Vaping Linked to Higher Respiratory Disease Risk in Large US Study

Use of electronic cigarettes (e-cigarettes) is associated with an increased risk of respiratory diseases, including chronic obstructive pulmonary disease (COPD), among young adults, irrespective of other tobacco product use, a large U.S.-based study shows.

Compared to healthy people, those currently using e-cigarettes, commonly called vaping, had a 43% increased risk of developing a respiratory disease, the data show.

“This provides some of the very first longitudinal evidence on the harms associated with e-cigarette products,” Andrew Stokes, PhD, assistant professor of global health at the Boston University School of Public Health, and the study’s lead author, said in a press release.

“In recent years we have seen dramatic increase in e-cigarette use among youth and young adults which threatens to reverse decades of hard-fought gains,” Stokes added. “This new evidence also suggests that we may see an increase in respiratory disease as youth and young adults age into midlife, including asthma, COPD, and other respiratory conditions.”

The study, “Association of Electronic Cigarette Use With Incident Respiratory Conditions Among US Adults From 2013 to 2018,” was published in JAMA Network Open.

E-cigarettes have become widely popular since their introduction to the U.S. market in 2007. While exposure to toxic substances from e-cigarettes is significantly lower compared to traditional cigarettes (according to a 2018 report by the National Academies of Sciences, Engineering, and Medicine), more recent studies indicate that vaping poses specific health risks, including respiratory issues.

E-cigarettes contain harmful components, such as heavy metals and ultra-fine particles, and their use has been linked to increased immune response impairments and toxic effects to lung cells.

An outbreak of lung injuries associated with vaping has also been reported in the U.S.  However, the long-term effects of e-cigarette use are not fully understood.

In the new study, a group of researchers at the Boston University School of Public Health investigated the clinical outcomes of e-cigarette use in a large representative group of the U.S. population, retrieved from the Population Assessment of Tobacco and Health (PATH) study, an initiative of the National Institutes of Health and the U.S. Food and Drug Administration.

PATH collected annual survey data about tobacco habits and how its use impacted the health of U.S. citizens. The data were collected four times from 2013 to 2018.

In total, the study included data from 21,618 respondents, 11,017 (49.1%) of whom were men and 12,969 (65.2%) were non-Hispanic white.

At the start of the analysis (baseline), 7,405 respondents (16.8%) had used e-cigarettes, including 2,329 (5.2%) current users.

Compared to respondents who had never used e-cigarettes (14,213 respondents), current users were younger — 21.9% were 18 to 24 years old vs. 10.8% of never users — and more likely to use other tobacco products and illicit drugs.

The researchers assessed the incidence of respiratory conditions with e-cigarette use. Follow-up data included 804 new cases of asthma, 336 new cases of emphysema, 573 newly diagnosed cases of COPD, and 948 new cases of chronic bronchitis.

In total, 1,460 respondents (6.8% of the group) reported having at least one respiratory disease.

After adjusting for factors that could influence the development of respiratory diseases, the researchers observed that former and current e-cigarette use was linked to a 1.28 times higher risk of developing a respiratory disease, and, in particular, to a 1.62 times greater risk of COPD.

Compared to respondents who never used e-cigarettes, former users had a 28% increased risk of developing respiratory diseases, while current users’ risk was 31%.

Compared to healthy participants only (with a self-rated health score of good, great, or excellent), former e-cigarette users had a 21% increased risk of developing a respiratory disease, with the risk being even higher at 43% among current users.

For respondents with no chronic conditions at baseline, current e-cigarette use increased the risk of a respiratory disease by 40%.

Overall, “e-cigarette use was associated with an increased risk of developing respiratory disease independent of cigarette smoking,” the researchers concluded, noting that “these findings add important evidence on the risk profile of novel tobacco products” and are “critical for informing state and federal regulatory standards for product safety.”

According to Hasmeena Kathuria, MD, associate professor of pulmonary medicine at the Boston University School of Medicine and study co-author: the findings “highlight the importance of standardizing documentation of e-cigarette product use in electronic health records, and pushing the CDC to develop International Classification of Diseases codes for e-cigarette product use, so that providers can facilitate cessation discussions and identify adverse events related to e-cigarette use.”