Pulmonary and extrapulmonary complications associated with e-cigarette use: an integrative review





Electronic Cigarette; Vaping; Adverse effects.


Objective: to investigate the pulmonary and extrapulmonary complications associated with the use of electronic cigarettes, considering their currently observed growth. Methodology: an integrative literature review was carried out during the years 2021 and 2022, through searches on the main scientific platforms, using the descriptors “vaping”, “adverse effects” and “e-cigarrette vapor”, chosen according to with DeCS (Descriptors in Health Sciences) and combining them with the Boolean operator “AND”. Results and discussion: through the aforementioned descriptors, 309 articles were found, of which 18 were selected for the integrative review and constitution of the final sample. In view of this, with the analysis of the aforementioned studies, it became evident that electronic cigarettes are related to the emergence of EVALI (E-cigarette or Vaping Product Use-Associated Lung Injury), with increased susceptibility to infections, cardiovascular diseases, cytotoxic and inflammatory effects, in addition to cerebrovascular impairment. Conclusion: given the above, it was concluded that the consumption of electronic cigarettes has systemic repercussions, at the pulmonary and extrapulmonary levels. With this, the study highlighted the implications of electronic cigarettes on the cardiovascular, respiratory, neural, genetic and immune systems, which affect the health and quality of life of the individual in a generalized way.


Ahmed, N., Kalininskiy, A., Gandhi, H., & Shin, J. J. (2018). Spontaneous coronary artery dissection in a postpartum e-cigarette smoker. BMJ Case Reports, bcr-2018-225194.

Antoniewicz, L., Brynedal, A., Hedman, L., Lundbäck, M., & Bosson, J. A. (2019). Acute Effects of Electronic Cigarette Inhalation on the Vasculature and the Conducting Airways. Cardiovascular Toxicology, 19(5), 441–450.

Archie, S. R., & Cucullo, L. (2020). Cerebrovascular and Neurological Dysfunction under the Threat of COVID-19: Is There a Comorbid Role for Smoking and Vaping? International Journal of Molecular Sciences, 21(11), 3916.

Artunduaga, M., Rao, D., Friedman, J., Kwon, J. K., Pfeifer, C. M., Dettori, A., … Lee, E. Y. (2020). Pediatric Chest Radiographic and CT Findings of Electronic Cigarette or Vaping Product Use–associated Lung Injury (EVALI). Radiology, 295(2), 430–438.

Barreto, I. F. (2018). Tabaco: a construção das políticas de controle sobre seu consumo no Brasil. História, Ciências, Saúde-Manguinhos, 25(3), 797–815.

Barrington-Trimis, J. L., & Leventhal, A. M. (2018). Adolescents’ Use of “Pod Mod” E-Cigarettes — Urgent Concerns. New England Journal of Medicine, 379(12), 1099–1102.

Benowitz, N. L., & Burbank, A. D. (2016). Cardiovascular toxicity of nicotine: Implications for electronic cigarette use. Trends in Cardiovascular Medicine, 26(6), 515–523.

Benowitz, N. L., & Fraiman, J. B. (2017). Cardiovascular effects of electronic cigarettes. Nature Reviews Cardiology, 14(8), 447–456.

Bhatnagar, A. (2016). E-Cigarettes and Cardiovascular Disease Risk: Evaluation of Evidence, Policy Implications, and Recommendations. Current Cardiovascular Risk Reports, 10(7).

Biondi‐Zoccai, G., Sciarretta, S., Bullen, C., Nocella, C., Violi, F., Loffredo, L., Pignatelli, P., Perri, L., Peruzzi, M., Marullo, A. G. M., De Falco, E., Chimenti, I., Cammisotto, V., Valenti, V., Coluzzi, F., Cavarretta, E., Carrizzo, A., Prati, F., Carnevale, R., & Frati, G. (2019). Acute Effects of Heat‐Not‐Burn, Electronic Vaping, and Traditional Tobacco Combustion Cigarettes: The Sapienza University of Rome‐Vascular Assessment of Proatherosclerotic Effects of Smoking (SUR‐VAPES) 2 Randomized Trial. Journal of the American Heart Association, 8(6).

Borchert, D. H., Kelm, H., Morean, M., & Tannapfel, A. (2021). Reporting of pneumothorax in association with vaping devices and electronic cigarettes. BMJ Case Reports, 14(12), e247844.

