May 2024
Do electronic cigarettes cause respiratory symptoms in adolescents and young adults?

Evidence shows that e-cigarette use is associated with wheezing, dyspnoea and bronchitis.

Increasing evidence suggests that electronic-cigarette use (vaping) might have a role in smoking cessation (NEJM JW Gen Med Mar 1 2024 and N Engl J Med 2024; 390: 601-610). However, nonsmokers make up an increasing proportion of people who vape. For nonsmokers (for whom vaping is not being used as a smoking-cessation tool), the potential adverse respiratory effects of vaping are especially important. To collect additional information about the effect of e-cigarettes on respiratory health, researchers prospectively followed 2000 Californian youths (mean age, 17 years) from 2014 to 2018. Participants completed annual online surveys about respiratory symptoms (i.e. shortness of breath, wheeze, cough and congestion), cigarette use, e-cigarette use, cannabis use and passive exposures in the previous 30 days.

The following results were reported:

  • prevalence of e-cigarette use increased from 10% to 15% during the four-year study; the prevalence of smoking rose from 6% to 10%, and the prevalence of cannabis use was 26% in year four
  • compared with participants who never used e-cigarettes, those who used e-cigarettes in the prior 30 days reported significantly more shortness of breath, wheezing and bronchitis symptoms, with odd ratios ranging from 1.8 to 2.0
  • the excess risk for respiratory symptoms from e-cigarette use persisted after adjusting for history of asthma, current use of cigarettes or cannabis, and passive exposures, although the effect sizes were smaller.

Comment: Approximately 15% of youths are current e-cigarette users (NEJM JW Gen Med Jan 1 2024 and JAMA Intern Med 2024; 184: 106-108). It is likely that many of us do not routinely ask our patients about vaping, but if we see someone with recurrent, otherwise-unexplained respiratory symptoms, we should think about e-cigarettes as a potential cause.

Marie Claire O’Dwyer, MB BCh BAO, MPH, Clinical Assistant Professor in Family Medicine, University of Michigan Medical School, Ann Arbor, USA.

Tackett AP, et al. Prospective study of e-cigarette use and respiratory symptoms in adolescents and young adults. Thorax 2024; 79: 163-168.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Pediatrics and Adolescent Medicine.