1
|
Alqahtani MM, Alenezi FK, Almeshari MA, Alanazi AM, Taleb ZB, Kalan MEE, Martinasek MP, McNab RJ, Culbreth R, Alotaibi M, Aljohani H, Goodfellow LT, Ismaeil TT, Algarni SS, Alotaibi TF, Alqahtani MK, Al-Ajel H, Alwadeai KS, Almutairi NS, Ford E. E-cigarette use and respiratory symptoms in adults: A systematic review and meta-analysis. Tob Induc Dis 2023; 21:168. [PMID: 38098748 PMCID: PMC10720266 DOI: 10.18332/tid/174660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Electronic cigarette (e-cigarette) use is gaining popularity among adults. Monitoring e-cigarette-induced respiratory symptoms is crucial for both clinical and regulatory purposes. We systematically reviewed the current literature to understand the prevalence of respiratory symptoms among exclusive e-cigarette users, dual users, and former smokers. METHODS Databases searched included PubMed, CINAHL, Cochrane Library, Embase, and Scopus. We included all English-language, empirical quantitative articles that explored the prevalence of e-cigarette-related respiratory symptoms. Random-effects models were utilized in conducting the meta-analyses. The quality of identified studies was evaluated using the NIH Study Quality Assessment Tools. This study is registered with PROSPERO(#CRD42020165973). RESULTS The literature search identified 1240 references. After removing duplicates and screening for eligibility, 168 studies were included in the final review. The majority of included studies reported a wide range of adverse respiratory symptoms. The respiratory symptoms were prevalent among the exclusive e-cigarette users, dual users, and those who switched from combustible cigarettes to e-cigarettes. Further, out of the RCT studies, 5 were rated as good quality, while 3 were rated as fair. Among the observational studies, 24 were rated as good quality, and 9 were rated as fair. The two experimental studies were both rated as fair quality. CONCLUSIONS Continued monitoring of respiratory symptoms among e-cigarette users is warranted. Due to the heterogeneity and inconsistencies among studies, which limit result interpretation and highlight the need for studies assessing causal inference, further research using robust study designs is essential. This will provide clinicians with comprehensive knowledge about the potential respiratory risks of e-cigarette use.
Collapse
Affiliation(s)
- Mohammed M. Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Population Science, American Cancer Society, Atlanta, United States
| | - Faraj K. Alenezi
- Department of Anaesthesia Technology, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Birmingham Acute Care Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mohammed A. Almeshari
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah M. Alanazi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ziyad Ben Taleb
- Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, United States
| | | | - Mary P. Martinasek
- Department of Health Sciences and Human Performance, University of Tampa, Tampa, United States
| | - Rheese J. McNab
- Department of Health Sciences and Human Performance, University of Tampa, Tampa, United States
| | - Rachel Culbreth
- Department of Respiratory Therapy, Georgia State University, Atlanta, United States
| | - Mansour Alotaibi
- Department of Physical Therapy, Northern Border University, Arar, Saudi Arabia
| | - Hassan Aljohani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Lynda T. Goodfellow
- Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, United States
| | - Taha T. Ismaeil
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Saleh S. Algarni
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Tareq F. Alotaibi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mobarak K. Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hamoud Al-Ajel
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, AlRiyadh, Saudi Arabia
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, United States
| | - Khalid S. Alwadeai
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Nafea S. Almutairi
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eric Ford
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, United States
| |
Collapse
|
2
|
Wasfi RA, Bang F, de Groh M, Champagne A, Han A, Lang JJ, McFaull SR, Melvin A, Pipe AL, Saxena S, Thompson W, Warner E, Prince SA. Chronic health effects associated with electronic cigarette use: A systematic review. Front Public Health 2022; 10:959622. [PMID: 36276349 PMCID: PMC9584749 DOI: 10.3389/fpubh.2022.959622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/29/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Over the last decade, e-cigarette use has been on the rise but with growing health concerns. The objective of this systematic review was to update findings for chronic health outcomes associated with e-cigarette use from the 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report. Methods Three bibliographic databases were searched to identify studies comparing the chronic health effects of e-cigarette users (ECU) to non-smokers (NS), smokers, and/or dual users indexed between 31 August 2017 and 29 January 2021. Two independent reviewers screened