What Clinicians and Researchers Should Know About E-Cigarette Use and Asthma: A New Review

Investigators from the Celedón Laboratory for Pediatric Asthma Research in the Division of Pediatric Pulmonary Medicine at UPMC Children's Hospital of Pittsburgh, in collaboration with colleagues at the University of California at San Diego (UCSD) and the University of North Carolina (UNC) at Chapel Hill, published a comprehensive review in the Journal of Allergy and Clinical Immunology examining current evidence on electronic cigarette use and asthma across the lifespan.

The review synthesizes experimental, epidemiologic, and clinical studies to help clinicians and researchers better understand what is currently known, where evidence is strongest, and which questions remain unanswered. Kimberly Pereira, MD, former Division fellow, was the study’s first author.

Review Details and High Level Learnings for Clinicians

The review was done in response to the accumulating experimental and epidemiologic research suggesting that vaping may adversely affect respiratory health, while recognizing that much of the available evidence remains fragmented and, in many cases, methodologically limited. Looking at studies published through the end of 2025, the Celedón Lab team evaluated what is currently known about e-cigarette devices and their constituents, patterns of use among children and adults, potential biologic mechanisms linking vaping to asthma, and findings from experimental models and human studies.

While the existing evidence generally supports an association between e-cigarette use and worse asthma symptoms or asthma control, particularly among adolescents and adults, relatively few prospective studies have been conducted so far, and many published studies rely on vaping histories and self-reported asthma, without including objective measures of lung function or airway inflammation.

The review also discusses emerging mechanistic evidence suggesting that e-cigarette exposure may contribute to asthma through various pathways, including altered lung development, airway inflammation, oxidative stress, epigenetic changes, and others.

The review highlights several important priorities for future research, including large prospective studies, improved characterization of vaping exposure, objective measures of asthma phenotypes and endotypes, and randomized cessation trials in patients with asthma.

For practical clinical care considerations, the review recommends that clinicians routinely screen children, adolescents, and adults with asthma for e-cigarette use and counsel patients about the potential respiratory risks of vaping. For adults seeking to quit traditional cigarettes, they recommend evidence-based smoking cessation strategies rather than a switch to e-cigarettes. The Celedón Lab team also emphasizes in the review the importance of continued public health efforts aimed at preventing vaping among children and adolescents.

“Approximately 1 in 10 middle- and high-school students in the United States report vaping. This is a major public health problem, since vaping has been linked to lung injury and negative effects on respiratory health, as well as higher risk of use of tobacco products and marijuana,” says Juan C. Celedón, MD, DrPH, ATSF, Niels K. Jerne Professor of Pediatrics, and chief, Division of Pediatric Pulmonary Medicine. “While more research on e-cigarette use and asthma is needed, this should not preclude policies to prevent e-cigarette use in children and young adults, including regulatory actions against marketing and enforcing restricted access to e-cigarettes by minors, educational programs targeting parents of middle- and high-school children at risk, and enhanced efforts to develop vaping cessation strategies, especially for adolescents and young adults.”

Reference

Pereira K, Rosser F, Han Y-Y, Jasper I, Crotty Alexander LE, Celedón JC. Use of Electronic Cigarettes and Asthma Across the Lifespan. J Allergy Clin Immunol. 2026 Jul 29: S0091-6749(26)00525-7. Online ahead of print. Review.