Vaping can cause a collapsed lung, and published case reports make this increasingly clear. The medical term is pneumothorax, where air leaks out of the lung into the space between the lung and chest wall, causing the lung to partially or fully deflate. A 2025 systematic review identified 16 patients across multiple case reports and case series who developed pneumothorax linked to e-cigarette use, and researchers have proposed recognizing it as a distinct clinical entity called vaping-associated spontaneous pneumothorax, or VASP.1PubMed Central. Vaping-Associated Pneumothorax: A Systematic Review of Case Reports and Case Series The numbers are still small, but the mechanisms behind it are becoming better understood, and the pattern is consistent enough that clinicians are paying attention.
Two Pathways to a Collapsed Lung
Researchers have identified two main ways vaping appears to cause a pneumothorax, and they probably work together rather than independently.
The first is straightforward physical stress on the lungs. When you draw on a vaping device, you inhale through a resistive mouthpiece. That resistance forces the chest muscles to generate stronger suction, creating larger-than-normal pressure swings inside the chest cavity. This is similar to what has been observed in marijuana smokers, where repeated forceful inhalation through a resistive device creates enough pressure difference to rupture small air sacs in the lung.2PubMed Central. Pneumothorax secondary to vaping Vapers tend to take deeper breaths, hold them longer, and exhale more slowly than cigarette smokers, which amplifies these pressure swings further.3PubMed Central. Vaping-related lung disease: a narrative review The result can be barotrauma, where tiny weak spots in lung tissue tear open under mechanical stress.
The second pathway is chemical damage. The nicotine and non-nicotine compounds in e-cigarette aerosol are associated with injury to the cells lining the airways and with ongoing inflammation.2PubMed Central. Pneumothorax secondary to vaping This chemical injury weakens the lung tissue over time, making it more vulnerable to rupture from everyday breathing or from the extra pressure of vaping. The two mechanisms feed each other: chemically weakened tissue is more likely to tear under physical stress, and the physical stress further damages tissue that is already inflamed. A narrative review published in 2025 described it as a compounding effect, where surfactant dysfunction and inflammation from inhaled toxins lower the threshold at which barotrauma occurs.3PubMed Central. Vaping-related lung disease: a narrative review
How Vaping Aerosols Damage Lung Tissue
Even without nicotine, the base liquids in e-cigarettes cause measurable harm to airway cells. Propylene glycol and vegetable glycerin, the two carrier solvents in virtually every e-liquid, trigger airway inflammation on their own. Lab studies have shown that exposing human bronchial cells to aerosols of these solvents for seven days significantly increases markers of inflammation and leads to excess mucus production, while simultaneously impairing the ion channels that keep mucus properly hydrated.4Scientific Reports. The combination of propylene glycol and vegetable glycerin e-cigarette aerosols induces airway inflammation and mucus hyperconcentration Thick, poorly hydrated mucus clogs the airways and creates additional resistance to airflow, which could worsen the pressure dynamics already described.
These same solvents also disrupt basic cellular energy production. Short exposures to propylene glycol and vegetable glycerin inhibit glucose uptake in airway cells and reduce the production of ATP, the molecule cells use for energy. The cells shrink, and the barrier between the airway surface and the bloodstream becomes more permeable, allowing substances that should stay out to pass through more easily.5PubMed Central. E-cigarette constituents propylene glycol and vegetable glycerin decrease glucose uptake and its metabolism in airway epithelial cells in vitro A leakier, energy-starved airway lining is less capable of repairing itself and more prone to structural failure.
