Lung damage caused by electronic cigarettes in non-smokers, a Systematic Review


  • Djament L UAI
  • Balmaceda M


Electronic Nicotine Delivery Systems, Vaping, Lung Injury, Lung Diseases


Background: The use of electronic cigarette by non-smokers is increasing under the belief that these are a harmless alternative to tobacco. It has been evidenced that the use of electronic cigarette causes damage to systemic health, but, up to date, a systematic review about how “vaping” affects non-smokers’ health has not been conducted. The objective of this study is to conduct a systematic review of the available evidence to determine the lung damage that electronic cigarettes cause in non-smokers’ health. Material and methods: We conducted a research of the available evidence on different online searching engines such as PubMed based on the MeSH terms. We selected studies which met the inclusion and exclusion criteria. Results: 14 articles were included, of those 7 were clinical trials and 7 were cross-sectional studies. The total of patients included was 2640 with an average age of 28 years old, 54% were female. None of the patients were ex or current smokers. The most common symptoms found on vapers were dizziness (75,5%), sore throat (38,8%) and shortness of breath (28,4%). Medium FEV1/FVC found on the spirometry was 85% and medium FeNO was 17,5 ppb. Conclusion: Even though measured variables do not show severe respiratory damage associated with vaping in non-smokers, electronic cigarettes’ safety cannot be assured due to the lack of available evidence.

Keywords: Electronic Nicotine Delivery Systems; Vaping, Lung Injury; Lung Diseases; Non-Smokers



Download data is not yet available.



Dr. Konfino J, Lic. Goldberg L, Dr. Linetzky B, Dr. Ferrante D. Encuesta Mundial de Tabaquismo en Adultos. Minist Salud la Nación. 2012;1(1):156.

Brunilda C, Videla A, Wurcel V, Zambón F, Gonzalez G, Alcuaz A, et al. Guía de Práctica Clínica Nacional de Tratamiento de la Adicción al Tabaco. Minist Salud Publica Argentina. 2016;1–56.

Bozier J, Chivers EK, Chapman DG, Larcombe AN, Bastian NA, Masso-Silva JA, et al. The Evolving Landscape of e-Cigarettes: A Systematic Review of Recent Evidence. Chest [Internet]. 2020;157(5):1362–90. Available from:

Dinakar C, O’Connor GT. The health effects of electronic cigarettes. N Engl J Med. 2016;375(14):1372–81.

Farsalinos KE, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: A systematic review [Internet]. Vol. 5, Therapeutic Advances in Drug Safety. Ther Adv Drug Saf; 2014 [cited 2020 Sep 3]. p. 67–86. Available from:

Cherian S V., Kumar A, Estrada -Y- Martin RM. E-Cigarette or Vaping Product-Associated Lung Injury: A Review. Am J Med. 2020;

Crotty Alexander LE, Ware LB, Calfee CS, Callahan SJ, Eissenberg T, Farver C, et al. NIH Workshop Report: E-cigarette or Vaping Product Use Associated Lung Injury (EVALI): Developing a Research Agenda. American Journal of Respiratory and Critical Care Medicine. 2020. 1–36 p.

Chiale C. Disposición 3226/11. Boletín la Adm Nac Aliment Medicam y Tecnol Médica [Internet]. 2011;10. Available from:

Dirección Nacional de Epidemiología y Análisis de la Situación de Salud, Nación M de S de la. Lesión pulmonar asociada al uso de cigarrillo electrónico: primer caso reportado en Argentina. 2019. p. 1–5.

Rosendo E, Posse L, Peronace G, Nápoli M, Berardi G. Cigarrillo electrónico: uso, regulación legal e implicancias en la salud. Secr Políticas Integr sobre Drog la Nación Argentina. 2017;

Ferkol TW, Farber HJ, Grutta S La, Leone FT, Marshall HM, Neptune E, et al. Electronic cigarette use in youths: A position statement of the Forum of International Respiratory Societies. Vol. 51, European Respiratory Journal. European Respiratory Society; 2018.

McMillen R, Klein JD, Wilson K, Winickoff JP, Tanski S. E-Cigarette Use and Future Cigarette Initiation Among Never Smokers and Relapse Among Former Smokers in the PATH Study. Public Health Rep. 2019;134(5):528–36.

Urrutia G, Bonfill X. PRISMA_Spanish.pdf [Internet]. Vol. 135, Medicina Clínica. 2010. p. 507–11. Available from:

Initiative G. Global Strategy for Asthma Management and Prevention (2020 update). Rev Française d’Allergologie d’Immunologie Clin. 1996;36(6):685–704.

Dinakar C. Exhaled nitric oxide in pediatric asthma. Curr Allergy Asthma Rep. 2009;9(1):30–7.

Gonzalez JE, Cooke WH. Acute effects of electronic cigarettes on arterial pressure and peripheral sympathetic activity in young nonsmokers. Am J Physiol - Hear Circ Physiol. 2021;320(1):H248–55.

