Association of tobacco product use with chronic obstructive pulmonary disease (COPD) prevalence and incidence in Waves 1 through 5 (2013–2019) of the Population Assessment of Tobacco and Health (PATH) Study

Laura M. Paulin, Michael J. Halenar, Kathryn C. Edwards, Kristin Lauten, Cassandra A. Stanton, Kristie Taylor, Dorothy Hatsukami, Andrew Hyland, Todd MacKenzie, Martin C. Mahoney, Ray Niaura, Dennis Trinidad, Carlos Blanco, Wilson M. Compton, Lisa D. Gardner, Heather L. Kimmel, Dana Lauterstein, Daniela Marshall, James D. Sargent

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11 Scopus citations


BACKGROUND: We examined the association of non-cigarette tobacco use on chronic obstructive pulmonary disease (COPD) risk in the Population Assessment of Tobacco and Health (PATH) Study.

METHODS: There were 13,752 participants ≥ 40 years with Wave 1 (W1) data for prevalence analyses, including 6945 adults without COPD for incidence analyses; W1-5 (2013-2019) data were analyzed. W1 tobacco use was modeled as 12 mutually-exclusive categories of past 30-day (P30D) single and polyuse, with two reference categories (current exclusive cigarette and never tobacco). Prevalence and incidence ratios of self-reported physician-diagnosed COPD were estimated using weighted multivariable Poisson regression.

RESULTS: W1 mean (SE) age was 58.1(0.1) years; mean cigarette pack-years was similar for all categories involving cigarettes and exclusive use of e-cigarettes (all > 20), greater than exclusive cigar users (< 10); and COPD prevalence was 7.7%. Compared to P30D cigarette use, never tobacco, former tobacco, and cigar use were associated with lower COPD prevalence (RR = 0.33, (95% confidence interval-CI) [0.26, 0.42]; RR = 0.57, CI [0.47, 0.70]; RR = 0.46, CI [0.28, 0.76], respectively); compared to never tobacco use, all categories except cigar and smokeless tobacco use were associated with higher COPD prevalence (RR former = 1.72, CI [1.33, 2.23]; RR cigarette = 3.00, CI [2.37, 3.80]; RR e-cigarette = 2.22, CI [1.44, 3.42]; RR cigarette + e-cigarette = 3.10, CI [2.39, 4.02]; RR polycombusted = 3.37, CI [2.44, 4.65]; RR polycombusted plus noncombusted = 2.75, CI]1.99, 3.81]). COPD incidence from W2-5 was 5.8%. Never and former tobacco users had lower COPD risk compared to current cigarette smokers (RR = 0.52, CI [0.35, 0.77]; RR = 0.47, CI [0.32, 0.70], respectively). Compared to never use, cigarette, smokeless, cigarette plus e-cigarette, and polycombusted tobacco use were associated with higher COPD incidence (RR = 1.92, CI [1.29, 2.86]; RR = 2.08, CI [1.07, 4.03]; RR = 1.99, CI [1.29, 3.07]; RR = 2.59, CI [1.60, 4.21], respectively); exclusive use of e-cigarettes was not (RR = 1.36, CI [0.55, 3.39]).

CONCLUSIONS: E-cigarettes and all use categories involving cigarettes were associated with higher COPD prevalence compared to never use, reflecting, in part, the high burden of cigarette exposure in these groups. Cigarette-but not exclusive e-cigarette-use was also strongly associated with higher COPD incidence. Compared to cigarette use, only quitting tobacco was protective against COPD development.

Original languageEnglish (US)
Article number273
JournalRespiratory research
Issue number1
StatePublished - Dec 2022

Bibliographical note

Funding Information:
Martin C. Mahoney has provided expert testimony on the health effects of smoking in lawsuits filed against the tobacco industry. He has also received research support from Pfizer, Inc., for a clinical trial of smoking cessation, and has previously served on external advisory panels sponsored by Pfizer to promote smoking cessation in clinical settings. Raymond Niaura receives funding from the Food and Drug Administration Center for Tobacco Products via contractual mechanisms with Westat and the National Institutes of Health. Within the past 3 years, he has served as a paid consultant to the Government of Canada via a contract with Industrial Economics Inc. and has received an honorarium for a virtual meeting from Pfizer Inc. Dr. Niaura was an unpaid grant reviewer for the Foundation for a Smoke Free World. Wilson Compton reports long-term stock holdings in General Electric, 3 M Company, and Pfizer Incorporated, unrelated to this article.

Funding Information:
This manuscript is supported with Federal funds from the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), and the Center for Tobacco Products (CTP), Food and Drug Administration (FDA), Department of Health and Human Services, under contract to Westat (contract nos. HHSN271201100027C and HHSN271201600001C), and through an interagency agreement between NIH NIDA and FDA CTP. (NIDA Federal Author name) was substantially involved in the scientific management of and providing scientific expertise for contract nos. HHSN271201100027C and HHSN271201600001C.

Publisher Copyright:
© 2022, The Author(s).


  • Cigarette
  • COPD
  • E-cigarette
  • Epidemiology
  • Prevention
  • Respiratory disease
  • Smoking-related lung disease
  • Tobacco
  • Prevalence
  • United States
  • Humans
  • Middle Aged
  • Tobacco Products/adverse effects
  • Incidence
  • Pulmonary Disease, Chronic Obstructive/diagnosis
  • Electronic Nicotine Delivery Systems
  • Adult

PubMed: MeSH publication types

  • Journal Article


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