PATHOLOGICAL CHANGES IN LUNG TISSUE UNDER THE INFLUENCE OF ELECTRONIC CIGARETTES. LITERATURE REVIEW.
Background: Electronic cigarettes (e-cigarettes) have gained substantial popularity worldwide, particularly among adolescents and young adults. Their aerosols contain nicotine, flavoring agents, propylene glycol, glycerol, and thermal degradation by-products capable of reaching the distal airways and inducing inflammatory, fibrotic, and potentially precancerous alterations. Coordinated public health measures are necessary to mitigate the global burden of e-cigarette–related respiratory disease.
Aim: To synthesize current evidence on morphological changes in lung tissue following exposure to e-cigarette aerosols.
Search strategy: A literature review was conducted using PubMed, Scopus, Google Scholar, and e-Library databases for studies published between from 2015 to March 2025. Search terms included “electronic nicotine delivery systems,” “vaping,” “lungs,” “morphology,” and “oxidative stress.” Eligible publications comprised systematic reviews and original research in English and Russian.
Results: Data analysis revealed a marked increase in e-cigarette use over the last decade. Given the direct inhalation route, pathological changes predominantly occur in lung tissue, including acute epithelial injury, chronic inflammation, and fibrotic remodeling.
Conclusions: E-cigarette aerosols exert deleterious effects on the respiratory system, with potential mechanisms involving oxidative stress, pro-inflammatory cytokine activation, and suppression of DNA repair. Further morphological and immunohistochemical studies are warranted to elucidate long-term pulmonary consequences.
Ugilzhan B. Tatykayeva, Candidate of Medical Sciences, Senior Lecturer, Department of Fundamental Medical Disciplines, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkestan, Kazakhstan, Bekzat Sattarkhanov avenue, 29, ugilzhan.tatykayeva@ayu.edu.kz; https://orcid.org/0000-0002-7519-479X; +77026141701
Albina A. Abdullayeva, 5 st year student on the educational program В086 Medicine (6В101188-«Medicine») Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkestan, Kazakhstan, Bekzat Sattarkhanov avenue, 29, albenichocolate@mail.ru, https://orcid.org/0009-0008-4359-0617; +77786353931
Karlygash Zh. Sadykova PhD, Head of «Special clinic subjects» department Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkestan, Kazakhstan, Bekzat Sattarkhanov avenue, 29, karlygash.sadykova@ayu.edu.kz, https://orcid.org/0000-0001-8623-2539 ; +77077316476
Saulesh A. Apbassova - MD, PhD, Department of Pathological Anatomy and Forensic Medicine, NJSC «Semey Medical University», apbasova65@mail.ru;https://orcid.org/0000-0001-6650-4971; +77079196975
Madina M. Apbassova - ass. Department of Pathological Anatomy and Forensic Medicine, NCJSC «Semey Medical University», Semey, Republic of Kazakhstan; orange_vip_1@mail.ru, https://orcid.org/0000-0003-3215-1076; +77478366135
Gulnaz O. Nuskabaeva - Candidate of medical sciences, associate professor, Dean of the «Faculty of Medicine», Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkestan, Kazakhstan, Bekzat Sattarkhanov avenue, 29, nuskabaeva.gulnaz@ayu.edu.kz , https://orcid.org/0000-0003-2139-3221;+77052853131
Nursultan S. Nurdinov - PhD, Senior Lecturer of «Fundamental Medical Sciences» department Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkestan, Kazakhstan, Bekzat Sattarkhanov avenue, 29, nursultan.nurdinov@ayu.edu.kz, https://orcid.org/0000-0001-5341-7211; +77053787891
1. Alduraywish S.A., Aldakheel F.M., Alsuhaibani O.S., Jabaan A.D.B., et al. Knowledge and Attitude toward E-Cigarettes among First Year University Students in Riyadh, Saudi Arabia. Healthcare (Basel). 2023 Feb 8;11(4):502. doi: 10.3390/healthcare11040502. PMID: 36833037; PMCID: PMC9957237.