Bowler, R. P., Hansel, N. N., Jacobson, S., Graham Barr, R., Make, B. J., Han, M. K., Oelsner, E. C., Casaburi, R., Barjaktarevic, I., Cooper, C., Foreman, M., Wise, A. R., DeMeo, D. L., Silverman, E. K., Bailey, W., Harrington, K. F., Woodruff, P. G., & Drummond, M. B. (2017). Electronic Cigarette Use in US Adults at Risk for or with COPD: Analysis from Two Observational Cohorts. Journal of General Internal Medicine, 32(12), 1315–1322.

Cao, D. J., Aldy, K., Hsu, S., McGetrick, M., Verbeck, G., De Silva, I., & Feng, S. (2020). Review of Health Consequences of Electronic Cigarettes and the Outbreak of Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury. Journal of Medical Toxicology, 16(3), 295–310.

Carnevale, R., Sciarretta, S., Violi, F., Nocella, C., Loffredo, L., Perri, L., Peruzzi, M., Marullo, A. G. M., De Falco, E., Chimenti, I., Valenti, V., Biondi-Zoccai, G., & Frati, G. (2016). Acute Impact of Tobacco vs Electronic Cigarette Smoking on Oxidative Stress and Vascular Function. Chest, 150(3), 606–612.

Chaumont, M., van de Borne, P., Bernard, A., Van Muylem, A., Deprez, G., Ullmo, J., Starczewska, E., Briki, R., de Hemptinne, Q., Zaher, W., & Debbas, N. (2019). Fourth generation e-cigarette vaping induces transient lung inflammation and gas exchange disturbances: results from two randomized clinical trials. American Journal of Physiology-Lung Cellular and Molecular Physiology, 316(5), L705–L719.

Chen, I-Ling., Todd, I., Tighe, P. J., & Fairclough, L. C. (2020). Electronic cigarette vapour moderately stimulates pro-inflammatory signalling pathways and interleukin-6 production by human monocyte-derived dendritic cells. Archives of Toxicology, 94(6), 2097–2112

Chen, I., Todd, I., & Fairclough, L. C. (2019). Immunological and pathological effects of electronic cigarettes. Basic & Clinical Pharmacology & Toxicology, 125(3), 237–252.

Chen, J., Bullen, C., & Dirks, K. (2017). A Comparative Health Risk Assessment of Electronic Cigarettes and Conventional Cigarettes. International Journal of Environmental Research and Public Health, 14(4), 382.

Chidambaram, A. G., Dennis, R. A., Biko, D. M., Hook, M., Allen, J., & Rapp, J. B. (2020). Clinical and radiological characteristics of e-cigarette or vaping product use associated lung injury. Emergency Radiology, 27(5), 495–501.

D’Almeida, P. C. V., Silveira, M. B., Poiano, R., Américo, B., Padula, A. L., & Santos-Junior, N. G.. (2020). Lesões Pulmonares Associadas ao Uso do Cigarro Eletrônico. Blucher Medical Proceedings, 6(4), 92–120.

De Souza, M. T., Da Silva, M. D., & De Carvalho, R. (2010). Revisão integrativa: o que é e como fazer Integrative review: what is it? How to do it? 8(1), 102–108.

Edmonds, P. J., Copeland, C., Conger, A., & Richmond, B. W. (2020). Vaping-induced diffuse alveolar hemorrhage. Respiratory Medicine Case Reports, 29, 100996.

El-Mahdy, M. A., Mahgoup, Elsayed M, Ewees, M. G., Eid, M. S., Abdelghany, Tamer M, & Zweier, J. L. (2021). Long-term electronic cigarette exposure induces cardiovascular dysfunction similar to tobacco cigarettes: role of nicotine and exposure duration. Am J Physiol Heart Circ Physiol, H2112–H2129.

Elliott, E. M., Weintraub, A. Y., Francis, C. R., & Lindell, R. B. (2020). E-cigarette and Vaping-associated Lung Injury: What’s Lurking Inside!. Anesthesiology, 133(2), 427–428.

Ercole, F. F., Melo, L. S. de, & Alcoforado, C. L. G. C. (2014). Integrative review versus systematic review. Reme: Revista Mineira de Enfermagem, 18(1).

Franzen, K. F., Belkin, S., Goldmann, T., Reppel, M., Watz, H., Mortensen, K., & Droemann, D. (2020). The impact of heated tobacco products on arterial stiffness. Vascular Medicine, 25(6), 572–574.

