E-cigarettes have different names, including electronic nicotine delivery systems (ENDS), electronic non-nicotine delivery system (ENNDS), alternative nicotine delivery systems (ANDS), e-cigs, vapes, e-hookahs, etc.
They are also known by their brand names.
They are available in many shapes and sizes, appearing like cigarettes, cigars, pipes, pens and USB drives, among others.
All e-cigarettes include a battery, an element that heats the e-liquid to convert it into an aerosol, a container of the e-liquid, and an opening for inhalation of the aerosol from the heated liquid into the lungs.
The marked increase in e-cigarette use among children and young people, with rates exceeding adult users in many countries, have raised alarms globally.
The young are targeted through social media and influencers, with at least 16,000 attractive flavours.
Some products use cartoons or designs that appeal to the younger generation, with some looking like toys or games.
Harmful contents
Most e-cigarettes contain nicotine – the same addictive chemical in cigarettes, cigars, hookah and other tobacco products – of varying levels.
Because of this, e-cigarettes are classified as “tobacco products” by regulators globally.
In addition, e-cigarettes may contain other chemicals like prophylene glycol and/or vegetable glycerin, which may cause lung irritation, allergies and cancer; and volatile organic chemicals (VOCs).
The latter can cause eye, nose and throat irritation; headaches; nausea; and damage to the liver, kidneys and nervous system. (Formaldehyde, a VOC, is known to cause cancer.)
Most e-cigarettes have flavouring chemicals, some of which are more harmful than others.
Some flavours contain the chemical diacetyl, which has been associated with a serious lung disease called bronchiolitis obliterans, also known as “popcorn lung”.
This association is why diacetyl is banned in e-liquids by many countries.
The more dangerous (and illegal) contents of e-cigarettes include fentanyl (used in anaesthesia) and/or xylazine (a horse sedative).
They are commonly termed “zombie drugs” as they can cause severe, often grotesque, effects often resembling that of a horror movie.
These drugs increase heart rate and cause hyperthermia (overheating), severe tissue damage, organ failure and extreme agitation, leading to long-term health problems.
They have been reported to be sold in Malaysia.
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Health risks
Although the long-term risks of vaping are yet to be fully elucidated as it has been in use for less than two decades, its health risks have raised alarms globally.
Some of the risks include:
Most e-cigarettes contain nicotine, which is very addictive.
Quitting e-cigarettes is as difficult as quitting other types of tobacco products.
Nicotine may harm brain development in children and teenagers who vape, which can lead to problems with thinking, focusing and behaviour control.
It is toxic to the developing brain and lungs of fetuses.
Vaping in pregnancy has been associated with low birth weight babies and pre-term birth.
Acute nicotine exposure can be toxic, with children and adults reported to have been poisoned by swallowing, breathing or absorbing vaping liquids via their skin or eyes.
The young who vape are more likely to smoke cigarettes in the future.
E-cigarettes produce dangerous chemicals, including acetaldehyde and formaldehyde.
These aldehydes can cause lung and heart diseases.
E-cigarettes also contain acrolein, a weedkiller.
It can cause acute lung injury and chronic obstructive pulmonary disease (COPD), and may increase the risk of worsening asthma, more frequent bronchitis and lung infections.
Current evidence suggests that vaping impacts negatively on heart health.
It increases blood pressure significantly and causes the heart rate to increase for about 45 minutes after vaping.
High blood pressure and a fast heart rate significantly increases the risk of cardiovascular disease and heart attack in the long term.
Vaping is also associated with arterial stiffness and damages the endothelial cells lining the blood vessels in those aged between 21 and 45 years.
Like cigarette smoking, vaping is linked to adverse effects on cholesterol levels.
In 2019, global reports of Evali emerged.
It is a serious acute or subacute respiratory illness that includes acute respiratory distress syndrome (ARDS), hypersensitivity pneumonitis and bronchiolitis obliterans.
Vapers who have features that include cough, breathing difficulties, chest pain, nausea, vomiting, diarrhoea, fatigue, fever and weight loss, are advised to seek immediate medical attention as many with Evali require admission to an intensive care unit (ICU) and some may die.
Parliament was informed last August (2025) that there were 44 cases of severe lung disease, with five deaths linked to vaping, between 2019 and June 2025.
Vaping is in a similar situation cigarettes were in before long-term population data – which took about a century to emerge – confirmed definitively that cigarette smoking caused lung cancer.
A review of the literature on e-cigarettes by Australian researchers, published March 30 (2026) in the medical journal Carcinogenesis, concluded that: “Nicotine-based e-cigarettes are likely to be carcinogenic to humans who use them, causing an indeterminate burden of oral cancer and lung cancer.”
Secondhand vape aerosol contains nicotine, ultra-fine particles and known carcinogens.
Studies have shown that those exposed to secondhand vape aerosol, including non-smokers, can absorb nicotine at the same levels as those exposed to secondhand cigarette smoke, thereby exposing them to the same health risks.
There have been reports of seizures after vaping, with most cases occurring in young people.
These seizures are thought to be due to nicotine.
There are also reports of an association with damage to teeth and other oral tissues, including cavities and irritation of the gums and other mouth membranes.
How serious are we?
According to the 2023 National Health and Morbidity Survey (NHMS), the frequency of cigarette smoking among those aged 15 years and above decreased from 21.3% in 2019 to 19% in 2023, but vapers increased from 4.9% to 5% in the same time.
Vaping in adolescents (13-17 years) increased from 9.8% in 2017 to 14.9% in 2022.
The frequency in 2022 was 23.5% in males and 6.2% in females; and 16.9% in Malays, 10.7% in Indians, 5.2% in Chinese and 20.2% in others.
The then Health Minister removed nicotine from the Poisons List on March 31, 2023, thereby legalising e-cigarettes and vapes with nicotine.
There were no other regulations in place as the Control of Tobacco Products Regulations 2004, under the Food Act 1983, only covered conventional cigarettes and other tobacco products.
This was rapidly followed by the DKECE: International E-Cigarettes Exhibitions Vape Show on May 13, 2023, in Kuala Lumpur that saw the participation of many in the vaping industry.
The High Court recently ruled that the delisting of nicotine was illegal, and that the then Health Minister had failed to act in accordance with Malaysia’s international commitments under the United Nations Convention on the Rights of the Child and the World Health Organization Framework Convention on Tobacco Control to prevent and reduce nicotine addiction.
The court also ruled that she had breached her duty to protect public health, and had put economic benefits before the public’s health.
The health and economic losses, both direct and indirect, of the then Health Minister’s delisting of nicotine have yet to be quantified.
Notwithstanding the High Court ruling, the fact is that the vaping industry had a field day for about 18 months without any regulations, before the Control of Smoking Products for Public Health Act (852) came into effect on Oct 1, 2024.
There has been waxing and waning about the implementation date of a vaping ban under Act 852.
The prevarication is telling despite the alarm bells of the health risks of vaping ringing incessantly.
As the world commemorates World No Tobacco Day on May 31 with the theme “Unmask the Appeal – Countering Tobacco and Nicotine Addiction”, there are legitimate questions for Malay-sian policymakers:
- Is there a political will to protect the population, particularly the young, from the serious health risks of vaping?
- Have commercial interests a priority over health?
- Will there be another nicotine policy failure?
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
