What you need to know about e-cigarettes and vaping

by Kaiser Permanente |
Hand holding an e-cigarette

As more and more cases of vaping-related lung illness pop up across the country, the dangers of e-cigarettes and vaping are becoming more apparent. Maybe you saw the news story about the the 19-year-old college student from Florida who received a double lung and kidney transplant. Or the 18-year-old Illinois student athlete who now has the lungs of a 70-year-old. Or the 21-year-old from Sacramento who went into acute respiratory failure. All results of vaping.

These stories and others are strong warning signs about the risks of using e-cigarettes. By the start of 2020, nearly 2,500 people were hospitalized and 54 people had died from lung injuries linked to vaping, according to the  Centers for Disease Control and Prevention.1

To help make sense of this growing public health crisis, Samjot Dhillon, MD, a pulmonologist at Kaiser Permanente in Roseville and Sacramento, explains the basics of e-cigarettes and what we know about the current outbreak of vaping-related lung injuries.

What are e-cigarettes?

"E-cigarettes are battery-powered smoking devices that can be used for nicotine or marijuana," Dr. Dhillon says. Also called e-cigs, vape pens, vapes, mods, or e-hookahs, they come in many shapes and sizes. Some look like real cigarettes and cigars, while some look like pens, USB flash drives, and other everyday items.

How do e-cigarettes work?

Most e-cigarettes have a place to add liquid. "The e-cigarette heats up the liquid, which becomes a vapor or aerosol, and it’s inhaled into the lungs," says Dr. Dhillon. "The liquid can contain nicotine, tetrahydrocannabinol (THC), cannabinoid (CBD) oils, flavoring agents, and multiple other chemicals."

What does vaping mean?

Vaping is the use of e-cigarettes. People say "vaping" because e-cigarettes don’t create tobacco smoke — they create an aerosol that’s inhaled. However, when you vape, you’re still using a tobacco product.

Are e-cigarettes less harmful than regular cigarettes?

"People like to say e-cigarettes are not as bad as cigarettes, but it’s not a good comparison," says Dr. Dhillon. E-cigarette aerosol generally has fewer toxic chemicals than the 7,000 harmful chemicals in regular cigarettes.2 But that doesn’t mean e-cigarettes are safe. "We’re now discovering that even e-cigarettes have several harmful additives and chemicals, and we’re seeing several cases of acute lung illnesses."

What are the health effects of vaping?

  • Addiction: Just like regular cigarettes, vaping liquid typically has a high concentration of nicotine, which is very addictive.2
  • Development issues: Nicotine can damage brain development for teens, and it’s toxic for pregnant women and their developing babies.2
  • Cancer: Liquid flavorings in e-cigarettes contain chemicals, like diacetyl, that are linked to serious lung disease.3 "The vaping aerosol can contain cancer-causing chemicals that reach deep into the lungs," says Dr. Dhillon.
  • Lung failure: EVALI (e-cigarette or vaping product use–associated lung injury) can cause acute lung failure, hospitalization, and even death.1

What do we know about the vaping-related lung illness outbreak?

  • EVALI started to appear in April 2019. Then cases rapidly increased in July. As of December 17, 2019, the CDC had reported 2,506 hospitalizations for vaping-related lung injuries, including 54 deaths.1
  • It’s most common in young men.  Based on current CDC data, 67% of hospitalized EVALI patients were male, and 78% were under 35.1
  • Symptoms resemble signs of the flu. Cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, fever, and chills are common symptoms of EVALI. "With flu season, it’s going to be even more challenging to diagnose vaping-related lung injuries," says Dr. Dhillon.
  • Many suffer respiratory failure. "About 1 in 3 patients end up on a ventilator to help them breathe," says Dr. Dhillon. "Steroids have helped some patients recover, but it depends on how much damage they’ve done to their lungs."
  • Most cases involved THC use. However, there have been some cases where it happened with nicotine-only products.
  • The exact cause of EVALI is unknown. Vitamin E acetate, used to thicken THC vaping liquid, is a possible cause, but CDC researchers are still investigating.

What do parents need to know about kids and e-cigarettes?

  • Youth are more likely than adults to use e-cigarettes. In 2019, over 5 million U.S. middle and high school students reported using e-cigarettes in the past 30 days, according to the CDC.2
  • Many kids think vaping is safe. Speaking about one of the more popular vaping products used by teens, Dr. Dhillon says, "…many (teens) don’t even know it contains nicotine." He adds that an e-cigarette can have as much nicotine as 20 regular cigarettes.
  • Vaping impacts brain development. The nicotine in vaping products can harm brain development, which continues until about age 25. It can also damage learning, memory, and attention.4
  • Youth are less likely to tell a doctor they vape. "Teens don’t always want to share the intimate details of their habits, like vaping, with their doctor," says Dr. Dhillon. This can make it harder for doctors to diagnose EVALI or help them quit. Learn tips on how to talk to your teen about vaping.

How do you protect yourself from EVALI?

"To be safe, you shouldn’t vape anything — nicotine or THC," Dr. Dhillon says. "We just don’t know what’s going on yet." New data is coming out weekly as the CDC continues to research the outbreak. In the meantime, the best way to protect yourself is to avoid vaping altogether.

What tools are available to quit vaping?

Talk to your Kaiser Permanente doctor today. They can help you find the right resources to help you quit vaping or smoking for good, including:

1 "Outbreak of Lung Injury Associated with the Use of E-cigarette, or Vaping, Products," Centers for Disease Control and Prevention, accessed December 19, 2019.

2 "About Electronic Cigarettes (E-cigarettes)," Centers for Disease Control and Prevention, accessed December 19, 2019.

3 "The Facts on E-cigarette Use Among Youth and Young Adults," U.S. Surgeon General, Know the Risks: E-cigarettes & Young People, accessed December 19, 2019.

4 "Quick Facts on the Risks of E-Cigarettes for Kids, Teens, and Young Adults," Centers for Disease Control and Prevention, accessed March 9, 2023.