Validated by: Dr Riju Thomas, pulmonologist at Life Wilgeheuwel Hospital

Where there is smoke, there is fire – and it seems where there is vapour, there may be dangers too. Over a decade ago, vaping gained popularity in South African markets as a safer alternative to traditional cigarettes, whose dangers have been widely documented.

However, science has shown that the reality of vaping in comparison to smoking is much more nuanced than the marketing suggests. While vaping is touted as exposing users to fewer toxic by-products, the truth is that it contains different, not necessarily fewer, toxins and many vaping products still contain nicotine. Nicotine is highly addictive and affects multiple systems in the body, including the brain, cardiovascular system and developing adolescent brain.

"Nicotine affects the brain's reward system, which is one of the reasons it can be so addictive. In young people, whose brains are still developing, regular nicotine exposure may affect areas involved in attention, learning and impulse control. The earlier nicotine use starts, the greater the risk of developing long-term dependence, says Dr Riju Thomas, pulmonologist at Life Wilgeheuwel Hospital.

Understanding the real risks of both cigarette smoking and vaping can help you make a more informed decision.

What’s inside a cigarette or vape?  

Every cigarette box is mandated to state clearly the dangers of habitual smoking. While the “smoking can be harmful” warning remains true, it barely scratches the surface of what happens in your body every time you inhale cigarette smoke into your lungs.

In addition to tobacco, one cigarette contains over 600 ingredients and releases over 7 000 toxic chemicals and more than 60 known carcinogens when burned. Studies have placed cigarette smoking as one of the leading causes of lung cancer, chronic obstructive pulmonary disease (COPD), heart disease and stroke.

Vapes or e-cigarettes work differently. Where cigarettes burn tobacco to produce smoke, vaping devices heat an e-liquid producing vapour (also called an aerosol) that is inhaled. This liquid may contain nicotine, flavourings and toxic additives. It is important to note that the exact contents can vary between vaping products and manufacturers.

A common misconception about vaping

One of the most common misconceptions is that vaping is harmless because it does not involve smoking. While vaping does not produce many of the toxic by-products created when tobacco burns, this does not mean it is risk free. Vaping aerosols may still contain nicotine, flavouring chemicals, fine particles and other substances that enter the lungs when inhaled.

"Although vaping does not produce cigarette smoke, the aerosol can still irritate the airways. For people with asthma or other respiratory conditions, this irritation may worsen symptoms and, in some cases, increase the likelihood of flare-ups or breathing difficulties," explains Dr Thomas.

How vaping may affect the body

Research into vaping is ongoing, but current evidence shows that vaping may affect more than the lungs.

Certain vaping products have been linked to serious lung injury, including e-cigarette or vaping use-associated lung injury (EVALI) and “popcorn lung”. These are both lung conditions associated with vaping, but they affect different parts of the lungs and develop in different ways.

EVALI, often confused with “popcorn lung”, can cause widespread inflammation in the lungs. “When the lungs become inflamed, the airways can become swollen and produce more mucus, making it harder for air to move in and out of the lungs,” explains Dr Thomas.

This inflammation of the lungs may lead to symptoms such as coughing, wheezing, chest tightness and shortness of breath.

“EVALI can develop suddenly or over a short period of time and cause serious symptoms that may require urgent medical attention. ‘Popcorn lung’ is a chronic condition – it develops over time and can lead to ongoing damage and scarring of the small airways in the lungs, which may cause long-term breathing difficulties,” he says.

While both conditions have different causes and affect the lungs in different ways, both highlight the potential risks associated with inhaling vape aerosol products.

Beyond the lungs, effects of vaping can include high blood pressure and increased risk of heart disease. Moreover, the chemicals in the e-liquid come into contact with different parts of the body. Concerns about its effect on oral health are increasing and some of the chemicals used have been linked to an increased risk of gum disease.

If you are pregnant, trying to conceive or breastfeeding, it is safer to avoid both smoking and vaping. Nicotine and other substances inhaled through smoking or vaping may affect fertility, pregnancy and a baby’s development. If you need help to quit, speak to your doctor about safe support options.

When it comes to pregnancy and fertility, there is no evidence that vaping is a risk-free alternative to smoking. “Both vaping and smoking can expose the body to substances that may affect fertility and pregnancy outcomes, which is why healthcare professionals generally recommend avoiding both during this time,” says Dr Thomas.

Can vaping help you quit smoking? 

For some smokers, vaping has been used as a cessation method to wean themselves off cigarettes.

However, quitting smoking is rarely only about nicotine. Habits, routines, social influences and behavioural cues all contribute to tobacco dependence. While some people successfully transition away from cigarettes using vaping products, others maintain nicotine dependence through vaping or continue using both products simultaneously. This practice, known as dual use, may increase overall exposure to harmful substances and reduce the likelihood of successfully quitting nicotine altogether.

This dependency is particularly concerning among young people, with a recent study of 25 000 high schoolers in South Africa showing that 61% of vape users have grown dependent and would not go a day without vaping. Unfortunately, access to these devices remains highly unregulated in South Africa. “The bigger concern is that vaping is increasingly becoming a gateway to developing the habit of cigarette smoking or smoking other substances,” says Dr Thomas.

Partaking in both smoking and vaping significantly increases the risk of severe lung and heart-related illnesses. This is considered more harmful than either habit alone, exposing the body to more toxins and defeating the purpose of quitting smoking if that was the goal.

"Many people assume that vaping while continuing to smoke will reduce their health risks, but this is not necessarily the case. Using both products together can increase overall exposure to harmful substances and may make it harder to break nicotine dependence completely," adds Dr Thomas.

Organisations like the World Health Organization (WHO) have stated that while vaping has contributed to a reduction in tobacco use, it is not completely risk-free and should not be marketed as such.

Neither smoking nor vaping is without risk, but understanding the impact of each on the body is the first step towards making an informed choice for your health. While quitting smoking and vaping may be difficult, there are many quitting benefits to consider – and your quality of life could improve as soon as you make the choice.

Speak to your GP if you have concerns about your respiratory health and the habits that may be affecting it. They can help you understand your options, assess health risks and provide support on your journey towards quitting. Find a pulmonologist or respiratory health specialist near you.