Nicotine-free 'fake' cigarettes may help smokers quit

Nicotine-free plastic inhalers -- fake cigarettes that allow people to simulate smoking -- may increase some smokers' odds of quitting smoking, a study shows.

Unlike electronic or "e-cigarettes," the nicotine-free inhalers are billed in Europe as aids for people who are trying to quit smoking that can be used in conjunction with nicotine replacement, drugs for smoking cessation, and counseling.

The study is published online in the European Respiratory Journal.

Italian researchers studied 120 smokers who were enrolled in a program to help them quit smoking. All participants were regular smokers of at least 20 cigarettes a day for at least 10 years.

All participants were also treated with a nicotine patch, bupropion (sold in the U.S. as Zyban), and counseling.

They were divided into two groups, with one set of participants receiving the plastic inhalers, and the others following the usual program.

Questionnaires were used to determine the participants' physical and behavioral dependence on cigarettes. After 24 weeks they were asked if they had been successful in attempts to abstain from smoking.

Quit-smoking success rates

There was no significant difference in the quit rates of the two groups. But people who were found to be more behaviorally dependent on cigarettes had a threefold higher success rate when using the inhaler.

People who were identified as being most heavily dependent on the behavioral pattern of smoking had a quit rate of 66.7% in the group using the plastic inhalers, compared with 19.2% in the other group.

Researchers say that the results indicate that for smokers who rely on the handling of a cigarette as a behavioral pattern, nicotine-free inhalers could increase their chance of success when trying to quit.

"By showing a clear predictive association between the measure of behavioral dependence and relapse, our study is the first to reveal that the concept of behavioral addiction can be exploited as a useful clinical tool for many smokers to quit," Riccardo Polosa, MD, PhD, a professor at the University of Catania, says in a news release.

Polosa, who is also director of the University Institute of Internal Medicine and Clinical Immunology at Catania, says the research results "will open up a potentially novel area of research in smoking cessation."

Cigarette alternative?

The inhalers used in the study, unlike e-cigarettes, consist of a fiber sponge filter plug soaked in naturally extracted herbal aroma oil and encased in a plastic cartridge container similar to a cigarette.

The FDA decided in April 2011 to oversee electronic cigarettes the same way it does tobacco products. E-cigarettes are powered by a battery and a liquid nicotine mixture derived from tobacco is converted into a vapor that can be inhaled.

But the device used in the study contains no nicotine. The device is called "Paipo," and its manufacturer claims it is safe for anyone using it.

"Smokers trying to quit have to cope not only with the pharmacologic aspect of nicotine addiction but also with the psychological components associated with tobacco dependence," the researchers. "Smoking is much more than the addicting effect of nicotine; the smoking habit is also the rituals that each smoker associates with his/her habit."

The plastic cigarettes are intended to substitute for the psychological part of addiction.

An online advertisement for Paipo bills the product as a "cigarette alternative" and says that even though people don't light it, "it feels like the real thing."

The researchers say they received free supplies of the Paipo inhalers for the study, but do not report any other disclosures.