abstracts and full texts. Data were extracted by one reviewer and verified by a second one. Outcomes were synthesized in a narrative manner using counts and based on statistical significance and direction of the association stratified by study design and exposure type. Risk of bias and certainty of evidence was assessed. The protocol was prospectively registered on Open Science Framework https://osf.io/u9btp. Results A total of 180 articles were eligible. This review focused on 93 studies for the 11 most frequently reported outcomes and from which 59 reported on daily e-cigarette use. The certainty of evidence for all outcomes was very low because of study design (84% cross-sectional) and exposure type (27% reported on exclusive ECU, i.e., never smoked traditional cigarettes). Overall, the summary of results for nearly all outcomes, including inflammation, immune response, periodontal and peri-implant clinical parameters, lung function, respiratory symptoms, and cardiovascular disease, suggested either non-significant or mixed results when daily ECU was compared to NS. This was also observed when comparing exclusive ECU to NS. The only notable exception was related to oral health where most (11/14) studies reported significantly higher inflammation among daily ECU vs. NS. Compared to the smokers, the exclusive-ECUs had no statistically significant differences in inflammation orperiodontal clinical parameters but had mixed findings for peri-implant clinical parameters. Conclusions This review provides an update to the 2018 NASEM report on chronic health effects of e-cigarette use. While the number of studies has grown, the certainty of evidence remains very low largely because of cross-sectional designs and lack of reporting on exclusive e-cigarette exposure. There remains a need for higher quality intervention and prospective studies to assess causality, with a focus on exclusive e-cigarette use.
Collapse
Affiliation(s)
- Rania A. Wasfi
- Applied Research Division, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada,*Correspondence: Rania A. Wasfi
| | - Felix Bang
- Surveillance and Epidemiology Division, Centre for Immunization and Respiratory Infectious Diseases, Infectious Diseases Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Margaret de Groh
- Applied Research Division, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Andre Champagne
- Behaviours, Environments and Lifespan Division, Centre for Surveillance and Applied Research, Health Promotions and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Arum Han
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Justin J. Lang
- Applied Research Division, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Steven R. McFaull
- Behaviours, Environments and Lifespan Division, Centre for Surveillance and Applied Research, Health Promotions and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Alexandria Melvin
- Centre for Indigenous Statistics and Partnerships, Statistics Canada, Ottawa, ON, Canada
| | - Andrew Lawrence Pipe
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada,Division of Cardiac Prevention & Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shika Saxena
- Behaviours, Environments and Lifespan Division, Centre for Surveillance and Applied Research, Health Promotions and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Wendy Thompson
- Behaviours, Environments and Lifespan Division, Centre for Surveillance and Applied Research, Health Promotions and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Emily Warner
- Vaccine Safety, Vaccine Surveillance, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Stephanie A. Prince
- Applied Research Division, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada,Stephanie A. Prince
| |
Collapse
|
3
|
Lallai V, Manca L, Fowler CD. E-cigarette vape and lung ACE2 expression: Implications for coronavirus vulnerability. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2021; 86:103656. [PMID: 33838329 PMCID: PMC8025581 DOI: 10.1016/j.etap.2021.103656] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 05/15/2023]
Abstract
Evidence in humans suggests a correlation between nicotine smoking and severe respiratory symptoms with COVID-19 infection. In lung tissue, angiotensin-converting enzyme 2 (ACE2) appears to mechanistically underlie viral entry. Here, we investigated whether e-cigarette vapor inhalation alters ACE2 and nicotinic acetylcholine receptor (nAChR) expression in male and female mice. In male lung, nicotine vapor inhalation induced a significant increase in ACE2 mRNA and protein, but surprisingly, these differences were not found in females. Further, both vehicle and nicotine vapor inhalation downregulated α5 nAChR subunits in both sexes, while differences were not found in α7 nAChR subunit expression. Finally, blood ACE2 levels did not differ with exposure, indicating that blood sampling is not a sufficient indicator of lung ACE2 changes. Together, these data indicate a direct link between e-cigarette vaping and increased ACE2 expression in male lung tissue, which thereby reveals an underlying mechanism of increased vulnerability to coronavirus infection in individuals vaping nicotine.
