Malvi Ajay, Khatib Mahalaqua Nazli, Ganesan Subbulakshmi, Kaur Mandeep, Srivastava Manish, Barwal Amit, Siva Prasad G V, Rajput Pranchal, Syed Rukshar, Hooda Ramesh Chander, Mohan Brijendra, Shabil Muhammed, Jena Diptismitha, Nanda Simranjeet, Aneja Aseem, Bushi Ganesh, Mehta Rachana, Sah Renu, Satapathy Prakasini, Gaidhane Shilpa
National Institute of Pharmaceutical Education and Research, Guwahati, India.
Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
Respir Med. 2025 May;241:108059. doi: 10.1016/j.rmed.2025.108059. Epub 2025 Mar 27.
Electronic Nicotine Delivery Systems (ENDS), commonly known as e-cigarettes or vapes, have gained widespread popularity, particularly among young adults and former smokers. While marketed as a harm reduction tool, concerns have emerged regarding their long-term impact on respiratory health, particularly their association with chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis aimed to evaluate the relationship between ENDS use and COPD risk while considering tobacco smoking as a key confounder.
A comprehensive search was conducted across PubMed, Embase, and Web of Science for studies published up to September 20, 2024. Observational studies assessing the association between ENDS use and COPD risk were included. A random-effects meta-analysis was performed using R statistical software (version 4.4). Tobacco smoking, a key confounder in COPD research, was accounted for in many included studies, with adjustments varying across studies.
Fifteen studies met the inclusion criteria. The pooled odds ratio (OR) for current ENDS use and COPD risk was 1.488 (95 % CI: 1.363-1.623). Former ENDS users had an OR of 1.839 (95 % CI: 1.513-2.234), and ever-users had an OR of 1.787 (95 % CI: 1.421-2.247). Sensitivity analyses confirmed the robustness of findings, and no publication bias was detected.
This meta-analysis provides evidence of a significant association between ENDS use and increased COPD risk, even after adjusting for tobacco smoking. Future research should standardize smoking adjustments and investigate the independent impact of ENDS use on COPD.
电子尼古丁传送系统（ENDS），通常被称为电子烟或汽化烟，已广泛流行，尤其在年轻人和曾经吸烟者中。虽然其作为一种减少危害的工具进行销售，但人们对其对呼吸健康的长期影响，特别是与慢性阻塞性肺疾病（COPD）的关联产生了担忧。本系统评价和荟萃分析旨在评估使用ENDS与COPD风险之间的关系，同时将吸烟作为一个关键混杂因素加以考虑。
在PubMed、Embase和Web of Science数据库中进行全面检索，纳入截至2024年9月20日发表的研究。纳入评估使用ENDS与COPD风险之间关联的观察性研究。使用R统计软件（版本4.4）进行随机效应荟萃分析。吸烟是COPD研究中的一个关键混杂因素，许多纳入研究对此进行了考量，各研究的调整方式有所不同。
15项研究符合纳入标准。当前使用ENDS与COPD风险的合并比值比（OR）为1.488（95%可信区间：1.363 - 1.623）。既往ENDS使用者的OR为1.839（95%可信区间：1.513 - 2.234），曾经使用者的OR为1.787（95%可信区间：1.421 - 2.247）。敏感性分析证实了研究结果的稳健性，未检测到发表偏倚。
本荟萃分析提供了证据，表明即使在调整吸烟因素后，使用ENDS与COPD风险增加之间仍存在显著关联。未来的研究应规范吸烟调整方法，并调查使用ENDS对COPD的独立影响。
