Association between Electronic Cigarette Use and Asthma among High School Students in South Korea

Jun Ho Cho, Samuel Y Paik, Jun Ho Cho, Samuel Y Paik

Abstract

Objectives: Little is known about health outcomes related to electronic cigarette (EC) use, despite its growing popularity. The aim of this study is to investigate the association between EC use and asthma.

Methods: The study design is a cross-sectional study. A total of 35,904 high school students were included as the final study population. The presence of asthma was based on a student's self-reported doctor diagnosis of asthma in the past 12 months.

Results: Prevalence rates of asthmatics in 'current EC users' (n = 2,513), 'former EC users' (n = 2,078), and 'never EC users' (n = 31,313), were 3.9% (n = 98), 2.2% (n = 46) and 1.7% (n = 530), respectively. Comparing 'current EC' users with 'never EC' users, the unadjusted OR for asthma was 2.36 (95% CI: 1.89-2.94). In order to control for the effect of conventional cigarette (CC) smoking, after stratifying the subjects by the three CC smoking categories (never CC, former CC, and current CC), within the 'never CC' category, the unadjusted OR for asthma for 'current EC' users was 3.41 (95% CI: 1.79-6.49), and the adjusted OR was 2.74 (95% CI: 1.30-5.78). Severe asthma was reflected by the number of days absent from school due to asthma symptoms; current EC users had the highest adjusted OR for severe asthma compared to 'never EC' users.

