Considering e-cigarettes (ENDS) to quit smoking? This evidence-based article explains what a Cochrane living systematic review and a major randomized clinical trial suggest about smoking cessation outcomes and reported adverse events. It also summarizes key points from a National Academies consensus report and an American Heart Association scientific statement on cardiopulmonary effects and evidence gaps, plus cohort research on ENDS use and asthma timing. You’ll learn who should be especially cautious (including teens and non-smokers), when to seek urgent in-person care, and how to prepare for an online consultation. Finally, you can book an online cardiologist on Doctors365 to personalize your quit plan and address symptoms like palpitations or blood pressure concerns.

Medical Disclaimer (Please Read First)

This article is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. If you have chest pain, severe shortness of breath, fainting, signs of stroke, or a severe allergic reaction, seek emergency care immediately.

Author: Dr. Diellza Rabushaj
Medically reviewed by: Dr. Spec Orhan Karahodza

1. What people really mean when they ask “Is vaping better than smoking?”

Most people aren’t looking for a debate—they’re looking for a safer way out. The real clinical question is usually:

“Does vaping help adults quit cigarettes—and what does it mean for the heart and lungs?” [1–4]

1.1 The goal is quitting cigarettes (not swapping one habit forever)

From a health perspective, the biggest win is stopping combustible cigarettes. Cigarette smoke contains thousands of chemicals and many toxins formed during combustion; switching away from combustion can reduce exposure to some harmful substances, but that doesn’t automatically make vaping harmless. [3,4]

1.2 Key terms: ENDS, vaping, nicotine dependence

• ENDS = electronic nicotine-delivery systems (often called e-cigarettes or vapes) [1–4]
• Nicotine dependence = the brain learns to expect nicotine; stopping can trigger cravings and withdrawal, which is why quitting is hard [3,4]

2. What the strongest evidence says about vaping for quitting smoking

When clinicians talk about “strong evidence,” they usually mean:

• Systematic reviews that combine many studies (especially randomized trials)
• Randomized clinical trials (RCTs) that test an approach under controlled conditions

2.1 Cochrane living systematic review: quit success and adverse events

The Cochrane living review on e-cigarettes for smoking cessation is one of the most influential summaries because it is updated as new trials appear. It evaluates:

• Whether nicotine e-cigarettes help adults stop smoking
• What adverse events occur during use in studies
• What remains uncertain (especially long-term health outcomes) [1]

A reader-friendly way to think of it:

Cochrane asks two questions at once:
“Does it help people quit?” and “What harms were seen while people used it in trials?” [1]

2.2 Randomized clinical trial: ENDS added to counseling

A recent RCT in The New England Journal of Medicine tested ENDS added to counseling—which reflects real clinical practice because counseling/support is a core part of quitting strategies. RCTs like this help answer a practical question:

“If you already have behavioral support, does adding ENDS improve quitting outcomes?” [2]

2.3 Practical takeaway: who might benefit (and why some don’t)

Across evidence summaries and expert statements, ENDS appear most relevant for:

• Adults who currently smoke cigarettes
• People who have struggled to quit using other methods
• People who can follow a plan that avoids dual use (smoking + vaping) [1,3,4]

3. Side effects and adverse events

3.1 Common short-term side effects reported in studies

Studies and expert reviews commonly describe short-term symptoms such as:

• throat or mouth irritation
• cough
• nausea
  These can vary by product, nicotine content, and usage patterns. [1,4]

3.2 Serious adverse events: what trials can and can’t detect

Trials and systematic reviews track serious adverse events, but there’s an important limitation:

• RCTs may be too short (months to a year) to detect long-latency diseases (like some cardiovascular or pulmonary outcomes) [1,3,4]

So the most academically correct way to say it is:

• Short-term safety signals can be measured reasonably well in trials
• Long-term population-level risk requires longer follow-up and broader evidence [3,4]

3.3 “Less harmful than cigarettes” is not the same as “safe”

