Assessing the impact of electronic nicotine delivery systems on chronic obstructive pulmonary disease: A systematic review and meta-analysis

Malvi A 1 , Khatib MN 2 , Ganesan S 3 , Kaur M 4 , Srivastava M 5 , Barwal A 6 Show all authors , Siva Prasad GV 7 , Rajput P 8 , Syed R 9 , Hooda RC 10 , Mohan B 11 , Shabil M 12 , Jena D 13 , Nanda S 14 , Aneja A 15 , Bushi G 16 , Mehta R 17 , Sah R 18 , Satapathy P 19 , Gaidhane S 20

Affiliations 

  • 1 National Institute of Pharmaceutical Education and Research, Guwahati, India. Electronic address: ajaymalvi86@gmail.com
  • 2 Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India. Electronic address: nazlikhatib@dmiher.edu.in
  • 3 Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to Be University), Bangalore, Karnataka, India. Electronic address: g.subbulakshmi@jainuniversity.ac.in
  • 4 Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan, 303012, India. Electronic address: mkphd2024@gmail.com
  • 5 Department of Endocrinology, NIMS University, Jaipur, India. Electronic address: manish.srivastava1@nimsuniversity.org
  • 6 Chandigarh Pharmacy College, Chandigarh Group of College, Jhanjeri, Mohali, 140307, Punjab, India. Electronic address: Amit2475.research@cgcjhanjeri.in
  • 7 Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh, 531162, India. Electronic address: sivaprasad.gv@raghuenggcollege.in
  • 8 School of Applied and Life Sciences, Division of Research and Innovation, Uttaranchal University, Dehradun, India. Electronic address: pranchalr2529@gmail.com
  • 9 IES Institute of Pharmacy, IES University, Bhopal, Madhya Pradesh, 462044, India. Electronic address: Rukshar.research@iesuniversity.ac.in
  • 10 New Delhi Institute of Management, Tughlakabad Institutional Area, New Delhi, India. Electronic address: rc.hooda@ndimdelhi.org
  • 11 Department of Emergency, Graphic Era Institute of Medical Sciences, Graphic Era (Deemed to Be University), Clement Town, Dehradun, India. Electronic address: brijendermohan.geims@geu.ac.in
  • 12 Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India; University of Cyberjaya, Persiaran Bestari, Cyber 11, 63000, Cyberjaya, Selangor Darul Ehsan, Malaysia. Electronic address: mohdshabil99@gmail.com
  • 13 Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India. Electronic address: diptismita.jena@gmail.com
  • 14 Centre of Research Impact and Outcome, Chitkara University, Rajpura, 140417, Punjab, India. Electronic address: simranjeet.nanda.orp@chitkara.edu.in
  • 15 Chitkara Centre for Research and Development, Chitkara University, Himachal Pradesh, 174103, India. Electronic address: aseem.aneja.orp@chitkara.edu.in
  • 16 School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India. Electronic address: ganeshbushi313@gmail.com
  • 17 Clinical Microbiology, RDC, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, 121004, India. Electronic address: mehtarachana41@gmail.com
  • 18 Department of Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, India; Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, India. Electronic address: renusahdoc@gmail.com
  • 19 University Center for Research and Development, Chandigarh University, Mohali, Punjab, India; Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001, Hillah, Babil, Iraq. Electronic address: prakasini.satapathy@gmail.com
  • 20 One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India. Electronic address: shilpa.gaidhane@dmiher.edu.in
Respir Med, 2025 Mar 27;241:108059.
PMID: 40157397 DOI: 10.1016/j.rmed.2025.108059

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

Similar publications