2. Askwith Z., Grignon J., Ismail M., Martin G., McEachern L.W. et al. Environmental influences on E-cigarette use among young people: A systematic review. Health Place. 2024 May;87:103212. doi: 10.1016/j.healthplace.2024.103212. Epub 2024 Mar 16. PMID: 38493658.
3. Bozier J., Rutting S., Xenaki D., Peters M., Adcock I., Oliver B.G. Heightened response to e-cigarettes in COPD. ERJ Open Res. 2019 Feb 26;5(1):00192-2018. doi: 10.1183/23120541.00192-2018. PMID: 30820437; PMCID: PMC6390269.
4. Breitbarth A.K., Morgan J., Jones A.L. E-cigarettes—an unintended illicit drug delivery system //Drug and alcohol dependence. – 2018. – Т. 192. – С. 98-111.
5. Cecchini M.J., Mukhopadhyay S., Arrossi A.V., Beasley M.B., Butt Y.M., Jones K.D., et al. E-Cigarette or Vaping Product Use-Associated Lung Injury: A Review for Pathologists. Arch Pathol Lab Med. 2020 Dec 1;144(12):1490-1500. doi: 10.5858/arpa.2020-0024-RA. PMID: 32401055.
6. Crotty Alexander L.E., Drummond C.A., Hepokoski M., Mathew D., Moshensky A., Willeford A., Das S., Singh P., Yong Z., Lee J.H., et al.
7. Chronic inhalation of e-cigarette vapor containing nicotine disrupts airway barrier function and induces systemic inflammation and multiorgan fibrosis in mice. Am J Physiol Regul Integr Comp Physiol. 2018 Jun 1;314(6):R834-R847. doi: 10.1152/ajpregu.00270.2017.
8. Dai Y., Duan K., Huang G., Yang X., Jiang X., Chen J., Liu P. Inhalation of electronic cigarettes slightly affects lung function and inflammation in mice. Front Toxicol. 2023 Sep 4;5:1232040. doi: 10.3389/ftox.2023.1232040. PMID: 37731664; PMCID: PMC10507352.
9. Eshraghian E.A., Al-Delaimy W.K. A review of constituents identified in e-cigarette liquids and aerosols. Tob Prev Cessat. 2021 Feb 10;7:10. doi: 10.18332/tpc/131111. PMID: 33585727; PMCID: PMC7873740.
10. Evans M.E., Twentyman E., Click E.S., Goodman A.B. et al. Update: interim guidance for health care professionals evaluating and caring for patients with suspected e-cigarette, or vaping, product use-associated lung injury and for reducing the risk for rehospitalization and death following hospital discharge MMWR Morb Mortal Wkly Rep, 68 (2019), pp. 1-9
11. Garg I., Vidholia A., Garg A., Singh S., Agahi A., Laroia A., Saboo S.S., Comellas A.P., Hoffman E.A., Nagpal P. E-cigarette or vaping product use-associated lung injury: A review of clinico-radio-pathological characteristics. Respir Investig. 2022 Nov;60(6):738-749. doi: 10.1016/j.resinv.2022.06.011. Epub 2022 Aug 11. PMID: 35963780.
12. Hage R., Fretz V., Schuurmans M.M. Electronic cigarettes and vaping associated pulmonary illness (VAPI): A narrative review. Pulmonology. 2020 Sep-Oct;26(5):291-303. doi: 10.1016/j.pulmoe.2020.02.009. Epub 2020 Jun 16. PMID: 32553826.
13. Hage R., Schuurmans M.M. Vaping-assoziierte Lungenerkrankung «VAPI» [Vaping-Associated Pulmonary Illness]. Praxis (Bern 1994). 2020;109(13):1063-1069. German. doi: 10.1024/1661-8157/a003529. PMID: 33050810.
14. Han H., Peng G., Meister M., Yao H., Yang J.J., Zou M.H., Liu Z.R., Ji X. Electronic Cigarette Exposure Enhances Lung Inflammatory and Fibrotic Responses in COPD Mice. Front Pharmacol. 2021 Jul 28;12:726586. doi: 10.3389/fphar.2021.726586. PMID: 34393802; PMCID: PMC8355703.
