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Study Adds Evidence Linking Vaping to Short-term Lung Symptoms in Youth


Use of electronic nicotine products was associated with an increased likelihood of dry nighttime cough and wheezing in adolescents, according to findings gleaned from a large survey.

A consequential cross-sectional study published in the International Journal of Environmental Research and Public Health has offered additional evidence that electronic nicotine product (ENP) use, also known as “vaping,” among young adults is linked with an increased likelihood of developing a dry nighttime cough and general wheezing. The findings may tie into the long-term effects of vaping, an activity that has been termed an epidemic among young adults in America.

Responses were gathered during 2015-2016 through the Population Assessment of Tobacco and Health (PATH) study database in its third wave of data collection. A total of 9750 participants aged 12 to 17 years were surveyed. This time frame overlapped with a distinct increase in vaping among youth in America. The authors observed that the young adults more likely to have vaped in the prior 12 months tended to be older teenage non-Hispanic Whites. Among this group, there were greater tendencies to also use more traditional nicotine products like cigars and cigarettes compared with their nonvaping peers.

After adjusting for covariates, the investigators found that wheezing/whistling, number of times wheezing, and dry cough at night were associated with ENP use (P < .05). Compared with adolescents who did not vape, those who vaped had 23% higher adjusted odds of dry nighttime cough (adjusted odds ratio, 1.23; 95% CI, 1.04-1.46; P = .02) and 37% higher adjusted odds of wheezing or whistling (adjusted odds ratio, 1.37; 95% CI, 1.11-1.71; P = .005).

On the other hand, the data did not find evidence to suggest a connection between e-cigarette use and new asthma diagnoses or exercise-induced wheezing in young adults who vape. Those surveyed who already were diagnosed with asthma did not show an association between ENP use and a changing need for a quick-relief or long-acting inhaler. 

The authors noted existing evidence that vaping as an adolescent can lead to other addiction patterns being stronger than if the activity began as an adult, and they added that the nicotine in some vaping pens may have negative effects on developing brains. There remains a possibility that vaping may render the body more vulnerable to lung injury from conditions including pneumonia and acute respiratory distress syndrome. 

How vaping may hurt the lungs is not yet definitively clear. One possibility the authors suggest is that aerosols from e-cigarettes may accumulate in the lungs and disrupt macrophages that clear blockages, possibly leading to irritation and poor robustness of airways.

Overall, the authors feel that their findings of increased coughing and wheezing among those surveyed are clinically relevant. The study had one of the largest sample sizes observed to date and was the first nationally representative US study of youth examining multiple variables of ENP use that controlled for variables that previously influenced other studies. 

The authors believe that in order to understand the long-term effects of e-cigarettes on respiration and asthma, additional highly focused data gathered from longitudinal studies that track pulmonary toxicity and clinical manifestations need to be produced.

To this end, the authors add that future studies should explore the differences in those surveyed who vape nicotine vs marijuana. There could be variations beyond the scope of their own research due to different substance types, the type of device used to vape, and the intensity of the vaping.

As it stands, the data gathered point to an association between ENP use and negative respiratory effects. The authors stress that these findings pave the way for more research in the field to be conducted going forward.


Cherian C, Buta E, Simon P, Gueorguieva R, Krishnan-Sarin S. Association of vaping and respiratory health among youth in the Population Assessment of Tobacco and Health (PATH) Study Wave 3. Int J Environ Res Public Health. 2021;18(15):8208. doi:10.3390/ijerph18158208

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