E‐cigarettes, nicotine, the lung and the brain: multi‐level cascading pathophysiology

2020/06/09 by Melissa Herman, Melissa A. Herman, Robert Tarran · 86 citations
Biochemistry, Genetics and Molecular Biology · Medicine · Neuroscience · Psychology · #Acetylcholine receptor #Addiction #Biology #Context (archaeology) #Environmental health #Internal medicine #Medicine #Neuroscience #Neuroscience of respiration and sleep #Nicotine #Nicotinic Acetylcholine Receptors Study #Nicotinic agonist #Pharmacology #Psychology #Receptor #Smoking Behavior and Cessation #Tobacco smoke

paper · pdf · doi:10.1113/jp278388

published in The Journal of Physiology 598(22), 5063-5071 (Wiley)

openalex publication_date 2020/06/09 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/06

Abstract

Tobacco smoking is highly addictive and causes respiratory disease, cardiovascular disease and multiple types of cancer. Electronic-cigarettes (e-cigarettes) are non-combustible tobacco alternatives that aerosolize nicotine and flavouring agents in a propylene glycol-vegetable glycerine vehicle. They were originally envisaged as a tobacco cessation aid, but whether or not they help people to quit tobacco use is controversial. In this review, we have compared and contrasted what is known regarding the effects of nicotine on the lungs vs. the effects of nicotine in the brain in the context of addiction. Critically, both combustible tobacco products and e-cigarettes contain nicotine, a highly addictive, plant-derived alkaloid that binds to nicotinic acetylcholine receptors (nAChRs). Nicotine's reinforcing properties are primarily mediated by activation of the brain's mesolimbic reward circuitry and release of the neurotransmitter dopamine that contribute to the development of addiction. Moreover, nicotine addiction drives repeated intake that results in chronic pulmonary exposure to either tobacco smoke or e-cigarettes despite negative respiratory symptoms. Beyond the brain, nAChRs are also highly expressed in peripheral neurons, epithelia and immune cells, where their activation may cause harmful effects. Thus, nicotine, a key ingredient of both conventional and electronic cigarettes, produces neurological effects that drive addiction and may damage the lungs in the process, producing a complex, multilevel pathological state. We conclude that vaping needs to be studied by multi-disciplinary teams that include pulmonary and neurophysiologists as well as behaviourists and addiction specialists to fully understand their impact on human physiology.

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