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Various studies suggest the vapors from e-cigarettes contain several cancer-causing substances, as well as incredibly tiny particles of tin, chromium, nickel and other heavy metals, which, in large enough concentrations, can damage the lungs. These particles likely fleck off the solder joints or metal coil in the devices when heated. Because they are so small, the tiniest bits of metal, known as nanoparticles, can travel deep into the lungs. There they could exacerbate asthma, bronchitis—an inflammation of the tubes that carry air to and from the lungs—and emphysema—a disease in which the lungs' many air sacs are destroyed, leaving patients short of breath. So far there are not enough data to say with certainty whether e-cigs worsen these disorders. E-cigarettes have a battery-operated component that heats liquid containing nicotine, flavorings, and other chemicals.

The e-liquid is quickly heated and converted to an aerosol that can be inhaled into the lungs. As smoking has declined dramatically in the U.S., vaping has gained tremendous popularity very quickly. A 2018 study reported 20% of high schoolers vaped at least once in the past 30 days. Since e-cigarettes often contain the same chemicals as traditional cigarettes, smoke produced by vaping may be toxic to people nearby. Manufacturers claim that e-cigarettes bypass many of the health risks of tobacco smoking, providing a healthful alternative.

When studying tobacco cigarettes, researchers rely on smoking machines that simulate how frequently a typical smoker takes a puff and how much smoke is inhaled with each breath. No one has yet determined how much e-cig vapor the typical user breathes in, so different studies assume different amounts of vapor as their standard, making it difficult to compare their results. Tracing what happens to that vapor once it is inhaled is equally problematic.

In some instances, because of its appearance and the vapours it emits, an e-cigarette may be confused with a regular cigarette. Other types of e-cigarettes, however, are similar to a cigar, a smoking pipe, or a ballpoint pen in appearance. This story has been updated to correct that two of the four menthol e-cigarettes from Njoy are disposable products.

The harmful effects of CS and their deleterious consequences are both well recognised and widely investigated. However, and based on the studies carried out so far, it seems that e-cigarette consumption is less toxic than tobacco smoking. This does not necessarily mean, however, that e-cigarettes are free from hazardous effects. Indeed, studies investigating their long-term effects on human health are urgently required. In this regard, the main additional studies needed in this field are summarized in Table 3.

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