More evidence that e-cigs damage lung health independent of smoking

Wubn Xie and colleagues just published another well-done study showing that e-cigarette use (current and past) increases risk of lung disease by about 30%-70% even after taking any current or past smoking in to account. They used 4 years of the large Population Assessment of Tobacco and Health (PATH) study that follows people over time. Such a longitudinal study is the strongest kind of epidemiological study because it allows researchers to ensure that the e-cigarette use occurred before lung disease was diagnosed.

Their results are almost identical to our earlier work based on the first three years of PATH as well as the results of a recent meta-analysis of e-cigarettes and lung disease. Because they had another year’s data, Xie et al were able to do a more fine-grained analysis of the relationship between e-cigarette use and different specific lung disease as well as the effects of different cigarette smoking patterns.

The fact that these findings were based on statistical models that included smoking behavior also indicates that e-cigarettes are a risk factor for lung disease independent of smoking and that dual use — the most common pattern of e-cigarette use — is more dangerous than just smoking cigarettes.

Here is the abstract:

Importance  Generating robust and timely evidence about the respiratory health risks of electronic cigarettes (e-cigarettes) is critical for informing state and federal regulatory standards for product safety.

Objective  To examine the association of e-cigarette use with incident respiratory conditions, including chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, and asthma.

Design, Setting, and Participants  This prospective cohort study used data from the nationally representative cohort of US adults from the Population Assessment of Tobacco and Health (PATH) study, including wave 1 from 2013 to 2014, wave 2 from 2014 to 2015, wave 3 from 2015 to 2016, and wave 4 from 2016 to 2018. Individuals aged 18 years and older at baseline with no prevalent respiratory conditions were included in the analyses. Analyses were conducted from February to July 2020.

Exposures  e-Cigarette use was assessed by self-reported current use status (never, former, or current) at baseline.

Main Outcomes and Measures  Incident respiratory conditions, including COPD, emphysema, chronic bronchitis, and asthma, as well as a composite respiratory disease encompassing all 4 conditions.

Results  Among 21 618 respondents included in the analyses, 11 017 (491%) were men and 12 969 (65.2%) were non-Hispanic White. A total of 14 213 respondents were never e-cigarette users, 5076 respondents (11.6%) were former e-cigarette users, and 2329 respondents (5.2%) were current e-cigarette users. Adjusted for cigarette and other combustible tobacco product use, demographic characteristics, and chronic health conditions, there was an increased risk of respiratory disease among former e-cigarette uses (incidence rate ratio [IRR], 1.28; 95% CI, 1.09-1.50) and current e-cigarette users (IRR, 1.31; 95% CI, 1.08-1.59). Among respondents with good self-rated health, the IRR for former e-cigarette users was 1.21 (95%CI, 1.00-1.46) and the IRR for current e-cigarette users was 1.43 (95% CI, 1.14-1.79). For specific respiratory diseases among current e-cigarette users, the IRR was 1.33 (95% CI, 1.06-1.67) for chronic bronchitis, 1.69 (95% CI, 1.15-2.49) for emphysema, 1.57 (95% CI, 1.15-2.13) for COPD, and 1.31 (95% CI, 1.01-1.71) for asthma.

Conclusions and Relevance  This cohort study found that e-cigarette use was associated with an increased risk of developing respiratory disease independent of cigarette smoking. These findings add important evidence on the risk profile of novel tobacco products.

The full citation is: Association of Electronic Cigarette Use With Incident Respiratory Conditions Among US Adults From 2013 to 2018. JAMA Netw Open. 2020;3(11):e2020816. November 12, 2020. Wubin Xie, Hasmeena Kathuria, Panagis Galiatsatos, Michael J. Blaha, Naomi M. Hamburg, Rose Marie Robertson, Aruni Bhatnagar, Emelia J. Benjamin, Andrew C. Stokes. It is available here:

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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