The National Academies report stresses that the strength of evidence differs by outcome, and many long-term endpoints still require further research. [3]
Translation: vaping may be less harmful than smoking, but it is not risk-free—and the certainty of evidence depends on what health outcome you’re asking about. [3,4]

4. Heart and lung health: what cardiology experts emphasize

4.1 Nicotine’s effects on heart rate and blood pressure

Nicotine can affect the cardiovascular system (including changes in autonomic activity that may influence heart rate and blood pressure). If someone already has hypertension, palpitations, or arrhythmias, that matters clinically. [4]

4.2 Vaping aerosols and the cardiopulmonary system

The American Heart Association scientific statement reviews mechanisms and clinical evidence related to cardiopulmonary effects of e-cigarettes and vaping products—while also emphasizing variability in products and exposures. [4]

4.3 Evidence gaps and why they matter for long-term risk

Cardiology experts highlight ongoing uncertainties, especially:

• long-term cardiovascular outcomes
• the impact of dual use
• differences between devices/liquids and evolving products [4]

If you’re trying to quit smoking and you notice new chest discomfort, worsening shortness of breath, racing heart, or blood pressure spikes, it’s worth discussing with a clinician—especially if you have underlying heart disease. [4]

5. Asthma and vaping: what large cohort research suggests

5.1 ENDS use and asthma timing

A large cohort study published in JAMA Network Open examined ENDS use in relation to age of asthma onset, adding to evidence about respiratory risks and timing. [5]

5.2 Understanding association vs causation

Cohort data can show that two things are linked, but it cannot fully prove that one caused the other. Researchers adjust for known confounders, but interpretation still requires caution—especially when smoking history overlaps with vaping. [5]

6. Who should be especially cautious

6.1 Teens and non-smokers

For people who do not smoke, the health rationale for starting ENDS is weak, and nicotine dependence is a real risk. Evidence discussions strongly emphasize avoiding uptake among youth and non-smokers. [3,4]

6.2 Pregnancy and people with heart/lung disease

If you are pregnant or have significant heart/lung disease, you should talk with a clinician about the safest quitting strategy for you. Nicotine and cardiopulmonary effects are part of that risk conversation. [3,4]

6.3 Dual use (smoking + vaping): why it’s a common trap

One of the biggest real-world problems is dual use—keeping cigarettes while also vaping. That can reduce the benefit you’re trying to achieve (eliminating smoke exposure). Expert statements frequently flag dual use as a key concern. [4]

7. Online vs in-person care

7.1 What’s appropriate for an online consultation

Online care can be a great fit for:

• planning a quit strategy with attention to heart symptoms
• reviewing blood pressure readings and palpitations
• discussing risk factors (family history, cholesterol, diabetes, asthma history) [4,5]

7.2 Red flags that need urgent in-person assessment

Seek urgent care if you have:

• severe or new chest pain/pressure
• fainting or near-fainting
• severe shortness of breath at rest
• signs of stroke (face droop, weakness, speech difficulty)

8. How Doctors365 works

8.1 Browse → choose a time → confirm & pay → secure visit → summary/prescriptions

Doctors365 is designed to be simple:

1. Browse specialists
2. Pick a time
3. Confirm & pay
4. Join a secure visit
5. Receive a visit summary and, when appropriate, prescriptions/documentation

Learn more here: https://doctors365.org/how-it-works/

9. Why patients choose Doctors365

9.1 24/7 access, privacy, convenience, reduced time costs

People choose online specialist visits because they can:

• access care without commuting
• speak privately from home
• fit appointments around school/work/travel

10. Quality and trust on Doctors365

10.1 Choosing verified specialists

Doctors365 profiles help you evaluate training and experience before booking.

10.2 Secure communication and documentation

After a secure visit, you typically receive written guidance that’s easier to follow than trying to remember everything from a rushed appointment.

