By Charlotte Webster-
Health authorities have strengthened warnings around vaping after mounting medical evidence linked e-cigarette use to rare but potentially irreversible lung diseases, intensifying concerns over the long-term safety of products once widely marketed as a less harmful alternative to smoking.
Respiratory specialists and public health agencies say a growing body of clinical research now shows that vaping can cause permanent damage to the small airways of the lungs, particularly with prolonged or intensive use.
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While the scale of risk is still being studied, experts agree the link is serious enough to warrant stronger regulation and clearer public messaging especially for young people.
The warning comes as vaping rates among teenagers and young adults remain high in many countries, driven by flavoured products and the persistent belief that inhaling e-cigarette aerosol is largely harmless. Most vapers on the face of it, are trying to give up smoking.
According to the World Health Organization (WHO), that belief is incorrect. “E-cigarettes are not safe and contain toxic substances that are harmful to health,” the WHO stated early this year in its public guidance on vaping and electronic nicotine delivery systems. Their is a flawed perceived belief in many circles that vaping is generally very safe health wise, despite this view being far from the truth.
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Experts in the field say that the levels of risk associated with using ENDS or tobacco products are likely to depend on a range of factors, some relating to the products used and some to the individual user. Factors include product type and characteristics, how the products are used, including frequency of use, how the products are
Medical attention has increasingly focused on a condition called bronchiolitis obliterans, a rare lung disease that causes inflammation and scarring of the smallest airways.
The damage is irreversible and can lead to chronic breathlessness, coughing, and reduced lung capacity. Although once associated mainly with industrial chemical exposure, similar patterns of injury have now been documented in some long-term vapers.
The American Lung Association warns that chemicals found in some e-cigarette aerosols are known to damage lung tissue and may contribute to chronic lung disease. “There is moderate evidence that youth who use e-cigarettes are at increased risk for cough, wheezing, and asthma exacerbations,” the organisation says, adding that long-term effects are still being uncovered.
What the Science Says and What It Doesn’t
Health experts stress that while vaping does not produce smoke, it does expose the lungs to aerosolised chemicals, ultra fine particles, and flavouring compounds capable of penetrating deep into lung tissue.
Research published in the European Respiratory Journal has shown that e-cigarette vapour can trigger inflammatory responses similar to those seen in chronic obstructive pulmonary disease (COPD), even in people with no prior smoking history.
One of the most widely discussed concerns is the presence of diacetyl, a flavouring chemical previously linked to bronchiolitis obliterans in industrial settings. Investigations have confirmed that diacetyl and related compounds were present in some flavoured e-cigarette products, particularly those sold before tighter regulations were introduced.
Dr Panagis Galiatsatos, a pulmonary specialist at Johns Hopkins, has repeatedly cautioned against dismissing vaping risks. “Inhaling anything other than clean air carries risk,” he said in a public briefing. “We are learning that repeated exposure to vaping aerosols can cause lasting injury to lung tissue.”
Public confusion has persisted in part because of earlier focus on EVALI e-cigarette or vaping product use-associated lung injury which was identified by the Centers for Disease Control and Prevention (CDC) during a 2019–2020 outbreak largely linked to illicit THC products.
While that outbreak declined after public warnings, the CDC continues to state that vaping can cause serious lung harm and that no e-cigarette product is risk-free.
Importantly, health authorities clarify that not every person who vapes will develop lung disease, and that research is ongoing. However, pulmonologists say the concern lies in the irreversibility of certain forms of airway damage once they occur.
Chronic lung pathology including small airway fibrosis and constrictive bronchiolitis has been reported in association with long‑term vaping… after thorough evaluation, vaping was considered the most likely common causal etiology due to the temporal association…”.
Public Health Response and Growing Calls for Regulation
The strengthening link between vaping and potential long-term lung damage has raised concerns among health professionals and policymakers, prompting ongoing discussions about stricter regulation of e-cigarette products, particularly in relation to youth access, marketing, and product composition.
While vaping is widely promoted as a safer alternative to smoking for current smokers, the NHS emphasises that it is not risk-free. The organisation specifically warns that the long-term effects of vaping are still not fully known, meaning that the potential consequences for respiratory health over decades of use remain uncertain.
The NHS also notes that vaping can irritate the mouth, throat, and lungs, which may lead to inflammation or discomfort even in the short term. Because of these uncertainties, the NHS strongly urges that children, young people under 18, and non-smokers should never take up vaping, highlighting that preventive caution is necessary until more is known about the long-term safety of these products.
In the United States, the Food and Drug Administration (FDA) has not approved any e‑cigarette products as smoking cessation devices, and under U.S. law manufacturers must demonstrate that new tobacco products (including e‑cigarettes) are “appropriate for the protection of the public health” weighing risks and benefits before they can be authorised for sale.
Clinical and epidemiological evidence shows that adolescents who use e‑cigarettes report higher rates of respiratory symptoms such as chronic cough, wheezing, and shortness of breath compared with those who do not vape, and may exhibit early declines in lung function.
These findings have raised concern among clinicians, including paediatric and adolescent health specialists, about the potential impact of vaping on long‑term lung development in youth.
Research shows that adolescents who use e‑cigarettes report higher rates of respiratory symptoms including cough, wheezing and shortness of breath compared with those who do not vape, and the more they vape the more likely they are to report breathing problems.
Experts also note that young people’s lungs are still developing and may be especially vulnerable to airway inflammation and potential long‑term harm, underscoring the importance of preventing youth uptake of vaping products.
Industry groups and some public health bodies argue that vaping is less harmful than combustible cigarette smoking and may help adult smokers quit; evidence shows that switching to vaping exposes users to fewer toxins and can support smoking cessation.
Public health experts do not dispute that smoking remains more dangerous overall, but caution that framing vaping as “safe” is misleading e‑cigarettes still pose significant health risks and their long‑term effects are not well understood.
Scientific literature and WHO guidance urge countries to regulate e‑cigarettes as harmful products rather than consumer lifestyle goods, including implementing advertising, flavour and promotional restrictions to protect health, especially youth.
Health authorities agree that e‑cigarettes are not harmless and, for some users, consequences may be serious or irreversible; as the American Lung Association concludes, the safest option is to avoid vaping altogether.
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