George, J., Hussain, M., Vadiveloo, T., Ireland, S., Hopkinson, P., Struthers, A. D., Donnan, P. T., Khan, F., & Lang, C. C. (2019). Cardiovascular Effects of Switching From Tobacco Cigarettes to Electronic Cigarettes. Journal of the American College of Cardiology, 74(25), 3112–3120.

Ghosh, B., Reyes-Caballero, H., Akgün-Ölmez, S. G., Nishida, K., Chandrala, L., Smirnova, L., Biswal, S., & Sidhaye, V. K. (2020). Effect of sub-chronic exposure to cigarette smoke, electronic cigarette and waterpipe on human lung epithelial barrier function. BMC Pulmonary Medicine, 20(1).

Hartmann-Boyce, J., Begh, R., & Aveyard, P. (2018). Electronic cigarettes for smoking cessation. BMJ, j5543.

Hooper, R. W., & Garfield, J. L. (2019). An Emerging Crisis: Vaping-Associated Pulmonary Injury. Annals of Internal Medicine, 172(1), 57.

Ip, M., Diamantakos, E., Haptonstall, K., Choroomi, Y., Moheimani, R. S., Nguyen, K. H., Tran, E., Gornbein, J., & Middlekauff, H. R. (2020). Tobacco and electronic cigarettes adversely impact ECG indexes of ventricular repolarization: implication for sudden death risk. American Journal of Physiology-Heart and Circulatory Physiology, 318(5), H1176–H1184.

Jensen, K., Nizamutdinov, D., Guerrier, M., Afroze, S., Dostal, D., & Glaser, S. (2012). General mechanisms of nicotine‐induced fibrogenesis. The FASEB Journal, 26(12), 4778–4787.

Kaisar, M. A., Villalba, H., Prasad, S., Liles, T., Sifat, A. E., Sajja, R. K., Abbruscato, T. J., & Cucullo, L. (2017). Offsetting the impact of smoking and e-cigarette vaping on the cerebrovascular system and stroke injury: Is Metformin a viable countermeasure? Redox Biology, 13, 353–362.

Kalininskiy, A., Bach, C. T., Nacca, N. E., Ginsberg, G., Marraffa, J., Navarette, K. A., McGraw M. D., & Croft, D. P. (2019). E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach. The Lancet Respiratory Medicine, 7(12).

Klawinski, D., Hanna, I., Breslin, N. K., Katzenstein, H. M., & Indelicato, D. J. (2021). Vaping the Venom: Oral Cavity Cancer in a Young Adult With Extensive Electronic Cigarette Use. Pediatrics, 147(5).

Kaur, G., Singh, K., Maremanda, K. P., Li, D., Chand, H. S., & Rahman, I. (2020). Differential plasma exosomal long non-coding RNAs expression profiles and their emerging role in E-cigarette users, cigarette, waterpipe, and dual smokers. PLOS ONE, 15(12), e0243065.

Kelesidis, T., Tran, E., Arastoo, S., Lakhani, K., Heymans, R., Gornbein, J., & Middlekauff, H. R. (2020). Elevated Cellular Oxidative Stress in Circulating Immune Cells in Otherwise Healthy Young People Who Use Electronic Cigarettes in a Cross‐Sectional Single‐Center Study: Implications for Future Cardiovascular Risk. Journal of the American Heart Association, 9(18).

Lerner, C. A., Sundar, I. K., Yao, H., Gerloff, J., Ossip, D. J., McIntosh, S., Robinson, R., & Rahman, I. (2015). Vapors Produced by Electronic Cigarettes and E-Juices with Flavorings Induce Toxicity, Oxidative Stress, and Inflammatory Response in Lung Epithelial Cells and in Mouse Lung. PLOS ONE, 10(2), e0116732.

Martin, E. M., Clapp, P. W., Rebuli, M. E., Pawlak, E. A., Glista-Baker, E., Benowitz, N. L., Fry, R. C., Jaspers, I. (2016). E-cigarette use results in suppression of immune and inflammatory-response genes in nasal epithelial cells similar to cigarette smoke. American Journal of Physiology-Lung Cellular and Molecular Physiology, 311(1), L135–L144.

Medeiros, A. K., Da Costa, F. M., Cezeroli, M. T., Chaves, H. L., & Torres, U. S. Differential diagnosis between lung injury associated with electronic cigarette use and COVID-19 pneumonia. J Bras Pneumol, v. 47, n. 3, p. e20210058, 2021.