15. Huang J., Kornfield R., Emery S.L. 100 Million Views of Electronic Cigarette YouTube Videos and Counting: Quantification, Content Evaluation, and Engagement Levels of Videos. J Med Internet Res. 2016 Mar 18;18(3):e67. doi: 10.2196/jmir.4265. PMID: 26993213; PMCID: PMC4818373.
16. Jeon J., Zhang Q., Chepaitis P.S., Greenwald R., Black M., Wright C. Toxicological Assessment of Particulate and Metal Hazards Associated with Vaping Frequency and Device Age. Toxics. 2023 Feb 7;11(2):155. doi: 10.3390/toxics11020155. PMID: 36851030; PMCID: PMC9967192.
17. Jerzyński T., Stimson G.V., Shapiro H., Król G. Estimation of the global number of e-cigarette users in 2020. Harm Reduct J. 2021 Oct 23;18(1):109. doi: 10.1186/s12954-021-00556-7. PMID: 34688284; PMCID: PMC8541798.
18. Kazakhstan country tobacco survey. GYTS 2018 results. Global Action to End Smoking. 2024. URL: https://globalactiontoendsmoking.org/research/tobacco-around-the-world/kazakhstan
19. Kligerman S., Raptis C., Larsen B., Henry T.S., Caporale A., et al. Radiologic, Pathologic, Clinical, and Physiologic Findings of Electronic Cigarette or Vaping Product Use-associated Lung Injury (EVALI): Evolving Knowledge and Remaining Questions. Radiology. 2020 Mar;294(3):491-505. doi: 10.1148/radiol.2020192585. Epub 2020 Jan 28. PMID: 31990264.
20. Kotewar S.S., Pakhale A., Tiwari R., Reche A., Singi S.R. Electronic Nicotine Delivery System: End to Smoking or Just a New Fancy Cigarette. Cureus. 2023 Aug 13;15(8):e43425. doi: 10.7759/cureus.43425. PMID: 37706142; PMCID: PMC10497069.
21. Layden J.E., Ghinai I., Pray I., Kimball A., Layer M., Tenforde M.W. et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report. N Engl J Med. 2020 Mar 5;382(10):903-916. doi: 10.1056/NEJMoa1911614. Epub 2019 Sep 6. PMID: 31491072.
22. Lee H.W., Park S.H., Weng M.W., Wang H.T., et al. E-cigarette smoke damages DNA and reduces repair activity in mouse lung, heart, and bladder as well as in human lung and bladder cells. Proc Natl Acad Sci U S A. 2018 Feb 13;115(7):E1560-E1569. doi: 10.1073/pnas.1718185115. Epub 2018 Jan 29. PMID: 29378943; PMCID: PMC5816191.
23. Mukhopadhyay S., Mehrad M., Dammert P., Arrossi A.V., Sarda R., Brenner D.S., Maldonado F., Choi H., Ghobrial M. Lung Biopsy Findings in Severe Pulmonary Illness Associated With E-Cigarette Use (Vaping). Am J Clin Pathol. 2020 Jan 1;153(1):30-39. doi: 10.1093/ajcp/aqz182. PMID: 31621873.
24. O'Farrell H.E., Brown R., Brown Z., Milijevic B., Ristovski Z.D., et al. E-cigarettes induce toxicity comparable to tobacco cigarettes in airway epithelium from patients with COPD. Toxicol In Vitro. 2021 Sep;75:105204. doi: 10.1016/j.tiv.2021.105204. Epub 2021 Jun 26. PMID: 34186184.
25. Ogunwale M.A., Li M, Ramakrishnam Raju M.V., Chen Y., Nantz M.H., Conklin D.J., Fu X.A. Aldehyde Detection in Electronic Cigarette Aerosols. ACS Omega. 2017 Mar 31;2(3):1207-1214. doi: 10.1021/acsomega.6b00489. Epub 2017 Mar 29. PMID: 28393137; PMCID: PMC5377270.
