E-Cigarettes & Vaping: What Pakistani Parents and Young Adults Need to Know
Vaping has spread rapidly among Pakistani teenagers and young adults, marketed as a safer alternative to smoking. A pulmonologist separates the genuine harm-reduction evidence from the marketing claims, explains what vaping actually does to developing lungs, and addresses the questions every parent and young vaper needs answered honestly.
A mother brought her seventeen-year-old son to my clinic recently — not for a chest infection, not for asthma, but because she had found a small device charging on his desk and did not know what it was. He explained, somewhat reluctantly, that it was a vape — and that "everyone" at his school used them, that it was "basically just flavoured water vapour," and that it was "much safer than cigarettes." He was repeating, almost word for word, the marketing claims of an industry that has very effectively reached Pakistani teenagers over the past several years.
I want to address vaping honestly in this article — not with reflexive alarm, and not with the dismissive reassurance that vaping marketing promotes, but with the actual evidence as it currently stands. The truth is more nuanced than either extreme: vaping is genuinely less harmful than smoking combustible cigarettes for an adult smoker trying to quit. It is also genuinely harmful — to the developing lungs of adolescents, to non-smokers who take it up recreationally, and in ways that are still being discovered as the long-term evidence accumulates. Both facts are true simultaneously, and a responsible conversation about vaping has to hold both of them.
This article is for parents who have found a device in their child's room, for young people who have started vaping and want honest information, and for adult smokers considering whether vaping is the right tool to help them quit.
What Is in an E-Cigarette?
Understanding vaping requires understanding what is actually being inhaled — because the "it's just water vapour" claim that has shaped public perception is not accurate.
The Device and the Heating Mechanism
An e-cigarette (vape) heats a liquid — called e-liquid or vape juice — using a battery-powered coil, converting it into an aerosol that is inhaled. This is fundamentally different from combustion (burning), which is what occurs in a traditional cigarette. The absence of combustion means e-cigarettes do not produce the tar and carbon monoxide that are among the most damaging components of cigarette smoke — this is the basis of the harm-reduction argument. However, "no combustion" does not mean "no harm." The heating process itself generates chemical byproducts, and the inhaled aerosol contains substances that have their own, distinct respiratory effects.
Nicotine
Most e-liquids contain nicotine — often in very high concentrations, particularly in the disposable pod-style devices that have become popular among young people. Nicotine salt formulations, developed specifically to allow higher nicotine concentrations to be inhaled smoothly without the harshness of freebase nicotine, mean that many modern vape devices deliver nicotine doses comparable to or exceeding traditional cigarettes — while feeling less harsh and therefore easier for a non-smoker, including an adolescent, to use comfortably. Nicotine is highly addictive at any age, but adolescent brains are particularly vulnerable to nicotine addiction — the developing prefrontal cortex is more readily rewired by nicotine exposure, producing stronger and more persistent addiction patterns than nicotine exposure in adulthood.
Propylene Glycol and Vegetable Glycerine
These are the carrier liquids that make up the bulk of most e-liquids, vaporised to deliver the nicotine and flavouring. Both are generally recognised as safe for ingestion (oral consumption) — but their safety profile when heated and inhaled repeatedly into the lungs over months and years has not been established with the same certainty. Inhaling heated propylene glycol and glycerine causes airway irritation, and the long-term respiratory consequences of years of daily inhalation are genuinely not yet known — vaping as a mass consumer product is simply too recent for that evidence to exist.
Flavouring Chemicals
The flavouring chemicals used in e-liquids — often designed to taste like fruit, candy, mint, or dessert flavours that are particularly appealing to younger users — include compounds whose safety for inhalation (as opposed to ingestion) has not been adequately studied. Diacetyl, a flavouring chemical historically used to produce buttery flavours, is associated with bronchiolitis obliterans — a severe, irreversible lung disease nicknamed "popcorn lung" after it was identified in workers in microwave popcorn factories exposed to diacetyl vapour. While many vaping product manufacturers have removed diacetyl from their formulations following this discovery, testing of vaping products has continued to identify it and related compounds in some products, particularly those from unregulated or counterfeit sources.
