Use of e-cigarettes may be inherently associated with respiratory issues regardless of traditional cigarette or cannabis exposure, a prospective study found.

Teenagers who reported using e-cigarettes in the previous 30 days subsequently reported an increased risk for shortness of breath (OR 1.78, 95% CI 1.23-2.57), wheezing (OR 1.81, 95% CI 1.28-2.56), and bronchitic symptoms (OR 2.06, 95% CI 1.58-2.69), reported Rob McConnell, MD, of the University of Southern California Keck School of Medicine, Los Angeles, and colleagues.

And after adjusting for current cigarette and cannabis use as well as secondhand exposure, the association remained for shortness of breath (OR 1.48, 95% CI 1.01-2.18) and bronchitic symptoms (OR 1.55, 95% CI 1.18-2.05), according to the analysis published in Thorax.

McConnell and colleagues noted that components of e-cigarette aerosols have known lung toxicity.

“For example, diacetyl and related diketone flavorings that cause bronchiolitis obliterans in occupationally exposed populations have also been found in e-cigarette liquids. E-cigarette aerosol has high concentrations of fine and ultrafine particles that can deliver these toxicants to the distal airways and alveoli, making the lung a target organ for injury and increasing risk for adverse respiratory health effects in e-cigarette users,” they wrote.

The researchers cited estimates from 2022 that indicate 14.1% of the youth population used e-cigarettes and were therefore exposed to these particles. Prior to that, more than half of teenage e-cigarette users said they intended to quit in a national study from 2020.

Study coauthor Alayna Tackett, PhD, of the Center for Tobacco Research at the Ohio State University in Columbus, said that while the perceived lower risk of e-cigarettes compared to traditional cigarettes may be attractive to adults interested in quitting smoking, there are still harmful risks present, particularly for younger users.

“The tobacco industry has left a legacy of long-term adult combustible cigarette users who are now trying to quit with the aid of e-cigarette devices. We are still learning about the long-term impacts of e-cigarettes, but we know based on existing literature that they likely pose fewer health risks to individuals than combustible cigarettes,” she stated in a press release.

“E-cigarettes are by no means risk-free, however, especially without careful regulation of flavorings and chemical additives that still exist in some products currently. Limiting the initiation of e-cigarette use by non-smokers is a critical public health goal, especially for younger generations who are becoming addicted to e-cigarettes,” Tackett stressed.

The present study used a high school-based survey on tobacco products and respiratory symptoms in 2014, conducted as part of the Southern California Children’s Health Study. A total of 2,097 participants completed the initial survey in 2014, with 1,609 supplying follow-up information in 2015, then 1,502 participants in 2017, and 1,637 in 2018.

At the time of the initial survey in 2014, the average participant age was 17.3 years. Of the survey respondents, 51.8% were Hispanic white and 35.1% were non-Hispanic white. The cohort was split between the sexes.

The proportion of students reporting e-cigarette usage within the previous 30 days was 9.6% at the time of the initial survey, followed by 12.9%, 9.4%, then 14.8% during subsequent follow-ups. Across the initial and follow-up surveys, 12-15% reported wheeze, 17-18% reported shortness of breath, and 19-26% reported bronchitic symptoms.

Approximately 22.7% of respondents reported having a history of physician-diagnosed asthma at the time of the initial survey. Cannabis use was added to the survey at the follow-up in 2017, when 21.7% of respondents reported using it.

Survey questions about shortness of breath were also not available until later follow-up waves, McConnell and colleagues acknowledged.

Among other major limitations of their study was its reliance on participants self-reporting their e-cigarette use and respiratory symptoms. Researchers also noted that it is difficult to accurately quantify e-cigarette usage compared with traditional cigarette usage.

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