e-Cigarette Use Likely Not Independently Associated With Wheezing Symptoms

In a study evaluating the prevalence of wheezing in relation to electronic nicotine delivery systems (ENDS) use, ENDS was not independently associated with an increase in self-reported wheezing. However, among individuals who were current cigarette smokers, there was a higher risk seen for wheezing with concomittant ENDS use.

“Similar results were observed when we conducted a sensitivity analyses stratifying ENDS use into 3 new categories: never, noncurrent (former), and current. Our sensitivity analysis, including 9 categories instead of 3, showed similar results,” wrote the researchers of the study. “This suggests that aside from the lasting impact of cigarettes on adult respiratory health in the former use group, ENDS use could independently increase the odds of reporting wheezing.”

The results of this cohort analysis study were published in JAMA Network Open.

E-cigarette use is increasing in the United States, yet it is unclear whether ENDS use has exacerbated wheezing symptoms among adults. The aim of this study was to analyze the relationship between ENDS use and wheezing, a common symptom for respiratory disease.

The data analyzed were part of the nationally representative US Population of Assessment of Tobacco and Health (PATH) Study, and this present analysis included adults 18 years or older from wave 1 (2013-2014) to wave 5 (2018-2019).

The researchers defined by participants' responses to this question, “Have you had wheezing or whistling in the chest in the past 12 months?” Data on ENDS use and reported smoking behavior (never, former, current) also were obtained.

Participants were grouped into 1 of 6 categories determined by their smoking status and current established ENDS use. The researchers included the patients’ sociodemographic factors at baseline: sex, race and ethnicity, household annual income, and self-reported history of disease.

Their sample population included 17,075 individuals, in which 8922 (51.5%) were women;l 10,242 (66.0%) were non-Hispanic White; 5956 (49.5%) reported having no exposure to second-hand smoking; and 3195 (16.4%) had a history of respiratory disease.

Compared with individuals who reported no current ENDS use and who never smoked cigarettes, the greatest association for self-reported wheezing was found among individuals who were current smokers and current ENDS users (adjusted odds ratio [AOR], 3.26; 95% CI, 2.82-3.77). Similarly, an association was found among individuals who reported current cigarette but noncurrent ENDS use (AOR, 3.20; 95% CI, 2.91-3.51). Both groups had significantly greater asspciations with self-reported wheezing than individuals with former cigarette use but current ENDS use (AOR, 1.94; 95% CI, 1.57-2.41).

Additionally, the association between never-smokers and current ENDS use compared with never-smokers and noncurrent ENDS use (AOR, 1.20; 95% CI, 0.83-1.72) and that seen for current cigarette and current ENDS use compared with current smokers and noncurrent ENDS use (AOR, 1.02; 95% CI, 0.91-1.51) were not statistically significant.

As a result, the researchers found that ENDS use was not an independent factor for wheezing symptoms. However, the slight increase among ENDS users who also reported a history of cigarette use suggests that the combination of smoking e-cigarettes and a history of smoking cigarettes may play a role in increasing risk of wheezing symptoms among this population.

“This study adds to the body of literature that investigates the potential harms and benefits associated with ENDS use compared with other tobacco products,” wrote the researchers. “Our results can help inform public health policy recommendations for ENDS use under different tobacco product user categories.”

Reference

Sánchez-Romero LM, Bondarenko I, Knoll M, et al. Assessment of electronic nicotine delivery systems with cigarette use and self-reported wheezing in the US adult population. JAMA Netw Open. Published online April 3, 2023. doi:10.1001/jamanetworkopen.2023.6247