Association of electronic cigarette use and risk of COPD: a systematic review and meta-analysis

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a global health concern, primarily linked to cigarette smoking. The potential role of electronic cigarettes (e-cigarettes) in COPD development remains unclear. Despite growing popularity as a smoking alternative, evidence suggests e-cigarettes may have harmful respiratory effects. This systematic review and meta-analysis assess the relationship between e-cigarette use and odds of having COPD. A comprehensive search of Web of Science, Embase, and PubMed was conducted to identify observational studies that assessed the association between e-cigarette use and the risk of COPD, providing risk estimates (hazard ratios, risk ratios, or odds ratios) for current, former, and ever e-cigarette users. Random-effects meta-analysis was performed using R software (V 4.4), and heterogeneity was assessed with the I2 statistic. Sensitivity analyses were conducted to test the robustness of the findings. Publication bias was evaluated using Egger’s test and funnel plots. Seventeen studies (1087 records screened) were included. E-cigarette use was associated with significantly higher odds of COPD compared to non-use. The pooled odds ratios were 1.48 (95% CI: 1.36–1.61) for current users, 1.84 (95% CI: 1.51–2.23) for former users, and 1.79 (95% CI: 1.42–2.25) for ever users. Sensitivity analysis confirmed the robustness of the findings. E-cigarette use is associated with higher odds of having COPD. Public health efforts should consider raising awareness of the potential respiratory risks associated with e-cigarette use.