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Electronic cigarette use and its association with asthma, chronic obstructive pulmonary disease (COPD) and asthma- COPD overlap syndrome among never cigarette smokers

Emine Bircan, Ummugul Bezirhan, Austin Porter, Pebbles Fagan, Mohammed S. Orloff

Tob. Induc. Dis. 2021;19(September):75, pages 1-10, doi: 10.18332/tid/142579

ABSTRACT
Introduction:
Although smoking is a strong risk factor for lung diseases including asthma, COPD, and asthma-COPD overlap syndrome (ACOS), studies are needed to examine the association between e-cigarettes and asthma, COPD, and ACOS. This study evaluated the association between e-cigarette use and self-reported diagnosis of asthma, COPD, and ACOS using a large nationally representative sample of adults aged ≥18 years in the United States.

Methods:
Cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2016 to 2018 was used to examine self-reported information on current e-cigarette use, demographic variables, and asthma and COPD status among never cigarette smokers (n=8736). Asthma and COPD were measured by self-reported diagnosis, and respondents who reported having both diagnoses were then classified as having ACOS. Of the 46079 never cigarette smokers, 4368 non-e-cigarette smokers were 1:1 propensity score-matched to e-cigarette smokers on age, sex, race/ethnicity and education level. We used multinomial logistic regression to examine association between current e-cigarette use and self-report asthma, COPD, and ACOS while controlling for marital status and employment in addition to matching variables.

Results:
Compared with never e-cigarette smokers, e-cigarette smokers had increased odds of self-reported ACOS (OR=2.27; 95% CI: 2.23–2.31), asthma (OR=1.26; 95% CI: 1.25–1.27) and COPD (OR=1.44; 95% CI: 1.42–1.46).

Conclusions:
Data from this large nationally representative sample suggest that e-cigarette use is associated with increased odds of self-reported asthma, COPD, and ACOS among never combustible cigarette smokers. The odds of ACOS were twice as high among e-cigarette users compared with never smokers of conventional cigarettes. The findings from this study suggest the need to further investigate the long-term and short-term health effects of e-cigarette use, since the age of those at risk in our study was 18–24 years.

CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this research.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
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