How Vaping Affects Asthma

Using e-cigarettes can have considerable effects

When they were first introduced into the market, electronic cigarettes (also known as e-cigarettes) were branded as the "safe" alternative to traditional cigarettes. Because of this, many people with asthma were encouraged to switch to e-cigarettes—that is, vape instead of smoke—under the presumption that the aerosolized vapors were less likely to trigger an asthma attack.

But studies now suggest that this may not be the case. There is, in fact, growing evidence that the use of e-cigarettes⁠ (vaping) can not only make asthma harder to control but may actually contribute to the development of the disease in those who don't yet have it.

How Does Vaping Impact Asthma?

Verywell / Ellen Lindner

Increased Symptoms and Asthma Attacks

Asthma is a chronic disease characterized by acute episodes of airway inflammation and bronchoconstriction (narrowing of airways). The inflammation can cause the airways to become increasingly hyperresponsive to environmental triggers, leading to symptoms such as wheezing, shortness of breath, coughing, and chest tightness. E-cigarette vapors should most certainly be included when considering possible triggers.

Most e-cigarette devices consist of a vaporization chamber, a nicotine cartridge with chemical flavorings, and a rechargeable battery. When inserted into the vaporization chamber, the chemicals inside the cartridge are heated and atomized into an inhalable mist.

This inhalable mist, according to the U.S. Surgeon General, contains a variety of volatile chemicals that can cause short- and long-term harm to the lungs. These include heavy metals (like tin, nickel, and lead) and oily substances that can become trapped in smaller airways.

Some of these compounds (like the flavoring diacetyl, used to create buttery flavors) not only incite lymphocytic inflammation⁠—the type associated with allergic asthma—but can also cause the progressive hardening and narrowing of the airways, making it all the more difficult to breathe during an attack.

Other additives like tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana, and vitamin E acetate, used to thicken or dilute THC vaping liquids, can increase the risk of attacks by placing stress on already-inflamed airways. (Both of these ingredients are linked to acute respiratory injury among e-cigarette users.)

There has been more and more evidence that many of the chemicals in e-cigarettes may be even more likely to trigger an attack in certain people than those in regular cigarettes.

Even the moist heat generated by vaping may be enough to trigger an attack in some people.

Altered Immune Response

Evidence also suggests that vaping can change the body's immune response in a way that increases a person's vulnerability to asthma triggers.

According to a 2018 study in the journal Thorax, aerosolized chemicals in e-cigarettes immobilize immune cells called alveolar macrophages that the body uses to remove allergens, dust, and other asthma triggers from the lungs.

By doing so, vaping effectively "landscapes" the lungs for inflammation by allowing vaporized microparticles access to even the smallest airways.

Secondhand Exposure

The risks of vaping are not only limited to users of e-cigarettes. A 2019 study in the journal Chest suggests that secondhand vapors from e-cigarettes increase the risk of attacks in non-users with asthma by 33%.

Risk of Developing Asthma

The exact cause of asthma remains unknown, but the disease is believed to be the result of a combination of genetic and environmental risk factors. How (or if) vaping plays a role in the development of asthma is equally unclear.

With that said, there is epidemiologic evidence linking vaping to the onset of asthma symptoms in high schoolers. People in this age group remain the prime consumers of e-cigarettes in the United States.

According to research published in Preventive Medicine, use of e-cigarettes among high schoolers is associated with a 1.5-fold increased risk of asthma compared to high schoolers who have never vaped.

The findings were supported by a 2016 study from Korea in which high schoolers who vaped had a nearly three-fold increased risk of asthma and missed more school days due to asthma than peers who smoked conventional cigarettes.

Furthermore, research from John Hopkins University found that non-smokers who vape have a higher risk of asthma, often developing the disease between the ages of 18 and 24.

While it is too early to suggest that e-cigarettes "cause" asthma, they appear to contribute to the risk and are now considered an independent risk factor for the development of the disease.

Risk of Other Lung Conditions

E-cigarettes pose several concerns when it comes to your health, especially your pulmonary health. And while these can affect any users and are of great concern, they especially do so if you have asthma given your already compromised airways and existing risk of certain complications, such as pneumonia.

For example, the aforementioned team of Johns Hopkins' researchers found that non-smokers who vape have an increased risk of chronic obstructive pulmonary disease (COPD)—as much as 2.6 times higher—and tend to develop the disease between ages 30 and 34.

This suggests that the ongoing use of e-cigarettes can cause a cascade of respiratory illnesses over time and may even speed the development of COPD, a disease that typically affects people 45 and over. Of note, asthma itself is considered a risk factor for COPD.

While it is true that e-cigarette solutions contain ingredients that are generally regarded as safe in their inert form, the heating of these ingredients can cause changes in their consistency and increase their toxicity in the lungs.

