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

Linnéa Hedman; Gustaf Lyytinen; Helena Backman; Magnus Lundbäck; Caroline Stridsman; Anne Lindberg; Hannu Kankaanranta; Lina Rönnebjerg; Eva Rönmark; Linda Ekerljung

doi:10.18332/tid/176949

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

Tob Induc Dis. 2024 Jan 22:22. doi: 10.18332/tid/176949. eCollection 2024.

Authors

Affiliations

¹ Department of Public Health and Clinical Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
² Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
³ Krefting Research Center, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁴ Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
⁵ Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

Abstract

Introduction: How e-cigarette use relates to changes in smoking status and respiratory symptoms in the population remains controversial. The aim was to study the association between e-cigarette use and, changes in smoking status and changes in respiratory symptoms.

Methods: A prospective, population-based study of random samples of the population (age 16-69 years) was performed within The Obstructive Lung Disease in Northern Sweden (OLIN) study and West Sweden Asthma Study (WSAS). A validated postal questionnaire containing identical questions was used in OLIN and WSAS at baseline in 2006-2008 and at follow-up in 2016. In total, 17325 participated on both occasions. Questions about respiratory symptoms and tobacco smoking were included in both surveys, while e-cigarette use was added in 2016.

Results: In 2016, 1.6% used e-cigarettes, and it was significantly more common in persistent tobacco smokers (10.6%), than in those who quit smoking (2.1%), started smoking (7.8%), or had relapsed into tobacco smoking at follow-up (6.4%) (p<0.001). Among current smokers at baseline, tobacco smoking cessation was less common in e-cigarette users than e-cigarette non-users (14.2% vs 47.6%, p<0.001) and there was no association with a reduction in the number of tobacco cigarettes smoked per day. Those who were persistent smokers reported increasing respiratory symptoms. In contrast, the symptoms decreased among those who quit tobacco smoking, but there was no significant difference in respiratory symptoms between quitters with and without e-cigarette use.

Conclusions: E-cigarette use was associated with persistent tobacco smoking and reporting respiratory symptoms. We found no association between e-cigarette use and tobacco smoking cessation, reduction of number of tobacco cigarettes smoked per day or reduction of respiratory symptoms.

Keywords: ENDS; airways; epidemiology; prospective; quitting smoking.

Grants and funding

FUNDING This work was supported by The Swedish Heart Lung Foundation, The Swedish Asthma and Allergy Foundation, VBG Group Herman Krefting Foundation for Asthma and Allergy Research, Swedish Research Council, ALF: a regional agreement between Umeå University and Region Västerbotten, and University of Gothenburg and Region Västra Götaland, respectively; Norrbotten County council and VISARE NORR Fund: Northern county councils’ Regional federation. None of the funding sources had any role in the design of the study and collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.