Collapse
Affiliation(s)
- Valeria Lallai
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, 92697, USA
| | - Letizia Manca
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, 92697, USA
| | - Christie D Fowler
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, 92697, USA.
| |
Collapse
|
4
|
Keith R, Bhatnagar A. Cardiorespiratory and Immunologic Effects of Electronic Cigarettes. CURRENT ADDICTION REPORTS 2021; 8:336-346. [PMID: 33717828 PMCID: PMC7935224 DOI: 10.1007/s40429-021-00359-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Although e-cigarettes have become popular, especially among youth, the health effects associated with e-cigarette use remain unclear. This review discusses current evidence relating to the cardiovascular, pulmonary, and immunological effects of e-cigarettes. RECENT FINDINGS The use of e-cigarettes by healthy adults has been shown to increase blood pressure, heart rate, and arterial stiffness, as well as resistance to air flow in lungs. Inhalation of e-cigarette aerosol has been shown to elicit immune responses and increase the production of immunomodulatory cytokines in young tobacco-naïve individuals. In animal models, long-term exposure to e-cigarettes leads to marked changes in lung architecture, dysregulation of immune genes, and low-grade inflammation. Exposure to e-cigarette aerosols in mice has been shown to induce DNA damage, inhibit DNA repair, and promote carcinogenesis. Chronic exposure to e-cigarettes has also been reported to result in the accumulation of lipid-laden macrophages in the lung and dysregulation of lipid metabolism and transport in mice. Although, the genotoxic and inflammatory effects of e-cigarettes are milder than those of combustible cigarettes, some of the cardiorespiratory effects of the two insults are comparable. The toxicity of e-cigarettes has been variably linked to nicotine, as well as other e-cigarette constituents, operating conditions, and use patterns. SUMMARY The use of e-cigarettes in humans is associated with significant adverse cardiorespiratory and immunological changes. Data from animal models and in vitro studies support the notion that long-term use of e-cigarettes may pose significant health risks.
Collapse
Affiliation(s)
- Rachel Keith
- American Heart Association Tobacco Regulation and Addiction Center & The Christina Lee Brown Envirome Institute, Division of Environmental Medicine, Department of Medicine, University of Louisville, 302E Muhammad Ali Blvd, Louisville, KY 40202 USA
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center & The Christina Lee Brown Envirome Institute, Division of Environmental Medicine, Department of Medicine, University of Louisville, 302E Muhammad Ali Blvd, Louisville, KY 40202 USA
| |
Collapse
|
5
|
Kaur G, Singh K, Maremanda KP, Li D, Chand HS, Rahman I. Differential plasma exosomal long non-coding RNAs expression profiles and their emerging role in E-cigarette users, cigarette, waterpipe, and dual smokers. PLoS One 2020; 15:e0243065. [PMID: 33290406 PMCID: PMC7723270 DOI: 10.1371/journal.pone.0243065] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/15/2020] [Indexed: 12/12/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) are the varied set of transcripts that play a critical role in biological processes like gene regulation, transcription, post-transcriptional modification, and chromatin remodeling. Recent studies have reported the presence of lncRNAs in the exosomes that are involved in regulating cell-to-cell communication in lung pathologies including lung cancer, chronic obstructive pulmonary disease (COPD), asthma, and idiopathic pulmonary fibrosis (IPF). In this study, we compared the lncRNA profiles in the plasma-derived exosomes amongst non-smokers (NS), cigarette smokers (CS), E-cig users (E-cig), waterpipe smokers (WP) and dual smokers (CSWP) using GeneChip™ WT Pico kit for transcriptional profiling. We found alterations in a distinct set of lncRNAs among subjects exposed to E-cig vapor, cigarette smoke, waterpipe smoke and dual smoke with some overlaps. Gene enrichment analyses of the differentially expressed lncRNAs demonstrated enrichment in the lncRNAs involved in crucial biological processes including steroid metabolism, cell differentiation and proliferation. Thus, the characterized lncRNA profiles of the plasma-derived exosomes from smokers, vapers, waterpipe users, and dual smokers will help identify the biomarkers relevant to chronic lung diseases such as COPD, asthma or IPF.
