Vaping linked to respiratory issues in young adults

By Dr. Liji Thomas, MDReviewed by Benedette Cuffari, M.Sc.May 31 2024

A recent study published in BMC Medicine explores the association of respiratory illness based on self-reported symptoms among young adolescents who vaped.

Study: Associations between vaping and self-reported respiratory symptoms in young people in Canada, England and the US. Image Credit: sergey kolesnikov / Shutterstock.com

How dangerous is vaping?

The prevalence of vaping continues to rise throughout the United States, Canada, and England, particularly among adolescents. Although vaping is considered less dangerous than smoking cigarettes and can even help adults looking to quit smoking, frequent vaping has the potential to cause adverse health effects.

Vaping exposes the lungs to fine and ultrafine particles, with several studies suggesting that the chemical components of e-cigarette aerosols could be harmful when used for extended periods.

Despite these observations, there remains a lack of evidence confimirng the adverse health effects of vaping, particularly using studies that include both vapers and smokers. The differences in vaping flavors and use of nicotine salts also requires additional research, as these features of vape products may affect the depth of inhalation or promote increased use.

About the study

Study participants completed the International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Surveys, which was conducted in Canada, the U.S., and England between 2020 and 2021. The current study included nearly 40,000 participants, 4,600 of whom vaped in the past 30 days.

About 66% of study participants were White, whereas about 25% reported experiencing difficulties in meeting basic expenses.

The respiratory symptoms experienced over the past week included shortness of breath, wheezing, chest pain, phlegm, and cough. Study participants also reported if they smoked or vaped over the last month, as well as their lifetime vaping history.

What did the study show?

Within the past 30 days, most of the study participants had neither vaped nor smoked, whereas few reported smoking or vaping in the previous 20 days. However, 16.3% of study participants had used one or more inhaled products other than vaping, with cannabis, tobacco, or heated tobacco accounting for 12.2%, 6.6%, and 0.9%, respectively.

Study participants who reported smoking in the past 30 days had done so for a median of 12 days. Nicotine salts were used by 53.5% and 21.6% of vapers who were aware about these products and who vaped over the last month, respectively.

About 28% of participants said they had experienced one or more respiratory symptom over the past week. Cough was the most common reported symptom among 16% of study participants, with 10% reporting shortness of breath and phlegm. Wheezing was rare and reported in less than 5% of study participants.

Among those who did not inhale any other products during the last month, respiratory symptoms were reported by 24%.

Both smokers and vapers reported similar symptom frequency. However, those who both smoked and vaped had a 26% increased risk of these symptoms as compared to either smokers or vapers. Conversely, the non-smoker and non-vaper group had a 33% reduced risk of respiratory symptoms as compared to smokers or vapers.

As compared to never-vapers, the risk of respiratory symptoms was higher among all other groups. Ever or current use of vaping, including experimental, occasional, and regular use, increased the risk of symptoms. The highest symptom risk was observed for those who vaped on 20 or more of the last 30 days, thus indicating a dose-response relationship with a 1% increase for each additional day of vaping.

Regular nicotine salt users had a 43% higher risk of symptoms as compared to non-salt users; however, this was associated with a high degree of uncertainty. The flavor of the vape was not associated with a change in risk level, except for fruity, multiple, or ‘other’ flavors, which were associated with a greater risk. Comparatively, mint or sweet flavors had the same risk as smoking.

Multiple and other vape flavors were associated with nearly twice the risk of respiratory symptoms as compared to a 44% increase with fruit flavors. All flavors and disposable devices were associated with a greater risk of cough. The use of other or unknown flavors was associated with chest pain, as was the use of unknown or multiple devices.

Symptom prevalence was overall and individually reduced for Canadian respondents as compared to those residing in England, whereas symptom prevalence was higher in the U.S. The difference between regular current vapers as compared to ever-vapers, experimenters, or never-vapers was greater in Canada as compared to England

Conclusions

Vaping is associated with increased self-reported respiratory symptoms as compared to non-smokers/non-vapers. Some flavors and the use of nicotine salts may also increase the risk of respiratory symptoms.

We were able to show for the first time in youth surveys a clear relationship between vaping frequency and respiratory symptoms.’

The dose-response relationship with respiratory symptoms was observed among past 30-day users, as well as lifetime or current users, with this association consistent in Canada, the U.S., and England.

Further research to understand the health impact of vaping must use standardized medical tests and laboratory markers, as well as validated long-term outcomes. Public health researchers should also know the constituents present in vaping liquids and how they act, both alone and in combination, on the bronchial tree and lung tissue. The prevalence of using other inhaled substances, as well as their interactions with vaping, is another important field of future study that will help regulate this product.