Three more epidemiological studies find that e-cigarette use increases lung disease

Three more epidemiological studies demonstrating increased risk of lung disease in e-cigarette users were presented at the Society for Nicotine and Tobacco Research meeting from Feb 20-23, 2019.  While they use different end points (respiratory disease generally, asthma, or COPD), they all show elevated risks associated with e-cigarette use, either by using people who are only using e-cigs or accounting for smoking in the statistical analysis. 

These epidemiological changes are precisely what you would predict based on the pathological changes that e-cigs cause in the lungs.

Here are the abstracts:

POS2-146

ELECTRONIC CIGARETTE USE IS ASSOCIATED WITH RESPIRATORY DISEASE AMONG ADULTS IN THE UNITED STATES POPULATION ASSESSMENT OF TOBACCO AND HEALTH: A LONGITUDINAL ANALYSIS

Dharma N. Bhatta, PhD, Stanton Glantz, PhD. University of California San Francisco, San Francisco, CA, USA.

Background: Electronic cigarettes are marketed as a less harmful nicotine delivery sys-tem and as a new smoking cessation tool. This study aim is to determine the longitudinal associations between electronic cigarette use and respiratory disease.

Methods: Longitudinal analysis of the Population Assessment of Tobacco and Health (PATH) Waves 1, 2 and 3. The Wave 1 dataset includes 32,320 adults, Wave 2 has 28,362 and Wave 3 has 28,148 American adults aged 18 years and above, of whom 23,670 completed all three waves. Wave 1 data were collected from September 2013 to December 2014, Wave 2 from October 2014 to October 2015 and Wave 3 from October 2015 to October 2016. PATH uses a four-stage stratified probability sample technique. Multivariable logistic regression was performed to determine the longitudinal associations between e-cigarette use and respiratory disease, controlling for cigarette smoking, demographic and clinical variables.

Results: Among people who did not report respiratory disease at Wave 1, the longitudinal analysis reveals statistically significant associations between former e-cigarette use (adjusted odds ratio, 1.24, 95% CI: 1.03, 1.51) and current e-cigarette use (1.23, 95% CI: 1.00, 1.52) at Wave 1 and having incident respiratory disease at Waves 2 or 3, controlling for cigarette smoking, demographic, and clinical variables. Current cigarette smoking (2.68, 95% CI: 2.10, 3.42) was also significantly associated with having respiratory disease at Waves 2 or 3. Odds of developing lung disease for a current dual user is 3.30 compared with a never smoker who never used e-cigarettes.

Conclusions: Current use of e-cigarettes is an independent risk factor for respiratory disease that accrues in addition to the effects of any cigarette smoking. Dual use is riskier than using either product alone.

PA4-4

ASSOCIATION OF ELECTRONIC CIGARETTES USE WITH WHEEZING AND OTHER RESPIRATORY SYMPTOMS IN ADULTS: RESULTS FROM THE POPULATION ASSESSMENT OF TOBACCO AND HEALTH (PATH) STUDY, WAVE 2

Dongmei Li, PhD1, Isaac K. Sundar, PhD1, Scott McIntosh, PhD1, Deborah Ossip, PhD1, Maciej L. Goniewicz, PhD, PharmD2, Richard J. O’Connor, PhD2, Irfan Rahman, PhD1. 1University of Rochester Medical Center, Rochester, NY, USA, 2Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.

Significance: Wheezing is a symptom of potential respiratory disease and known to be associated with smoking. Electronic cigarettes use, referred as vaping, has increased exponentially in recent years, but no study has examined the association of vaping with wheezing and other respiratory symptoms in adults. The objective of this investigation was to examine the association of vaping with wheezing and other respiratory symptoms in adults from the Population Assessment of Tobacco and Health (PATH) Study.

Methods: The PATH Wave 2 data collected from October 2014 to October 2015 with 28,171 adults were used to investigate the association of vaping with self-reported wheezing and other respiratory symptoms. Multivariable logistic regression models and cumulative logistic regression models were used with consideration of complex sampling design.