Collapse
Affiliation(s)
- Gagandeep Kaur
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Kameshwar Singh
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Krishna P. Maremanda
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Dongmei Li
- Department of Clinical & Translational Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hitendra S. Chand
- Department of Immunology and Nanomedicine, Florida International University, Miami, FL, United States of America
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
- * E-mail:
| |
Collapse
|
6
|
Shi H, Tavárez ZQ, Xie Z, Schneller LM, Croft DP, Goniewicz ML, McIntosh S, O'Connor RJ, Ossip DJ, Rahman I, Li D. Association of flavored electronic nicotine delivery system (ENDS) use with self-reported chronic obstructive pulmonary disease (COPD): Results from the Population Assessment of Tobacco and Health (PATH) study, Wave 4. Tob Induc Dis 2020; 18:82. [PMID: 33082739 PMCID: PMC7549379 DOI: 10.18332/tid/127238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Flavors other than tobacco flavor have been identified as a major reason for electronic nicotine delivery system (ENDS) initiation in youth and are thought to contribute to the continued use of ENDS in users of all ages. Our previous research showed a significant association between overall ENDS use and COPD. This study aims to identify the association of ENDS flavor categories with self-reported COPD. METHODS The data analysis included 4909 adults from Population Assessment of Tobacco and Health (PATH) Wave 4 data who were ever established ENDS users and responded to an item about diagnosis of COPD. Weighted multivariable logistic regression models were used to examine the association between different ENDS flavors and self-reported COPD considering complex sampling design. RESULTS Among 4909 ever established ENDS users, 418 adults (weighted percentage 9.8%) had self-reported COPD. Self-reported COPD prevalence differed between different ENDS flavor categories, with the highest (weighted percentage 19.9%) occurring among tobacco flavor users. Compared to non-tobacco flavor categories, tobacco flavor category showed significantly higher association with self-reported COPD (AOR=2.05; 95% CI: 1.20–3.53), after adjusting for potential confounding variables. No significant associations with self-reported COPD were found for other examined ENDS flavor categories including menthol/mint, fruit, candy/ desserts/other-sweets, and other flavors, compared to their corresponding non-users. CONCLUSIONS Tobacco flavored ENDS use was significantly associated with self-reported COPD. Future studies are needed to confirm the biological and epidemiological association of flavored ENDS use with COPD.
Collapse
Affiliation(s)
- Hangchuan Shi
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, United States.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, United States
| | - Zahíra Quiñones Tavárez
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, United States.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, United States
| | - Zidian Xie
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, United States
| | - Liane M Schneller
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, United States.,Department of Public Health Sciences, University of Rochester Medical Center, Rochester, United States
| | - Daniel P Croft
- Department of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, United States
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, United States
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Deborah J Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, United States
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, United States
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, United States
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to integrate recent research on the respiratory immune effects of e-cigarettes with the pathogenesis of asthma to better understand how e-cigarettes may affect asthmatics and to note critical knowledge gaps regarding the effects of e-cigarettes on asthmatics. RECENT FINDINGS Human, rodent, and cell culture studies show that key cellular functions of epithelial cells, macrophages, and neutrophils are altered by e-cigarette exposure. Because respiratory immunity is already dysregulated in asthma, further alteration of cellular function by e-cigarettes could impact asthma development, severity, and/or exacerbations. Future research is needed to more directly investigate this relationship using controlled human exposure studies and exposure of cell culture or animal models of asthma to e-cigarettes.
Collapse
|