The effects of electronic cigarettes on the respiratory tract

Data on the effects of e-cigarettes on the airways are limited to short-term exposure studies. We continue our section on the dangers of vaping by selecting bibliographic works carried out by the Royal College of Physicians in 2016.

What are the health effects of electronic cigarettes?

In 2021, a major American research indicated in its conclusions that vaping does not induce no oxidative stresskey factor in smoking-induced cardiovascular disease. In 2022, another study, conducted with 24,000 peoplenoticed a 92.8% decrease in cardiovascular disease in the group of vapers, compared to the group of smokers. Finally, if it is impossible to know with certainty the effects of electronic cigarettes on health, and in particular on the lungs, several studies are encouraging. Since 2015, the UK Department of Health has claimed that vaping is “at least 95% less harmful” what to smoke.

Few effects of electronic cigarettes on lung function

Studies on the effects of vaping on the lungs are reassuring.

E-cigarette use in healthy people for 5 minutes noted a reduction in exhaled nitric oxide (NO) and an increase in airway resistance (1) making an irritant effect on the airways plausible. respiratory conditions, which could lead to edema of the mucous membranes, contraction of smooth muscles or increased production of pulmonary secretions in response to vapour.

Another study reported a reduction in exhaled NO after inhaling vapour, with or without nicotine, of an order of magnitude similar to that caused by conventional cigarette smoke (2). However, short-term cigarette smoking has been found to have no effect on spirometric markers of lung function and another study found no no difference in reported adverse events during 12 weeks of e-cigarette use with or without nicotine, or classic pharmaceutical withdrawal aid (3).

Reassuring short-term effects

Illustration of healthy human lungs

In the long term, if other studies are necessary, the first elements are very positive.

We are therefore far from knowing if these short-term effects of electronic cigarettes on the airways will translate into long-term damage to the airways. Additionally, since quitting smoking is associated with reduced respiratory symptoms in people with respiratory disease (4, 5), many smokers who switch to e-cigarettes are likely to improve their respiratory symptoms. This is illustrated in a study that followed a small cohort of patients with asthma, in whom improvements in symptoms and lung function were observed after a transition from smoking tobacco to vaping (6).

These observations are therefore reassuring about the short-term use of e-cigarettes in relation to negative respiratory effects. A survey in Hong Kong found a higher prevalence of respiratory symptoms among Chinese adolescents who were ex-smokers or non-smokers, and who reported e-cigarette use in the previous month (7 ).

However, e-cigarettes were used by only 1.1% of the total sample and 0.1% of non-smokers, and since e-cigarette use was not quantified, there is no evidence that those who reported symptoms used this product regularly.

No carbon monoxide, which also explains the low health effects of electronic cigarettes

Illustration of the absence of carbon emissions therefore a reduction in the effects of electronic cigarettes on health

No oxidative stress is induced by the electronic cigarette.

E-cigarette vapor has been reported to influence resistance to infection and may delay recovery from influenza infection, in an animal model (8), although the validity of these findings and the relevance of effects in man are not clear.

Since then, many studies have looked at the cardiovascular effects of vaping. In 2021, an American research (9) concluded that the electronic cigarette does not induce any oxidative stresskey factor in smoking-induced cardiovascular disease. In 2022, a new analysis (10) indicated that the group of vapers reported 41 cardiovascular diseases, compared to 569 for the group of smokers, a reduction of almost 93%. The effects of electronic cigarettes on health would therefore be much less.

A study of the presence of carcinogens in participants’ urine after using e-cigarettes or tobacco cigarettes found significantly lower levels of NAST, benzene, and polyaromatic hydrocarbons with e-cigarettes (11), which which would tend to demonstrate systemic absorption of these carcinogens and therefore some degree of potential cancer risk, although significantly lower than that generally associated with smoking.

What about long term effects?

