Association between dual use of e-cigarette and cigarette and chronic obstructive pulmonary disease: an analysis of a nationwide representative sample from 2013 to 2018.

The association between the dual use of electronic cigarette (e-cigarette) and conventional cigarettes (c-cigarette) and spirometry-defined chronic obstructive pulmonary disease (COPD) has not been studied thoroughly. A total of 47,217 participants were identified in the 2013–2018 Korea National Health and Nutrition Examination Survey; of them, 12,919 participants aged ≥ 40 who underwent spirometry and had no missing data were enrolled. Pulmonary function testing, urinary cotinine, and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) levels were compared between dual users, current smokers, former smokers, and non-users using complex sample linear regression analysis. The odds ratio (OR) for COPD was calculated using a complex sample logistic regression model after adjusting for covariates. Among current e-cigarette users, approximately 85% of the participants used c-cigarette concurrently, and 1.3% of all the participants were dual users (2.3% in males and 0.1% in females). Both dual users and current smokers showed higher levels of urine cotinine and NNAL than non-users and former smokers. The weighted prevalence of COPD was the highest in dual users (13.8% for all participants and 14.1% for males). The multivariate-adjusted OR of COPD for male dual users, compared to non-users, was 3.46 (Ptrend < 0.001). The OR for COPD was 3.10 (Ptrend < 0.001) in middle-aged (40–64 years) and 3.70 (Ptrend < 0.001) in older (≥ 65 years) men. In females, the association was not observed and could not be precisely measured because of the small proportion of the smoking population. Dual use of e-cigarette and c-cigarette is associated with COPD in males.