HealthDay News — Dual use of an electronic nicotine delivery system (ENDS) and smoked tobacco is associated with an increased risk for incident respiratory symptoms compared with use of either product alone, according to a study published online April 15 in the American Journal of Respiratory and Critical Care Medicine.

Krishna P. Reddy, M.D., from Massachusetts General Hospital in Boston, and colleagues evaluated the association of ENDS use, tobacco smoking, and dual use with incident respiratory symptoms among people without baseline respiratory symptoms. The analysis included wave 3 respondents (2015 to 2016; 20,882 participants aged 12 years and older) to the Population Assessment of Tobacco and Health study. Incident respiratory symptoms were assessed in participants of wave 4 (2016 to 2018).

The researchers found that 1.4 percent of wave 3 respondents were exclusive ENDS users, 14.3 percent were exclusive tobacco smokers, and 2.7 percent were dual users. Incident respiratory symptoms were identified in 10.7 percent of wave 3 noncurrent users, 11.8 percent of exclusive ENDS users (adjusted odds ratio [aOR] compared with noncurrent users, 1.17; 95 percent confidence interval [CI], 0.79 to 1.74), 17.1 percent of exclusive tobacco smokers (aOR, 1.78; 95 percent CI, 1.56 to 2.03), and 19.7 percent of dual users (aOR, 2.22; 95 percent CI, 1.79 to 2.75). Higher odds of incident respiratory symptoms were seen among dual users versus either exclusive ENDS users (aOR 1.90; 95 percent CI, 1.23 to 2.93) or exclusive tobacco smokers (aOR 1.24; 95 percent CI, 1.00 to 1.55).


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“Those who use ENDS to stop smoking tobacco should be cautioned against dual use,” the authors write.

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