Disclosures: Reddy reports he wrote an e-cigarette article for UpToDate. Please see the study for all other authors’ relevant financial disclosures.
May 07, 2021
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Dual use of tobacco and e-cigarettes linked to increased risk for respiratory symptoms

Disclosures: Reddy reports he wrote an e-cigarette article for UpToDate. Please see the study for all other authors’ relevant financial disclosures.
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Respiratory symptoms such as cough and wheeze are more likely in individuals who use both e-cigarettes and tobacco cigarettes together, compared with use of either product alone.

“People who vape e-cigarettes in an effort to stop smoking tobacco cigarettes should be cautioned against using both, and instead should switch over completely from smoking to vaping, with an ultimate goal of stopping vaping as well,” Krishna P. Reddy, MD, MS, investigator at the Medical Practice Evaluation Center and the Tobacco Research and Treatment Center at Mongan Institute and the division of pulmonary and critical care medicine at Massachusetts General Hospital and Harvard Medical School, told Healio.

Krishna P. Reddy, MD, MS, quote
Data were derived from Reddy KP, et al. Am J Respir Crit Care Med. 2021;doi:10.1164/rccm.202012-4441LE.

Researchers evaluated data from 20,882 participants (aged > 12 years) in the Population Assessment of Tobacco and Health Study, a U.S. nationally representative longitudinal survey. Participants reported no respiratory symptoms in the previous 12 months, which were defined as self-reported wheezing, whistling in the chest or nocturnal dry cough not associated with a cold or chest infection.

Participants were categorized by self-reported electronic nicotine delivery system use and tobacco smoking into noncurrent users that included former users (81.6%), current exclusive electronic nicotine delivery system users (1.4%), current exclusive tobacco smokers (14.3%) or current dual users of both electronic nicotine delivery systems and tobacco (2.7%) based on wave 3 (2015-2016) reports. Current use was defined as self-reported use of any electronic nicotine delivery system product or tobacco product some days or everyday for adults and self-reported use in the previous 30 days for youths aged 12 to 17 years.

Among adults, everyday use of electronic nicotine delivery system products was reported among 54.8% of exclusive users and 22.2% of dual users compared with 53.9% of exclusive tobacco smokers and 50% of dual users who reported everyday tobacco smoking. Among daily exclusive tobacco smokers and dual users who used the products every day, the median number of daily tobacco cigarettes smoked was 10.

At wave 4 (2016-2018), 10.7% of wave 3 noncurrent users, 11.8% of exclusive electronic nicotine delivery system users, 17.1% of exclusive tobacco smokers and 19.7% of dual users reported incident respiratory symptoms.

Dual users had significantly higher odds of incident respiratory symptoms compared with both exclusive electronic nicotine delivery system users (adjusted OR = 1.9; 95% CI, 1.23-2.93) and exclusive tobacco smokers (aOR = 1.24; 95% CI, 1-1.55).

“Despite similar frequency and intensity of tobacco smoking among exclusive tobacco smokers and dual users, dual users had a higher risk of new respiratory symptoms. In other words, dual users did not smoke more cigarettes than exclusive tobacco smokers,” Reddy said.

Looking ahead, “research about how vaping and smoking might interact to cause symptoms is needed,” Reddy said. “Also, more research is needed about the factors linked to continued smoking among those who vape to try to stop smoking.”

For more information:

Krishna P. Reddy, MD, MS, can be reached at kpreddy@mgh.harvard.edu.