Electronic nicotine delivery systems linked to higher risk for earlier asthma onset
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Key takeaways:
- Adults who used electronic nicotine delivery systems in the past 30 days had an increased risk for asthma incidence.
- These findings did not hold for youths aged 12 to 17 years.
The use of electronic nicotine delivery systems by adults in the last 30 days was associated with earlier ages of asthma onset, suggesting that public health measures should be taken to motivate users to stop, according to a recent study.
Published in JAMA Network Open, the study aimed to examine the association between adult and youth participants who did not have asthma or COPD and never used cigarettes with a past 30-day use of electronic nicotine delivery systems (ENDS) with the age of asthma onset, Adriana Pérez, PhD, professor of biostatistics and data science at UTHealth Houston School of Public Health, and colleagues wrote.
“We want physicians to realize that they have to ask the question if the patient smoked an e-cigarette in the past 30 days, and not just tobacco, because if you did then you are at a higher risk of asthma,” Pérez told Healio.
Study design
The researchers conducted a secondary analysis of the U.S. nationally representative, longitudinal cohort Population of Tobacco and Health (PATH) Study that ran from 2013 to 2021 and measured the affect of tobacco use behaviors on the health of adults and youths aged 12 to 17 years.
Data analysis was conducted from September 2022 to April 2024 and included those who entered the PATH study at wave 1 (2013-2014) and wave 4 (2016-2017). Additionally, youths who entered a wave as replacements due to aging out were also included.
At their first wave of adult participation, adults were asked if they were ever given an asthma or COPD diagnosis by a physician. Those who answered negatively were asked again during waves 2 through 6 (2014-2021).
The parents of youths in the study were asked about an asthma diagnosis at wave 1. COPD was not measured. Those without an asthma diagnosis were asked again during waves 2 through 6. Researchers determined age of onset of asthma using data from waves 2 to 6.
Measurement of ENDS use — including e-cigarettes, vape pens, personal vaporizers and mods, e-cigars, e-pipes, e-hookahs and hookah pens — in the last 30 days was conducted by questioning.
The age of asthma onset was estimated by noting the age at the first wave of study participation and the number of weeks between survey dates. For the time to event analyses, lower and upper age bounds for asthma onset were estimated.
A total of 24,789 participants were included in analysis. There were 7,766 adults (59.11% women; 19.62% Hispanic; 54.19% non-Hispanic white) and 17,023 youths (50.6% girls; 23.67% Hispanic; 52.95% non-Hispanic white).
The median follow-up time for adults was 4.94 years and for youths was 4.19 years.
Study findings
Researchers found that 6.2 per 1,000 adults who did not have asthma or COPD and who never used cigarettes reported asthma incidence by age 27 years (HR = 0.62%; 95% CI, 0.46%-0.75%). By age 35 years, 10.8 per 1,000 adults reported asthma incidence (HR = 1.08%; 95% CI, 0.82%-1.42%), and by age 55 years, 25.8 per 1,000 adults reported asthma incidence (HR = 2.58%; 95% CI, 2.09%-3.24%).
Among youths, 22.3 per 1,000 reported asthma by age 15 years (HR = 2.23%; 95% CI, 1.88%-2.45%). By age 20 years, 79.6 per 1,000 youths reported incidence of asthma (HR = 7.96%; 95% CI, 7.31%-8.61%).
“If they were using an e-cigarette, we found that the age of onset of asthma was earlier, which means that they initiate asthma at earlier ages in comparison to adults who did not use e-cigarettes,” Pérez said.
Adults who used vs. did not use ENDS in the past 30 days had a 252% increased risk for asthma onset at an earlier age (HR = 3.52; 95% CI, 1.24-10.02). Youths did not show this association.
Adults who used only tobacco products and no ENDS in the past 30 days had a 69% increased risk for earlier asthma onset (HR = 1.69; 95% CI, 1.25-2.29) vs. those who never used tobacco products or ENDS in the past 30 days. However, adults who reported use of any tobacco products and ENDS in the last 30 days exhibited a 143% increased risk for earlier asthma onset (HR = 2.43; 95% CI 1.71-3.34). No association was found in the youth cohort.
Researchers urged that these findings should further emphasize the need for tobacco regulations and public health legislation that would address prevention, intervention and cessation programs.
“From a policy standpoint, we’d want lawmakers to move the age limit to 21 years old for tobacco and nicotine products,” Pérez told Healio.
She further noted the need for regulation in tobacco and e-cigarette advertising that can reach and influence youths as well as adults to use ENDS and that future studies are needed to examine the exact point of asthma incidence.