26. Pikalyuk V.S., Shalanin V.V., Zhuravel' E.A., Asanova Z.V. Structural Changes in the Lung of Rats as the Result of the Aerosol Inhalation of Non-nicotine Liquid Used for Electronic Cigarettes. Journal of Anatomy and Histopathology. 2016;5(2):41-45. (In Russ.) https://doi.org/10.18499/2225-7357-2016-5-2-41-45
27. Podzolkov V.I., Vetluzhskaya M.V., Abramova A.A., Ishina T.I., Garifullina K.I. Vaping and vaping-associated lung injury: A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(7):591–596. DOI: 10.26442/00403660.2023.07.202293
28. Reagan-Steiner S., Gary J., Matkovic E., Ritter J.M., Shieh W.J., Martines R.B., Werner A.K., Lynfield R. et al. Lung Injury Response Pathology Working Group. Pathological findings in suspected cases of e-cigarette, or vaping, product use-associated lung injury (EVALI): a case series. Lancet Respir Med. 2020 Dec;8(12):1219-1232. doi: 10.1016/S2213-2600(20)30321-0. Epub 2020 Aug 4. PMID: 32763198; PMCID: PMC9477212.
29. Sciuscio D., Calvino-Martin F., Kumar A., Langston T.B., Martin E., Marescotti D., Mathis C., et al. Toxicological Assessment of Flavor Ingredients in E-Vapor Products. Front Toxicol. 2022 Apr 20;4:878976. doi: 10.3389/ftox.2022.878976. PMID: 35516526; PMCID: PMC9065440.
30. Selya A., Ruggieri M., Polosa R. Measures of youth e-cigarette use: strengths, weaknesses and recommendations. Front Public Health. 2024 Jul 2;12:1412406. doi: 10.3389/fpubh.2024.1412406. PMID: 39015391; PMCID: PMC11250581.
31. Sohal S.S., Eapen M.S., Naidu V.G.M., Sharma P. IQOS exposure impairs human airway cell homeostasis: direct comparison with traditional cigarette and e-cigarette. ERJ Open Res. 2019;5(1):00159-2018. DOI:10.1183/23120541.00159-2018
32. Sreeramareddy C.T., Acharya K., Manoharan A. Electronic cigarettes use and 'dual use' among the youth in 75 countries: estimates from Global Youth Tobacco Surveys (2014-2019). Sci Rep. 2022 Dec 5;12(1):20967. doi: 10.1038/s41598-022-25594-4. PMID: 36470977; PMCID: PMC9722706.
33. Sun J., Xi B., Ma C., Zhao M., Bovet P. Prevalence of E-Cigarette Use and Its Associated Factors Among Youths Aged 12 to 16 Years in 68 Countries and Territories: Global Youth Tobacco Survey, 2012‒2019. Am J Public Health. 2022 Apr;112(4):650-661. doi: 10.2105/AJPH.2021.306686. PMID: 35319939; PMCID: PMC8961851.
34. Tang M.S., Wu X.R., Lee H.W., Xia Y., et al.. Electronic-cigarette smoke induces lung adenocarcinoma and bladder urothelial hyperplasia in mice. Proc Natl Acad Sci U S A. 2019 Oct 22;116(43):21727-21731. doi: 10.1073/pnas.1911321116. Epub 2019 Oct 7. Erratum in: Proc Natl Acad Sci U S A. 2019 Nov 5;116(45):22884. doi: 10.1073/pnas.1918000116. PMID: 31591243; PMCID: PMC6815158.
35. Truth Initiative. E-cigarettes: facts, stats and regulations. 2024. URL: https://truthinitiative.org/research-resources/emerging-tobacco-products/e-cigarettes-facts-stats-and-regulations
36. Yanina I.Y., Genin V.D., Genina E.A., Mudrak D.A., Navolokin N.A., et al. Multimodal Diagnostics of Changes in Rat Lungs after Vaping. Diagnostics (Basel). 2023 Oct 30;13(21):3340. doi: 10.3390/diagnostics13213340. PMID: 37958237; PMCID: PMC10650729.
