When e-cigarettes first hit the shelves, they were advertised as a “safer” alternative for adults looking to quit tobacco. But Panagis Galiatsatos, M.D., MHS, a pulmonary and critical care physician at Johns Hopkins School of Medicine, warns that this incorrect perception could be setting up another generation for decades of health problems.
Researchers quickly determined that the “e-juice” that fills vaping cartridges is highly addictive, with one pod containing as much nicotine as an entire pack of cigarettes. Additionally, the creative advertising and flavoring has enticed the younger generations to pick up this “seemingly harmless” tobacco product. As of 2024, 5.9% or 1.63 million middle and high school students reported currently using e-cigarettes, prompting the U.S. Surgeon General to call youth vaping a "public health crisis."
The mid-to-long-term health consequences of e-cigarettes are just starting to be understood. This is because, as with traditional tobacco, it takes many years before the damage that is being done to the body becomes obvious. “People generally don’t see immediate effects, so they don’t worry. But that doesn’t mean it couldn’t lead to more insidious diseases later,” Dr. Galiatsatos explains. “When you think about traditional cigarettes, you need to smoke for about 20 to 30 years before you see outcomes like COPD, emphysema, or lung cancer.”
Dr. Galiatsatos warns that vaping hasn’t been around long enough for us to see those irreversible diseases yet. “But biologically, damage is happening. The inflammation is happening. And the concern is, we’re creating the conditions that will lead to those diseases later.”
Unassuming Signs of E-cigarette-Related Illness
When matching any substance dependency with aging and constant use, the effects can be very damaging, even if, like in the case of vaping, the signs seem subtle at first. For example, a child’s sports endurance may decrease because their lungs are being impacted. “For most of my patients it starts with something small,” says Dr. Galiatsatos. “A young kid who can’t shake a cough or keeps getting bronchitis or lung infections or asthma that has suddenly become harder to manage. Nothing catastrophic—but suddenly this kid who was fine is constantly sick.”
Those recurring infections aren’t coincidental, warns Dr. Galiatsatos; they are red flags. Research has shown that pneumonia, bronchitis, and other lung infections are more common in people who vape. Though these effects might not immediately be life-threatening, doctors worry about the long-term consequences. “A lot of acute bronchitis will at some point become chronic bronchitis and COPD,” he warns. “These are toxins. So, they’re likely to develop into emphysema later.”
“If you’re breathing in chemicals that constantly challenge your immune system,” he explains, “you’re setting yourself up for any infection to really run amok in the lungs.”
The Risk You Take Every Time You Vape
Some of the most extreme consequences of vaping, like lung collapse (pneumothorax), may be rare—but that doesn’t mean they aren’t serious. “Usually pneumothorax in a 20-year-old isn’t common,” says Dr. Galiatsatos. “But if you were born with an underlying lung defect or had childhood asthma, it is more likely to happen, so why take the risk?”
In several cases he’s treated, vaping has actually revealed a hidden disease. “Sometimes the first time a young person learns they have an underlying lung condition is after their lung collapses—and they were vaping. It’s heartbreaking, because by then they’re often addicted to the product.”
Another rare but serious condition is bronchiolitis obliterans, or “popcorn lung,” which is linked to the flavoring chemical called diacetyl. “The chemical is used in food flavoring, and when it was found in some early vape products, people understandably got concerned,” he said. Similarly, EVALI is an acute or subacute respiratory illness that is rare but can be fatal.
But that’s not what keeps Dr. Galiatsatos up at night. Other chemicals like formaldehyde, volatile organic compounds (VOCs), and other toxins known to irritate and inflame lung tissue cause far broader threats. “These aren’t chemicals that belong in your lungs,” says Dr. Galiatsatos. “Vaping is essentially a slow form of chemical exposure. It’s death by a thousand cuts.”
Slow, but Permanent Damage
Vaping, like smoking, rarely kills quickly, which is why Dr. Galiatsatos is particularly concerned for the next generation. “I try to make it clear to my younger patients that these things are not good for your lungs and though you may not see the consequences now, you are setting yourself up for a lifelong addition to something that if you continue to use it, at some point they will give you a disease.”
Though we may not see the exact impact immediately, one thing is obvious — the nicotine addiction these product cause. “These are very strong products for addiction,” he warns. “And youth are at the most susceptible age for being conditioned into needing them.” He believes stronger public policies are needed to protect young people from what he calls a “new generation of nicotine addiction.” Without intervention, he fears the U.S. could see history repeat itself: “We lost generations of Americans to tobacco. Now we’re watching it happen again with vaping.”
At the end of the day, Dr. Galiatsatos says, vaping represents an unsettling déjà vu. “The vaping community is very organized,” he says. “They love that we perseverate on things that rarely happen because they think we’re fear-mongering. But that’s exactly what tobacco companies did in the 1920s—they blamed cars for lung cancer.”
His ultimate message is clear: vaping is not harmless, and we need to save another generation from disease and addiction.
Learn more about How to talk to Teens about Vaping.
Blog last updated: December 3, 2025