Conclusions: When compared to a reference population of high school students in South Korea, EC users have an increased association with asthma and are more likely to have had days absent from school due to severe asthma symptoms. In conclusion, the results indicate that EC use may be a risk factor for asthma. The results may be useful in developing a scientific basis for the evaluation of a potential health hazard by EC.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Williams M, Villarreal A, Bozhilov K, Lin S, Talbot P. Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol. PLoS One. 2013; 8: e57987 10.1371/journal.pone.0057987 Epub. 2013 Mar 20.
    1. Fairchild AL, Bayer R, Colgrove J. The Renormalization of Smoking? E-Cigarettes and the Tobacco “Endgame”. N Engl J Med. 2014; 370: 293–295. 10.1056/NEJMp1313940
    1. Martínez-Sánchez JM, Ballbè M, Fu M, Martín-Sánchez JC, Saltó E, Gottlieb M, et al. Electronic cigarette use among adult population: a cross-sectional study in Barcelona, Spain (2013–2014). BMJ Open. 2014; 4: e005894 10.1136/bmjopen-2014-005894
    1. King BA, Patel R, Nguyen KH, Dube SR. Trends in Awareness and Use of Electronic Cigarettes among U.S. Adults, 2010–2013. Nicotine Tob Res. 2014. September 19. pii: ntu191. [Epub ahead of print]
    1. Lee S, Grana RA, Glantz SA. Electronic cigarette use among Korean adolescents: a cross-sectional study of market penetration, dual use, and relationship to quit attempts and former smoking. J Adolesc Health. 2014; 54: 684–690. 10.1016/j.jadohealth.2013.11.003
    1. Cho JH, Shin EY, Moon SS. Electronic-cigarette smoking experience among adolescents. J Adolesc Health. 2011; 49: 542–546. 10.1016/j.jadohealth.2011.08.001
    1. Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V. Characteristics, perceived side effects and benefits of electronic cigarette use: a worldwide survey of more than 19,000 consumers. Int J Environ Res Public Health. 2014; 11: 4356–4373. 10.3390/ijerph110404356
    1. Brown J, Beard E, Kotz D, Michie S, West R. Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction. 2014; 109: 1531–1540. 10.1111/add.12623
    1. Dutra LM, Glantz SA. Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study. JAMA Pediatr. 2014; 168: 610–617.
    1. Jensen RP, Luo W, Pankow JF, Strongin RM, Peyton DH. Hidden Formaldehyde in E-Cigarette Aerosols. N Engl J Med. 2015; 372: 392–394. 10.1056/NEJMc1413069
    1. Cheng T. Chemical evaluation of electronic cigarettes. Tob Control. 2014; 23 Suppl 2: ii11–7. 10.1136/tobaccocontrol-2013-051482
    1. Brandon TH, Goniewicz ML, Hanna NH, Hatsukami DK, Herbst RS, Hobin JA, et al. Electronic Nicotine Delivery Systems: A Policy Statement from the American Association for Cancer Research and the American Society of Clinical Oncology. J Clin Oncol. 2015. January 8. pii: JCO.2014.59.4465. [Epub ahead of print]
    1. Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control. 2014; 23: 133–139. 10.1136/tobaccocontrol-2012-050859
    1. Dörger M, Münzing S, Allmeling AM, Krombach F. Comparison of the phagocytic response of rat and hamster alveolar macrophages to man-made vitreous fibers in vitro. Hum Exp Toxicol. 2000; 19: 635–640.
    1. Dörger M, Münzing S, Allmeling AM, Messmer K, Krombach F. Differential responses of rat alveolar and peritoneal macrophages to man-made vitreous fibers in vitro. Environ Res. 2001; 85: 207–214.
    1. Callesen M, Bekö G, Weschler CJ, Sigsgaard T, Jensen TK, Clausen G, et al. Associations between selected allergens, phthalates, nicotine, polycyclic aromatic hydrocarbons, and bedroom ventilation and clinically confirmed asthma, rhino conjunctivitis, and atopic dermatitis in preschool children. Indoor Air. 2014; 24: 136–147. 10.1111/ina.12060
    1. Schweitzer KS, Chen SX, Law S, Van DM, Poirier C, Justice MJ, et al. Endothelial disruptive pro-inflammatory effects of nicotine and e-cigarette vapor exposures. Am J Physiol Lung Cell Mol Physiol. 2015. May 15:ajplung.00411.2015. 10.1152/ajplung.00411.2014 [Epub ahead of print]
    1. Zalk DM, Paik SY, Swuste P. Evaluating the Control Banding Nanotool: a qualitative risk assessment method for controlling nanoparticle exposures. Journal of Nanoparticle Research. 2009; 11: 1685–1704.
    1. Nemmar A, Albarwani S, Beegam S, Yuvaraju P, Yasin J, Attoub S, et al. Amorphous silica nanoparticles impair vascular homeostasis and induce systemic inflammation. Int J Nanomedicine. 2014; 9: 2779–2789. 10.2147/IJN.S52818 eCollection. 2014.
    1. Orthen B. Approaches for the definition of threshold limit values for nanomaterials. In: OECD workshop on exposure assessment and exposure mitigation, 20 Oct 2008, Frankfurt, Germany.
    1. Gibdon PG, McDonald VM, Marks GB. Asthma in older adults. Lancet. 2010; 376: 803–813. 10.1016/S0140-6736(10)61087-2
    1. Deshpande M, Chewning B, Mott D, Thorpe JM, Young HN. Asthma medication use among U.S. adults 18 and older. Res Social Adm Pharm. 2014. Nov-Dec; 10(6): e113–23. 10.1016/j.sapharm.2014.02.006 Epub 2014 Mar 1.
    1. Polosa R, Thomson NC. Smoking and asthma: dangerous liaisons. Eur Respir J. 2013. March; 41(3): 716–726. 10.1183/09031936.00073312 Epub 2012 Aug 16.
    1. Polosa R, Knoke JD, Russo C, Piccillo G, Caponnetto P, Sarvà M, et al. Cigarette smoking is associated with a greater risk of incident asthma in allergic rhinitis. J Allergy Clin Immunol. 2008; 121: 1428–1434. 10.1016/j.jaci.2008.02.041
    1. Korean Center for disease Control and Prevention. The statistics on adolescent health-related behavior in South Korea. Available: . Accessed 01 September 2015.
    1. Wu Q, Jiang D, Minor M, et al. Electronic cigarette liquid increases inflammation and virus infection in primary human airway epithelial cells. PLoS One. 2014; 9: e108342 10.1371/journal.pone.0108342 eCollection. 2014.
    1. Lim HB, Kim SH. Inhallation of e-Cigarette Cartridge Solution Aggravates Allergen-induced Airway Inflammation and Hyper-responsiveness in Mice. Toxicol Res. 2014; 30: 13–18. 10.5487/TR.2014.30.1.013

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe