Vaping Alone May Boost Lung Troubles

In a web-based survey involving more than 2,900 teens and young adults, electronic cigarette use was associated with shortness of breath and other respiratory events, even among those who did not smoke combustible cigarettes or use marijuana.

After controlling for demographic characteristics and multi-product use, past 30-day e-cigarette use was associated with an increased odds of self-reported wheezing and shortness of breath, reported Alayna Tackett, PhD, of the Keck School of Medicine at the University of Southern California in Los Angeles, at the American Thoracic Society (ATS) virtual meeting.

Tackett told MedPage Today that previous observational studies have shown associations between e-cigarette, combustible cigarette, and marijuana use and respiratory symptoms, such as asthma, wheeze, and shortness of breath. But many did not attempt to tease out the impact of concurrent combustible cigarette and/or marijuana use in e-cigarette users.

“It is certainly worthwhile to ask about ever use or current use of these other products, which can certainly impact respiratory symptoms,” she said.

The study included a national cross-sectional sample of teens and young adults (mean age 18.9 years; 80% female; 70% white; 16% Black) who completed the online survey in August 2020.

A total of 24%, 13%, and 20% reported having asthma, wheeze, or shortness of breath, respectively.

Unadjusted multivariate logistic regression modeling showed that compared with e-cigarette never users, current e-cigarette use was associated with an increased risk for asthma (OR 1.4, 95% CI 1.1-1.7, P=0.009), wheeze (OR 3.1, 95% CI 2.4-4.1, P<0.001), and shortness of breath (OR 2.9, 95% CI 2.3-3.6, P<0.001).

In modeling adjusted for age, sex, race/ethnicity, and co-use of cigarettes and cannabis, e-cigarette use was no longer associated with an increased risk for asthma (OR 1.1, 95% 0.9-1.4, P=0.04). But use of e-cigarettes was associated with an increased risk for self-reported wheeze (OR 2.3, 95% CI 1.6-3.0, P<0.001), and shortness of breath (OR 2.3, 95% CI 1.6-2.8, P<0.001).

“These findings add to a growing body of research linking e-cigarette use to wheeze and shortness of breath,” Tackett said. “I think it is very important to keep investigating this, and follow-up on these self-reported symptoms with objective respiratory indicators of health.”

Tackett and colleagues are currently exploring e-cigarette use and respiratory symptoms measured through mobile spirometry, and they are collecting biological specimens to examine markers of inflammation.

“Hopefully, we will be able to confirm these findings using objective indicators of symptoms,” she said.

In related research, Denitza Blagev, MD, of Intermountain Health in Murray, Utah, and colleagues examined cases of vitamin E acetate-related e-cigarette-related lung injury (EVALI) during the COVID-19 pandemic at two Utah academic health systems.

Vitamin E acetate added to vaping products was identified in November 2019 as the likely main cause of a nationwide outbreak of acute lung injury among e-cigarette users and blamed for more than 2,800 deaths.

“With the onset of the COVID-19 pandemic in the spring of 2020, it seemed like EVALI had really disappeared from the minds of both the general public and many healthcare professionals,” Blagev said in an ATS video presentation.

By March 2020, the two health systems were testing all patients presenting with acute lung injury for COVID-19. After this time, an EVALI diagnosis required a negative PRC test for COVID-19.

Between June 2019 and February 2021, 208 cases of EVALI were diagnosed at the two health systems. While the peak of the EVALI outbreak occurred in the fall of 2019, nearly half of cases were identified after March 2020 following initiation of COVID-19 testing — months after the vitamin E acetate connection to EVALI had been widely reported.

Patients were predominantly male and younger, with an average age of 31; 86% were white.

“We have seen a number of patients who have presented during the course of the pandemic — all of them requiring the exclusion of COVID-19 as a diagnosis,” Blagev said. “Despite the COVID pandemic, EVALI remains a cause of acute lung injury, and it is really critical that we obtain a vaping history in our patients.”

Blagev’s group, along with other researchers from Intermountain Health, published EVALI-related findings during the pandemic in 2020.