Vaping vs. Smoking: Is One Better for Your Lungs? Here's What Experts Say
For years, you were a member of the pack-a-day club, enjoying a quick puff in the parking lot before work, another drag on your lunch break, then chilling out with a leisurely smoke on your way home from the office. Or perhaps it was just a casual smoke to relax with friends on the weekends. But then your friend started experiencing shortness of breath and developed this weird cough, and your doctor diagnosed her with lung cancer. It was a big enough wake-up call that you decided to quit—and you bought yourself your first Juul.
It took a little getting used to, but after about a month, you were hooked on vaping. No smoke in your clothing, no icky aftertaste in your mouth, no rummaging through your bag to find your lighter again. Not that you gave up cigarettes entirely—but now you had another way to satisfy your cravings, one you figured was better for your health. After all, no one dies from vaping, right?
Well, not no one. Prior to 2020 there were reports of 68 deaths related to the use of vaping products and about 2,700 vaping-caused hospitalizations, according to the Centers for Disease Control and Prevention. In the years since, no additional stats have been released, but more deaths have met the criteria to be considered a vaping-related death. Experts are still trying to get to the bottom of these e-cigarette or vaping-associated lung injuries (also called EVALI), but evidence is mounting that the products pose serious health risks. Nevertheless, the perception that vaping is better than smoking persists.
Given the fact that vaping does away with tobacco, it’s natural to conclude it’s a healthier alternative to smoking. “The idea that e-cigarettes might be better than traditional cigarettes is not a crazy one—you can see why people might think that,” says Stanton Glantz, Ph.D., a professor of medicine at the University of California, San Francisco, and former director of the UCSF Center for Tobacco Control Research and Education. “But the evidence is showing that’s simply not the case.”
Confused? We get it— it's a lot to take in. Here’s what you should know about vaping vs. smoking when it comes to your health.
What’s the difference between vaping and smoking?
Traditional cigarettes, also called combustible cigarettes, and e-cigarettes, also referred to as vapes, share a common purpose: to provide nicotine to the person using the product. Nicotine is a stimulant that helps people feel focused and alert; ironically, the experience of smoking or vaping itself is psychologically soothing to many people—and also highly addictive. “The patients I see tell me they smoke because it makes them feel more relaxed,” says Humberto Choi, M.D., a pulmonologist at the Cleveland Clinic in Ohio. “They cannot stop because the nicotine addiction is so strong.”
But while both electronic and combustible cigarettes contain nicotine, they differ in the mechanism by which they deliver the chemical to the user. With e-cigarettes, a metal coil heats liquid in the vaping device, which then releases nicotine as an aerosol that people inhale. With combustible cigarettes, burning tobacco releases nicotine particles.
Although nicotine is addictive, it’s not considered toxic like tar or other byproducts of burning tobacco. But that doesn’t mean it’s good for your health. “Nicotine causes memory issues, concentration problems, poor sleep and major withdrawal issues if you stop using it,” says Dr. Choi. “It can also have cardiovascular effects and can harm a child’s development if the mother vapes while pregnant.”
Still, it’s the byproducts of burning tobacco when you smoke that have alarmed health experts the most over the years, including cadmium (found in batteries), lead and ammonia (also used in cleaning products). “The argument is that without combustion, you don’t have the byproducts which are pretty nasty,” says Glantz. “And it’s true, e-cigarettes don’t produce the same byproducts as cigarettes, or they have them in lower levels.” But e-cigarettes create their own secondary products, many of which are also bad for the body, including heavy metals and flavoring agents that become toxic to your lungs when heated and inhaled. “E-cigarettes are simply delivering a different mixture of toxins,” says Glantz.
Related: Why Flavored Vape Juice Is So Bad For You
Are there health risks of vaping?
We all know the bad news about cigarettes: They cause cancer. When e-cigs popped up on the scene in the last decade, the promise seemed too good to be true—all the joys of inhaling nicotine with none of those scary stats about lung cancer.
