavorings. She also raised safety concerns over device malfunctions.
From a public health standpoint, she pointed to risks of dual use, relapse among former smokers, and a possible “gateway effect” for adolescents. She presented data indicating that e-cigarette use may increase the odds of continued smoking and relapse rather than cessation.
Critiquing the evidence base, Dilektaşlı argued that many trials are unblinded and favor e-cigarettes in design, while real-world data often show lower quit success. She also raised ethical concerns about industry funding and the influence of tobacco companies on e-cigarette promotion.
Her recommendation was for policy to prioritize nicotine-free abstinence, using established evidence-based cessation approaches rather than promoting e-cigarettes as a solution.
“The problem is, in nicotine replacement therapies, the therapy is limited for 2 or 3 months, but in vaping, in electronic cigarettes, it turns into a continuous behavior, so people start vaping and don’t stop vaping,” she explained.
Audience questions centered on the addictive potential of e-cigarettes, the role of flavors in youth uptake, and the need for specific cessation programs for vaping. The discussion also touched on whether e-cigarettes should ever be considered during pregnancy, with panelists agreeing that more evidence is needed.
The session concluded with another audience vote, which showed that many participants remained skeptical of e-cigarettes as a cessation tool. Moderators reiterated ERS’s official position: while reducing smoking remains a public health priority, policies should be grounded in established evidence, and caution is warranted regarding the long-term health effects of vaping.
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