From Aerosol to Epithelium: An Integrated Clinical, Pathologic, and Mechanistic Review of Nicotine and Cannabis Vaporizer Use and Pulmonary Disease.

Nicoli C.; Chittathoor A.; Sharma S. · Current allergy and asthma reports · 2026

**Background & Methods** This is a comprehensive literature review integrating clinical, pathologic, and molecular evidence on the respiratory effects of nicotine and cannabis vaporizer use. The authors synthesized epidemiologic associations, histopathologic findings, and mechanistic data from existing research to characterize pulmonary disease outcomes across both substance categories. **Key Findings** • **Nicotine vaporizer use** demonstrates consistent epidemiologic associations with obstructive airway disease, bronchitis, emphysema, and constrictive bronchiolitis. At the molecular level, nicotinic receptor activation drives collagen deposition, epithelial barrier dysfunction, and impaired mucociliary clearance—mechanisms contributing to chronic structural lung injury. • **Cannabis vaporizer use** is more frequently associated with acute lung injury syndromes and acute airway disease symptoms. Cannabinoid receptor activation affects airway inflammation, epithelial integrity, and immune cell function through distinct pathways from nicotine. • **Shared mechanistic pathways** include oxidative stress and mitochondrial dysfunction as receptor-independent mechanisms affecting both nicotine and cannabis vaporizer users, suggesting convergent pathways despite different primary receptor targets. **Dosage & Administration** Not reported. This review does not specify particular doses, frequency, or administration protocols for either nicotine or cannabis vaporizers. **Safety & Adverse Effects** Nicotine vaporizers: obstructive lung disease, bronchitis, emphysema, constrictive bronchiolitis, epithelial barrier dysfunction, and impaired mucociliary clearance. Cannabis vaporizers: acute lung injury syndromes, airway disease symptoms, and airway inflammation. Both substances: oxidative stress and mitochondrial dysfunction. **Evidence Quality** This review is limited by its synthesis of existing literature rather than primary data collection, reflecting the current state of knowledge with acknowledged significant gaps. The authors identify that molecular investigations of cannabis vaporizer use remain incomplete and dual nicotine-cannabis use is understudied. Evidence quality varies across cited studies, and mechanistic data are more established for nicotine than cannabis. The review emphasizes the need for integrated investigations combining molecular mechanisms with clinical and histopathologic outcomes to better characterize these emerging public health risks. Future prospective studies and mechanistic research are necessary to establish causality and clarify dose-response relationships.

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