Thoracic Society of Australia and New Zealand (TSANZ) Guidance for the Management of Electronic Cigarette Use (Vaping) in Adolescents and Adults.

Electronic cigarette (EC) use, especially among younger members of society, has grown to concerning levels in many countries, including Australia and New Zealand. Uptake in the general population, driven by technological and pharmacological innovations, and accelerated by aggressive tobacco/vaping industry marketing, has outpaced medical research. As the harms of EC use become increasingly evident, the Australian Government has introduced policies to curb recreational EC use, whilst still allowing access for smoking cessation. This highly dynamic environment presents new challenges to clinicians as the evidence to support clinical practice with respect to vaping use and its cessation remains very limited. This guidance document from the Thoracic Society of Australia and New Zealand aims to address this unmet need by offering practical advice for clinicians to help protect their patients' lung and general health by: preventing EC uptake in children, adolescents, and young adults; providing guidance for ceasing EC use in adolescents and adults who have never smoked; and providing guidance for ceasing EC use in people who currently or formerly smoked who now use EC long-term. Underpinned by a systematic review, this multidisciplinary expert consensus document summarises the current landscape of EC use, nicotine addiction, behavioural and pharmacotherapy treatments. Illustrative case vignettes are provided. The advice, largely extrapolated from the smoking cessation literature, is based on the consensus of the authors in the absence of high-quality randomised trials for vaping cessation and is applicable to all age groups. We emphasise the urgent unmet need for vaping-specific cessation research to inform future practice.