Vaping Without Cigarette Smoking Is Not Associated With Wheezing

Vaping, or the use of electronic nicotine delivery systems (ENDS), is not associated with increased odds of self-reported wheezing independent of cigarette smoking, according to a study in JAMA Network Open.

Researchers performed a longitudinal analysis of the association between vaping and cigarette use and self-reported wheezing symptoms among US adults with data from the Population Assessment of Tobacco and Health (PATH) for waves 1 (September 2013 to December 2014) through 5 (December 2018 to November 2019).

The cohort included 17,075 adults (mean (SD) age, 45.4 (17.0) years; 51.5% female)

in PATH waves 1 through 5 who had completed sociodemographic and health history data at wave 1. Wheezing was assessed with use of follow-up data from waves 2 (October 2014 to October 2015) to 5.

The population was divided, based on a combination of their smoking status (never, former, or current) and ENDS use status (current or noncurrent), into 6 cohorts: (1) those never using cigarettes and noncurrently using ENDS; (2) those never using cigarettes and currently using ENDS; (3) those currently using cigarettes and noncurrently using ENDS; (4) those current using cigarettes and currently using ENDS; (5) those formerly using cigarettes and noncurrently using ENDS; and (6) those formerly using cigarettes and currently using ENDS. The data were analyzed from August 2021 to January 2023.

The investigators found ENDS use was not associated with self-reported wheezing at the follow-up wave, overall (adjusted odds ratio [AOR], 1.09; 95% CI, 0.98-1.21), although current cigarette use (AOR, 3.15; 95% CI, 2.87-3.46) and former cigarette use (AOR, 1.50; 95% CI, 1.33-1.68) had a positive association.

The combination of never using cigarettes and current ENDS use was not associated with a significant increase in the odds of self-reported wheezing (AOR, 1.20; 95% CI, 0.83-1.72) vs never using cigarettes and noncurrent ENDS use. Former cigarette use and noncurrent ENDS use was associated with a 48.0% (AOR, 1.48; 95% CI, 1.32-1.67) increased odds of self-reporting wheezing, and former cigarette use and current ENDS use was associated with a 94.0% (AOR, 1.94; 95% CI, 1.57-2.41) increased odds.

The greatest increased risk for wheezing was found in individuals with current cigarette use. The odds of self-reported wheezing among those with current cigarette use and noncurrent ENDS use (AOR, 3.20; 95% CI, 2.91-3.51) were comparable to those with current cigarette use and ENDS use (AOR, 3.26; 95% CI, 2.82-3.77).

Among those formerly using cigarettes, current ENDS use was associated with a 31.0% (AOR, 1.31; 95% CI, 1.08-1.58) increase in odds of self-reported wheezing vs no current ENDS use. A 20.0% increase in odds of wheezing was associated with ENDS use in those never using cigarettes, although this increase was not statistically significant (AOR, 1.20; 95% CI, 0.83-1.72). No association was observed between ENDS use and wheezing among those currently using cigarettes (AOR, 1.02; 95% CI, 0.09-1.15).

In sensitivity analyses that stratified ENDS into never, noncurrent, and current use categories, a statistically significant increase was found in self-reported wheezing among those formerly using cigarettes and currently using ENDS (AOR, 1.33; 95% CI, 1.08-1.63) compared with those formerly using cigarettes and never using ENDS.

Among several limitations, all data were self-reported, and the sample size of some of the cigarette and ENDS use categories could have limited the ability to detect the actual association. Also, data across waves included information about ENDS products that were available at the time of the survey, and phrasing of questions in the PATH study could have led to misclassification of ENDS use.

“[O]ur findings suggest that the use of ENDS does not appear to be an independent factor associated with risk for self-reported wheezing,” the study authors concluded.

“This study adds to the body of literature that investigates the potential harms and benefits associated with ENDS use compared with other tobacco products. Our results can help inform public health policy recommendations for ENDS use under different tobacco product user categories,” the researchers noted.