Dr Corelli said that although the overall behavioral approaches to smoking cessation are similar when counseling individuals who are vaping and those who are using combustible cigarettes, there are unique pharmacologic challenges in dosing. “One of the problems is that there is no regulation of what goes into e-cigarettes, such as the liquids used in pen and tank model units,” she said. 

Because of the regulation of combustible cigarettes, it is easier to estimate the dose of nicotine a smoker is getting from each cigarette. That is not the case with e-cigarettes and vaping products. 

Further clouding the issue is the fact that e-cigarette liquids are commonly mislabeled. For example, the label may state that there is 10mg nicotine/mL, but the measured concentrations can be as high as 100mg/mL. 

“I am comfortable helping adults who are vaping and were former [combustible cigarette] smokers because they were accustomed to getting a certain dose of nicotine from their combustible cigarettes. For example, a pack a day smoker is likely to be getting a similar amount of nicotine from their vaping to replace what they had originally been receiving from smoking,” she said.

If this patient wanted to use NRT as a vaping cessation strategy, she would dose the selected NRT product for an individual smoking a pack a day. 

Dr Corelli described helping youth to quit using e-cigarettes and vaping as “an ongoing dilemma.” It is important to work with the teenager’s parents as much as possible, she said.

In the meantime, Dr Corelli said, clinicians can adapt approaches used for combustible cigarettes to e-products while research and more formal guidance continue to emerge.


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