E-cigarette use and respiratory symptoms in adults: A systematic review and meta-analysis

Mohammed M Alqahtani; Faraj K Alenezi; Mohammed A Almeshari; Abdullah M Alanazi; Ziyad Ben Taleb; Mohammad E Ebrahimi Kalan; Mary P Martinasek; Rheese J McNab; Rachel Culbreth; Mansour Alotaibi; Hassan Aljohani; Lynda T Goodfellow; Taha T Ismaeil; Saleh S Algarni; Tareq F Alotaibi; Mobarak K Alqahtani; Hamoud Al-Ajel; Khalid S Alwadeai; Nafea S Almutairi; Eric Ford

doi:10.18332/tid/174660

E-cigarette use and respiratory symptoms in adults: A systematic review and meta-analysis

Tob Induc Dis. 2023 Dec 14:21:168. doi: 10.18332/tid/174660. eCollection 2023.

Authors

Mohammed M Alqahtani^{1

2

3}, Faraj K Alenezi^{4

5}, Mohammed A Almeshari⁶, Abdullah M Alanazi^{1

2}, Ziyad Ben Taleb⁷, Mohammad E Ebrahimi Kalan⁸, Mary P Martinasek⁹, Rheese J McNab⁹, Rachel Culbreth¹⁰, Mansour Alotaibi¹¹, Hassan Aljohani^{1

2}, Lynda T Goodfellow¹², Taha T Ismaeil^{1

2}, Saleh S Algarni^{1

2}, Tareq F Alotaibi^{1

2}, Mobarak K Alqahtani^{1

2}, Hamoud Al-Ajel^{13

14}, Khalid S Alwadeai⁶, Nafea S Almutairi¹⁵, Eric Ford¹⁶

Affiliations

¹ Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
² King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
³ Population Science, American Cancer Society, Atlanta, United States.
⁴ Department of Anaesthesia Technology, College of Applied Medical Sciences, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia.
⁵ Birmingham Acute Care Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
⁶ Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
⁷ Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, United States.
⁸ School of Health Professions, Eastern Virginia Medical School, Norfolk, United States.
⁹ Department of Health Sciences and Human Performance, University of Tampa, Tampa, United States.
¹⁰ Department of Respiratory Therapy, Georgia State University, Atlanta, United States.
¹¹ Department of Physical Therapy, Northern Border University, Arar, Saudi Arabia.
¹² Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, United States.
¹³ Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, AlRiyadh, Saudi Arabia.
¹⁴ Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, United States.
¹⁵ Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
¹⁶ Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, United States.

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.

Keywords: e-cigarette; respiratory symptoms; systematic review.

Publication types

Review