Research Article
Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

https://doi.org/10.1016/j.amepre.2019.07.028Get rights and content

Introduction

E-cigarettes deliver an aerosol of nicotine by heating a liquid and are promoted as an alternative to combustible tobacco. This study determines the longitudinal associations between e-cigarette use and respiratory disease controlling for combustible tobacco use.

Methods

This was a longitudinal analysis of the adult Population Assessment of Tobacco and Health Waves 1, 2, and 3. Multivariable logistic regression was performed to determine the associations between e-cigarette use and respiratory disease, controlling for combustible tobacco smoking, demographic, and clinical variables. Data were collected in 2013–2016 and analyzed in 2018–2019.

Results

Among people who did not report respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, or asthma) at Wave 1, the longitudinal analysis revealed statistically significant associations between former e-cigarette use (AOR=1.31, 95% CI=1.07, 1.60) and current e-cigarette use (AOR=1.29, 95% CI=1.03, 1.61) at Wave 1 and having incident respiratory disease at Waves 2 or 3, controlling for combustible tobacco smoking, demographic, and clinical variables. Current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41) was also significantly associated with having respiratory disease at Waves 2 or 3. Odds of developing respiratory disease for a current dual user (e-cigarette and all combustible tobacco) were 3.30 compared with a never smoker who never used e-cigarettes. Analysis controlling for cigarette smoking alone yielded similar results.

Conclusions

Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking. Dual use, the most common use pattern, is riskier than using either product alone.

Section snippets

INTRODUCTION

Respiratory diseases are leading causes of morbidity and mortality in the U.S.1,2 Smoking is a major cause3 and, like combustible tobacco products, e-cigarettes expose users to nicotine, ultrafine particles, and other toxicants.4 Some pulmonary toxicants are in e-cigarette aerosol at higher levels than combusted cigarettes, including propylene glycol,5 diacetyl6,7 (butter flavor), cinnamaldehyde8 (cinnamon), benzaldehyde (cherry), and metals.9,10

Animal studies found that e-cigarettes increase

METHODS

Data were collected in 2013–2016 and analyzed in 2018–2019.

RESULTS

Table 1 shows baseline descriptive statistics and Appendix Table 1, available online, shows the relationships between e-cigarette use and combusted tobacco and cigarette smoking. A total of 5,466 (15.1%) adults reported that they had respiratory disease at baseline. Table 2 shows the descriptive statistics stratified by respiratory disease at Wave 1 and combined Waves 2 and 3. Appendix Table 2, available online, reports detailed information by specific diagnosis.

Among people who did not report

DISCUSSION

This study is the first population-based longitudinal analysis of the association between e-cigarette use and incident respiratory disease, with current e-cigarette use elevating the odds of developing incident respiratory disease by a factor of 1.29 (95% CI=1.03, 1.61) in the longitudinal sample. The risk of respiratory disease is independent of, and in addition to, the risks associated with current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41), as well as cigarettes alone. This

CONCLUSIONS

Current use of e-cigarettes appears to be an independent risk factor for respiratory disease in addition to all combustible tobacco smoking. Although switching from combustible tobacco, including cigarettes, to e-cigarettes theoretically could reduce the risk of developing respiratory disease, current evidence indicates a high prevalence of dual use, which is associated with increased risk beyond combustible tobacco use. In addition, for most smokers, using an e-cigarette is associated with

ACKNOWLEDGMENTS

This work was supported by grants R01DA043950 from the National Institute on Drug Abuse; P50CA180890 from the National Cancer Institute and the U.S. Food and Drug Administration Center for Tobacco Products; U54HL147127 from the National Heart, Lung, and Blood Institute and the Food and Drug Administration Center for Tobacco Products; and the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center Global Cancer Program. The content is solely the responsibility of

REFERENCES (36)

  • G Wieslander et al.

    Experimental exposure to propylene glycol mist in aviation emergency training: acute ocular and respiratory effects

    Occup Environ Med

    (2001)
  • K Kreiss et al.

    Clinical bronchiolitis obliterans in workers at a microwave-popcorn plant

    N Engl J Med

    (2002)
  • KE Farsalinos et al.

    Evaluation of electronic cigarette liquids and aerosol for the presence of selected inhalation toxins

    Nicotine Tob Res

    (2015)
  • RZ Behar et al.

    Distribution, quantification and toxicity of cinnamaldehyde in electronic cigarette refill fluids and aerosols

    Tob Control

    (2016)
  • P Olmedo et al.

    Metal concentrations in e-cigarette liquid and aerosol samples: the contribution of metallic coils

    Environ Health Perspect

    (2018)
  • M Williams et al.

    Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol

    PLOS ONE

    (2013)
  • LF Chun et al.

    Pulmonary toxicity of e-cigarettes

    Am J Physiol Lung Cell Mol Physiol

    (2017)
  • N Moretto et al.

    Acrolein effects in pulmonary cells: relevance to chronic obstructive pulmonary disease

    Ann N Y Acad Sci

    (2012)
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