Moheimani, R. S., Bhetraratana, M., Yin, F., Peters, K. M., Gornbein, J., Araujo, J. A., & Middlekauff, H. R. (2017). Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette Users. JAMA Cardiology, 2(3), 278.

Narimani, M., & da Silva, G. (2020). Does “Dry Hit” vaping of vitamin E acetate contribute to EVALI? Simulating toxic ketene formation during e-cigarette use. PLOS ONE, 15(9), e0238140.

Overbeek, D. L., Kass, A. P., Chiel, L. E., Boyer, E. W., & Casey, A. M. H. (2020). A review of toxic effects of electronic cigarettes/vaping in adolescents and young adults. Critical Reviews in Toxicology, 50(6), 531–538.

Prochaska, J. J. (2018). The public health consequences of e‐cigarettes: a review by the National Academies of Sciences. A call for more research, a need for regulatory action. Addiction, 114(4), 587–589.

Ramirez, J. E. M., Karim, Z. A., Alarabi, A. B., Hernandez, K. R., Taleb, Z. B., Rivera, J. O., … Alshbool, F. Z. (2020). The JUUL E-Cigarette Elevates the Risk of Thrombosis and Potentiates Platelet Activation. Journal of Cardiovascular Pharmacology and Therapeutics, 25(6), 578–586.

Shao, X. M., & Fang, Z. T. (2020). Severe Acute Toxicity of Inhaled Nicotine and e-Cigarettes. Chest, 157(3), 506–508.

Suhling, H., Welte, T., & Fuehner, T. (2020). Three Patients With Acute Pulmonary Damage Following the Use of E-Cigarettes. Deutsches Ärzteblatt International.

Silva, A. L. O. da, & Moreira, J. C. (2019). A proibição dos cigarros eletrônicos no Brasil: sucesso ou fracasso? Ciência & Saúde Coletiva, 24(8), 3013–3024.

Silverman, A. L., Siddique, H., Kumar, V., Le, T.-H., & Ng, J. (2020). Vaping induced pneumonitis: a small community hospital’s case series and analysis. BMC Pulmonary Medicine, 20(1).

Simonavicius, E., McNeill, A., Shahab, L., & Brose, L. S. (2018). Heat-not-burn tobacco products: a systematic literature review. Tobacco Control, 28(5), 582–594.

Son, Y., Mainelis, G., Delnevo, C., Wackowski, O. A., Schwander, S., & Meng, Q. (2019). Investigating E-Cigarette Particle Emissions and Human Airway Depositions under Various E-Cigarette-Use Conditions. Chemical Research in Toxicology, 33(2), 343–352.

St. Helen, G., Liakoni, E., Nardone, N., Addo, N., Jacob, P., & Benowitz, N. L. (2019). Comparison of Systemic Exposure to Toxic and/or Carcinogenic Volatile Organic Compounds (VOC) during Vaping, Smoking, and Abstention. Cancer Prevention Research, 13(2), 153–162.

Striley, C. W., & Nutley, S. K. (2020). World vaping update. Current Opinion in Psychiatry, 33(4), 360–368.

Teixeira, E., Medeiros, H. P., Nascimento, M. H. M., Silva, B. A. C. e, & Rodrigues, C. (2014). Integrative literature review step-by-step & convergences with other methods of review / Revisão Integrativa da Literatura passo-a-passo & convergências com outros métodos de revisão. Revista de Enfermagem Da UFPI, 2(5), 3.

Wills, T. A., Soneji, S. S., Choi, K., Jaspers, I., & Tam, E. K. (2020). E-cigarette use and respiratory disorders: an integrative review of converging evidence from epidemiological and laboratory studies. European Respiratory Journal, 57(1), 1901815.

Xantus, G. Z. (2019). Vaping-associated lung injury—VALI facts, assumptions and opportunities: review of the present situation. Postgraduate Medical Journal, 96(1132), 61–63.



How to Cite

CARDOSO, B. E. M. .; SILVA, C. M. F. e .; BEZERRA, M. E. C. .; SOUZA, L. K. M. de . Pulmonary and extrapulmonary complications associated with e-cigarette use: an integrative review. Research, Society and Development, [S. l.], v. 11, n. 15, p. e280111536348, 2022. DOI: 10.33448/rsd-v11i15.36348. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/36348. Acesso em: 2 dec. 2023.



Review Article