San Francisco—Immediate problems with use of e-cigarettes have been well publicized, but what about longer term consequences?

An article in the American Journal of Preventive Medicine reports that e-cigarette use significantly increases the risk of developing chronic lung diseases, including asthma, bronchitis, emphysema, or chronic obstructive pulmonary disease. The first longitudinal study linking e-cigarettes to respiratory illness in a sample representative of the entire United States adult population was led by University of California San Francisco researchers.

The highest risk, however, was found with people who used e-cigarettes and also smoked tobacco—by far the most common pattern among adult e-cigarette users, according to the study team.

Those findings resulted from an analysis of publicly available data from the Population Assessment of Tobacco and Health (PATH), which tracked e-cigarette and tobacco habits as well as new lung disease diagnoses in more than 32,000 American adults from 2013 to 2016. The study used the first three waves of the public-use data files for this investigation.

Background information in the report notes that e-cigarettes deliver an aerosol of nicotine by heating a liquid and are promoted as an alternative to combustible tobacco.

Researchers point out that, 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,” the researchers explain. “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.”

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

Researchers recount how several earlier population studies had found an association between e-cigarette use and lung disease at a single point in time but explain that the cross-sectional studies made it difficult to determine whether lung disease was being caused by e-cigarettes or if people with lung disease were more likely to use e-cigarettes.

By starting with subjects who did not have any reported lung disease, tracking their e-cigarette use and smoking from the start, and then following up for 3 years, the new longitudinal study offers stronger evidence of a causal link between adult e-cigarette use and lung diseases than prior studies.

“What we found is that for e-cigarette users, the odds of developing lung disease increased by about a third, even after controlling for their tobacco use and their clinical and demographic information,” explained senior author Stanton Glantz, PhD, a UCSF professor of medicine and director of the UCSF Center for Tobacco Control Research and Education. “We concluded that e-cigarettes are harmful on their own, and the effects are independent of smoking conventional tobacco.”

“Dual users—the most common use pattern among people who use e-cigarettes—get the combined risk of e-cigarettes and conventional cigarettes, so they’re actually worse off than tobacco smokers,” he added, noting, “Switching from conventional cigarettes to e-cigarettes exclusively could reduce the risk of lung disease, but very few people do it. For most smokers, they simply add e-cigarettes and become dual users, significantly increasing their risk of developing lung disease above just smoking.”

Results reported in this study are unrelated to EVALI (E-cigarette or Vaping Product Use-Associated Lung Injury), the acute lung disease first reported last summer.

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