{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T19:06:35Z","timestamp":1780081595178,"version":"3.54.0"},"posted":{"date-parts":[[2026,2,5]]},"group-title":"Respiratory Medicine","reference-count":61,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,2,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality in the United States (US), largely driven by cigarette smoking and characterized by progressive lung injury. While e-cigarettes are promoted as a less harmful alternative to cigarette smoking, their long-term health effects, including the impact of prolonged use on COPD incidence among adults who have smoked, are not well understood.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate the prospective association between duration of e-cigarette use and incident COPD among US adults aged 40 years or older with a history of cigarette smoking, and to determine whether baseline respiratory symptoms modify this association.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Design, Settings, and Participants<\/jats:title>\n                  <jats:p>We used data from Waves 4 to 7 (2017-2022) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative US longitudinal cohort study. Our analysis included adults aged 40 years or older who currently or formerly smoked cigarettes.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Main Outcomes and Measures<\/jats:title>\n                  <jats:p>The outcome was incident, self-reported COPD diagnosis. The main exposure was the time-varying duration of e-cigarette use. Baseline functionally important respiratory symptoms were defined by a validated index. Multivariable models adjusted for demographics, COPD risk factors, and detailed tobacco use history, including cigarette smoking status, time since quitting, and pack-years.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 4,895 adults aged 40 year or older who currently or formerly smoked cigarettes, 408 reported an incident COPD diagnosis. Among individuals with baseline respiratory symptoms, longer e-cigarette use duration was associated with increased COPD risk (adjusted hazard ratio [AHR]: 1.28, 95% CI: 1.16, 1.40), whereas no significant association was observed among those without baseline respiratory symptoms (AHR: 1.01, 95% CI: 0.92, 1.12). Results were consistent after adjusting for cumulative cigarette exposure and other risk factors and remained robust across multiple sensitivity analyses.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion and Relevance<\/jats:title>\n                  <jats:p>Prolonged e-cigarette use may increase COPD risk among individuals with pre-existing respiratory vulnerabilities. Although switching from combustible cigarettes remains an important harm reduction strategy, behavioral counseling and pharmacotherapy should be prioritized for those at high risk for COPD, with e-cigarette cessation support available to high-risk former smokers. Continued surveillance and research are warranted as e-cigarette products and use patterns evolve.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Key Points<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Question<\/jats:title>\n                    <jats:p>Does longer e-cigarette use increase COPD risk in adults with a smoking history?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>In this national cohort study of U.S. adults aged 40+ who currently or formerly smoked, e-cigarette duration was associated with higher self-reported COPD incidence among individuals with respiratory symptoms at baseline (adjusted hazard ratio [AHR] 1.28, 95% CI 1.16, 1.40) but not among those without symptoms (AHR 1.01, 95% CI 0.92, 1.12).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Meaning<\/jats:title>\n                    <jats:p>Prolonged e-cigarette use may increase COPD risk among individuals with respiratory vulnerabilities. While cigarette cessation should remain the priority, evidence-based e-cigarette cessation strategies are needed to prevent long-term use in this population.<\/jats:p>\n                  <\/jats:sec>\n                <\/jats:sec>","DOI":"10.64898\/2026.02.04.26345592","type":"posted-content","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T23:55:24Z","timestamp":1770335724000},"source":"Crossref","is-referenced-by-count":1,"title":["E-cigarette Duration and Incident COPD Among Adults Aged 40 Years and Older with a Smoking History"],"prefix":"10.64898","author":[{"given":"S.","family":"Cook","sequence":"first","affiliation":[{"name":"Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.F.","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.M.G.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KM.","family":"Cummings","sequence":"additional","affiliation":[{"name":"College of Medicine, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.A.","family":"Arenberg","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.L.","family":"Fleischer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Meza","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, BC Cancer Research Institute, Vancouver, BC, Canada"},{"name":"School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada"},{"name":"Rutgers Cancer Institute, Rutgers University, New Brunswick, NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026020719251152000_2026.02.04.26345592v1.1","doi-asserted-by":"crossref","unstructured":"Xu J , Murphy SL , Kochanek KD , Arias E. 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