Cochrane update supports nicotine vapes over NRT for quitting smoking

An update to Cochrane’s living review, published on 26 August 2026, supports nicotine e-cigarettes as a tool for stopping smoking. The authors report high-certainty evidence that they help more adults stop smoking for at least six months than nicotine replacement therapy, such as patches or gum.

The Cochrane summary says its evidence search runs to 1 January 2026. The August publication date therefore marks a review update; it does not mean every included study was carried out in August or that the broad conclusion has suddenly reversed.

Keep the comparison in the headline

The strong finding concerns nicotine vapes compared with nicotine replacement therapy, usually shortened to NRT. Evidence against nicotine-free vapes is less certain. Comparisons with behavioural support alone or no support have greater uncertainty because of limitations in the study designs.

That is a more useful description than calling one option universally “best”. A comparison with NRT does not establish superiority over every medicine, every combination of treatments or every person’s existing quit plan.

Effectiveness and safety answer different questions

Cochrane calls for larger, longer studies to assess safety. Helping someone stop smoking and proving a product harmless over decades are different questions; the cessation finding cannot answer both.

The NHS guidance on vaping to quit smoking makes the practical distinction clear. It describes vaping as less harmful than smoking, while explaining that it is not risk-free and its long-term effects remain uncertain. Children and people who do not smoke should not take it up.

Three questions worth asking about a quit-smoking headline

• What does “quit” mean here? Check whether the outcome is stopping cigarettes, reducing cigarette use or stopping nicotine altogether. Those outcomes should not be used interchangeably.
• What was it compared with? A result against one treatment cannot simply be relabelled as a ranking of every possible treatment.
• What decision can the evidence support? A finding across study groups can inform a conversation about options. It cannot promise that a particular reader will succeed with a particular device.

Using the finding in a real quit attempt

For an adult who smokes, NHS advice is to aim to stop cigarettes completely: continuing to smoke prevents the full benefit of switching. It recommends getting help from a local stop smoking service or a specialist retailer when choosing a device and nicotine strength.

That support can turn a general research finding into a practical plan: discuss cravings, how the product is being used and what is making cigarettes difficult to leave behind. The research is useful evidence for that discussion, rather than a reason to abandon support or treat a difficult first attempt as the final result.