Long-Term Cardiopulmonary Outcomes and Quality of Life: A Comparative Study Among Cigarette, Electronic Cigarette, and Dual Use Consumers in Saudi Arabia

Background: Smoking is a leading cause of heart and lung diseases worldwide. Though there is a decline in tobacco smoking the use of e-cigarettes is growing in popularity. Objective: To assess the long-term effects of smoking, vaping, and dual use on cardiopulmonary function capacity and quality of life. Methods: The study participants were classified into five groups: 1- The control group included participants who had never smoked or vaped. 2- Individuals who use cigarettes only had a history of smoking for at least 3.5 pack years or above and smoked only cigarettes based on previously conducted study. 3- E-cigarette use only group participants were required to have a history of vaping for at least 3.5 years and above. 4- The previously smoked and currently uses e-cigarette group includes participants who report no smoking for the past year and a history of vaping for at least 3.5 years and above. 5- Use of both cigarette and e-cigarette group, participants had smoked for 3.5 years and had vaped for at least 3.5 years. Participants performed PFT, 6MWT and completed HRQOL using RAND SF-36 questionnaire. Results: A total of 175 (85.7% male) participants with an average age of mean (± SD) 27.38 (± 5.75) enrolled in the study. PFT results showed significant difference in FEV1 (L/s) [F(4,170) = 7.73, P ≤ .001]; FEV1 (%predicted) [F(4,170) = 24.63, P ≤ .001]; and FEV1/FVC (%) [F(4,170) = 16.85, P ≤ .001] values across the 5 groups. On further analysis, FEV1 and FEV1 (%predicted) significantly decreased in all user groups. Similarly, in FEV1/FVC (%) significant difference was observed with user groups except those who only use e-cigarettes. 6MWT showed a significant difference in walking distance [F(4,170) = 19.93, P ≤.001]. HRQOL reported a significant difference in physical function [H(4) = 20.55, P ≤ .001], emotional well-being [H(4) = 19.21, P = .001], and social function [H(4) = 29.63, P ≤ .001] domains. Individuals who use both cigarettes and e-cigarettes reported a significant decline in lung function [(FEV1 2.96 ± 0.41, FEV1 (% predicted) 72.6 ± 6.07 and FEV1/FVC (%) 73.65 ± 11], 6MWT walking distance (m) (mean ± SD) 416.26 ± 53.49. Conclusions: We observed a significant long-term impairment in lung function, cardiopulmonary capacity, and quality of life among individuals who use cigarettes and e-cigarettes compared to those who never smoked or vaped. Also, individuals who use both cigarettes and e-cigarettes showed the worst health outcomes.FEV1 comparison between the groups6 minute walked distance between the groups