Exclusive e-cigarette use not linked to heightened risk for wheeze
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Key takeaways:
- E-cigarettes by themselves did not elevate the chances for wheezing.
- Risk for wheeze went up with use of both cigarettes and e-cigarettes.
Use of only electronic-nicotine delivery systems did not raise the odds for wheezing; however, when used in current and former cigarette smokers, it showed a small elevated risk, according to study results published in JAMA Network Open.
“While e-cigarette use alone was not found to be an independent factor for self-reported wheezing, dual use with e-cigarettes is a concern,” Luz M. Sánchez-Romero, PhD, assistant professor at Georgetown University, told Healio. “Clinicians should still collect information and advice regarding the patient’s tobacco and other nicotine product use.”
In a longitudinal cohort study, Sánchez-Romero and colleagues evaluated 17,075 adults (mean age, 45.4 years; 51% women; 66% non-Hispanic white) to determine if use of electronic-nicotine delivery systems (ENDS) and cigarettes raises the chances for self-reported wheezing.
Researchers looked at usage data that spanned from 2013-2014 (wave 1) to 2018-2019 (wave 5) and wheezing data from 2014-2015 (wave 2) to wave 5.
In order to evaluate how different levels of tobacco product use were related to wheezing, researchers created six usage groups: never cigarette and noncurrent ENDS use; never cigarette and current ENDS use; current cigarette and noncurrent ENDS use; current cigarette and current ENDS use; former cigarette and noncurrent ENDS use; and former cigarette and current ENDS use. Researchers then used generalized estimating equations to find how each product/group was related to wheezing.
For both cigarette use and ENDS use, researchers found little changes in behavior over the studied years, with cigarette use only fluctuating between 18% and 19% and ENDS use fluctuating between 2.6% to 3.5%. However, wheezing frequency did differ with time, with a decrease in wave 5 (14.3%) vs. wave 2 (16.4%).
Notably, ENDS use was more often found in current or former smokers than in those who only used ENDS, according to researchers.
Usage groups with the greatest reports of wheezing (over 30% in all yearly waves) included current cigarette and noncurrent ENDS use, as well as current cigarette and current ENDS use. Users of neither tobacco product had the smallest number of wheezing reports.
When accounting for ENDS and cigarette use separately, researchers found that exclusive ENDS did not raise the odds for wheezing after adjusting for several covariates (adjusted OR = 1.09; 95% CI, 0.98-1.21). However, an increase in the risk for wheeze was found with cigarette use, both current (aOR = 3.15; 95% CI, 2.87-3.46) and former (aOR = 1.5; 95% CI, 1.33-1.68). These findings signal that sole cigarette use is linked to higher odds for wheezing than sole ENDS use, which was surprising, Sánchez-Romero told Healio.
However, she said that when ENDS was used in current or former smokers, it did show a heightened risk for wheeze.
In evaluating the six usage groups and each of their associations with wheeze, researchers found that current dual use of cigarettes and ENDS demonstrated the highest odds for wheezing (aOR = 3.26; 95% CI, 2.82-3.77) vs. use of neither tobacco product.
Former cigarette and current ENDS use also showed an increase in odds for wheezing (aOR = 1.94; 95% CI, 1.57-2.41), but this was not nearly as high as the odds observed for current use of both smoking methods or the odds found for current cigarette and noncurrent ENDS use (aOR = 3.2; 95% CI, 2.91-3.51).
Looking within each cigarette use group to see if ENDS is related to wheezing, researchers found no significant increase in the likelihood for wheeze with ENDS use in the never cigarette use group.
Similar to the odds found for wheezing with exclusive ENDS use, in the current cigarette group, ENDS use was not linked to wheezing. Compared with no ENDS use, current ENDS use in the former cigarette group was the only group that demonstrated a higher likelihood for wheeze (aOR = 1.31; 95% CI, 1.08-1.58).
“As the availability of e-cigarettes changes and more detailed data on consumption becomes available, it will be important to update analyses on the health impact of long and short-term use,” Sánchez-Romero told Healio. “Research on the potential harms and benefits of e-cigarettes use compared to other tobacco products is ongoing and will require continued attention in the years to come.”
For more information:
Luz M. Sánchez-Romero, PhD, can be reached at ls1364@georgetown.edu.