Take coconut oil and the sweetener glycerol, two ingredients commonly used in vaping products, for example. Both are well-tolerated on the skin or in the digestive tract, but can cause inflammation when inhaled and accumulate in the airways as the thickened oils cling to tissues. Over time, this can lead to a rare respiratory condition called lipid pneumonia (a form of aspiration pneumonia).

Other ingredients like diacetyl can lead to an irreversible condition called bronchiectasis in which the airways become permanently hardened and widened.

In fact, many of the same hazardous chemicals found in tobacco smoke are created when e-cigarette chemicals are heated. A 2017 study from Greece concluded that the amount of formaldehyde produced by e-cigarettes is five to 15 times greater than regular cigarettes and is delivered deeper into the lungs due to the gaseous state.

Formaldehyde and benzene are two examples of major carcinogens found in e-cigarette vapors that are linked not only to lung cancer but other cancers such as leukemia and breast cancer.

Whether this will increase the risk of cancer in later life is still unclear. Because vaping was only introduced to the U.S. market in 2007, it may be many years before scientists are able to fully evaluate the true long-term harms of e-cigarettes.

Arguably, though, the most harmful ingredients used in vaping are THC and vitamin E acetate. The Centers for Disease Control and Prevention (CDC) regard them as major causes of hospitalizations and deaths among e-cigarette users.

As of February 2020, 68 Americans have died and more than 2,800 have been hospitalized as a result of e-cigarette use. The majority were under the age of 35, 82% of whom used a THC-containing product.

The majority of people with e-cigarette-associated lung injury (EVALI) also had traces of vitamin E acetate in their lungs.

These factors not only increase the frequency and severity of asthma attacks but may increase the risk of COPD and other lung diseases in people who have never smoked.

Vaping should, in no way, be considered a "healthier" alternative to tobacco smoke—for those with asthma or without it. Since 2014, public health officials have noted an alarming spike in the number of e-cigarette-related illnesses in users as young as 17 and old as 75.

Vaping for Smoking Cessation

Traditional cigarettes cause over 480,000 deaths in the United States each year and are responsible for around nine of every 10 lung cancer-related deaths. Smoking is also responsible for 80% of COPD diagnoses and increases the risk of both heart disease and stroke by as much as 400%.

Furthermore, cigarette smoking is known to be a risk factor for the frequency and severity of acute asthma symptoms. Not only are smokers less able to control the disease compared to non-smoking counterparts, but they are more likely to require hospitalization for severe attacks.

Smoking cessation, while encouraged for everyone, is obviously something that is stressed for those with asthma for these reasons.

Some studies do suggest that when used as part of a combination approach with counseling and other cessation aids, such as Chantix (varenicline), e-cigarettes can be a very effective tool for quitting smoking.

When used on their own without medical oversight, however, the benefits are far less certain. And e-cigarettes do pose other health concerns that must be considered when weighing them against other cessation tools.

Side Effects of Vaping

Vaping was actually initially endorsed as a tool for smoking cessation, providing the user with nicotine to suppress cravings without exposure to tar and other harmful ingredients. Nicotine in e-cigarettes may offer positive benefits to a person trying to quit by increasing alertness, relaxation, memory, mood, and concentration.

However, in addition to the risks of developing or worsening pulmonary and other diseases, the fact that nicotine is addictive must be kept in mind.

Clearly, this poses a risk of a first-time addiction for those who vape but have never smoked. But studies have also shown that people who use e-cigarettes for smoking cessation tend to stay on the device longer than those who use other cessation aids. The nicotine dose in e-cigarettes is higher than in patches or gums, so the risk of a secondary addiction in those trying to quit smoking is increased.

In addition to this, there are other side effects that you should be aware of.

Even at low doses, vaping can also cause:

  • Headache
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dizziness
  • Throat irritation
  • Cough
  • Eye pain

At high doses, vaping can cause potentially severe side effects, including:

Deaths from e-cigarettes are most often the result of acute respiratory distress syndrome (ARDS), caused by the accumulation of fluids in the lungs.

Call 911 or seek emergency care if you use e-cigarettes and develop some or all of the following symptoms of ARDS:

  • Severe shortness of breath
  • Labored and rapid breathing
  • Extreme tiredness
  • Dizziness or fainting
  • Nausea or vomiting
  • Blurred vision
  • Confusion

Other Ways to Quit

Particularly if you have asthma, it's recommended that you don't smoke or vape. If you already smoke and still decide that you want to include e-cigarettes as part of your smoking cessation plan, do so under the care of a healthcare provider with clearly set goals.

This includes a scheduled plan to wean you off vaping, either by gradually reducing doses or switching you to low-dose nicotine replacement aid.

Other effective smoking cessation aids that you may want to consider and discuss with your healthcare provider include:

  • Nicotine patch
  • Nicotine gum
  • Nicotine lozenges
  • Nicotine nasal spray
  • Nicotine inhaler
  • Chantix (varenicline)
  • Zyban (bupropion)

You may find that many of the most effective cessation aids are available free of charge under the Affordable Care Act, even for multiple quit attempts.