11. Doctors365 cardiologists who can support quitting and heart-risk concerns

If quitting nicotine (or considering ENDS) raises heart questions—palpitations, chest tightness, blood pressure concerns—these cardiologists are available on Doctors365:

11.1 5 cardiologists to consider

• Dr Andreas Mussigbrodt MD (Cardiology) — rhythmology/invasive electrophysiology and complex arrhythmia management (per profile)
• Dr Walid Shibl Ibrahim (Cardiology) — cardiovascular diagnostics/echocardiography focus (per profile)
• Dr Petar Pekic (Internal Medicine + Cardiology subspecialty) — arrhythmias and cardiac device follow-up interests (per profile)
• Dr Stojan Mitreski (Cardiology) — education/experience listed across multiple centers (per profile)
• Dr William Novick (Cardiology) — education/experience listed on profile

Browse and book a cardiologist here:

12. Pricing and availability

12.1 Where to see fees

Pricing can vary by clinician and appointment type. The clearest way is to open a doctor profile and review the booking details.

12.2 How to find the earliest slot

Start from the cardiology list and choose the first available time that suits you:

13. How to prepare for an online consultation

13.1 What to track

Before your visit, jot down:

• cigarette history (how long you’ve smoked, typical daily amount) [1–4]
• whether you’re currently vaping or using any nicotine products [1–4]
• symptoms: palpitations, chest tightness, shortness of breath, dizziness (when, triggers) [4]
• asthma/wheeze history, especially if symptoms are new or changing [5]

13.2 Questions to ask

Try these:

• “Based on my symptoms and history, what quit approach is safest?” [4]
• “How can I avoid dual use and make a clear plan to stop cigarettes completely?” [4]
• “What warning signs should make me stop and seek urgent assessment?” [4,5]

If you want expert input fast, book online:

14. FAQs

14.1 Do e-cigarettes help adults quit smoking?

Evidence from systematic reviews and randomized trials supports that nicotine e-cigarettes can help some adults quit smoking, though results vary and depend on support and usage patterns. [1,2]

14.2 What side effects are common when people use ENDS in studies?

Short-term symptoms like throat irritation, cough, and nausea are commonly described, with variation by product and use. [1,4]

14.3 Is vaping safe for the heart?

Cardiology experts emphasize potential cardiopulmonary effects and important evidence gaps—especially for long-term outcomes and dual use. [4]

14.4 Can vaping affect asthma?

Large cohort research has examined ENDS use and asthma timing; interpretation needs caution because observational studies cannot prove cause on their own. [5]

14.5 Should teens use vaping to quit smoking?

Evidence discussions emphasize preventing nicotine product uptake among youth and non-smokers due to dependence and health concerns. A clinician can help teens who already use nicotine choose the safest cessation support. [3,4]

15. Conclusion

If you smoke cigarettes and you’re trying to quit, the best evidence suggests nicotine e-cigarettes may help some adults stop smoking, and clinical trials continue to refine how well they work when paired with counseling. [1,2] At the same time, major scientific and cardiology reviews stress that “less harmful than cigarettes” is not “harmless,” and long-term cardiopulmonary risks and dual-use patterns remain key concerns. [3,4]

Next step: If you’re quitting and have heart-related symptoms (palpitations, chest tightness, blood pressure concerns), consider an online cardiology visit to personalize your plan:

References

1. Lindson N, et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews. Living systematic review (updated).
2. Auer R, et al. Electronic Nicotine-Delivery Systems for Smoking Cessation. N Engl J Med. 2024.
3. National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes. Washington (DC): National Academies Press; 2018.
4. Rose JJ, et al. Cardiopulmonary Impact of Electronic Cigarettes and Vaping Products. Circulation. 2023.
5. Pérez MF, et al. Electronic Nicotine Delivery Systems and Age of Asthma Onset. JAMA Network Open. 2024.

Written by Diellza Rabushaj, Medical Writer & Researcher.