Except, as with most things that seem too good to be true, e-cigarettes are not the boon to lung health that they initially seemed. As the number of vaping-related deaths piled up last year, experts scrambled to understand the exact reason e-cigs were killing people. Unlike smoking, where scientists had decades of patient information to draw on, the relative newness of vaping meant there was little data to review.
“We believe maybe 80 percent of those vaping deaths were caused by people customizing their vaping devices for cannabis products, where the cannabis was dissolved in vitamin E acetate, which tears up your lungs when inhaled,” says Glantz. “Having said that, 10 to 15 percent of people who got sick were using regular nicotine e-cigarettes.” In the remaining 5 to 10 percent of vaping-related deaths, the cause is not yet understood.
The health risks of vaping are especially timely right now, as COVID-19 dominates the medical landscape. A new study in the Journal of Adolescent Health found that young people who vape are at five times greater risk of being diagnosed with the virus, and are at seven times greater risk if they both vape and smoke cigarettes.
And while the number of people smoking has steadily declined in the last 20 years (an estimated 30.8 million Americans still smoke every day or most days, according to the CDC), the number of e-cig puffers rose 300% in the U.S. from 2016 to 2019. According to the British Medical Journal, there are about 7 million adult e-cigarette users in the U.S., and the growth rate among adolescent users is higher than any substance tracked in the last 44 years. For a sliver of good news, the latest figures released from the CDC show a decline in vaping among high schoolers in the past year (one in five students versus one in four previously); but that’s countered by the alarming 1,000% increase in the use of disposable e-cigs among teens, a result of a loophole in the new law banning flavored e-cigarette cartridges, but not the disposable version (flavored vapes are believed to be especially toxic).
Related: Social Media Can Make It Harder to Quit Vaping—Here’s How
Should you vape to quit smoking?
Despite these health concerns, vaping companies still present e-cigarettes as a viable method to help people quit smoking. And in fact, according to a study in the New England Journal of Medicine, 18 percent of smokers who used e-cigs as a cessation tool were able to quit—and stay quit—for an entire year. Now, that number might not sound particularly impressive, but consider that it’s nearly double the 10 percent of smokers who quit using traditional methods. (Both, by the way, rocked the group that tried to quit on their own, which had a measly 3 percent success rate—takeaway message: You need help.)
OK, so vaping works to help you quit smoking, you’re thinking. Cool. Except it doesn’t, necessarily. In a July 2020 study in the American Journal of Epidemiology, researchers found that just 13 percent of people who used vaping as a tool to quit smoking were successful, and a second study published this September by researchers at the University of California, San Diego, found that just 9.6 percent of people who used e-cigarettes as a method of quitting smoking were successful over the course of 12 months.
Moreover, in both studies, the cessation rate with vaping was no better than the rate for people who tried to quit using traditional methods like medication, patches and gum. “The idea that e-cigarettes is a better method to help you quit smoking is a message that the vaping industry wants to spread,” says Dr. Choi. “It's a very controversial topic, because even if vaping helps people cut down on smoking, in the end, they are still using e-cigarettes, so there has been no improvement in their addiction to nicotine.” Because doctors don’t know the long-term harm vaping may do, he adds, he doesn’t recommend e-cigarettes to patients trying to quit smoking.
Related: 8 Ways to Quit Vaping
What vaping vs smoking does to your lungs
Here’s the other thing: Even if vaping weans you off cigarettes, it doesn’t mean it’s good for your lungs. “Your lungs are not made to inhale anything other than clean air,” says Dr. Choi. “Once aerosols from vaping enter your lungs, they activate inflammatory cells and increase the risk of infection.”
Inflammation is also a result of smoking, but the causes are slightly different. To start with, combustible cigarettes are made from, wait for it, 7,000 chemicals, including all kinds of less-than-stellar things, like acetone (a.k.a. your nail polish remover) and arsenic, which is used to poison rats, according to the American Lung Association. Those chemicals can do damage to your lungs in several ways:
The smoke irritates and inflames your lung tissue.
