Is vaping dangerous, especially for adolescents and young adults with a history of respiratory problems such as asthma or Chronic Obstructive Pulmonary Disease (COPD)?

Is Vaping Dangerous?

Yes, vaping is dangerous, particularly for adolescents and young adults with respiratory conditions like asthma or COPD, and should be strongly discouraged in all youth populations. 1, 2

Primary Health Risks

Respiratory System Damage

• Vaping causes decline in lung function and increases the risk of respiratory problems in adolescents, with particular concern for those with pre-existing conditions like asthma or COPD 1
• E-cigarette aerosol contains multiple toxic substances including propylene glycol, vegetable glycerin, flavoring chemicals, fine and ultrafine particles, metals, and carcinogens that directly cause lung injury 1
• The condition known as EVALI (electronic-cigarette/vaping associated lung injury) represents an immediate and serious pulmonary threat 3
• Respiratory symptoms associated with vaping, while sometimes transient, indicate ongoing harm to developing lungs 4

Cardiovascular Effects

• E-cigarettes pose significant cardiovascular risks, including increased risk of coronary artery disease, atherosclerosis, and aortic aneurysm due to nicotine and other toxic substances 1, 5
• Nicotine from vaping adversely affects cholesterol metabolism and cardiovascular health 5
• Smoking (including vaping) is associated with doubling the relative risk of stroke 5

Neurological and Addiction Concerns

• Nicotine exposure during adolescence permanently alters neurological development and brain structure, as the adolescent brain is particularly vulnerable 1, 2
• Nicotine is highly addictive and adversely affects children from prenatal development through adolescence 2
• High-nicotine delivery systems like JUUL have dramatically increased addiction potential for young people 2

Special Concerns for Adolescents with Respiratory Disease

For adolescents with asthma or COPD, vaping represents a compounded threat because:

• Their already compromised respiratory systems are more vulnerable to the toxic substances in e-cigarette aerosol 1
• The inflammatory effects of vaping can worsen existing respiratory conditions 3
• There is no safe level of exposure to these substances for individuals with respiratory disease 6

Gateway Effect and Dual Use

• E-cigarette use is associated with increased odds of transitioning to combustible cigarettes among adolescents who had no previous intention of smoking 2
• Many adolescent vapers become dual or multiple users, combining different tobacco and nicotine products 6
• This contradicts industry marketing claims that e-cigarettes help people quit smoking 6

Detection Challenges

A critical pitfall for healthcare providers and parents:

• E-cigarette use is extremely difficult to detect due to minimal odor, few obvious physical signs, and devices designed to look like everyday objects (USB drives, pens) 2
• This concealment ability allows adolescents to develop hazardous use patterns without detection 2
• Traditional signs of tobacco use will not be present, requiring direct screening 2

Clinical Recommendations

Screening and Counseling

• Screen for e-cigarette use at every adolescent healthcare visit, regardless of whether traditional tobacco use signs are present 1, 5, 2
• Specifically ask about vaping, JUUL, pods, and other electronic nicotine delivery systems as part of routine care 6, 1
• Advise all adolescents to avoid both smoking and vaping for optimal health outcomes 2

For Those Currently Vaping

• Advise complete cessation of all nicotine products rather than transitioning between products 5
• If patients are using e-cigarettes to quit smoking, counsel them to avoid dual use and develop a plan to eventually quit e-cigarettes as well 5
• Use evidence-based behavioral strategies and FDA-approved pharmacotherapy for cessation, not e-cigarettes 1

Regulatory Position

The Forum of International Respiratory Societies and American College of Cardiology recommend that electronic nicotine delivery devices should be:

• Restricted or banned until more safety information is available 1, 5
• Regulated as medicines or tobacco products with comprehensive restrictions 6
• Prohibited from sale to minors with strict enforcement 6
• Subject to bans on advertising, promotion, and flavors that appeal to children 6

Evidence Quality Note

While some research suggests most e-cigarette use among youth is infrequent 4, the guideline consensus from major medical societies (American Academy of Pediatrics, American College of Cardiology, Forum of International Respiratory Societies) is unequivocal that vaping poses clear threats to adolescent health 6, 1, 2. The lack of long-term safety data, combined with known immediate harms and addiction potential, supports a precautionary approach of complete avoidance, especially in youth with respiratory conditions.