Vegetable glycerin on its own is enough to cause problems. In a study that included both lab-grown cells and human volunteers who vaped VG-only e-liquids for one week, inflammatory markers were elevated across the board. Nasal samples from the volunteers showed increased levels of the same inflammation markers seen in the lab, along with elevated mucus protein levels.6Frontiers in Pharmacology. Vegetable glycerin e-cigarette aerosols cause airway inflammation and ion channel dysfunction
Flavorings add another layer. Even without nicotine, flavoring chemicals used in popular e-liquids are directly toxic to immune and lung cells and generate reactive oxygen species that damage tissue. Mixing multiple flavors together, as many users do, produces greater toxicity than any single flavor alone.7Frontiers in Physiology. Inflammatory and Oxidative Responses Induced by Exposure to Commonly Used e-Cigarette Flavoring Chemicals and Flavored e-Liquids without Nicotine Flavored pod aerosols have been shown to cause not only inflammation but also DNA damage in lung cells, with some flavors triggering especially high levels of damaging molecules inside cell mitochondria.8Scientific Reports. E-cigarette flavored pods induce inflammation, epithelial barrier dysfunction, and DNA damage in lung epithelial cells and monocytes
Who Is Most at Risk
Spontaneous pneumothorax, collapsed lung without an obvious external cause like a car accident or stab wound, has a well-known demographic profile even outside of vaping. It classically affects tall, thin males between about 10 and 30 years old. Cigarette smoking and cannabis use are established risk factors. Vaping overlaps with this demographic almost perfectly: e-cigarette use has grown most rapidly among adolescents and young adults, exactly the group already most prone to this condition.2PubMed Central. Pneumothorax secondary to vaping
That overlap makes it hard to separate how much of the risk comes from vaping itself versus from the baseline vulnerability of being young, tall, and thin. But published cases keep appearing, and the surgical findings are telling. In one case, a young adult who needed surgery after a collapsed lung that did not resolve with a chest drain was found to have multiple ruptured blebs, small bubble-like weak spots at the top of the lung, consistent with vaping-associated barotrauma.9British Journal of Surgery. 295 Vaping-Associated Primary Spontaneous Pneumothorax in a Young Adult: From Chest Drain to VATS Bullectomy These blebs are the structural weak points where air escapes when a lung collapses, and finding them in a young vaper with no other risk factors strengthens the connection.
Symptoms and What Happens at the Hospital
If you have a collapsed lung, you will almost certainly know something is wrong. The typical presentation is sudden, sharp chest pain on one side, often accompanied by shortness of breath. Some people describe a popping or tearing sensation. In published vaping-related cases, patients tend to arrive at the emergency room with exactly these symptoms, sometimes just minutes to hours after a vaping session.10PubMed Central. Recurrent spontaneous pneumothoraces and vaping in an 18-year-old man: a case report and review of the literature
Diagnosis is usually straightforward. A chest X-ray will show whether air has collected in the space around the lung. Small pneumothoraces, where only a small portion of the lung has deflated, can sometimes be managed with observation and supplemental oxygen while the body reabsorbs the leaked air. Larger ones, or ones that are not resolving, require a chest tube: a tube inserted between the ribs to drain the trapped air and allow the lung to re-expand. In published vaping-associated cases, both teenagers and young adults have initially been treated with chest tube placement.11Journal of Pediatric Surgery Case Reports. Vaping is a risk factor for spontaneous pneumothorax: Two cases
The Recurrence Problem
A collapsed lung coming back is a major concern in vaping-related cases. In a study comparing outcomes among vapers, cigarette smokers, and never-smokers who had a first spontaneous pneumothorax, vapers had roughly twice the odds of recurrence compared to people who had never smoked. They also had the shortest time between their initial hospital stay and a repeat episode: a median of just 10 days, compared to 20 days for cigarette smokers and 27 days for never-smokers.12PubMed. The Impact of Vaping on Primary Spontaneous Pneumothorax Outcomes
That 10-day median is striking. It means that for many vapers, the lung collapses again within about a week and a half of leaving the hospital. One published case report describes an 18-year-old man who presented with a right-sided pneumothorax, was treated, and returned with the same thing two weeks later. Both episodes followed vaping.10PubMed Central. Recurrent spontaneous pneumothoraces and vaping in an 18-year-old man: a case report and review of the literature In another report, two teenage boys aged 15 and 16 both had initial collapsed lungs treated with chest tubes, then both had recurrences that ultimately required surgery. Both have been recurrence-free since the surgical repair.11Journal of Pediatric Surgery Case Reports. Vaping is a risk factor for spontaneous pneumothorax: Two cases
The surgery typically involves removing the blebs or weak spots and roughening the surface of the lung so it adheres to the chest wall, making future collapse less likely. It is effective but involves general anesthesia and recovery time, and the fact that teenagers are ending up in operating rooms over an avoidable habit is a point that keeps coming up in the clinical literature.
