Do electronic cigarettes impart a lower potential disease burden than conventional tobacco cigarettes? Review on E-cigarette vapor versus tobacco smoke

Laryngoscope. 2014 Dec;124(12):2702-6. doi: 10.1002/lary.24750. Epub 2014 Oct 9.


Objectives/hypothesis: Development and utilization of electronic cigarettes (ECs) resulted from the search for healthier alternatives to conventional tobacco cigarettes (TCs) and the search for alternative methods for quitting TCs. This review compares the potential disease burden presented by TC smoke to that of EC vapor.

Methods: Potential disease burden of EC vapor versus TC smoke was assessed by reviewing clinical studies that measured inhaled components. Chemicals and carcinogens produced by vapor versus smoke were compared.

Results: Studies show that EC vapors contain far less carcinogenic particles than TC smoke. Whereas ECs have the ability to reach peak serum cotinine/nicotine levels comparable to that of TCs, ECs do not cause an increase in total white blood cell count; thus, ECs have the potential to lower the risk of atherosclerosis and systemic inflammation. Use of ECs has been shown to improve indoor air quality in a home exposed to TC smoke. This reduces secondhand smoke exposure, thus having the potential to decrease respiratory illness/asthma, middle-ear disease, sudden infant death syndrome, and more. However, some studies claim that propylene glycol (PG) vapor can induce respiratory irritation and increase chances for asthma. To minimize risks, EC manufacturers are replacing PG with distilled water and glycerin for vapor production.

Conclusion: Based on the comparison of the chemical analysis of EC and TC carcinogenic profiles and association with health-indicating parameters, ECs impart a lower potential disease burden than conventional TCs.

Keywords: Electronic cigarette; carcinogen; disease burden; second-hand smoke exposure; smoke; tobacco cigarette; vaping; vapor.

Publication types

  • Review

MeSH terms

  • Air Pollution, Indoor / adverse effects*
  • Cost of Illness*
  • Electronic Nicotine Delivery Systems / economics*
  • Humans
  • Inhalation Exposure / adverse effects*
  • Polycyclic Aromatic Hydrocarbons
  • Smoking / economics*
  • Tobacco Smoke Pollution / adverse effects*
  • Volatile Organic Compounds / adverse effects*


  • Polycyclic Aromatic Hydrocarbons
  • Tobacco Smoke Pollution
  • Volatile Organic Compounds