New Study Shows that E-Cigarette Use Is an Independent Risk Factor for Respiratory Disease

As vaping continues to grow in popularity, it becomes increasingly critical to correct misconceptions about its safety and long-term effects.

Use of electronic cigarettes (e-cigarettes), or vaping, has drastically increased in recent years, primarily among young adults. About 1 in 5 young adults use e-cigarettes regularly, and 1 in 4 believe that e-cigarettes are harmless and nonaddictive.1

E-cigarettes aerosolize nicotine mixed with flavoring and preservative agents. Though combustible tobacco products, such as cigarettes and cigars, are widely recognized as causes of respiratory disease, e-cigarettes are often promoted as safe alternatives. However, studies show that vaping leads to chronic pulmonary inflammation, tissue damage, oxidative stress, and mucus hypersecretion.

A December 2019 study published in the American Journal of Preventive Medicine shows the first population-based, longitudinal analysis of the relationship between e-cigarettes and respiratory disease. The researchers used data from 32,320 participants in the Population Assessment of Tobacco and Health (PATH) study, a national population-based study led by the NIH and FDA.2-3 At baseline and over 2 years, researchers noted whether respondents had respiratory disease, used e-cigarettes, and/or used combustible tobacco products.

A number of subjects reported both respiratory disease and e-cigarette use at baseline. Even after controlling for confounding factors that included age, BMI, poverty level, and combustible tobacco smoking, there was a significant association between former or current e-cigarette use and the risk of respiratory disease.

The researchers then studied the incidence of respiratory disease that occurred throughout the study in initially disease-free subjects. Again, even after controlling for confounding factors, former or current e-cigarette use was shown as an independent risk factor. Notably, current e-cigarette use increased the odds of incident respiratory disease by a factor of 1.29.

The data also revealed a pattern of reverse causality—subjects who had respiratory disease at baseline were significantly more likely to participate in future e-cigarette use. Patients may be unaware of the risk e-cigarettes pose, viewing them as safe alternatives that will not further exacerbate respiratory conditions.

More than 90% of e-cigarette users in the study also reported using combustible tobacco. This usage pattern may be explained by patients who are aware of traditional smoking’s risks and, though not entirely quitting, are smoking less and vaping instead. However, since both activities are independent risk factors, a dual user has 3.3 increased odds of respiratory disease—higher odds than either smoking or vaping alone.

This study highlights the respiratory risks of e-cigarette use and reveals alarming patterns in dual usage of e-cigarettes and combustible tobacco. As vaping continues to grow in popularity, it becomes increasingly critical to correct misconceptions about its safety and long-term effects. Health care providers should counsel patients accordingly, and should not recommend e-cigarettes for smoking cessation.

May Zhang is a 2022 PharmD Candidate at the University of Connecticut in Storrs.


  • Tallent A. National Survey Reveals One in Five Young Adults Regularly Uses E-Cigarettes and Believes They are Harmless, Not Addictive. American Society of Clinical Oncology. Published September 26, 2019. Accessed January 10, 2020.
  • Bhatta DN, Glantz SA. Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis. Am J Prev Med. December 2019. doi:10.1016/j.amepre.2019.07.028.
  • Population Assessment of Tobacco and Health (PATH) - Home. National Institutes of Health. Accessed January 10, 2020.