37. Wang J., Zhang T., Johnston C.J., Kim S.Y., Gaffrey M.J., et al. Protein thiol oxidation in the rat lung following e-cigarette exposure. Redox Biol. 2020 Oct;37:101758. doi: 10.1016/j.redox.2020.101758. Epub 2020 Oct 10. PMID: 33080441; PMCID: PMC7575796.
38. Wawryk-Gawda E., Chylińska-Wrzos P., K Zarobkiewicz M., Chłapek K., Jodłowska-Jędrych B. Lung histomorphological alterations in rats exposed to cigarette smoke and electronic cigarette vapour. Exp Ther Med. 2020 Apr;19(4):2826-2832. doi: 10.3892/etm.2020.8530. Epub 2020 Feb 17. PMID: 32256766; PMCID: PMC7098213.
39. Wawryk-Gawda E., Zarobkiewicz M.K., Wolanin-Stachyra M., Opoka-Winiarska V. Inflammatory markers activation associated with vapor or smoke exposure in Wistar rats. Front Immunol. 2025 Mar 21;16:1525166. doi: 10.3389/fimmu.2025.1525166. PMID: 40191199; PMCID: PMC11968385.
40. Ween M.P., Hamon R., Macowan M.G., Thredgold L., Reynolds P.N., Hodge S.J. Effects of E-cigarette E-liquid components on bronchial epithelial cells: Demonstration of dysfunctional efferocytosis. Respirology. 2020 Jun;25(6):620-628. doi: 10.1111/resp.13696. Epub 2019 Sep 22. PMID: 31542893.
41. WHO report. Electronic nicotine delivery systems. Conference of the Parties to the WHO Framework Convention on Tobacco Control, sixth session; September 1, 2014, Moscow, Russian Federation. Available at: https://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10Rev1-ru.pdf?ua=1&ua=1. Accessed: 12.05.2022 (in Russian)].
42. WHO/Glasgow. Youth vaping in Europe: country-level comparisons. The Sun. 2024. URL: https://www.thesun.co.uk/health/27523714/vape-english-kids-heaviest-europe
42. Wiriansya E.P., Rahman D., Zuhair M.N., Rijal S., Ikram D., Pangnguriseng U.A. Effects of E-Cigarette Vapor Smoke on Pulmonary Alveoli in Rattus norvegicus Lungs. JR [Internet]. 2023 Sep. 30 [cited 2025 Jul. 29];9(3):200-5. https://doi.org/10.20473/jr.v9-I.3.2023.200-205 Available from: https://e-journal.unair.ac.id/JR/article/view/46281
Number of Views: 174
Category of articles:
Reviews
Bibliography link
Tatykayeva U.B., Abdullayeva A.A., Sadykova K.Zh., Apbassova S.А., Apbassova M., Nuskabaeva G.О., Nurdinov N.S. Pathological changes in lung tissue under the influence of electronic cigarettes. Literature review // Nauka i Zdravookhranenie [Science & Healthcare]. 2025. Vol.27 (4), pp. 187-195. doi 10.34689/SH.2025.27.4.020Related publications:
MAPPING THE RESEARCH LANDSCAPE: IONIZING RADIATION-INDUCED OXIDATIVE STRESS AND INFLAMMATION IN THE BRAIN – A BIBLIOMETRIC ANALYSIS
ASSOCIATION BETWEEN EXPOSURE TO IONIZING RADIATION AND THE DEVELOPMENT OF CARDIOVASCULAR DISEASES: A LITERATURE REVIEW
ADVANCES IN POTENTIAL BIOMARKERS FOR RHEUMATOID ARTHRITIS: SYSTEMATIC REVIEW
RISK FACTORS AND PREVALENCE OF URINARY INCONTINENCE AMONG WOMEN IN FOREIGN COUNTRIES. LITERATURE REVIEW
THE IMPACT OF SCREEN TIME ON THE HEALTH OF THE MUSCULOSKELETAL SYSTEM IN CHILDREN AND ADOLESCENTS: A SYSTEMATIC REVIEW