Vaping and E-Cigarette Use in Children and Adolescents

Implications on Perioperative Care From the American Society of Anesthesiologists Committee on Pediatric Anesthesia, Society for Pediatric Anesthesia, and American Academy of Pediatrics Section on Anesthesiology and Pain Medicine

Deborah A. Rusy, MD, MBA, FASA; Anita Honkanen, MD; Mary F. Landrigan-Ossar, MD, PhD, FASA, FAAP; Debnath Chatterjee, MD, FAAP, FASA; Lawrence I. Schwartz, MD; Kirk Lalwani, MBBS, FRCA, MCR; Jennifer R. Dollar, MD; Randall Clark, MD, FASA; Christina D. Diaz, MD, FASA, FAAP; Nina Deutsch, MD; David O. Warner, MD; Sulpicio G. Soriano, MD


Anesth Analg. 2021;133(3):562-568. 

In This Article

Association of E-cigarette use With Non-EVALI Respiratory Conditions

A cross-sectional study of 705,159 respondents from the 2016 and 2017 Behavioral Risk Factor Surveillance System pooled data reported that among e-cigarette users who were never combustible cigarette smokers, there was an associated 75% higher odds of chronic bronchitis, emphysema, or chronic obstructive pulmonary disease compared with never e-cigarette users.[38]

Another large cohort study of 21,618 US adults demonstrated that e-cigarette use was associated with significantly increased risk of major respiratory diseases, independent of cigarette smoking, and other tobacco product use.[39] Among current e-cigarette respondents with good self-reported health, the incidence rate ratio (IRR) was 1.33 (95% confidence interval [CI], 1.06–1.67) for chronic bronchitis, 1.69 (95% CI, 1.15–2.49) for emphysema, 1.57 (95% CI, 1.15–2.13) for chronic obstructive lung disease (COPD), and 1.31 (95% CI, 1.01–1.71) for asthma. The limitations of this study included a reliance on self-reported data. They concluded that despite existing evidence, the long-term effects of e-cigarette use on clinical respiratory end points remain unclear. As COPD is typically a disease that is evident after years of smoking, future studies, such as serial pulmonary function tests, may be needed to understand the full risk of e-cigarette–attributable lung disease, such as COPD.