The rise of electronic nicotine delivery systems and the emergence of electronic-cigarette-driven disease

Am J Physiol Lung Cell Mol Physiol. 2020 Oct 1;319(4):L585-L595. doi: 10.1152/ajplung.00160.2020. Epub 2020 Jul 29.


In 2019, the United States experienced the emergence of the vaping-associated lung injury (VALI) epidemic. Vaping is now known to result in the development and progression of severe lung disease in the young and healthy. Lack of regulation on electronic cigarettes in the United States has resulted in over 2,000 patients and 68 deaths. We examine the clinical representation of VALI and the delve into the scientific evidence of how deadly exposure to electronic cigarettes can be. E-cigarette vapor is shown to affect numerous cellular processes, cellular metabolism, and cause DNA damage (which has implications for cancer). E-cigarette use is associated with a higher risk of developing crippling lung conditions such as chronic obstructive pulmonary disease (COPD), which would develop several years from now, increasing the already existent smoking-related burden. The role of vaping and virus susceptibility is yet to be determined; however, vaping can increase the virulence and inflammatory potential of several lung pathogens and is also linked to an increased risk of pneumonia. As it has emerged for cigarette smoking, great caution should also be given to vaping in relation to SARS-CoV-2 infection and the COVID-19 pandemic. Sadly, e-cigarettes are continually promoted and perceived as a safer alternative to cigarette smoking. E-cigarettes and their modifiable nature are harmful, as the lungs are not designed for the chronic inhalation of e-cigarette vapor. It is of interest that e-cigarettes have been shown to be of no help with smoking cessation. A true danger lies in vaping, which, if ignored, will lead to disastrous future costs.

Keywords: COVID-19; ENDS; Heat-Not-Burn; SARS-CoV-2; VALI; electronic cigarettes.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Betacoronavirus
  • Coronavirus Infections / pathology
  • Disease Susceptibility / chemically induced
  • E-Cigarette Vapor / toxicity*
  • Electronic Nicotine Delivery Systems / statistics & numerical data
  • Female
  • Humans
  • Lung Diseases, Interstitial / chemically induced
  • Lung Diseases, Interstitial / epidemiology*
  • Lung Injury / chemically induced
  • Lung Injury / epidemiology*
  • Lung Injury / mortality
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia / epidemiology
  • Pneumonia, Viral / pathology
  • Pulmonary Disease, Chronic Obstructive / chemically induced
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Smoking Cessation / methods
  • United States / epidemiology
  • Vaping / adverse effects*
  • Vaping / epidemiology
  • Vaping / mortality


  • E-Cigarette Vapor

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2