Heavy Metals and Other Contaminants
The heating coil in e-cigarette devices is typically made from metal alloys containing nickel, chromium, lead, and other metals. Studies analysing e-cigarette aerosol have detected trace amounts of these heavy metals, believed to leach from the heating coil into the aerosol — particularly with device age, higher power settings, and lower-quality manufacturing. The health significance of chronic low-level heavy metal inhalation from vaping is an area of active ongoing research.
What Vaping Does to the Lungs
Regular vapers show measurable increases in airway inflammatory markers and report higher rates of cough, throat irritation, and chest tightness compared to non-vapers. The heated propylene glycol and glycerine, combined with flavouring chemicals, irritate the airway lining with repeated daily exposure.
Adolescents and adults with asthma who vape have demonstrably worse asthma control, more frequent exacerbations, and increased reliance on reliever medication compared to those who do not vape. This is a particularly important risk given how many young vapers have undiagnosed or poorly controlled underlying asthma.
A severe, acute inflammatory lung condition that emerged as a recognised syndrome in 2019, causing breathlessness, chest pain, cough, fever, and in severe cases respiratory failure requiring intensive care. Most cases have been linked to vaping products containing vitamin E acetate, an additive used particularly in illicit THC-containing vape products, though cases have also occurred with nicotine-only products. EVALI demonstrated unambiguously that "just vapour" is a dangerous oversimplification.
Laboratory studies show that e-cigarette aerosol exposure impairs the function of airway immune cells, reducing their ability to clear bacteria and respond to viral infections. This may explain emerging epidemiological associations between vaping and increased susceptibility to respiratory infections, though this research area continues to develop.
High-nicotine vape products produce rapid, strong addiction — particularly in adolescents, whose developing brains are more vulnerable to nicotine's addictive effects. Many young people who started vaping believing it was a low-risk experiment find themselves with a genuine, difficult-to-break nicotine addiction within weeks to months of regular use.
A substantial and growing body of evidence shows that adolescents who vape are significantly more likely to subsequently take up combustible cigarette smoking than those who never vaped — undermining the claim that vaping primarily functions as a smoking cessation tool when examined at the population level, particularly among young people who were never smokers to begin with.
I want to be precise about this, because precision matters in a topic this polarised: for a 50-year-old who has smoked two packs a day for thirty years and switches completely to vaping, the harm reduction is real and clinically meaningful. For a 15-year-old who has never smoked and starts vaping because the flavours are appealing and the marketing suggests it is harmless, there is no harm reduction at all — there is simply harm, plus a new nicotine addiction, plus an increased likelihood of taking up cigarettes later. The same product can be a genuinely useful medical tool and a genuinely dangerous consumer product, depending entirely on who is using it and why.
— Dr. Nabila Zaheer, Pulmonologist
Why Vaping Has Spread So Rapidly Among Pakistani Youth
Understanding why vaping has taken hold among young people in Pakistan — despite limited domestic marketing compared to Western markets — helps parents and educators address the issue more effectively than generic warnings alone.
Flavour variety designed for youth appeal — mango, cotton candy, mint, bubblegum, and dessert flavours — makes the products palatable and even enjoyable to first-time users in a way that the harshness of a first cigarette typically is not, lowering the barrier to initial experimentation. Social media marketing and influencer culture have normalised vaping imagery extensively, often presenting it as a lifestyle accessory rather than a nicotine delivery product, reaching Pakistani youth through international platforms regardless of local regulatory restrictions. Discreet device design — many devices resemble USB drives, pens, or other innocuous objects and produce minimal lingering odour compared to cigarettes — makes vaping easier to conceal from parents and teachers than smoking. Peer normalisation within schools and universities, where vaping has in some settings become a common social activity, creates strong social pressure for adolescents to participate. And the perception of reduced harm — actively promoted by vaping marketing and only partially corrected by public health messaging — leads many young people to underestimate the genuine risks involved.
For Parents — Recognising the Signs and Having the Conversation
Signs Your Teenager May Be Vaping
- Unfamiliar devices — small, often colourful or discreet devices resembling USB drives, pens, or small cylindrical objects, sometimes with a charging port. Disposable vapes are typically small plastic devices, often brightly coloured.
- Sweet or fruity smells on clothing, in their room, or on their breath — without an obvious food source. This is one of the most reliable indicators, as vape aerosol carries a distinctive flavoured scent quite different from the smell of cigarette smoke.