Beyond Collapsed Lungs
A pneumothorax is not the only way trapped air causes problems in vapers. Pneumomediastinum, where air escapes into the central chest cavity around the heart rather than the space around the lung, is a recognized complication of vaping-associated lung injury. It can present with chest pain, a crackling sensation under the skin of the neck or chest, and sometimes difficulty swallowing. In one documented case, a patient with EVALI (e-cigarette or vaping product-associated lung injury) developed pneumomediastinum and was treated with antibiotics, steroids, and careful avoidance of anything that could raise chest pressure, like straining or coughing.13PubMed Central. Electronic Cigarette or Vaping-Associated Lung Injury Case Report
EVALI itself, the severe acute lung injury that made headlines in 2019, deserves a brief mention because it and pneumothorax share some of the same territory. EVALI typically presents with respiratory distress, fever, and characteristic patterns on chest imaging. In some patients, imaging shows the lung injury progressing to include a pneumothorax as a secondary complication.14Frontiers in Medicine. Review of quantitative and functional lung imaging evidence of vaping-related lung injury The 2019 outbreak was largely traced to vitamin E acetate used as a thickening agent in illicit THC cartridges, but the American Thoracic Society has emphasized that the broader risks of e-cigarette use extend beyond any single additive. Their 2021 workshop report called for a national case registry, better regulatory authority over nicotine e-cigarettes, and long-term clinical follow-up studies, noting that the research infrastructure to track these harms barely exists.15PubMed Central. The E-cigarette or Vaping Product Use-Associated Lung Injury Epidemic: Pathogenesis, Management, and Future Directions
How Device Settings Change the Equation
Not all vaping devices deliver the same amount of harmful chemicals, and the difference between settings can be enormous. Sub-ohm vaping, which uses low-resistance coils to produce bigger clouds and more vapor, dramatically increases the levels of toxic byproducts in the aerosol. In one study comparing low-resistance (0.15 ohm) and standard-resistance (1.5 ohm) atomizers at the same high voltage, the sub-ohm setup produced over 270 times more acetaldehyde, about 136 times more formaldehyde, and over 230 times more acrolein than the standard setup.16PubMed Central. Sub-ohm vaping increases the levels of carbonyls, is cytotoxic, and alters gene expression in human bronchial epithelial cells exposed at the air–liquid interface Acrolein and formaldehyde are potent irritants that damage airway tissue directly.
The implication is that someone chasing bigger clouds with a high-power sub-ohm device is exposing their lungs to orders of magnitude more harmful chemicals per puff than someone using a basic low-wattage device. This does not make low-power vaping safe, but it means the risk is not uniform across all vapers. Device choice, voltage settings, and coil resistance all matter, and the trend in the vaping community toward higher-power devices and cloud-chasing likely increases population-level lung injury risk.
What About Bystanders
Secondhand e-cigarette aerosol is not just water vapor, despite what some marketing suggests. An integrative review found that household exposure to secondhand vaping aerosol increased the risk of bronchitic symptoms in adolescents and was associated with nearly double the rate of uncontrolled asthma. Even in healthy non-smokers, a controlled 30-minute chamber exposure to secondhand aerosol caused significant throat irritation, increased airway resistance, and changes in exhaled markers of airway inflammation.17Journal of Advances in Health and Medical Sciences. Secondhand exposure to e‐cigarette aerosol and lung health outcomes For people with existing lung conditions like COPD, passive exposure for several hours was enough to elevate blood markers of inflammation and nudge lung function tests toward worse performance.
None of this means bystanders are at risk of a collapsed lung from secondhand aerosol, and no published case has suggested that. But it underscores that the aerosol itself is biologically active and irritating to airways, which is consistent with the tissue damage mechanisms that eventually lead to pneumothorax in direct users.
Why the Evidence Is Still Thin
If you are reading this and thinking the numbers sound small, you are right, and that is part of the story. The medical literature on vaping-associated pneumothorax still consists mostly of individual case reports and small case series. The largest systematic review on the topic, published in 2025, gathered just 16 patients total.1PubMed Central. Vaping-Associated Pneumothorax: A Systematic Review of Case Reports and Case Series That is not because the problem is necessarily rare. It is because pneumothorax in young people is relatively common from other causes, and unless a clinician specifically asks about vaping and documents it, the connection goes unrecorded. Researchers who proposed the VASP designation pointed out that, at the time of their publication, only seven cases existed in the entire literature, and they were adding four more from their own institution alone.18Respiratory Medicine Case Reports. Vaping associated spontaneous pneumothorax – A case series of an enigmatic entity!
The lack of large-scale studies does not mean the risk is negligible. It means the field is at an early stage where the signal is clear enough for researchers to take seriously but not yet quantified precisely enough to say exactly how much vaping raises your risk compared to not vaping. The lab evidence for tissue damage is robust and comes from multiple independent research groups. The clinical case reports are consistent in their demographics and surgical findings. What is missing is the large epidemiological study that could put a reliable number on the risk, and building that kind of study requires exactly the case registries and coding systems that the American Thoracic Society has called for.15PubMed Central. The E-cigarette or Vaping Product Use-Associated Lung Injury Epidemic: Pathogenesis, Management, and Future Directions