February 7, 2019

Stanton A. Glantz, PhD

New evidence that e-cigs pose substantial risks of adult asthma and COPD similar to cigarettes

Tom Wills and colleagues just published “E-cigarette use and respiratory disorder in an adult sample,” documenting the link between e-cigarette use and asthma and chronic obstructive pulmonary disease, controlling for smoking among a large sample of Hawaiians.  The found e-cigs increase the risk of COPD by a factor of 2.58, with dual users (people use e-cigarettes and cigarettes at the same time) higher than using cigarettes or e-cigarettes alone.  They found similar risks for e-cigarettes, cigarettes, and dual use for asthma.

This figure, from their paper, makes these points nicely.  Note that the lines for e-cigarettes, cigarettes, and dual use all fall on top of each other, above the line for nonsmokers.  For COPD, the risks of e-cigarettes and cigarettes are similar, with dual use above both of them.

The COPD results for dual use are particularly important since about 70% of e-cigarette users continue to smoke (i.e., are dual users).  It adds to the case that, in terms of respiratory disease, e-cigarettes are about as bad as cigarettes, but also are different from cigarettes and add to the risk of smoking.  (This is the same finding we found for heart attacks.)

These results are consistent with an earlier study using PATH showing that e-cigarette users were at higher risk of COPD, controlling for smoking.

Here is the abstract:

OBJECTIVES:  Little evidence is available on the association of e-cigarettes with health indices. We investigated the association of e-cigarette use with diagnosed respiratory disorder among adults in data from the Behavioral Risk Factor Surveillance Survey (BRFSS).

METHODS: The 2016 Hawaii BRFSS, a cross-sectional random-dial telephone survey, had 8087 participants; mean age was 55 years. Items asked about e-cigarette use, cigarette smoking, and being diagnosed by a health professional with (a) asthma or (b) chronic obstructive pulmonary disease. Multivariable analyses tested associations of e-cigarette use with the respiratory variables controlling for smoking and for demographic, physical, and psychosocial variables.

RESULTS:  Controlling for the covariates and smoking there was a significant association of e-cigarette use with chronic pulmonary disorder in the total sample (AOR = 2.58, CI 1.36-4.89, p < 0.01) and a significant association with asthma among nonsmokers (AOR = 1.33, CI 1.00-1.77, p <  0.05). The associations were stronger among nonsmokers than among smokers. Results were similar for analyses based on relative risk and absolute risk. There was also a greater likelihood of respiratory disorder for smokers, females, and persons with overweight, financial stress, and secondhand smoke exposure.

CONCLUSIONS:  This is the first study to show a significant independent association of e-cigarette use with chronic respiratory disorder. Several aspects of the data are inconsistent with the possibility that e-cigarettes were being used for smoking cessation by persons with existing respiratory disorder. Theoretical mechanisms that might link e-cigarettes use and respiratory symptoms are discussed.

The full citation is:  Wills TA, Pagano I, Williams RJ, Tam EK.  E-cigarette use and respiratory disorder in an adult sample.  Drug Alcohol Depend. 2019 Jan 1;194:363-370. doi: 10.1016/j.drugalcdep.2018.10.004. Epub 2018 Nov 7.  It is available here.

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