Even today, no large study allows us to know the effects of these liquids and the components of electronic cigarettes beyond 12 months.[6](12), even if, as repeated previously, the risk is estimated to be much lower compared to that posed by tobacco. It is therefore important to keep in mind that electronic cigarettes can still be harmful to health over the long term. For example, it is not known whether tobacco-specific nitrosamines (NASTs, other than those present in tobacco leaves) are formed during the production of “vapor”.[7](13).

In November 2017, doctor Riccardo Polosa published the first study[8](14) long-term follow-up which is interested in the state of health of new vapers who have never been smokers. While this study has its limitations, it provides very reassuring answers for users of vaporizers by concluding that no long-term negative effects.

The conclusions of the main studies are based on what we currently know about the components of the aerosol to propose hypotheses: the repeated inhalation of particles, oxidants and carcinogens is likely to increase the risk of lung cancer, respiratory disorders and cardiovascular diseases in the short and medium term. So there are reasons to think that this is also the case in the long term. These are very small proportions compared to the risks induced by tobacco consumption.but even in lesser degrees they cannot be ignored, all the more so because these effects will take time to be studied.


(1) Vardavas CI, Anagnostopoulos N, Kougias M et al. Short-term pulmonary effects of e-cigarette use: impact on airflow resistance, impedance, and exhaled nitric oxide. Chest 2012;141:1400–6.

(2) Marini S, Buonanno G, Stabile L, Ficco G. Short-term effects of e-cigarettes and tobacco on expired nitric oxide. Toxicol Appl Pharmacol 2014;278:9–15.

(3) Bullen C, Howe C, Laugesen M et al. Electronic cigarettes for smoking cessation: a randomized controlled trial. Lancet 2013;382:1629–37.

(4) At DH, Bryson CL, Chien JW et al. The effects of smoking cessation on the risk of exacerbation of chronic obstructive pulmonary disease. J Gen Intern Med 2009;24:457–63.

(5) Godtfredsen NS, Vestbo J, Osler M, Prescott E. Risk of hospital admission for COPD
following smoking cessation and reduction: a Danish population-based study. Thorax 2002;57:967–72.

(6) Polosa R, Morjaria J, Caponnetto P et al. Effect of smoking abstinence and reduction in the number of asthmatic smokers switching to e-cigarettes: evidence for harm reversal. Int J Environ Res Public Health 2014;11:4965–77.

(seven) Wang MP, Ho SY, Leung LT, Lam TH. Electronic cigarette use and respiratory symptoms among Chinese adolescents in Hong Kong. JAMA Pediatr 2015;9;1–2.

(8) Sussan TE, Gajghate S, Thimmulappa RK et al. Exposure to e-cigarettes impairs lung antibacterial and antiviral defenses in a mouse model. PloS One 2015;10:e0116861.

(9) Association of Cigarette and E-Cigarette Use Patterns with Levels of Inflammatory and Oxidative Stress Biomarkers in US Adults: A Population-Based Smoking and Health Assessment Study –

(ten) Electronic Cigarette Use and Risk of Cardiovascular Disease: A Longitudinal Analysis of the PATH Study, 2013-2019, Berlowitz et al, Traffic. 2022;145:00–00 –

(11) Hecht SS, Carmella SG, Kotandeniya D et al. Evaluation of toxic and carcinogenic metabolites in the urine of electronic cigarette users compared to cigarette smokers. Nicotine Tob Res 2015;17:704–9.

(12) Smokeless Nicotine: Tobacco Harm Reduction | RCP London

(13) Farsalinos, Gillman, Poulas et al., Tobacco-specific nitrosamines in electronic cigarettes, Comparison between liquid and aerosol levels, Int. J. About. Res. Public Health, 2015, 12, 9050.

(14) Riccardo Polosa, Fabio Cibella, Pasquale Caponnetto, Marilena Maglia, Umberto Prosperini, Cristina Russo, Donald Tashkin. – Health impact of e-cigarettes: a 3.5-year prospective study of regular daily users who have never smoked. Scientific reports | 7:13825 |

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