We all know that smoking is bad for your health, but how does vaping compare? While vaping is often marketed as a safer alternative, it is not without risks. This article explores the differences between smoking and vaping, their potential health effects, and what you need to know if you’re trying to quit.

How much nicotine is in cigarettes and vapes?

Nicotine is highly addictive and can lead to dependence, disrupt brain development in adolescents, and increase the risk of heart disease. Both cigarettes and vapes contain nicotine:

• A UK-regulated disposable vape with the highest legal nicotine level (20mg/ml) (2%), delivering about 20mg of nicotine to the user.
• A standard JUUL pod in the UK contains roughly the same amount of nicotine as a pack of 20 cigarettes, with each pod holding around 40mg of nicotine.
• A pack of 20 cigarettes contains 200–300mg of nicotine, with the smoker absorbing 20–30mg on average.

This means that the nicotine side effects between cigarettes and Vapes can be similar (NHS, Better Health).

• In some regions outside the UK, nicotine levels can reach up to 50mg (5%).

Is vaping really less harmful than smoking?

Vapes do not contain tar or tobacco, which are responsible for a multitude of cancers and lung disease in smokers. In line with this, Public Health England published a paper in 2015 stating that e-cigarettes are 95% less harmful than traditional cigarettes. As a result, e-cigarettes are widely used in NHS clinics to support smoking cessation. In fact, a study in the New England Journal of Medicine (NEJM, Jan 2019) found that vaping is much more effective than other nicotine replacement therapies (NRT) in maintaining one-year abstinence from conventional cigarettes. However, while vaping may be less harmful than smoking, it is not risk-free, and long-term effects are still not fully understood.

Is vaping a long-term solution?

However, the same NEJM study found that 80% of patients who quit smoking with the help of vapes continued to vape, whereas fewer continued using NRT. This raises concerns about ongoing nicotine dependence.

What chemicals are in vapes?

Vapes contain e-liquids, which carry nicotine and flavourings. These typically include:

• Propylene glycol and vegetable glycerin (used to thicken vapour)
• Artificial flavourings and sweeteners

There has been speculation about diacetyl, a chemical found in some flavoured e-liquids, being linked to ‘popcorn lung’ (bronchiolitis obliterans). This serious lung condition was first identified in factory workers exposed to diacetyl in microwave popcorn production. However, diacetyl is banned in UK-regulated nicotine vapes, making it rare in the UK (NHS, Better Health).

Can vaping cause lung disease?

E-cigarette or vaping-associated lung injury (EVALI) is now a recognised complication of vaping. It is a serious inflammatory lung disease most likely caused by the components of the e-liquids. The Center of Disease Control and Prevention (CDC) reports that 86% of cases were associated with vaping THC (tetrahydrocannabinol) products, but other chemicals may also contribute. Symptoms include:

• Acute chest pain
• Cough
• Shortness of breath
• Unexplained weight loss

Severe cases may require hospital admission, oxygen therapy, and steroids.

What are the long-term risks of vaping?

There are many uncertainties surrounding e-cigarettes, and it may take years before we fully understand their long-term effects. One certainty, however, is that vaping among children and adolescents is increasing, raising concerns about a new generation developing nicotine addiction and associated risks.

Why is vaping in children and young people a concern?

While evidence supports e-cigarettes as an effective method for quitting smoking, their use by young people who have never smoked is a different issue. A recent BMJ article (BMJ 2022;379:e073824) highlights how e-cigarettes target children and young people through marketing, design, and appealing flavours.

Serious adverse effects have been reported, including acute lung injury, immune system changes, increased asthma risk, and even deaths when devices are tampered with or ‘hacked’. Additionally, vaping remains a gateway to smoking. Data from the UK and US suggests that early vaping in teens is linked to persistent and heavier smoking later in life.

What are the best ways to quit smoking or vaping?

We can provide advice, resources, and prescribe medications to help you quit, such as nicotine replacement therapies (NRT) or prescription medications like varenicline (Champix) or bupropion (Zyban).

Nicotine Replacement Therapy (NRT) products—such as patches, gum, lozenges, nasal sprays, or inhalers—deliver a controlled, lower dose of nicotine to reduce cravings gradually without the harmful chemicals found in smoking or vaping.

Cognitive-behavioural therapy (CBT) can also help address the psychological addiction, providing strategies to manage triggers and cravings effectively.

What if I’m not ready to quit?

Health checks focusing on lung health can help detect smoking- and vaping-related conditions early. These may include:

• Chest examination: Assessing cardiac and respiratory health.
• Reproductive health examination: Evaluating potential impacts on fertility.
• Mental health evaluation: Identifying mood changes linked to nicotine dependence.
• Blood pressure check: Monitoring for nicotine-induced hypertension.
• Blood tests: Screening for raised cholesterol and inflammation markers.
• Oral examination: Checking for gum disease and oral cancers.
• Dermatology assessment: Identifying skin irritation or premature ageing.
• Spirometry: A simple clinic test to detect early chronic lung disease.
• Chest X-ray: Recommended for persistent coughing, wheezing, or breathlessness.
• Low-dose CT scan: Advised for long-term smokers or vapers to detect early signs of lung disease or cancer.

Where can I get more help?

If you are considering quitting smoking or vaping, we can support you with personalised advice and treatment options. Book an appointment here or call 0207 245 9333 to discuss the best approach for you.

References:

• NHS, Better Health: www.nhs.uk/better-health/quitsmoking
• New England Journal of Medicine, 2019;380:629
• British Medical Journal 2022;379:e073824
• Center for Disease Control and Prevention: www.cdc.gov/tobacco/e-cigarettes