Electronic Cigarette Use Might Cause Lung Dysfunction

Christie Cherian

Electronic nicotine devices (END) could ultimately cause lung injuries or dysfunction for adolescents.

In a study planned for presentation at the American Thoracic Society (ATS) 2020 International Conference, a team led by Christie Cherian, Yale School of Medicine, examined whether the early identification of respiratory symptoms that might progress to lung dysfunction could be crucial in understanding the pathophysiology of e-cigarette/vaping product use-associated lung injuries.

The investigators used evidence from the Population Assessment of Tobacco and Health (PATH) study to identify the link between e-cigarette use and respiratory symptoms indicative of airway inflammation for 9750 adolescents between October 2015 and October 2016.

The team used multivariable logistic models to estimate the adjusted association between electronic nicotine devices use within the previous 12 months and a number of respiratory outcomes including wheezing/whistling, number of times wheezing in chest, chest sounded wheezy during/after exercise, dry cough at night, and subject told by a health professional that he/she has asthma.

For individuals diagnosed with asthma, the investigators examined the link between past-12 months electronic nicotine device use and asthma medication use, such as a quick-relief inhaler or controller/long-acting inhaler.

The investigators adjusted the models for age, sex, race/ethnicity, parent education, and prior 12-month use of cigarette, cigars, hookah, and other methods of smoking.

Among the study population, only 1105 (12%) used ENDs and 1503 (15.7%) experienced wheezing/whistling in the previous 12 months.

For the multivariable models, wheezing/whistling and the number of times wheezing were linked with ENDs usage (P <0.05).

The adjusted odds of reporting wheezing/whistling were 31% (95% Cim, 6-61%) times higher in individuals who use ENDs when compared to participants who do not (P = 0.01), while the adjusted odds of reporting wheezing was 4-12 times rather than no wheezing were 70% higher in ENDs users than in non-users (AOR, 1.70; 95% CI, 1.01-2.86; P = 0.046).

However, there was no association found between END’s use and asthma diagnosis, long-acting inhaler use, quick-relief inhaler use, exercise-induced wheezing or dry cough at night.

“After adjusting for demographics and other tobacco use, vaping was associated with a significantly increased risk of wheezing,” the authors wrote. “These results suggest that perhaps airway inflammation as evidenced by wheezing may be the initial symptoms of subacute and subsequent acute EVALI manifestations. Additionally, this study demonstrates that vaping continues to be a public health threat among youth and must be addressed.”

Earlier this year, the US Centers for Disease Control and Prevention (CDC) identified 2668 e-cigarette/vaping produce use-associated lung injury cases or deaths (≈15% under 18 years of age).

In February, experts unveiled new guidance, presented at the Society of Critical Care Medicine (SCCM) 2020 Critical Care Congress, advising persons who vaped or used e-cigarettes within 90 days, and are experiencing chest pain, weight loss, cough, fatigue, or shortness of breath, to seek medical care.

“The spectrum of the impact of vaping on patients ranges from anxiety about the health risks or costs of addiction to progressive symptoms of a life-threatening disorder,” they wrote. “Our recommendations for management are based on the presence of vaping exposure and clinical findings that allow cases to be placed into three groups with distinct evaluation and management care plan goals and strategies.”

The study, “Association of Vaping and Respiratory Health Among Youth in the Population Assessment of Tobacco and Health (PATH) Study Wave 3,” was published online by the ATS International Conference.