Smoking remains one of the leading causes of preventable respiratory diseases and premature death. From a health perspective, smoking is not merely an individual habit, but also involves nicotine addiction, exposure of non-smokers to second-hand smoke, and long-term effects on the health and safety of future generations due to the promotion and variety of smoking products, including electronic cigarettes or vape devices. In Malaysia, the Global Adult Tobacco Survey Malaysia 2023 reported that 19.0% of adults, equivalent to approximately 4.8 million people, are still smokers. The prevalence of smoking among men is significantly higher at 35.7%, compared to only 1.5% among women. At the same time, the use of electronic cigarettes or vape products has increased to 5.8% of adults, equivalent to about 1.4 million people. Among younger age groups, particularly those aged 15 to 24 years, electronic cigarette use increased from 1.1% in 2011 to 8.6% in 2023. These figures indicate that tobacco control challenges now involve not only conventional cigarettes, but also nicotine products such as electronic cigarettes or vape devices that are increasingly attracting the younger generation. Cigarette smoke contains thousands of harmful chemicals, including tar, carbon monoxide, formaldehyde, benzene, nitrosamines, and fine particles. These substances can cause chronic inflammation of the respiratory tract, oxidative stress, DNA damage, blood vessel dysfunction, and deterioration of lung function. In the long term, continuous exposure increases the risk of chronic obstructive pulmonary disease, lung cancer, coronary heart disease, stroke, respiratory infections, and various other chronic illnesses. The dangers of smoking are not limited to smokers alone. Smoke exhaled by smokers can be inhaled by family members, co-workers, and the public. Children exposed to cigarette smoke are at higher risk of asthma, respiratory tract infections, chronic cough, and impaired lung function. Therefore, smoke-free environments at home, workplaces, educational institutions, and public areas are essential to protect the health of families and communities. The emergence of vape products has created new challenges. Vape devices are often marketed as modern products with various flavors and are promoted as being less harmful. However, vape aerosol is not simply water vapor. Heating vape liquids containing nicotine, flavoring agents, and solvents such as propylene glycol and vegetable glycerin can produce other harmful chemicals including formaldehyde, volatile organic compounds (VOC), heavy metals, and fine particles that may damage the lungs. Nicotine is a psychoactive substance with a high potential for addiction because it stimulates the release of dopamine in the brain’s reward system. Among adolescents, exposure to nicotine is particularly concerning because the brain is still developing, especially areas responsible for learning, attention, emotional control, decision-making, and impulse control. Early exposure to nicotine is also associated with a higher risk of nicotine dependence and a greater tendency toward the use of other addictive substances later in life. In addition to nicotine addiction, vaping has also been associated with acute lung injury known as EVALI or e-cigarette or vaping product use-associated lung injury. EVALI refers to lung injury caused by the use of electronic cigarette or vape products. Patients may experience shortness of breath, cough, chest pain, fever, vomiting, diarrhea, fatigue, and reduced oxygen levels. In severe cases, hospitalization, oxygen support, intensive care treatment, and respiratory assistance may be required. EVALI is clear evidence that the lungs are highly sensitive to heated and inhaled chemicals, and the situation becomes even more concerning when the actual contents of vape products are unclear, modified, or mixed with drugs or other harmful substances. Furthermore, electronic cigarettes or vape products should not be regarded as smoking cessation treatments. The use of vape products as a smoking cessation method requires further research, particularly regarding effectiveness, safety, and clinical monitoring. To date, electronic cigarettes and vape products do not meet the standards for smoking cessation therapy. In fact, vape use may cause individuals to remain dependent on nicotine. In many cases, users do not completely stop smoking, but instead use both cigarettes and vape products simultaneously, a practice known as dual use. As a result, nicotine addiction persists, and users continue to be exposed to harmful substances, making complete freedom from smoking even more difficult. Unlike vape products, smoking cessation methods supported by clinical evidence involve a combination of behavioral interventions and pharmacological treatment. The WHO 2024 guidelines list several effective treatment options, including varenicline, Nicotine Replacement Therapy (NRT), bupropion, and cytisine. These treatments help reduce withdrawal symptoms, control cravings, and improve the chances of long-term smoking cessation when combined with counseling and regular follow-up. Nicotine, whether from conventional cigarettes or electronic cigarettes and vape products, acts on the brain’s reward system by stimulating dopamine release. Dopamine is a brain chemical that creates feelings of pleasure and relief. Although this effect is temporary, repeated exposure causes the brain to become increasingly dependent on nicotine to achieve the same sensation. When nicotine intake is stopped, individuals may experience withdrawal symptoms such as restlessness, irritability, difficulty sleeping, poor concentration, headaches, increased appetite, and strong urges to smoke or vape. These symptoms are usually most intense during the early stages of quitting, but they can be managed through a structured quit plan, appropriate treatment, and support from healthcare professionals. Practical steps to quit smoking include setting a quit date, identifying smoking triggers, disposing of cigarettes and related items, seeking family support, attending counseling sessions, and obtaining professional healthcare advice regarding suitable treatments. Smoking triggers such as emotional stress, habits after meals, caffeine consumption, driving, or being in social environments that encourage smoking should be identified and managed systematically. These triggers can be replaced with healthier behavioral strategies such as taking short walks, drinking water, engaging in light physical activities, or practicing relaxation techniques to reduce the urge to smoke. From a prevention perspective, protecting adolescents and young adults must become a priority. The increasing use of electronic cigarettes and vape products among teenagers highlights the need for clearer, interactive, and evidence-based health education. Educational institutions, families, communities, and workplaces should foster smoke-free and vape-free cultures and environments, while ensuring easier, user-friendly, and continuous access to smoking cessation services. In conclusion, both smoking and vaping pose risks to lung health, heart health, and the overall body system. The most effective strategy is not to replace cigarettes with other nicotine products such as vape devices, but to overcome nicotine addiction through scientifically proven treatments, behavioral support, and supportive environments. The safest and most meaningful choice is to choose healthy lungs, clean air, and a life free from harmful smoke and vapor.

Prepared by: Dr. Tasnim Binti Abdul Aziz Department of Medicine Faculty of Medicine and Health Sciences / Hospital Sultan Abdul Aziz Shah

Date of Input: 28/05/2026 | Updated: 28/05/2026 | ahmadfaiq