Your lungs produce excess mucus to try and protect themselves from infection.
Inflammation and mucus constrict your airway.
The micro-hairs lining your lungs, called cilia, that are designed to keep lungs clean are destroyed.
The toxic chemicals you inhale are passed into your blood, and then circulated around your body.
Related: The Risks of Chewing Tobacco vs Cigarettes
Meanwhile, e-cigarettes contain fewer toxic chemicals, but there is still plenty of overlap with the ones found in combustible cigarettes. So what ingredients can you find in your electronic cigarette? Let’s start with propylene glycol (also known as antifreeze), and acrolein, frequently used as a weed killer. Formaldehyde is another (a known human carcinogen) and benzene (found in car exhaust). It wouldn’t be that big of a leap, then, to assume those things are probably not great for the state of your lungs or adding years to your life.
And in fact, researchers at Johns Hopkins School of Medicine found that people who vape have a 75 percent greater chance of developing chronic obstructive pulmonary disease (COPD), along with other lung disorders, than those who don’t vape. It’s hard to say exactly how long it takes before vaping-related pulmonary diseases occur in people, or what their health outcomes are in the long-term, because the trend is so new, says Michael J. Blaha, M.D., co-author of the study and director of clinical research at Johns Hopkins’ Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore, Maryland. “It’s complicated by the fact that e-cigarette users tend to be young, and you need at least five to 10 years of data to measure the impact,” he says. “And the younger the population, the longer you need to follow them for.”
One thing we do know: E-cigarettes cause something called “popcorn lung” (or obliterative bronchiolitis if you’re a science geek). This basically refers to inflammation of small airways in your lungs that makes it hard to breathe. (Popcorn lung is named after employees in a popcorn factory who got lung disease from inhaling the butter flavoring used in making the popcorn.) “Certain compounds, like humectants, are pulmonary toxins,” says Glantz. “They are used to add moisture in food. If you eat them it’s fine, but if you aerosol and inhale them like with e-cigarettes, it’s not good.”
Related: Can Essential Oils Harm Your Lungs?
Why vaping is no better than smoking
By now, you’re probably catching on: No matter how you spin it, vaping has serious health risks, just like smoking. But wait, there’s more!
Because there are fewer regulations for e-cigarettes than there are for tobacco products, manufacturers have much more leeway in what they put in their e-devices, including how much nicotine each vaping cartridge can provide. “In e-cigarettes, the biggest determinants of nicotine delivery are the concentration of nicotine in the vaping liquid and the voltage used to run the device,” says Glantz. “The hotter you run it, the more nicotine it delivers.”
The problem, say experts, is that vaping devices like Juul deliver almost three times as much nicotine in a single cartridge as an entire pack of traditional cigarettes. That’s compounded by the way in which people vape, versus how they smoke. “With a cigarette, you’re only smoking 5 to 10 percent of the time, so a lot of nicotine ends up as air pollution,” says Glantz. “With an e-cigarette, there is no secondhand smoke, so all the nicotine ends up inhaled.”
And finally, while neither smoking nor vaping is good for your lungs or cardiovascular system, an increasing body of research suggests that doing both is even worse. A study from the University California, San Francisco, found a measurable increase in coronary heart disease, COPD, asthma and other respiratory ailments among people who vaped and smoked, compared to those who did one or the other. “There appears to be a synergistic effect,” says Glantz. “If you smoke, you have greater risk for certain health problems, and if you vape, you have independent risk factors. But if you do both, your risk of health problems multiplies.”
If you’re looking to quit smoking and improve your lung health, talk with your doctor about medically approved treatments that can help you get started. Turning to e-cigs as an alternative is kind of like swapping chocolate ice cream for vanilla when you’re on a diet: the flavors are different, but at the end of the day, you’re still eating ice cream.
Up next, here's why more women are getting lung cancer—and how to prevent it.
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