Impact of electronic cigarette usage on the onset of respiratory symptoms and COPD among Chinese adults

Beibei Song; Honglin Li; Huiran Zhang; Libin Jiao; Siyu Wu

doi:10.1038/s41598-024-56368-9

Impact of electronic cigarette usage on the onset of respiratory symptoms and COPD among Chinese adults

Sci Rep. 2024 Mar 7;14(1):5598. doi: 10.1038/s41598-024-56368-9.

Authors

Beibei Song¹, Honglin Li¹, Huiran Zhang², Libin Jiao³, Siyu Wu⁴

Affiliations

¹ The First Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University/Hebei Key Laboratory of Respiratory Critical Care/Hebei Institute of Respiratory Diseases, No. 215 Heping West Road, Shijiazhuang, 050000, China.
² Department of Biological Pharmacy, Hebei Medical University, Shijiazhuang, 050000, China.
³ Hebei Far East Communication System Engineering Company, Shijiazhuang, 050000, China.
⁴ The Third Department of Respiratory and Critical Care Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China. wusiyu.2003@163.com.

Abstract

The prevalence of dual usage and the relatively low cessation rate among e-cigarette (EC) users suggest that ECs have not demonstrated significant effectiveness as a smoking cessation tool. Furthermore, there has been a substantial increase in the prevalence of EC usage in recent years. Therefore, the objective of this study is to investigate the association between EC use and the incidence of respiratory symptoms and chronic obstructive pulmonary disease (COPD). A total of 10,326 participants aged between 20 and 55 years, without any respiratory diseases or COPD, were recruited for the study. These individuals attended employee physical examinations conducted at 16 public hospitals in Hebei province, China from 2015 to 2020. Logistic regression models were utilized to assess the association between EC use and the risk of respiratory symptoms and COPD using risk ratios along with their corresponding 95% confidence intervals. Restricted cubic spline functions were employed to investigate the dose-response non-linear relationship. The robustness of the logistic regression models was evaluated through subgroup analyses, and sensitivity analyses. During the 5-year follow-up period, a total of 1071 incident cases of respiratory symptoms and 146 incident cases of COPD were identified in this cohort study. After adjusting for relevant confounding factors, EC users demonstrated a respective increase in the risk of reporting respiratory symptoms and COPD by 28% and 8%. Furthermore, dual users who used both ECs and combustible cigarettes exhibited an elevated risk of incident respiratory symptoms and COPD by 41% and 18%, respectively, compared to those who had never used non-users of any cigarette products. The association between daily EC consumption and the development of respiratory symptoms, as well as COPD, demonstrated a significant J-shaped pattern. The potential adverse association between the consumption of ECs, particularly when used in combination with combustible cigarettes, and the development of respiratory symptoms and COPD necessitates careful consideration. Policymakers should approach ECs cautiously as a prospective smoking cessation tool.

Keywords: COPD; Combustible cigarette; Electronic cigarette; Respiratory symptoms.

MeSH terms

Adult
Cohort Studies
Electronic Nicotine Delivery Systems*
Humans
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive* / diagnosis
Pulmonary Disease, Chronic Obstructive* / epidemiology
Pulmonary Disease, Chronic Obstructive* / etiology
Smoking Cessation*
Young Adult