Association between tobacco product use and asthma among US adults from the Population Assessment of Tobacco and Health (PATH) Study waves 2–4

Abstract

BackgroundResearch on cigarettes and adult asthma offers mixed findings, perhaps due to overlap with chronic obstructive pulmonary disease (COPD) and inadequate adjustment for other smoke exposures. Associations between other tobacco products, including e-cigarettes, and asthma are also understudied.Research questionUsing Population Assessment of Tobacco and Health Study waves 2–4 (2014/2015–2016/2017) data, we assessed the relation between tobacco product use and asthma in persons unlikely to have COPD.Study design and methodsProspective study of 10 267 adults aged 18–39 years without COPD diagnoses. Past-month tobacco use at wave 2 was modelled first as combustible versus non-combustible use and second as specific product categories (former, cigarettes, e-cigarettes, cigars, hookah, smokeless tobacco). Outcomes included lifetime asthma prevalence at wave 2, incidence (waves 3 and 4) and Asthma Control Test score (lower=worse). Multivariable regressions adjusted for predictors of asthma, including other smoke exposures: cigarette pack-years, secondhand smoke and marijuana use. Sensitivity analyses examined findings when persons >39 years and those with both COPD and asthma were added, and when smoke exposure adjustments were removed.ResultsNo product, including cigarettes and e-cigarettes, was associated with prevalence or incidence of asthma. Among people with asthma at wave 2, combustible tobacco (beta=−0.86, 95% CI (−1.32 to –0.39)) and cigarettes (beta=−1.14, 95% CI (−1.66 to –0.62)) were associated with worse asthma control. No tobacco product was associated with asthma control over time. In sensitivity analyses, tobacco use became associated with incident asthma as adults >39 years and those with asthma+COPD were added, and as adjustments for other smoke exposures were omitted.InterpretationAlthough cigarette use was associated with worse asthma control, there were no longitudinal associations between combustible tobacco or e-cigarette use and new onset or worsening asthma in these preliminary analyses. Research on tobacco and asthma should exclude COPD and adjust for smoking history and other smoke exposures.

Use of Electronic Nicotine Delivery Systems and Age of Asthma Onset Among US Adults and Youths

“…Our sensitivity analysis among adults who did not have asthma or COPD showed a dose response association of P30D tobacco use with earlier age of asthma onset. These findings are in contrast with a 2014 to 2015 study 25 that started with adults without asthma aged 18 to 39 years and found that use of P30D ENDS or P30D use of any combustible product was not associated with asthma incidence 1 or 2 years later.…”

“…study 25 that started with adults without asthma aged 18 to 39 years and found that use of P30D ENDS or P30D use of any combustible product was not associated with asthma incidence 1 or 2 years later.…”

“… 12 , 13 , 14 , 15 Previous studies have examined the differences by biological sex of the age of asthma onset in adults 16 , 17 , 18 and youths, 19 , 20 but not with recent data. Several studies, 21 , 22 , 23 , 24 but not all, 25 , 26 have reported that ENDS use is associated with increased risk of asthma in adults 21 , 22 and youths 23 , 24 after controlling for other tobacco product (TP) use. While these studies have merit, there is a substantial gap in the field because prior studies have not examined the age of asthma onset with recent data or the association of P30D ENDS use with age of asthma onset for adults and for youths.…”

Risk factor analysis and nomogram for predicting poor symptom control in smoking asthmatics

“…Smoking is the second most significant risk factor (9.9%) for reducing the lifespan of asthma patients, amongst many other factors [ 3 ]. Compared with non-smokers, patients with smoking asthma experience poorer symptom control, a higher frequency of acute attacks, a more rapid decline in lung function, less effective ICS treatment, and a lack of guidance on a more efficient medication regimen, imposing a considerable burden on both patients and society [ 8 , 9 , 17 ]. In this study, we collected data from 190 patients suffering from smoking-asthma to explore the factors that could impact the level of symptom control after a 6 month period.…”

“…Since the proposal of the concept of ‘asthma control’ by the Global Initiative for Asthma (GINA) in 2006, ‘symptom control’ has been used as a measure to assess asthma and determine treatment options. It found that the mean asthma control test (ACT) score was about 1 point lower in combustible tobacco users compared with people who had never used tobacco (22.4 (SE=0.1) vs 23.6 (SE=0.2), P <0.01) [ 8 ].China is the world’s largest tobacco victim country - the smoking rate of people aged ≥15 years is as high as 26.6%, and the smoking rate of asthma patients is similar to that of ordinary people, which is 20-25%. However, in order to control for the influence of confounding factors and other potential mechanisms, a quantity of previous studies have excluded smoking asthma patients, resulting in a lack of progress in related studies on smoking asthma patients and a lack of targeted treatment guidance programs.…”