E-cigarette use and Respiratory Symptoms in Residents of the United States: A BRFSS Report

AbstractPurposeE-cigarettes are the most common type of electronic nicotine delivery system in the United States, rapidly gaining presence worldwide. E-cigarettes contain numerous toxic compounds that have been shown to induce mild to severe structural damage to the airways. The objective of this study is to assess if there is an association between e-cigarette use and respiratory symptoms in adults in the US as reported in the BRFSS in an attempt to drive potential early detection and prevention of severe or permanent respiratory disease.MethodsWe analyzed data from 18,079 adults, 18-44 years, who participated at the Behavioral Risk Factor Surveillance System (BRFSS) in the year 2017. E-cigarette smoking status was categorized as current everyday user, current some days user, former smoker, and never smoker. The frequency of any respiratory symptoms (cough, phlegm, or shortness of breath) was compared. We calculated unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CI).ResultsThe BRFSS reported prevalence of smoking e-cigarettes was 6%. About 28% of the participants reported any of the respiratory symptoms assessed. The frequency of reported respiratory symptoms was highest among current some days e-cigarette users (45%). After adjusting for selected participant’s demographic, socio-economic, and behavioral characteristics, and asthma and COPD status, the odds of reporting respiratory symptoms increased by 49% among those who use e-cigarettes some days (OR 1.49; 95% CI: 1.06-2.11), and by 29% among those who were former users (OR 1.29; 95% CI: 1.07-1.55) compared with those who never used e-cigarettes. No statistically significant association was found for those who used e-cigarettes every day (OR 1.41; 95% CI 0.96-2.08)ConclusionE-cigarettes cannot be considered safe alternatives to combustible traditional cigarettes. Cohort studies may shed more evidence on the association between e-cigarette use and specific respiratory diseases.