- Increased thirst and nosebleeds — propylene glycol is hygroscopic (draws moisture) and can cause dry mouth, increased thirst, and nasal dryness with regular vaping.
- Unexplained coughing, particularly a new dry cough or throat clearing that was not previously present.
- Increased irritability or mood changes — particularly noticeable as periods of restlessness or irritability that improve after time alone (suggesting nicotine withdrawal followed by a vaping episode).
- Unexplained spending or unusual online purchase history, as vaping products and accessories represent an ongoing recurring expense.
- Academic or behavioural changes — nicotine dependence can affect concentration, sleep, and mood in ways that may manifest as declining school performance.
If you find a vaping device or suspect your teenager is vaping, the most effective response is a calm, informed conversation rather than punitive confrontation alone. Adolescents who feel they can discuss the topic honestly with a parent — rather than facing only punishment — are more likely to disclose accurately and engage with cessation support. Approach the conversation with curiosity about why they started (peer pressure, stress, curiosity, perceived safety) rather than immediate anger, share the genuine evidence about respiratory and addiction risks rather than exaggerated claims that teenagers can easily dismiss as scare tactics, and involve a healthcare professional if nicotine dependence has developed — adolescent nicotine addiction is a genuine medical issue that benefits from appropriate clinical support rather than willpower alone.
Vaping for Smoking Cessation — The Genuine Harm-Reduction Case
Having addressed the risks clearly, it is equally important to address the legitimate harm-reduction role that vaping can play for adult smokers. This nuance matters because an oversimplified "vaping is dangerous, full stop" message can inadvertently discourage smokers from using a tool that, used correctly, substantially reduces their health risk compared to continued smoking.
For an adult smoker who has been unable to quit using nicotine replacement therapy, varenicline, or bupropion — or who has tried and relapsed multiple times — complete switching to vaping eliminates exposure to tar, carbon monoxide, and the majority of carcinogens present in cigarette smoke. Public health bodies in several countries have endorsed vaping as a harm-reduction tool specifically for this population, with evidence suggesting meaningfully reduced risk of smoking-related disease compared to continued combustible cigarette use.
However, this harm-reduction case comes with important caveats that are frequently omitted from vaping marketing. The switch must be complete — continuing to smoke cigarettes alongside vaping (dual use), which is extremely common, provides little to no harm reduction and may simply add vaping's risks on top of continued smoking risks. The goal should ultimately be complete nicotine cessation, not indefinite vaping, since the long-term respiratory effects of years of vaping use are not yet established with certainty. And vaping should never be recommended to someone who was not already a regular smoker — the harm-reduction argument applies specifically to substituting a less harmful product for a more harmful one in an existing smoker, not to introducing nicotine to a new user.
When a long-term heavy smoker asks me whether vaping could help them quit, my honest answer is: it could be part of the plan, used correctly, as a complete substitute rather than alongside continued smoking, ideally with a goal of eventually stopping nicotine altogether. When a teenager who has never smoked asks me whether vaping is safe, my honest answer is completely different: no — there is no version of that conversation where the answer is yes. The same substance, the same device, two entirely different clinical conversations depending on who is asking.
— Dr. Nabila Zaheer, Pulmonologist
Recognising EVALI — When Vaping Becomes a Medical Emergency
Vaping-associated lung injury (EVALI) is a serious acute condition that any vaper, parent, or clinician should be able to recognise. While most cases globally have been linked to illicit THC-containing vape products adulterated with vitamin E acetate, cases have also occurred with nicotine-only products, and the condition should be considered in any vaper presenting with significant respiratory symptoms.
Symptoms typically develop over days to weeks and include progressive breathlessness, chest pain, persistent cough, fever, and frequently gastrointestinal symptoms including nausea, vomiting, diarrhoea, and abdominal pain — a combination of respiratory and gastrointestinal symptoms that can initially be confused with a viral illness. Any vaper presenting with significant breathlessness or chest symptoms should disclose their vaping history clearly to their treating physician, as this history is essential for prompt diagnosis. EVALI is treated with supportive care including oxygen and, in significant cases, corticosteroids, with most patients recovering over weeks, though severe cases have required intensive care and a small number of cases globally have been fatal.
