What are the health risks of vaping?

Health Risks of Vaping

Vaping poses serious and potentially life-threatening health risks, most notably E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI), which can cause severe respiratory failure requiring hospitalization and has resulted in deaths. 1, 2

Acute Severe Lung Injury (EVALI)

EVALI represents the most critical immediate health risk from vaping, characterized by acute respiratory distress that can rapidly progress to respiratory failure. 2, 3

Clinical Presentation

• Respiratory symptoms: Shortness of breath, cough, chest pain, and respiratory distress requiring oxygen support 2, 3
• Systemic symptoms: Fever, fatigue, muscle aches, nausea, and vomiting 2
• Severity: Over 2,800 hospitalizations and 60+ deaths have been documented in the United States, with up to one-third of patients requiring mechanical ventilation 3, 4

High-Risk Indicators Requiring Hospitalization

• Oxygen saturation <95% on room air 1, 2
• Respiratory distress 1, 2
• Comorbidities that compromise cardiopulmonary reserve (asthma, COPD, cardiac disease) 2, 5

Chronic Respiratory Health Effects

Beyond acute EVALI, vaping causes persistent lung damage and functional impairment that can last months after exposure. 5, 6

Documented Pulmonary Damage

• Persistent lung capacity reduction: Requires spirometry and DLCO testing at 1-2 months post-injury to assess ongoing impairment 5
• Gas exchange disturbance and reduced lung function 6
• Increased airway inflammation and oxidative stress 6
• Downregulation of immunity leading to increased risk of respiratory infections 6

Toxic Chemical Exposures

• Respiratory toxicants: Benzene, formaldehyde, acrolein, and polyaromatic hydrocarbons cause chronic inflammatory responses 5
• Heating element hazards: High-power settings with certain heating elements (e.g., nichrome) can produce lung injury even without THC, vitamin E acetate, or nicotine 7

Cardiovascular Risks

Vaping products, particularly those containing nicotine, produce acute cardiovascular physiological effects that warrant concern for long-term cardiac health. 8

• Early molecular and clinical evidence demonstrates various acute physiological cardiovascular effects from electronic nicotine delivery systems 8
• The American Heart Association emphasizes the need for additional research as use continues to grow, given the established cardiovascular risks of nicotine exposure 8

Substance-Specific Risks

THC-Containing Products

The CDC specifically recommends that persons should not use e-cigarette or vaping products that contain THC due to particularly high risk of severe lung injury. 3

Nicotine-Containing Products

The CDC recommends persons consider refraining from using e-cigarette or vaping products that contain nicotine. 3

Populations at Highest Risk

Youth and Young Adults

• Youth prevalence reached 27.5% among high school students in 2019 in the United States 8
• E-cigarette or vaping products should never be used by youths, young adults, or women who are pregnant 3

Patients with Preexisting Conditions

• Individuals with asthma, COPD, or other lung conditions face exacerbation of underlying respiratory compromise 5
• Those with cardiac disease have increased risk for severe outcomes and mortality 4

Critical Clinical Pitfalls

Common dangerous misconceptions include:

• "Safer than cigarettes" fallacy: While containing fewer combustion products, vaping products have not undergone the premarket safety studies required of drug products or medical devices 8
• Unregulated ingredients: Thousands of flavors and continuously evolving devices exist without stringent regulation 6
• Device operation risks: Operating electronic cigarette units at high power settings poses particular danger regardless of liquid contents 7

Cessation Imperative

For patients who have experienced EVALI or any vaping-related symptoms, complete and permanent abstinence from all vaping products is mandatory to prevent recurrence. 3, 2

• Evidence-based tobacco cessation strategies, including behavioral counseling, should be offered to all patients 1, 3
• No FDA-approved medications exist for e-cigarette cessation in children and adolescents, though behavioral interventions shown effective for adult cigarette smoking cessation should be considered 1