E-cigarettes are often referred to as “just vapor,” but the aerosol they produce can contain nicotine, chemicals and tiny particles that reach deep into the lungs.
November is Lung Cancer Awareness Month, a time to think about the many factors that can affect lung health. Cigarette smoking is the leading preventable cause of lung cancer, but e-cigarettes and vaping have raised new questions about what we are putting into our lungs. Many people began vaping because they believed it was harmless or less harmful than smoking. The reality is more complicated. As pulmonologists, we are learning more about the effects of vaping while also recognizing that we do not yet have decades of data on its long-term health effects.
Here’s what you should know.
What Does an E-cigarette Contain?
An e-cigarette heats a liquid and turns it into an aerosol that is inhaled into the lungs. It is not simply water vapor.
According to the Centers for Disease Control and Prevention (CDC), e-cigarette liquid typically contains nicotine, flavorings and other ingredients. Depending on the product and device, the aerosol may also contain:
- Nicotine, which is highly addictive
- Ultrafine particles that can travel deep into the lungs
- Heavy metals, including lead, nickel and tin
- Volatile organic compounds and other chemicals
- Chemicals that may be harmful or cancer-causing
The exact contents can vary considerably from one product to another. This can make it difficult for consumers to know exactly what they are inhaling.
How Many Puffs of a Vape Equal One Cigarette?
There is no reliable one-to-one answer.
Disposable vaping devices are often marketed by puff count, but the number of puffs does not tell you exactly how much nicotine you are taking in. Nicotine concentration varies between products, and the amount delivered can also depend on the device, how long you inhale and how deeply you breathe in.
For that reason, saying that a certain number of vape puffs is equivalent to one cigarette can give a misleading impression of how much nicotine you are using.
Does Vaping Cause Lung Cancer?
We do not yet know whether vaping directly causes lung cancer in humans.
That may seem like an unsatisfying answer, but it is important to distinguish what we know from what we are still learning.
What we know
- Cigarette smoking is a major cause of lung cancer.
- E-cigarette aerosol can contain substances that are harmful to the lungs, including some chemicals associated with cancer.
- E-cigarettes are relatively new compared with traditional cigarettes, so researchers do not yet have the same decades of data on long-term use.
What we are still learning
Lung cancer can take many years to develop. Because widespread e-cigarette use is relatively recent, researchers are still studying whether long-term vaping increases the risk of lung cancer and, if so, by how much.
The absence of long-term evidence does not mean vaping is proven safe. For people who do not smoke, there is no health benefit to starting to vape.
What Do We Know About the Effects Vaping Has on Lung Health?
We already know that vaping can affect the lungs in ways that deserve attention.
One important example is e-cigarette or vaping product use-associated lung injury (EVALI). In 2019, the Centers for Disease Control and Prevention (CDC) and other public health agencies investigated an outbreak of serious lung illness associated with vaping. Many of the cases involved Tetrahydrocannabinol (THC)-containing products, particularly products containing vitamin E acetate.
EVALI is different from the potential long-term effects of routine vaping, but the outbreak demonstrated that inhaling certain substances through vaping devices can cause serious lung injury.
Vaping may also be associated with respiratory symptoms such as:
- Coughing
- Wheezing
- Shortness of breath
- Chest discomfort
Researchers continue to study how vaping affects lung inflammation, airway function and long-term respiratory health.
What about secondhand vape aerosol?
Vaping can affect more than the person using the device. When someone exhales, people nearby may also be exposed to the aerosol and the substances it contains.
If you vape, avoiding vaping around children, pregnant people and others is an important way to reduce their exposure.
Is Vaping Safer Than Smoking?
This is one of the most common — and most complicated — questions about e-cigarettes.
Cigarette smoke contains thousands of chemicals, many of which are toxic and cancer-causing. E-cigarette aerosol generally contains fewer harmful chemicals than cigarette smoke, but that does not make vaping harmless.
For someone who does not smoke, starting to vape introduces unnecessary exposure to nicotine and other substances.
For someone who does smoke, completely switching from cigarettes to e-cigarettes may reduce exposure to some harmful chemicals compared with continuing to smoke cigarettes. However, using e-cigarettes does not eliminate the health risks of smoking.
If you smoke or vape and want to quit, talk with your health care provider about a plan that is right for you.
How to Quit Vaping
Quitting vaping can be difficult, particularly when nicotine is involved. If you’ve tried before and struggled, that does not mean you failed. Nicotine dependence can make quitting challenging, and it often takes more than one attempt.
These strategies may help:
- Choose a quit date. Give yourself time to prepare and remove vaping products from your home, car, and other places where you use them.
- Identify your triggers. Stress, boredom, driving, alcohol and being around other people who vape can trigger cravings.
- Prepare for withdrawal. You may experience cravings, irritability, anxiety, or difficulty concentrating. These symptoms generally improve over time.
- Get support. Smokefree.gov from the National Cancer Institute offers smoking cessation plans, educational resources and text-based support. New York residents can also contact the New York State Smokers’ Quitline at 1-866-NY-QUITS (1-866-697-8487).
- Talk with your health care provider. Research specifically on medications for quitting vaping is still developing. Your provider can help you understand your options for managing nicotine cravings and withdrawal.
When Should You Talk With a Doctor?
Make an appointment with your health care provider if you develop a cough that does not go away, unexplained shortness of breath or wheezing, or persistent chest discomfort.
These symptoms can have many causes, and they do not necessarily mean you have lung cancer. But persistent or unexplained changes in your breathing are worth discussing with a health care professional.
Coughing up blood, significant difficulty breathing or severe chest pain requires prompt medical attention.
If you have a history of cigarette smoking, you can also ask your provider whether you are eligible for lung cancer screening. Screening recommendations are based on factors such as your age and history of cigarette smoking. Your provider can help determine whether screening is appropriate for you. Learn more about lung cancer screening at Stony Brook Medicine.
The Bottom Line
Vaping is not simply inhaling water vapor. E-cigarette aerosol can contain nicotine, ultra fine particles, heavy metals, and other potentially harmful chemicals.
We are still learning about the long-term effects of vaping, including its potential relationship to lung cancer. What we do know is that protecting your lungs starts with avoiding exposure to harmful substances whenever possible.
If you vape and are ready to quit, you do not have to do it alone. Talk with your health care provider about creating a plan to quit and protect your lung health.