Frequently Asked Questions
Is vaping really 95 percent safer than smoking, as I have heard?
This figure originates from a UK Public Health England assessment and applies specifically to the comparative harm of vaping versus smoking for an existing adult smoker who switches completely. It does not mean vaping is 95 percent safe in absolute terms — it means it carries substantially less harm than continuing to smoke combustible cigarettes, which are exceptionally harmful. The figure has also been the subject of ongoing scientific debate regarding its methodology and applicability, particularly as longer-term vaping data has accumulated since the original assessment. For a non-smoker, particularly an adolescent, this comparative statistic is not relevant at all — the correct comparison for a non-smoker is vaping versus not using any nicotine product, not vaping versus smoking, and on that comparison, vaping carries clear and unambiguous net harm.
My teenager says vaping has no nicotine, just flavouring. Could that be true?
It is possible but should not be assumed — and independent testing of vaping products has repeatedly found discrepancies between labelled and actual nicotine content, particularly in unregulated products common in markets without strict enforcement, including much of Pakistan's vaping market. Nicotine-free vape liquids do exist and are marketed specifically as such, but many products labelled as low-nicotine or nicotine-free have been found on laboratory analysis to contain meaningful nicotine concentrations. Additionally, even nicotine-free vaping carries respiratory risks from the heated carrier liquids and flavouring chemicals discussed in this article — "no nicotine" does not mean "no harm." If nicotine dependence symptoms are present (irritability, strong cravings, difficulty stopping use) despite a "nicotine-free" claim, this should be taken seriously rather than dismissed based on product labelling alone.
Can vaping cause the same lung cancer risk as smoking?
Based on current evidence, vaping appears to carry substantially lower carcinogenic risk than combustible cigarette smoking, primarily because it does not produce the tar and the majority of the combustion-generated carcinogens present in cigarette smoke. However, "substantially lower" is not the same as "no risk" — some carcinogenic compounds have been detected in e-cigarette aerosol, including certain aldehydes generated during the heating process, and the carcinogenic risk of long-term vaping use cannot be definitively established yet because vaping as a mass consumer product has not existed long enough for the multi-decade latency period typical of smoking-related cancers to have elapsed in the vaping population. This uncertainty itself is an important piece of information — current vapers, particularly those who started young, are participating in what is effectively a large, unplanned, multi-decade natural experiment whose full results will not be known for years.
Is it safer to vape than to smoke shisha?
Based on current evidence, vaping is likely less harmful than shisha — shisha smoking, as discussed in our dedicated smoking article, exposes users to combustion-generated tar, carbon monoxide, and carcinogens comparable to or exceeding many cigarettes in a single session, while vaping avoids combustion entirely. However, this comparison should not be misread as endorsing vaping as a safe alternative — both products carry genuine respiratory risks, and the appropriate response to "is X safer than Y" when both X and Y are harmful is not to choose the lesser harm but to avoid both. This is particularly true for non-smokers and non-users of either product who might otherwise interpret a relative safety comparison as permission to start.
My child has been vaping for about a year. Should we see a doctor even if they have no symptoms?
Yes — a consultation is worthwhile even in the absence of obvious symptoms. A pulmonology assessment can establish a baseline of lung function through spirometry, which provides both a useful clinical baseline and, often, a powerful motivational tool — seeing objective evidence of their own lung function can be more persuasive to a teenager than parental concern alone. The consultation also provides an opportunity to assess and address nicotine dependence, which is a genuine medical condition deserving of proper clinical support rather than willpower alone, and to have an honest, judgment-free conversation about the risks directly from a specialist rather than only from a parent, which adolescents sometimes receive more openly. Early intervention — addressing vaping use before years of continued exposure accumulate — gives the best chance of preventing any lasting respiratory consequence and breaking the nicotine dependence before it becomes more deeply entrenched.
Honest Information Protects Young Lungs Better Than Fear Does.
Whether you are a parent concerned about your teenager's vaping, a young adult who wants honest answers about the risks, or an adult smoker considering vaping as a quitting tool — Dr. Nabila Zaheer at PulmoCare provides clear, evidence-based guidance tailored to your specific situation. Book a consultation today.
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