Grassi G, Seravalle G, Calhoun DA, Bolla GB, Giannattasio C, Marabini M, et al. Mechanisms Responsible for Sympathetic Activation by Cigarette Smoking in Humans [Internet]. 1994 [cited 2021 Apr 6]. Available from:

Palamidas A, Tsikrika S, Katsaounou P, Vakali S, Gennimata S-A, kaltsakas G, et al. Acute effects of short term use of e-cigarettes on airways physiology and respiratory symptoms in smokers with and without airways obstructive diseases and in healthy non smokers. Tob Prev Cessat. 2017;3(March).

Brożek GM, Jankowski M, Zejda JE. Acute respiratory responses to the use of e-cigarette: an intervention study. Sci Rep [Internet]. 2019 Dec 1 [cited 2021 Jan 20];9(1). Available from:

Staudt MR, Salit J, Kaner RJ, Hollmann C, Crystal RG. Altered lung biology of healthy never smokers following acute inhalation of E-cigarettes. Respir Res [Internet]. 2018 May 14 [cited 2020 Aug 7];19(1). Available from:

Hedman L, Backman H, Stridsman C, Bosson JA, Lundbäck M, Lindberg A, et al. Association of Electronic Cigarette Use With Smoking Habits, Demographic Factors, and Respiratory Symptoms. JAMA Netw open [Internet]. 2018 Jul 6 [cited 2020 Aug 8];1(3):e180789. Available from:

Wang JB, Olgin JE, Nah G, Vittinghoff E, Cataldo JK, Pletcher MJ, et al. Cigarette and e-cigarette dual use and risk of cardiopulmonary symptoms in the Health eHeart Study. PLoS One [Internet]. 2018 Jul 1 [cited 2020 Aug 6];13(7). Available from:

McConnell R, Barrington-Trimis JL, Wang K, Urman R, Hong H, Unger J, et al. Electronic cigarette use and respiratory symptoms in adolescents. Am J Respir Crit Care Med. 2017;195(8):1043–9.

Alnajem A, Redha A, Alroumi D, Alshammasi A, Ali M, Alhussaini M, et al. Use of electronic cigarettes and secondhand exposure to their aerosols are associated with asthma symptoms among adolescents: a cross-sectional study. Respir Res [Internet]. 2020 Dec 1 [cited 2021 Jan 20];21(1). Available from:

Polosa R, Cibella F, Caponnetto P, Maglia M, Prosperini U, Russo C, et al. Health impact of E-cigarettes: a prospective 3.5-year study of regular daily users who have never smoked OPEN. Available from:

Dicpinigaitis P V., Chang AL, Dicpinigaitis AJ, Negassa A. Effect of e-cigarette use on cough reflex sensitivity. Chest. 2016;149(1):161–5.

Manzoli L, La Vecchia C, Flacco ME, Capasso L, Simonetti V, Boccia S, et al. Multicentric cohort study on the long-term efficacy and safety of electronic cigarettes: Study design and methodology. BMC Public Health. 2013;13(1):2–7.

Singh KP, Lawyer G, Muthumalage T, Maremanda KP, Khan NA, McDonough SR, et al. Systemic biomarkers in electronic cigarette users: implications for noninvasive assessment of vaping-associated pulmonary injuries. ERJ Open Res [Internet]. 2019;5(4):00182–2019. Available from:

T M, JH L, Q W, T L, MD M, I R. Pulmonary toxicity and inflammatory response of e-cigarettes containing medium-chain triglyceride oil and vitamin E acetate: Implications in the pathogenesis of EVALI but independent of SARS-COV-2 COVID-19 related proteins. bioRxiv Prepr Serv Biol [Internet]. 2020 [cited 2020 Aug 6]; Available from:

Herman M, Tarran R. E-cigarettes, nicotine, the lung and the brain: multi-level cascading pathophysiology. J Physiol. 2020;1–18.

Boulay MÈ, Henry C, Bossé Y, Boulet LP, Morissette MC. Acute effects of nicotine-free and flavour-free electronic cigarette use on lung functions in healthy and asthmatic individuals [Internet]. Vol. 18, Respiratory Research. BioMed Central Ltd.; 2017 [cited 2020 Aug 7]. Available from:

Cooke WH, Pokhrel A, Dowling C, Fogt DL, Rickards CA. Acute inhalation of vaporized nicotine increases arterial pressure in young non-smokers: a pilot study. Clin Auton Res. 2015;25(4):267–70.

Song MA, Reisinger SA, Freudenheim JL, Brasky TM, Mathé EA, McElroy JP, et al. Effects of electronic cigarette constituents on the human lung: A pilot clinical trial. Cancer Prev Res [Internet]. 2020 [cited 2020 Aug 7];13(2):145–51. Available from:

Meo SA, Ansary MA, Barayan FR, Almusallam AS, Almehaid AM, Alarifi NS, et al. Electronic Cigarettes: Impact on Lung Function and Fractional Exhaled Nitric Oxide Among Healthy Adults. Am J Mens Health [Internet]. 2019 Jan 1 [cited 2021 Jan 20];13(1). Available from:

(31), (18), (32),(19), (20), (33), (16), (21), (22), (23), (34), (25), (28), (24)




How to Cite

Djament L, Balmaceda M. Lung damage caused by electronic cigarettes in non-smokers, a Systematic Review. Int Jour HS [Internet]. 2021 Dec. 3 [cited 2022 Oct. 3];(1). Available from:



Clinical Research