Evidence

Surveillance report 2017 – Smoking: harm reduction (2013) NICE guideline PH45 and Smoking: acute, maternity and mental health services (2013) NICE guideline PH48

Consideration of the evidence for PH45 and PH48

Consideration of the evidence for PH45 and PH48

A brief overview of how new evidence impacts upon NICE guideline PH45 and NICE guideline PH48 is provided below. A more detailed summary of the evidence for PH45 and PH48 is provided in appendices 1 and 2, respectively.

Smoking: harm reduction (2013) PH45

  • New published evidence was identified relating to the use of e-cigarettes for harm reduction. The evidence from 20 effectiveness studies on electronic cigarettes indicated that they are potentially effective at reducing cigarette consumption or increasing abstinence rates, whilst evidence from 25 safety studies indicated that on the whole they are safer than cigarettes. This evidence potentially directly impacts on:

    • Recommendation 1: Raising awareness of licensed nicotine-containing products

  • If recommendation 1 was updated to reflect the new evidence on e-cigarettes, the following recommendations may also need some level of refreshing or updating:

    • Recommendation 2: Self-help materials advising on non-licensed nicotine-containing products

    • Recommendation 3: Choosing a harm-reduction approach

    • Recommendation 8: Supporting temporary abstinence

    • Recommendation 9: People in closed institutions

    • Recommendation 10: Staff working in closed institutions

  • New published evidence was also identified on electronic-cigarettes specifically in populations in closed institutions. Two studies indicated that electronic cigarettes are acceptable and effective for smoking reduction and abstinence. This evidence may potentially directly impact upon:

    • Recommendation 9: People in closed institutions

  • Experts also provided evidence that indicated that electronic-cigarettes are effective for tobacco harm reduction and safer than conventional cigarettes. Furthermore, experts indicated that the omission of electronic-cigarettes from PH45 undermines the guideline in practice.

Please note, the current update of PH1 and PH10 includes consideration of evidence on electronic cigarettes. As such, any update of PH45 would only be considered after the update of PH1 and PH10 has been completed.

Smoking: acute, maternity and mental health services (2013) PH48

  • A number of recommendations may require refreshing to reflect any changes made in the ongoing update of PH1 and PH10.

  • There is a need to refresh the wording of recommendation 6 around varenicline to make consistent with the Summary of Product Characteristics.

  • PH48 makes a number of cross-referrals to other guidelines, such as PH45. Hence, should further work be undertaken on electronic cigarettes then PH48 would require refreshing.


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