Smoking, e-cigarettes and the effect on respiratory symptoms among a population sample of youth: Retrospective cohort study

Abstract

INTRODUCTION E-cigarettes have been steadily increasing in popularity, both as cessation methods for smoking and for recreational and social reasons. This increase in vaping may pose cardiovascular and respiratory risks. We aimed to assess respiratory symptoms in youth users of e-cigarettes and cigarettes. METHODS A retrospective survey design was utilized to assess Canadian youth aged 16–25 years. Participants were recruited from the Ontario Tobacco Research Unit Youth and Young Adult Research Registration Panel November 2020 to March 2021. A total of 3082 subjects completed the baseline survey. Of these, 2660 individuals who did not have asthma were included in the analysis. The exposure of interest was pack-equivalent years, a novel measure of vaping exposure equivalent conceptually to cigarette pack years incorporating number of puffs per day, number of days vaped per month, and number of years vaped. Respiratory symptoms were measured using the five-item Canadian Lung Health Test. Poisson regression analyses were performed while adjusting for demographic confounders, stratified by smoking status. A non-stratified model tested the interaction of status and vaping dose and the effect of vaping device used was assessed among ever vapers. Analyses controlled for demographic characteristics, use of cannabis and alcohol, and survey date. RESULTS Each additional puff year increased the rate ratio (RR) of respiratory symptoms by a factor of 11.36 (95% CI: 4.61–28.00; p<0.001) for never smokers, but among current daily smokers higher pack-equivalent years were not associated with more respiratory symptoms (RR=0.83; 95% CI: 0.23–3.11). Among current vapers, those using pod-style devices were more likely to have more respiratory symptoms (RR=1.25; 95% CI: 1.08–1.45) after adjusting for dose. CONCLUSIONS Vaping is associated with an increased risk of reporting respiratory symptoms among never smoking youth and non-daily ever cigarette smokers. Use of e-cigarettes among non-smokers should be discouraged.

E-cigarette use and respiratory symptoms in adults: A systematic review and meta-analysis

“…The prevalence of cough among exclusive e-cigarette users encompassed a total of 54658 individuals from 12 separate studies 21 , 24 , 29 , 38 , 47 , 51 , 54 , 57 - 59 , 63 , 66 . A random-effects model was employed, revealing a pooled prevalence of cough at 21% (95% CI: 0.14–0.31).…”

“…In the meta-analysis focusing on the prevalence of phlegm among exclusive e-cigarette users, we included a total of 897 individuals from two distinct studies 24 , 57 . The pooled prevalence of phlegm was found to be 24% (95% CI: 0.11–0.46).…”

“…The prevalence of phlegm among dual e-cigarette users included 215 individuals’ data from three studies 22 , 24 , 57 . The random-effects model yielded a pooled phlegm prevalence of 20% (95% CI: 0.01–0.85).…”

“…In the meta-analysis investigating the prevalence of shortness of breath among dual e-cigarette users included 4697 individuals from seven studies 22 , 39 , 52 , 54 , 57 , 61 , 66 . The pooled prevalence of shortness of breath was 12% (95% CI: 0.03–0.36) using a random-effects model.…”

Electronic cigarette use in relation to changes in smoking status and respiratory symptoms

“…Our results are in line with a longitudinal US study, showing that dual use of tobacco and electronic cigarettes increased the risk of respiratory disease more than either product alone 15 . Already among adolescents, it has been shown that the greater the frequency of e-cigarette use, the higher the number of respiratory symptoms 26 . Whether switching from tobacco to e-cigarettes improves respiratory health remains controversial.…”