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Puff or pass? The truth about vaping, marijuana, and tobacco safety

R. Bowler, F. Rezaee

Journal of Precision Respiratory Medicine, 2026

1 citation

Abstract

Background:

Cannabis and electronic cigarettes (EC) are often perceived as safer than combustible tobacco, yet contemporary evidence shows important pulmonary risks. Cannabis use has shifted toward high-potency products and aerosolized delivery (vaping, dabbing).

Methods:

We performed a targeted narrative review of PubMed/MEDLINE, Web of Science, Scopus, and the Cochrane Library, supplemented by manual reference review, emphasizing English-language studies relevant to pulmonary outcomes of cannabis, electronic cigarettes, and tobacco.

Results:

Although acute bronchodilation is described, chronic use is linked to respiratory symptoms and airway injury, and rare complications (e.g., bullous disease). In large cohorts of older smokers, moderate marijuana use was not clearly associated with accelerated chronic

obstructive pulmonary disease (COPD) progression; however, heavy lifetime exposure may increase chronic bronchitis symptoms. EC aerosols contain nicotine and/or Δ

9

-tetrahydrocannabinol, solvents, metals, and flavorants; menthol increases inhaled particle counts and associates

with worse spirometry. The 2019 EC or vaping-associated lung injury (EVALI) outbreak, strongly linked to vitamin E acetate contamination and underscores the hazards of illicit and/or poorly regulated products. In two studies of long smoking histories, EC use correlated with chronic bronchitis

and did not improve cessation; however, more recent evidence from multiple randomized controlled trials and…

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