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Vaping and subsequent comorbidities potentially associated with increased mortality and more severe illness in COVID-19: a narrative review

  • Kyle Blalock1
  • Frank Breve1
  • Giustino Varrassi2
  • Peter Magnusson3
  • Joseph Pergolizzi4

1School of Pharmacy, Temple University, Philadelphia, PA 19140 USA

2Paolo Procacci Foundation, 00193 Roma, Italy

3Centre for Research and Development, Region Gävleborg/Uppsala University, 803 20 Gävle, Sweden

4Clinical Research, Department of Analgesic Development, NEMA Research Inc., Naples, FL 34102, USA

DOI: 10.22514/sv.2021.113

Submitted: 30 April 2021 Accepted: 27 May 2021

Online publish date: 24 June 2021

*Corresponding Author(s): Kyle Blalock E-mail:


Introduction: COVID-19 (or COVID) is a highly virulent viral disease which more frequently presents severe infection in specific populations, such as the elderly, patients with hypertension, patients with respiratory disease, and patients who smoke. The effects vaping (i.e., an electronic cigarette or JUUL device) has on COVID progression remains unclear, because there is an information paucity correlating e-cigarette use and COVID. This review sought to identify links between vape use and COVID severity via literature review. Additionally, because there is more widespread information about cigarette smoking than about vaping, this review sought to illustrate commonalities between smoking and vaping. If smoking and vaping are deemed near-identical practices, then it is possible the effects of smoking on human health and on COVID disease could be comparable in vaping.

Methods: Several searches were performed on PubMed with MeSH headings and JSTOR between 17 December 2020 and 22 December 2020. Search results were excluded if they were not trials or controlled clinical trials, if the articles were not about COVID, if the articles were about smoking behaviors or habits, or if the articles were not related to vaping or smoking. Key findings were summarized and tabled based on relevance, substantiability, and applicability to COVID.

Results: Multiple sources viewed smoking and vaping as equal risk factors for COVID disease, whereas other sources viewed the two as unique risk factors. Because of this controversy, it is challenging to view the two practices as similar enough to pose equivalent risks for COVID. Both practices pose significant health risks to its users, but these health risks are unique to each practice.

Discussion: There are several limitations which exacerbate ambiguity—(1) it is unclear how harmful smoking is for COVID patients, because several publications found smoking may have protective effects; (2) few older patients vape, but yet most severe COVID cases occur in older populations; (3) older patients and impoverished patients show a statistically significant risk for severe COVID disease independent of other factors; (4) vaping is a relatively new practice, and there are few patients who self-report long-term e-cigarette use or long-term adverse effects as a result thereof.

Conclusion: Although vaping may present serious health risks, clinically, it is uncertain how significantly vaping affects COVID disease, especially when compared against cigarette smoking. More research is needed on both the effects of vaping on COVID and the likeness of vaping versus smoking.


COVID; Vaping; Vaping and COVID; Vaping and smoking; COVID mortality; COVID hospitalizations; EVALI; Nicotine exposure; Angiotensin converting enzyme-2

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Kyle Blalock,Frank Breve,Giustino Varrassi,Peter Magnusson,Joseph Pergolizzi. Vaping and subsequent comorbidities potentially associated with increased mortality and more severe illness in COVID-19: a narrative review. Signa Vitae. 2021.doi:10.22514/sv.2021.113.


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