Association of Cannabis and E-cigarette use with respiratory disorders in national-sample data for 2020 through 2023

Cannabis and e-cigarette products have been changing over time but there has been little investigation about the effects of contemporary products in the same study. In this research we investigated the association of 2020–2023 cannabis and e-cigarette products with diagnosed respiratory disease, controlling for cigarette smoking. To test for associations of cannabis and e-cigarette use with asthma and with obstructive lung disease (COPD, chronic bronchitis, and emphysema). We predicted that cannabis and e-cigarettes would have independent positive associations with these outcomes. We also predicted that significant findings would be observed for both former and current use. We analyzed data from four administrations of the Behavioral Risk Factor Surveillance Survey (BRFSS). Analytic sample sizes for the asthma model with e-cigarettes and tobacco smoking (similar for obstructive lung disease analyses) were 191,229; 295,227; 296,555; and 299,909 for 2020–2023, respectively. Associations of former and current e-cigarette use, former and current tobacco smoking, and intermediate and all 30-day cannabis use were tested in multinomial regression (for previous and current asthma) and in logistic regression (for obstructive lung disease). These analyses controlled for age, sex, education/income, overweight/obesity, and race/ethnicity. Parallel models were analyzed for data from the four independent BRFSS samples. Significant associations, replicated across studies, were found for cannabis and e-cigarettes with both asthma and obstructive lung disease, controlling for tobacco smoking and six covariates. For asthma, averaged Adjusted Odds Ratios (AORs) for current [previous] asthma were 1.09 [1.17] for former e-cigarette use and 1.11 [1.20] for current e-cigarette use. For former tobacco smoking, average AORs were 1.08 [1.10] and for current tobacco smoking 1.12 [0.98]. For intermediate-dose cannabis use, averages were 1.25 [1.23] and for high-dose cannabis use, 1.49 [1.35]. For obstructive lung disease, the averaged AOs were 1.35 (former e-cigarette use) and 1.34 (current e-cigarette use); 3.09 (former smoking) and 5.80 (current smoking); 1.05 (for intermediate-dose cannabis) and 1.40 (for high-dose cannabis). Asthma and obstructive lung disease were more prevalent among participants who were female, had lower education, had obesity, and were White, Black, or Hispanic (ref. group Asian-Americans); younger (for asthma); or older (for obstructive lung disease). Results replicated across four representative samples indicated that current cannabis and e-cigarette products were independently associated with both asthma and obstructive lung disease. The findings suggest that preventive efforts directed toward users of cannabis and e-cigarettes may be needed.