Record vaping separately from smoking. The pack year calculator counts combustible smoking products only, so vaping and heated tobacco add nothing to a pack year figure. FAQ 11 suggests years vaped may be the best way to record vaping, and Dr Nigel Masters currently advises recording the two separately, even when someone uses both.
What does the calculator count, and what does it leave out?
FAQ 11 says: “The pack year calculator records combustible smoking products only. Years vaped may be the best way to record vaping on the clinical record.”
A pack year is 20 cigarettes a day for one year. The calculator converts cigars, spliffs, cigarillos, bidis, pipe tobacco, loose tobacco and waterpipe sessions into cigarettes and adds them up. E-cigarettes (vapes) and heated tobacco products, which Public Health England’s 2018 evidence review described as “so-called ‘heat-not-burn’ tobacco products”, are not part of that figure. A person who has only ever vaped has a pack year figure of zero, and years spent only vaping are left out of a smoking history in the same way as years without smoking. Entering a smoking history that changed explains how to enter periods of smoking around them.
What does Dr Masters advise?
Dr Masters gave his current advice on 19 October 2026: “I would personally advise recording both separately at the present time. Despite the fact they may use both methods on and off.”
In practice that means keeping two records side by side. The smoking history is recorded as pack years, years smoked and the date stopped, as described on pack years and years smoked. Vaping is recorded on its own, and FAQ 11 suggests years vaped as the measure.
What do UK guidelines say about recording vaping?
NICE guideline NG209 on tobacco asks health and social care professionals to “ask people if they smoke or have recently stopped smoking” at every opportunity (1.11.1), to discuss stop-smoking aids used before, “including personally purchased nicotine-containing products” (1.11.3), and to “record smoking status and all actions, discussions and decisions related to advice, referrals or interventions about stopping smoking” (1.11.6) (NICE NG209). We did not find a recommendation in NG209 that deals specifically with recording e-cigarette use. The committee did note “that there may be substantial dual use; that is, when someone is both smoking and using e-cigarettes” (rationale).
For smoking status in England, the Quality and Outcomes Framework guidance for 2026/27 says: “For the purposes of QOF, users of electronic cigarettes (vapes) who have never smoked or given up smoking should be classified as non-smokers or ex-smokers respectively. Patients who dual use electronic cigarettes and cigarettes should continue to be classed and treated as smokers.” This sets the smoking status; it does not record the vaping itself.
A 2023 analysis of UK primary care records by Tildy and colleagues concluded: “Few patients are being asked about vaping.” The authors noted that a 2018 Royal College of Physicians consultation recommended recording vaping in electronic health records, and suggested that a QOF indicator “could be introduced for recording vaping status” (BMC Public Health 2023).
Are there clinical codes for vaping?
Yes. The UK edition of SNOMED CT, searched on the NHS SNOMED CT browser in October 2026, includes active concepts such as:
- Electronic cigarette user (722499006)
- Ex user of electronic cigarette (908781000000104)
- Never used electronic cigarette (1137690000)
- Uses electronic cigarette daily (35341000087101) and Uses electronic cigarette occasionally (35371000087109)
- Uses heated tobacco product (1388653002)
These codes describe whether someone vapes, not for how long, so the number of years vaped may still need to be added. Tildy and colleagues also point out that vaping codes “are not carried forward automatically to future consultation records”. Which codes appear in a particular clinical system’s templates is for each practice to check.
What do UK sources say about using both?
The NHS Better Health page on vaping says: “Nicotine vaping is less harmful than smoking,” and also that “Vaping is not completely harmless and we don’t know yet what the long-term effects may be.” It adds: “Any smoking is harmful and you will only get the full benefits of vaping if you stop smoking completely.” NICE NG209 (1.12.15) similarly advises explaining that “any smoking is harmful, so people using e-cigarettes should stop smoking tobacco completely.” The 2018 Public Health England review said all smokers should be supported to stop completely, “including ‘dual users’ who smoke and use e-cigarettes.”
Clinicians can use the calculator in clinician mode on the clinicians page, which gives a record-ready line for EMIS or SystmOne covering pack years, years smoked and the date stopped. Vaping can then be recorded alongside it.