Results: Among the 28,171 adult participants, 641 adults (1.2%) were established exclusive vapers, 8,525 adults (16.6%) were established exclusive cigarette users,1,106 adults (2.0%) were dual users, and 17,899 adults (80.2%) were non-users. Compared to non-users, exclusive vapers have significantly elevated risks of wheezing or whistling in chest at any time in the past (aOR, 1.64; 95% CI, 1.30-2.07) or in past 12 months (aOR, 1.61; 95% CI, 1.29-2.00), more than 12 wheezing attacks in past 12 months (aOR, 1.60; 95% CI, 1.24-2.07), sleep disturbed at one or more nights per week due to wheezing (aOR, 1.64; 95% CI, 1.26-2.13), speech limitations to one or two words between breath due to wheezing in past 12 months (aOR, 1.67; 95% CI, 1.28-2.18), dry cough at night not associated with a cold or chest infection (aOR, 1.46; 95% CI, 1.11-1.92), after adjusting age, sex, race, ethnicity, education, income, BMI, duration of vaping, and second-hand smoke exposure. Further analysis including ex-smokers who quitted smoking indicated the prolonged effect of previous smoking on wheezing and other respiratory symptoms. Exclusive vapers who were ex-smokers had doubled the risk of wheezing and other respiratory symptoms compared to never smokers. Current vapers had significantly lower risk in wheezing and other respiratory symptoms compared to established exclusive smokers and dual users. No significant differences in risk of wheezing and other respiratory symptoms were found between dual users and smokers.

Conclusion: Vaping was associated with increased risk of wheezing and other respiratory symptoms in adults. Dual use does not reduce the risk of wheezing and other respiratory symptoms compared to smoking.

POS4-98

ELECTRONIC CIGARETTE USE AND CHRONIC RESPIRATORY DISORDER IN ADULTS FROM HAWAII AND CALIFORNIA

Rebecca J. Williams, DrPh, MPH1, Thomas A. Wills, PhD2, Ian Pagano3, Tam D. Vuong, MPH1. 1California Department of Public Health, California Tobacco Control Program, Sacramento, CA, USA, 2University of Hawaii Cancer Center, Honolulu, HI, USA, 3University of Life Cancer Center, Honolulu, HI, USA.

Significance: The use of electronic nicotine delivery systems (e-cigarettes) has increased in recent years, yet there is little evidence between the association of e-cigarette use and health outcomes. This study investigated the association of e-cigarette use with a diagnosed respiratory disorder among adults in Hawaii and California.

Methods: Data from adults participating in the 2016 Behavioral Risk Factor Surveillance Survey (BRFSS) in both Hawaii (unweighted N=8,087; weighted N=1,132,153) and California (unweight-ed N=11,393; weighted N= 30,439,756) were analyzed. Survey measures included e-cigarette use, cigarette smoking, and being diagnosed by a health professional with asthma or chronic obstructive pulmonary disease (COPD). Multivariable analyses tested associations of e-cigarette use with the respiratory variables controlling for cigarette smoking, demographics, and physical and psychosocial covariates.

Results: In Hawaii, statistically significant associations of e-cigarette use with asthma (AOR = 1.33, CI 1.03 - 1.77, p < .05) and COPD (AOR = 1.44, CI 1.08 - 1.92, p < .05) were found, occurring primarily among non-cigarette smokers. Results from California data were similar; a statistically significant association of e-cigarette use was found with asthma (AOR = 2.03, CI 1.48 - 2.79, p < .05) and COPD (AOR = 1.98, CI .99 - 3.97, p < .05) among non-cigarette smokers.

Conclusion: Findings from two large, representative samples of adults showed a statistically significant independent association of e-cigarette use with asthma and COPD. Study data were inconsistent with the possibility that persons with an existing respiratory disorder were using e-cigarettes for smoking cessation and support laboratory research on physiological mechanisms linking e-cigarettes with respiratory system irritation. These findings occurring among non-cigarette smokers suggest the possibility that e-cigarette use may be adding to respiratory disorders in this population.