Support groups and counseling are also invaluable tools that can improve your odds of quitting.

A Word From Verywell

Vaping has become more than a fad with an estimated 11 million users in the United States. Due to the known and unknown that risks e-cigarettes pose, it is difficult to endorse their use or regard them as a "safer" alternative to smoking. This is especially true if you have asthma. In the end, the risks of vaping may well exceed the benefits.

20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Office of the U.S. Surgeon General. The facts on e-cigarette use among youth and young adults.

  2. National Institute for Occupational Safety and Health (NIOSH). Flavorings-related lung disease.

  3. Scott A, Lugg ST, Aldridge K, et al. Pro-inflammatory effects of e-cigarette vapour condensate on human alveolar macrophages. Thorax. 2018;73(12):1161-69. doi:10.1136/thoraxjnl-2018-211663

  4. Bayly JE, Bernat D, Porter L, Choi K. Secondhand exposure to aerosols from electronic nicotine delivery systems and asthma exacerbations among youth with asthma. Chest. 2019;155(1):88-93. doi:10.1016/j.chest.2018.10.005

  5. Jenssen BP, Boykan R. Electronic cigarettes and youth in the United States: A call to action (at the local, national and global levels). Children (Basel). 2019;6(2):30. doi:10.3390/children6020030

  6. Schweitzer RJ, Wills TA, Tam E, Pagano I, Choi K. E-cigarette use and asthma in a multiethnic sample of adolescents. Prev Med. 2017;105:226-31. doi:10.1016/j.ypmed.2017.09.023

  7. Cho JH, Paik SY. Association between electronic cigarette use and asthma among high school students in South Korea. PLoS ONE. 2016;11(3):e0151022. doi:10.1371/journal.pone.0151022

  8. Osei AD, Mirbolouk M, Orimoloye OA, et al. The association between e-cigarette use and asthma among never combustible cigarette smokers: behavioral risk factor surveillance system (BRFSS) 2016 & 2017. BMC Pulm Med. 2019;19(1):180. doi:10.1186/s12890-019-0950-3

  9. Clapp PW, Peden DB, Jaspers I. E-cigarettes, vaping-related pulmonary illnesses, and asthma: A perspective from inhalation toxicologists. J Allergy Clin Immunol. 2020;145(1):97-9. doi:10.1016/j.jaci.2019.11.001

  10. Holm KE, Plaufcan MR, Ford DW, et al. The impact of age on outcomes in chronic obstructive pulmonary disease differs by relationship status. J Behav Med. 2014;37(4):654-63. doi:10.1007/s10865-013-9516-7

  11. Farsalinos KE, Voudris V, Spyrou A, Poulas K. E-cigarettes emit very high formaldehyde levels only in conditions that are aversive to users: A replication study under verified realistic use conditions. Food Chem Toxicol. 2017;109(Pt 1):90-4. doi:10.1016/j.fct.2017.08.044

  12. Swenberg JA, Moeller BC, Lu K, Rager JE, Fry R, Starr TB. Formaldehyde carcinogenicity research: 30 years and counting for mode of action, epidemiology, and cancer risk assessment. Toxicol Pathol. 2013 Feb;41(2):181-9. doi:10.1177/0192623312466459

  13. Hsu G, Sun JY, Zhu SH. Evolution of electronic cigarette brands from 2013-2014 to 2016-2017: Analysis of brand websites. J Med Internet Res. 2018;20(3):e80. doi:10.2196/jmir.8550

  14. Centers for Disease Control and Prevention. Outbreak of lung injury associated with the use of e-cigarette, or gaping, products.

  15. Centers for Disease Control and Prevention. Health effects of cigarette smoking.

  16. Stapleton M, Howard-thompson A, George C, Hoover RM, Self TH. Smoking and asthma. J Am Board Fam Med. 2011;24(3):313-22. doi:10.3122/jabfm.2011.03.100180

  17. Valentine G, Sofuoglu M. Cognitive effects of nicotine: Recent progress. Curr Neuropharmacol. 2018;16(4):403-4. doi:10.2174/1570159X15666171103152136

  18. Meier E, Tackett AP, Wagener TL. Effectiveness of electronic aids for smoking cessation. Curr Cardiovasc Risk Rep. 2013;7(6):8. doi:10.1007/s12170-013-0343-8

  19. Butt YM, Smith ML, Tazelaar HD, et al. Pathology of vaping-associated lung injury. N Engl J Med. 2019;381:1780-1. doi:10.1056/NEJMc1913069

  20. Blaha MJ, Ratchford EV. Electronic cigarettes. Vasc Med. 2019;24(3):267-9. doi:10.1177/1358863X19837361

By Daniel More, MD
Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California.