COPD Associated With Concurrent Use of Electronic, Conventional Cigarettes

man holding electronic cigarette and cigarettes
The increased risk for COPD from dual use of electronic and conventional cigarettes was especially notable in men older than 65.

Individuals who concurrently used both electronic and conventional cigarettes had a higher probability of developing chronic obstructive pulmonary disease (COPD) in a study recently published in BMC Pulmonary Medicine.

To determine whether dual use of electronic cigarettes (e-cigarettes) and conventional cigarettes (c-cigarettes) was associated with COPD, spirometry data were retrospectively analyzed from a cohort of participants in the Korea National Health and Nutrition Examination Survey. Pulmonary function testing, urinary cotinine, and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) levels were compared between dual users, current smokers, former smokers, and nonusers of cigarettes.

Among the 47,217 participants in the survey, 12,919 participants aged 40 and older for whom complete spirometry data were available were included in the analysis. Of these, 6924 were nonusers, 3282 were former smokers, 2549 were current smokers, and 164 were dual users. Both dual users and current smokers showed higher levels of urine cotinine and NNAL than nonusers and former smokers. Additionally, the weighted prevalence of COPD was the highest in dual users (13.8% for all participants and 14.1% for men).

The study authors wrote, “Dual use of e-cigarette and c-cigarette is associated with an increased risk of COPD.” They added, “Although switching to e-cigarette from c-cigarette theoretically reduces the harm from smoking, concurrent use might result in a synergistic negative effect on lung function, and appropriate policymaking should be based on solid evidence for e-cigarette use.”


Kim T, Kang J. Association between dual use of e-cigarette and cigarette and chronic obstructive pulmonary disease: an analysis of a nationwide representative sample from 2013 to 2018. BMC Pulm Med. Published online July 13, 2021. doi:10.1186/s12890-021-01590-8