Association between heated tobacco product use and worsening asthma symptoms: findings from a nationwide internet survey in Japan, 2023.

Shingo NOGUCHI; Tomohiro ISHIMARU; Kazuhiro YATERA; Yoshihisa FUJINO; Takahiro TABUCHI

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Association between heated tobacco product use and worsening asthma symptoms: findings from a nationwide internet survey in Japan, 2023.

Author: Shingo NOGUCHI ¹ ; Tomohiro ISHIMARU ² ; Kazuhiro YATERA ¹ ; Yoshihisa FUJINO ³ ; Takahiro TABUCHI ⁴
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1. Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan.
2. Department of Medical Humanities, School of Medicine, University of Occupational and Environmental Health, Japan.
3. Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan.
4. Division of Epidemiology, School of Public Health, Tohoku University Graduate School of Medicine.
Publication Type:Journal Article
Keywords: Adults; Allergic disease; Asthma; Cigarette; Heated tobacco products
MeSH: Humans; Japan/epidemiology*; Asthma/etiology*; Male; Female; Middle Aged; Adult; Aged; Tobacco Products/adverse effects*; Internet; Surveys and Questionnaires; Young Adult; Hot Temperature; Longitudinal Studies
From:Environmental Health and Preventive Medicine 2025;30():77-77
CountryJapan
Language:English
Abstract: BACKGROUND:Heated tobacco products (HTPs) are widely used in Japan, following cigarettes, but their health effects remain unclear. HTPs are often considered a less harmful alternative to cigarettes and are commonly used by adults with asthma, even though smoking is one of the most obvious and treatable factors in asthma. We aimed to elucidate the association between HTP use and asthma symptoms in adults with asthma.
METHODS:A total of 3,787 individuals with asthma were extracted from the data in the Japan COVID-19 and Society Internet Survey 2023, an ongoing longitudinal internet-based cohort study conducted by a nationwide internet research company in Japan. They were categorized into three groups (never, past, and current smokers) based on cigarette use. The association between HTP use and worsening of asthma symptoms within the previous 2 months in each group was analyzed using univariate and multivariate logistic regression analyses. Both exposure and outcomes were assessed by self-reporting.
RESULTS:Among the participants, 2,470 (65.2%) were never smokers, 845 (22.3%) were past smokers, and 472 (12.5%) were current smokers. Overall, the proportion of HTP users was 429 (11.3%), and worsened asthma symptoms were observed in 400 (10.6%) individuals. The total proportion of HTP users and worsened asthma symptoms was 70 (2.8%) and 259 (10.5%) among never smokers, 180 (21.3%) and 72 (8.5%) among past smokers, and 179 (37.9%) and 69 (14.6%) among current smokers. After adjusting for confounders, the odds ratio (OR) was 3.25 (95% confidence interval [CI] 1.86-5.68, p < 0.001), 1.47 (95% CI 0.93-2.34, p = 0.1), and 2.23 (95% CI 1.46-3.43, p < 0.001) for never, past, and current cigarette smokers with HTP use, respectively, where never smokers without HTP use were set as the standard.
CONCLUSION:The use of HTPs, not only cigarette smoking, was associated with worsening of asthma symptoms in adults with asthma. Therefore, people need to understand the harmful effects of HTPs on asthma symptoms.