E-cigarette use elevates risk for bronchitic symptoms, shortness of breath in adolescents
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Key takeaways:
- Odds for respiratory symptoms increased with recent e-cigarette use with adjustment for simultaneous cigarette/cannabis use and secondhand exposure.
- These results encourage changes in e-cigarette regulation.
Adolescent e-cigarette users had greater risk for bronchitic symptoms and shortness of breath even with consideration of simultaneous cigarette and cannabis use and secondhand exposure, according to results published in Thorax.
“Among young people surveyed in this prospective, longitudinal study, we found that e-cigarette use was associated with self-reported bronchitic symptoms and shortness of breath,” Alayna P. Tackett, PhD, assistant professor in the division of medical oncology at The Ohio State University, told Healio. “Bronchitic symptoms were the most commonly reported symptom at each assessment timepoint. Asking about e-cigarette use and specific respiratory symptoms may be useful in identifying early respiratory symptoms among young people who currently use e-cigarettes.”
Using questionnaires that inquired about e-cigarette, cigarette and cannabis use in the past 30 days, as well as respiratory symptoms, Tackett and colleagues evaluated responses from 2,094 adolescents/young adults (mean age, 17.3 years; 51.8% Hispanic white; 50.4% male) in 2014, 1,609 in 2015 (wave 2), 1,502 in 2017 (wave 3) and 1,637 in 2018 (wave 4) to determine if e-cigarettes heighten the risk for wheeze, bronchitic symptoms and shortness of breath.
E-cigarette use was the greatest in wave 4 at 15.6%, whereas it ranged from 11% to 11.8% during waves 1 through 3.
Researchers found links between e-cigarette use and the above respiratory symptoms using mixed-effects logistic regression models that accounted for study wave, age, sex, race, lifetime asthma diagnosis (22.7%) and parental education level.
During each study wave, the respiratory symptom with the highest prevalence was bronchitic symptoms (wave 1, 19.4%; wave 2, 22.5%; wave 3, 23.5%; wave 4, 26%), followed by shortness of breath (wave 2, 16.5%; wave 3, 18.1%; wave 4, 17%) and wheeze (wave 1, 12.2%; wave 2, 13.9%; wave 3, 14.2%; wave 4, 14.8%).
In the adjusted model, recent e-cigarette use raised the risk for all three respiratory symptoms vs. never e-cigarette use, with the highest odds found for bronchitic symptoms (adjusted OR = 2.06; 95% CI, 1.58-2.69), followed by wheeze (aOR = 1.81; 95% CI, 1.28-2.56) and shortness of breath (aOR = 1.78; 95% CI, 1.23-2.57).
With added control for simultaneous cigarette and cannabis use and secondhand exposure to e-cigarettes, cigarettes or cannabis, researchers observed reduced elevated odds compared with the ones initially found for bronchitic symptoms (aOR = 1.55; 95% CI, 1.18-2.05) and shortness of breath (aOR = 1.48; 95% CI, 1.01-2.18). Wheeze was no longer significant in this model.
Notably, the risk for all three respiratory symptoms was raised among those with recent e-cigarette use and no concurrent cigarette or cannabis use in a sensitivity analysis (wheeze, aOR = 2.92; 95% CI, 0.85-10.1; bronchitic symptoms, aOR = 1.86; 95% CI, 0.83-4.19; shortness of breath, aOR = 1.53; 95% CI, 0.65-3.63).
Researchers also evaluated risk among individuals who reported recent e-cigarette use in a prior wave and found high odds for wheeze in both the first adjusted model (aOR = 2.17; 95% CI, 1.41-3.35) and the second adjusted model (aOR = 1.77; 95% CI, 1.14-2.74).
“While we are still learning about the long-term impacts of e-cigarettes, we know based on existing literature that they likely pose fewer health risks to individuals than combustible cigarettes,” Tackett told Healio. “However, e-cigarettes are by no means risk free, especially without careful regulation of flavorings and chemical additives that currently exist in some products. Limiting the initiation of e-cigarette use by nonsmokers is a critical public health goal, especially for younger generations who initiated tobacco product use and became nicotine dependent by using e-cigarettes.”
Tackett further told Healio that these findings can help protect young individuals by being considered in e-cigarette regulation.
“This study contributes to emerging evidence from human and toxicological studies that e-cigarette use is associated with increased risk for developing respiratory symptoms and it should be considered in the regulation of e-cigarettes to minimize the health impact of e-cigarette product use among young people,” Tackett said. “Future studies incorporating longitudinal and objective measurement on the respiratory effects associated with e-cigarette use, particularly how dual nicotine/tobacco use and/or cannabis use, impacts respiratory health among young people is needed.”
Reference:
- Young vapers at risk of bronchitis + shortness of breath even if they also smoke. https://www.bmj.com/company/newsroom/young-vapers-at-risk-of-bronchitis-shortness-of-breath-even-if-they-also-smoke/. Published Aug. 15, 2023. Accessed Aug. 15, 2023.