E-Cigarette Use Leads to Wheezing and Shortness of Breath in Young Adults
Presenter: Alayna P. Tackett, PhD
Young adults and adolescents who use e-cigarettes are at increased risk of wheezing and shortness of breath, even if they do not smoke cigarettes or marijuana.
The number of adolescents and young adults who use e-cigarettes continues to rise, with estimates of 5.4 million new users in 2019. E-cigarettes are the most commonly used tobacco product in this age group, but researchers have found it difficult to disentangle the risk of asthma and related respiratory symptoms associated with e-cigarettes due to a high frequency of cigarette and cannabis smoking among young e-cigarette users.
“As more products, including cannabis and various e-cigarette devices, enter the market, assessing respiratory health will be important both where adolescents and young adults receive their health care and in research,” said Alayna P. Tackett, PhD, assistant professor of preventive medicine, University of Southern California Keck School of Medicine.
Tackett and colleagues conducted a study to examine the use of e-cigarettes, cigarettes, and cannabis, along with self-reported asthma diagnosis and respiratory symptoms, over the previous 30 days. A sample of 2,931 American adolescents and young adults, mean age 18.9 years, 80% female, 75% white, provided cross-sectional, self-reported data via a web-based survey. The survey was fielded between August 6 and 30, 2020, among a national convenience sample of youth and young adults aged 14 to 21 using Lucid™, a survey management company. Recruitment, data collection, and compensation were handled by Lucid and company partners.
The researchers used multivariable logistic regression analyses to evaluate the associations between past 30-day e-cigarette, cigarette, and cannabis use and asthma diagnosis, wheeze, and shortness of breath. The results show that, after controlling for age, gender, and race/ethnicity, past 30-day e-cigarette use was associated with increased odds of self-reported asthma (odds ratio [OR]: 1.4), wheezing (OR: 3.1), and shortness of breath (OR: 2.9), compared with survey respondents who reported never using e-cigarettes. This relationship held true, even after statistically controlling for those who said they had ever used cigarettes or cannabis.
After controlling for past 30-day cigarette and cannabis use, past 30-day e-cigarette use was no longer associated with asthma, but was still associated with shortness of breath (OR: 2.3) and increased wheezing (OR: 2.1). The prevalence of asthma, wheeze, and shortness of breath was 24%, 13%, and 20%, respectively. Among past 30-day e-cigarette users, 15% reported using cigarettes, and 37% reported cannabis use.
“This preliminary study highlights the need for more longitudinal studies and studies that incorporate objective assessments of respiratory health to further determine the specific respiratory risks from e-cigarettes. We also need to better understand the complex relationships between these products and whether multiple product use is associated with worse respiratory outcomes,” said Tackett.
Wheeze and shortness of breath are just two indicators of many to assess respiratory health, she said. “The respiratory system is complex and it may be that measuring respiratory health more frequently through such means as spirometry may help tell us more about the relationship between e-cigarette use, multiple product use, and respiratory outcomes,” said Tackett.
The researchers are currently conducting two follow-up studies that use objective measurement tools, including handheld, home-based spirometry, to examine reports by adolescents and young adults of respiratory symptoms. Those who exclusively use e-cigarettes as well as those who have never used them will be recruited to examine their differences and better understand the relationship between e-cigarette use and respiratory health.
Link to abstract: Adolescent and Young Adult Use of Tobacco and Nicotine Products: Associations with Respiratory Symptoms
Alayna P. Tackett, PhD:
Research reported in this publication was supported by the National Cancer Institute and the FDA Center for Tobacco Products (CTP) under award number U54CA180905, award number K01HL148907 (Tackett) from the National Heart, Lung, and Blood Institute at the NIH, and award number 092-016-0002 (Tackett) from the Oklahoma Tobacco Settlement Endowme