The impact of electronic cigarettes on the respiratory system: a narrative review
Abstract
Background: The rapidly increasing global prevalence of e-cigarette use, particularly among adolescents and young adults, has raised significant concern regarding their respiratory safety. E-cigarettes generate an aerosol by heating a liquid mixture containing nicotine, propylene glycol, vegetable glycerin, flavorings, and various toxic and potentially carcinogenic compounds such as aldehydes, acrolein, and heavy metals. The respiratory system, being the primary route of exposure, is especially vulnerable to both acute and chronic toxic effects. Aims: This review aims to synthesize and critically evaluate current evidence on the respiratory consequences of e-cigarette use, with a focus on acute and chronic pulmonary effects, underlying cellular and molecular mechanisms of injury, and implications for public health and clinical practice. Methods: A narrative review was conducted following a structured literature search in PubMed, Scopus, Web of Science, and Embase for studies published between 2018 and 2025. The search included the terms “e-cigarette”, “vaping”, “respiratory system”, “lung injury”, “EVALI”, “oxidative stress”, “nicotine”, and “pulmonary disease”. The initial search identified 246 records; after screening and eligibility assessment, 74 studies were included. Priority was given to systematic reviews, meta-analyses, and large-scale observational or experimental studies. Data were synthesized narratively with emphasis on methodological rigor, quality of evidence,…
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