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Meta-Analysis
. 2021 Jan 21;57(1):1901815.
doi: 10.1183/13993003.01815-2019. Print 2021 Jan.

E-cigarette use and respiratory disorders: an integrative review of converging evidence from epidemiological and laboratory studies

Thomas A Wills  1 , Samir S Soneji  2 , Kelvin Choi  3 , Ilona Jaspers  4 , Elizabeth K Tam  5
Affiliations
Meta-Analysis

E-cigarette use and respiratory disorders: an integrative review of converging evidence from epidemiological and laboratory studies

Thomas A Wills et al. Eur Respir J. .

Abstract

Background: Use of electronic cigarettes (e-cigarettes) is prevalent among adolescents and young adults, but there has been limited knowledge about health consequences in human populations. We conduct a systematic review and meta-analysis of results on respiratory disorders from studies of general-population samples and consider the mapping of these results to findings about biological processes linked to e-cigarettes in controlled laboratory studies.

Method: We conducted a literature search and meta-analysis of epidemiological studies on the association of e-cigarette use with asthma and with COPD. We discuss findings from laboratory studies about effects of e-cigarettes on four biological processes: cytotoxicity, oxidative stress/inflammation, susceptibility to infection and genetic expression.

Results: Epidemiological studies, both cross-sectional and longitudinal, show a significant association of e-cigarette use with asthma and COPD, controlling for cigarette smoking and other covariates. For asthma (n=15 studies), the pooled adjusted odds ratio (aOR) was 1.39 (95% CI 1.28-1.51); for COPD (n=9 studies) the aOR was 1.49 (95% CI 1.36-1.65). Laboratory studies consistently show an effect of e-cigarettes on biological processes related to respiratory harm and susceptibility to illness, with e-cigarette conditions differing significantly from clean-air controls, although sometimes less than for cigarettes.

Conclusions: The evidence from epidemiological studies meets established criteria for consistency, strength of effect, temporality, and in some cases a dose-response gradient. Biological plausibility is indicated by evidence from multiple laboratory studies. We conclude that e-cigarette use has consequences for asthma and COPD, which is of concern for respirology and public health.

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Conflict of interest statement

Conflict of interest: S.S. Soneji has nothing to disclose. Conflict of interest: K. Choi has nothing to disclose. Conflict of interest: I. Jaspers has nothing to disclose. Conflict of interest: E.K. Tam has nothing to disclose. Conflict of interest: T.A. Wills reports grants from National Cancer Institute (P30 CA071789), during the conduct of the study.

Figures

FIGURE 1
FIGURE 1
Flow chart for selection of studies a) asthma; b) COPD.
FIGURE 2
FIGURE 2
Forest plots for meta-analysis of studies a) asthma; b) COPD.
FIGURE 3
FIGURE 3
Heuristic model for exploring relationship of e-cigarettes to respiratory outcomes.
See this image and copyright information in PMC

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