Cigarettes, ENDS Use, and Chronic Obstructive Pulmonary Disease Incidence: A Prospective Longitudinal Study

Area of Science:

• Respiratory Medicine
• Public Health
• Epidemiology

Background:

• Understanding the respiratory health effects of electronic nicotine delivery systems (ENDS) is crucial, but prior research often inadequately adjusted for cigarette smoking history.
• Cigarette smoking is a well-established risk factor for chronic obstructive pulmonary disease (COPD).

Purpose of the Study:

• To examine the association between ENDS use and self-reported incident COPD in adults aged 40 years and older.
• To determine if ENDS use independently increases COPD risk after controlling for cigarette smoking history.

Main Methods:

• Analysis of Waves 1-5 of the U.S. Population Assessment of Tobacco and Health (PATH) study (2013-2019).
• Discrete-time survival models were used to assess the association between time-varying ENDS use and incident COPD.
• Multivariable models adjusted for demographics, health characteristics (asthma, obesity, secondhand smoke exposure), and detailed smoking history (status and pack-years).

Main Results:

• Unadjusted analysis suggested ENDS use doubled COPD incidence risk (HR=1.98).
• After adjusting for current cigarette smoking status and cigarette pack years, ENDS use was no longer significantly associated with incident COPD (aHR=1.10).
• Cigarette pack years remained a significant predictor of increased COPD incidence risk.

Conclusions:

• ENDS use was not significantly associated with an increased risk of self-reported incident COPD over a 5-year period when controlling for cigarette smoking.
• Adequate adjustment for cigarette smoking history is essential for accurately assessing the independent health effects of ENDS.
• Cigarette smoking remains a critical risk factor for COPD development.