What Vaping Really Does to Your Lungs: A Doctor Explains

Electronic cigarettes, or “vaping,” are often promoted as a modern, healthier alternative to smoking traditional tobacco. While it’s true that vaping avoids the combustion that releases thousands of toxic chemicals in cigarette smoke, the perception of it being a harmless activity is a dangerous misconception. Vaping can cause significant lung injury even with short-term use, and because the practice is relatively new, the full spectrum of its long-term effects is still being uncovered. We spoke with a lung doctor at University of Utah Health to learn more about what really happens inside your lungs when you vape.

The Immediate Danger: What is EVALI?

In the short term, one of the most severe risks associated with vaping is a condition known as e-cigarette or vaping-associated lung injury (EVALI). This is a significant inflammatory injury to the lungs that can develop rapidly over a few days or more slowly over several months. Common symptoms of EVALI include:

Shortness of breath
Pain when breathing
Persistent cough

In more serious cases, blood oxygen levels can drop dangerously low. Internally, EVALI involves widespread inflammation and fluid buildup in the lungs, a condition that can lead to severe lung damage known as acute respiratory distress syndrome. In rare but tragic cases, EVALI can be deadly.

While most people who vape do not develop EVALI, the exact triggers are still being investigated. Researchers strongly suspect that vape liquids containing vitamin E acetate (often found in illicit THC vape products) are a primary culprit. The presence of THC (the psychoactive component of cannabis) may also increase the risk. However, it’s crucial to note that people can get EVALI from nicotine-only vapes as well. Dr. Scott Aberegg, a lung doctor at University of Utah Health (referred to as “Freeman” in the source text, but identified as Dr. Aberegg in the linked article), notes that there is likely significant individual variability in susceptibility to this type of injury, but “it seems like more frequent users are more at risk.” While a large spike in EVALI cases occurred in 2019, he still sees occasional cases in his clinic and in the hospital.

Treatment for EVALI begins with the most critical step: **stopping vaping immediately** to prevent repeated exposure to the trigger and allow the lungs to recover. More severe cases may require hospitalization, supplemental oxygen, and steroids to reduce lung inflammation. If a lung infection is also present, doctors may prescribe antibiotics.

The Long-Term Health Consequences of Vaping

Because modern e-cigarettes have only been in popular use for about two decades, their full long-term health consequences are still unknown. However, a growing body of evidence points to significant potential risks.

Increased Risk of Chronic Lung and Heart Diseases

Long-term vaping has been linked to a greater risk of developing chronic lung diseases like asthma or chronic bronchitis. There is also emerging evidence connecting e-cigarette use with heart problems, including an increased risk of heart failure. For individuals who have already experienced an EVALI diagnosis, continuing to vape may cause permanent scarring in the lungs. Furthermore, some research suggests that vaping may lead to a decline in some measures of lung function over time.

Exposure to Harmful Chemicals and Toxins

The wide variety of chemicals present in vape juice makes it difficult to assess the danger of any given product. The aerosol produced by vaping is not just harmless water vapor. Some studies have found that vape aerosol can contain unhealthy levels of toxic metals, including lead and arsenic, which can leach from the device’s heating coil. Additionally, some of the chemical flavorings used in e-liquids, while safe for ingestion, may have different effects when heated and inhaled. Research has shown that some flavorings may kill cells or prevent them from growing in laboratory settings.

Dr. Aberegg emphasizes a fundamental point about lung health: “Our lungs are not a good organ to absorb substances for recreational use. They are an incredible organ, providing our bodies with vital oxygen and exchanging carbon dioxide, all while protecting us from infections and other harmful elements from our environment. We all begin to slowly lose lung function after about our early to mid-20s, and yet they must last us a lifetime. If people don’t take care of their lungs, they really suffer more difficulties breathing later in life due to habits such as vaping.”

Is Vaping a “Better” Alternative to Smoking?

This is a complex question. Smoking traditional cigarettes is known to cause a host of serious and deadly health consequences, including lung cancer, due to the thousands of toxic chemicals produced by burning tobacco. In comparison, vaping is widely considered to be less harmful. Some people successfully use vaping as a tool to help them stop smoking.

However, given the known short-term risks like EVALI and the largely unknown long-term consequences, health professionals like Dr. Aberegg advise that people should aim to avoid vaping as well. “There are other options for temporary nicotine replacement therapy to assist with quitting tobacco cigarettes,” he says. While there is some limited evidence that people can be more successful at quitting cigarettes by switching to nicotine-containing e-cigarettes, this approach is not without its own risks.

A major concern is the potential for “dual use,” where individuals continue to smoke traditional cigarettes while also vaping. This practice may be even more harmful than smoking cigarettes alone, as it exposes the body to the risks of both products. Dr. Aberegg advises, “So while it may be temporarily better to make this step first, you need to have a plan to get beyond that and stop vaping.”

Conclusion: Prioritizing Lung Health

The message from lung health experts is clear: the safest choice is to not inhale anything into your lungs other than clean air. While vaping may be less harmful than smoking, it is not a risk-free activity. It can cause severe, acute lung injury and is associated with an increased risk of chronic lung and heart diseases, with its full long-term effects still unknown. For those looking to quit smoking, it’s crucial to consider all available cessation aids, including FDA-approved nicotine replacement therapies, and to have a clear plan to eventually stop vaping as well. If you are ready to quit vaping or smoking, resources like the Utah Department of Health and Human Services’ Way to Quit program offer free, confidential support, including personalized coaching and nicotine replacement therapy, to help you on your journey to better health.