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Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

Author/s: 
Bhatta, DN, Glantz, SA

INTRODUCTION:

E-cigarettes deliver an aerosol of nicotine by heating a liquid and are promoted as an alternative to combustible tobacco. This study determines the longitudinal associations between e-cigarette use and respiratory disease controlling for combustible tobacco use.

METHODS:

This was a longitudinal analysis of the adult Population Assessment of Tobacco and Health Waves 1, 2, and 3. Multivariable logistic regression was performed to determine the associations between e-cigarette use and respiratory disease, controlling for combustible tobacco smoking, demographic, and clinical variables. Data were collected in 2013-2016 and analyzed in 2018-2019.

RESULTS:

Among people who did not report respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, or asthma) at Wave 1, the longitudinal analysis revealed statistically significant associations between former e-cigarette use (AOR=1.31, 95% CI=1.07, 1.60) and current e-cigarette use (AOR=1.29, 95% CI=1.03, 1.61) at Wave 1 and having incident respiratory disease at Waves 2 or 3, controlling for combustible tobacco smoking, demographic, and clinical variables. Current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41) was also significantly associated with having respiratory disease at Waves 2 or 3. Odds of developing respiratory disease for a current dual user (e-cigarette and all combustible tobacco) were 3.30 compared with a never smoker who never used e-cigarettes. Analysis controlling for cigarette smoking alone yielded similar results.

CONCLUSIONS:

Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking. Dual use, the most common use pattern, is riskier than using either product alone.

Keywords 
e-cigarette or vaping product use-associated lung injury vaping e-cigarettes smoking lung injury tobacco copd respiratory disease

Update: Characteristics of Patients in a National Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injuries — United States, October 2019

Author/s: 
Moritz, E.D., Zapata, L.B., Lekiachvili, A, Glidden, E, Annor, F.B., Werner, A., Ussery, E, Hughes, M.M., Kimball, A, DeSisto, C.L., Kenemer, E.H., Shamout, M, Garcia, M.C., Reagan-Steiner, S, Petersen, E.E., Koumans, E.H., Ritchey, M.D., King, BA, Jones, CM, Briss, PA, Delaney, L, Patel, A, Polen, KD, Sives, K, Meaney-Delman, D, Chatham-Stephens, K, Lung Injury Response Epidemiology/Surveillance Group

What is already known about this topic?

CDC and partners are investigating the ongoing outbreak of e-cigarette, or vaping, product use–associated lung injury (EVALI) in the United States, the District of Columbia, and one U.S. territory.

What is added by this report?

As of October 22, 2019, a total of 1,604 cases of EVALI, including 34 deaths, were reported to CDC. Based on data collected as of October 15, 2019, use of tetrahydrocannabinol (THC)-containing products in the 3 months preceding symptom onset was reported by 86% of patients. The median age of EVALI patients who survived was 23 years, and the median age of EVALI patients who died was 45 years.

What are the implications for public health practice?

Most EVALI patients report using THC-containing products before symptom onset. CDC recommends that persons should not use e-cigarette, or vaping, products containing THC. Because the specific compound or ingredient causing EVALI is not known, persons should consider refraining from use of all e-cigarette, or vaping, products.

 

TABLE. Characteristics of patients with electronic cigarette (e-cigarette), or vaping, product use–associated lung injury (EVALI) reported to CDC — United States, August–October 2019*

 
Characteristic No. /Total No. (%†)
EVALI patients who survived EVALI–associated deaths All EVALI patients
Sex
Male 947/1,349 (70) 17/29 (59) 964/1,378 (70)
Female 402/1,349 (30) 12/29 (41) 414/1,378 (30)
Age group (yrs)
13–17 735/1,335 (55)§ 2/29 (7)§ 196/1,364 (14)
18–24 541/1,364 (40)
25–34 339/1,335 (25) 5/29 (17) 344/1,364 (25)
35–44 165/1,335 (12) 7/29 (24) 172/1,364 (13)
45–64 79/1,335 (6) 8/29 (28) 87/1,364 (6)
65–75 17/1,335 (1) 7/29 (24) 24/1,364 (2)
Median age, yrs (range)
Overall 23 (13–72) 45 (17–75) 24 (13–75)
Male 23 (13–68) 55 (17–71) 23 (13–71)
Female 25 (13–72) 43 (27–75) 25 (13–75)
Race/Ethnicity      
White 283/365 (78) 15/18 (83) 298/383 (78)
Black or African American 22/365 (6)** 1/18 (6)** 9/383 (2)
American Indian or Alaska Native 4/383 (1)
Asian, Native Hawaiian, or other Pacific Islander 5/383 (1)
Other 5/383 (1)
Hispanic 60/365 (16) 2/18 (11) 62/383 (16)
Substances used in e-cigarette, or vaping, products ††,§§
THC-containing products, any use 733/848 (86) 16/19 (84) 749/867 (86)
Nicotine-containing products, any use 545/848 (64) 7/19 (37) 552/867 (64)
Both THC- and nicotine-containing products, any use 451/848 (53) 4/19 (21) 455/867 (52)
THC-containing products, exclusive use 282/848 (33) 12/19 (63) 294/867 (34)
Nicotine-containing products, exclusive use 94/848 (11) 3/19 (16) 97/867 (11)
No THC- or nicotine-containing products reported 21/848 (2) 0/19 (0) 21/867 (2)

 

Abbreviation: THC = tetrahydrocannabinol.
* Reported as of October 15, 2019.
† Percentages might not add up to 100% because of rounding.
§ Data for the 13–17 and 18–24 age groups were combined to protect patient identity.
 Whites; blacks or African Americans; American Indians or Alaska Natives; Asians, Native Hawaiians and other Pacific Islanders; and Others were non-Hispanic. Hispanic persons could be of any race.
** Data for persons in the following race/ethnicity groups were combined to protect patient identity: black or African American; American Indian or Alaska Native, Asian, Native Hawaiian, or other Pacific Islander, and Other.
†† In the 3 months preceding symptom onset; categories not mutually exclusive.
§§ Data on both THC- and nicotine-containing product use required to be included.

Keywords 
vaping lung injury e-cigarettes EVALI e-cigarette or vaping product use-associated lung injury
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