Recently, a college student reported at the emergency of PGIMER Chandigarh with persistent coughing, acute breathlessness and chest tightness. Initially mistaken for severe asthma, scans later revealed damage to the small airways of his lungs — a condition doctors warned resembled “popcorn lung”, where such airways are inflamed and scarred, making it difficult for oxygen to move in and out. This is a rare disease linked to chemicals used in flavoured vape liquids, the kind used for butter flavouring in popcorn factories, except at much higher levels.
Cases like these are raising alarm as vaping gains popularity among Indian teenagers and young adults drawn to sweet flavours, sleek devices and social media trends. “Vaping is no longer just a trend but a challenge that families, schools and governments can no longer ignore,” says Dr Sonu Goel, professor, Department of Community Medicine and School of Public Health, PGIMER Chandigarh. As Lead, WHO Collaborative Centre for Research & Training in Tobacco Control, and Convenor, Scientific Support Group, MoHFW, she told The Indian Express, “Research has shown that some toxic metals in vape aerosols may be present at dramatically higher levels than in conventional cigarette smoke.”
Vapes, also called electronic cigarettes, are battery-operated devices that heat a liquid into an aerosol inhaled by users. “These liquids usually contain nicotine, flavouring chemicals, propylene glycol and glycerine. While they do not burn tobacco like traditional cigarettes, they still expose users to addictive and harmful substances,” Dr Goel says. Excerpts:
Why are vapes becoming increasingly popular among teenagers?
According to the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC), vaping is becoming popular among teenagers due to attractive flavours like candy, mint and fruit, along with colourful packaging, sleek designs, influencer marketing and widespread promotion on social media platforms. These products are often portrayed as less harmful than cigarettes, increasing curiosity and experimentation among young people.
Is vaping really just harmless water vapour?
No. E-cigarettes produce an aerosol that can contain nicotine, toxic chemicals, ultrafine particles, heavy metals and cancer-causing substances that are inhaled deep into the lungs.
Research has shown that some toxic metals in vape aerosols may be present at dramatically higher levels than in conventional cigarette smoke. One study reported lead concentrations in certain e-cigarette aerosols at around 407 µg/L, compared with 0.126–1.252 µg/L in cigarette smoke, meaning lead levels in some vape aerosols were reported to be up to 300 times higher than cigarette smoke samples tested under standard conditions.
The same study also found zinc concentrations of around 36 µg/L in vape aerosols, compared with 1.252 µg/L in cigarette smoke, making zinc levels nearly 30 times higher in some vape aerosol samples.Researchers have additionally detected harmful chemicals such as formaldehyde, acetaldehyde, acrolein, nickel and chromium in vape aerosols. While vaping is often marketed as a safer alternative to smoking, it is far from harmless, especially for adolescents and non-smokers.
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What health problems are associated with vaping?
A major umbrella review conducted by our team, which was published in BMJ Open in 2025, found that vaping is linked to serious health risks affecting the lungs, heart and mental health.
The study found that people who vape had a 30 per cent higher risk of asthma and a 49 per cent higher risk of respiratory diseases. Current vape users had up to 52 per cent higher risk of stroke compared to non-users. The review also found evidence of increased blood pressure, faster heart rate, reduced lung function, and higher rates of depression and suicidal thoughts among adolescents who use e-cigarettes.
What is EVALI, and why did it become a major concern globally?
EVALI stands for “E-cigarette or Vaping Product Use-Associated Lung Injury.” It became a major global public health concern after thousands of people, especially young adults, developed severe lung damage linked to vaping.
Symptoms included coughing, chest pain, shortness of breath, fever, nausea and, in some cases, respiratory failure requiring intensive care. Chemicals in vape liquids and aerosols, including vitamin E acetate in some products, played a major role in these injuries.
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What is “popcorn lung,” and how is it linked to vaping?
“Popcorn lung” is the common name for bronchiolitis obliterans, a rare and serious lung disease that damages the small airways in the lungs, causing coughing, wheezing, chest pain and breathing difficulties. The condition has been linked to exposure to diacetyl, a chemical used in some flavoured vape liquids to create buttery or sweet flavours.
Flavoured vapes may be particularly concerning because users tend to vape more intensely due to the appealing taste and smoother inhalation experience. According to WHO, flavours are among the strongest drivers behind the growing popularity of vaping among children and adolescents.
Researchers warn that with more than 16,000 flavours available globally — including mango, bubble gum, cotton candy, mint, cola and dessert-inspired options — vaping products are often engineered to mask the harshness of nicotine and encourage experimentation among first-time users.
Can vaping affect mental health?
Our review found that adolescents who vape had about a 37 per cent higher likelihood of depression and around a 23 per cent higher likelihood of suicidal thoughts and behaviours compared to non-users. The review also highlighted links between vaping, anxiety symptoms, emotional distress and sleep problems among young people.
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How can parents and teachers detect that a child has started vaping?
Unlike traditional cigarettes, modern vaping devices are intentionally designed to blend into everyday life. Modern vape devices are often small, sleek and easy to conceal, making them difficult for parents and teachers to detect. Some devices resemble USB flash drives, pens, highlighters, smartwatches or cosmetic products, while many produce less visible aerosol and reduced odour compared to traditional cigarettes.
Parents and teachers should pay attention to unfamiliar electronic devices and watch for warning signs such as fruity smells on clothing, coughing, throat irritation, dry mouth, increased thirst, unusual secrecy, irritability, headaches, declining concentration, mood swings and behavioural changes. Some adolescents may also display nicotine withdrawal symptoms, including anxiety, restlessness and difficulty concentrating.
Can second-hand vape aerosols affect other people nearby?
Vape aerosols can remain suspended in indoor air and may be inhaled by children, pregnant women and non-users nearby, exposing them to nicotine and other harmful chemicals even if they do not vape themselves.
