Anatomical Pathology Differences in Lung Alveoli Damage with Exposure to Conventional and Electric Cigarettes

Citra Paramita Esti Cahyaningrum, Desy Andari, Djoni Djunaedi


In conventional cigarettes, tobacco is a major risk factor in the development of diseases involving the lungs, including pulmonary emphysema, fibrosis and lung cancer. Many people think that using e-cigarettes is much safer than conventional cigarettes. Whereas smoking with electronic cigarettes can cause the same feeling of cotton mouth as felt by conventional smokers, with symptoms such as itchy throat, cough and complications to the lungs. This literature review conducted a literature search with the keywords cigarette, e-cigarette, popcorn lung, and alveoli. Conventional cigarettes and electronic cigarettes (e-cigarettes) cause damage to the pulmonary alveoli in the form of alveolar spaces; this depends on the nicotine content in them. Electronic cigarettes and conventional cigarettes exert different effects on the oxidative stress response of the airway epithelium. In addition, the image of popcorn lung can be found due to the presence of diacetyl that appears when heating e-juices in e-cigarettes.


alveoli, cigarette, e-cigarette, popcorn lung

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Tobacco Control Support Center-Ikatan Ahli Kesehatan Masyarakat Indonesia. Atlas tembakau Indonesia 2020. Soewarso K, Siregar H, Kusuma MAPN, Hikmah L, Fauzi R, Antojo A, editors. Jakarta: Tobacco Control Support Center-Ikatan Ahli Kesehatan Masyarakat Indonesia; 2020.

Tempesta E. Scratchy throat, increased blood pressure and inflamed lungs: Infographic shows how the after-effects from vaping an e-cigarette can be just as harmful as the real deal [Internet]. Daily Mail. 2015 [cited 2020 Sep 10]. Available from:

Raloff J, Mole B. Vaping may harm the lungs [Internet]. ScienceNewsExplores. 2015 [cited 2020 Sep 10]. Available from:

Sangani R, Rojas E, Forte M, Zulfikar R, Prince N, Tasoglou A, et al. Electronic cigarettes and vaping-associated lung injury (EVALI): A rural Appalachian experience. Hosp Pract (1995). 2021;49(2):79–87.

K A, A N. Oxidative stress, cell death, and other damage to alveolar epithelial cells induced by cigarette smoke. Tob Induc Dis. 2003;1(3):219–26.

Rowell TR, Reeber SL, Lee SL, Harris RA, Nethery RC, Herring AH, et al. Flavored e-cigarette liquids reduce proliferation and viability in the CALU3 airway epithelial cell line. Am J Physiol Lung Cell Mol Physiol. 2017;313(1):L52–66.

Andrault PM, Schamberger AC, Chazeirat T, Sizaret D, Renault J, Staab-Weijnitz CA, et al. Cigarette smoke induces overexpression of active human cathepsin S in lungs from current smokers with or without COPD. Am J Physiol Lung Cell Mol Physiol. 2019;317(5):L625–38.

Triantara YA, Almira I, Kusumo SA, Fajar M, Darmawan D, Winarni D. Perbandingan pengaruh asap rokok elektrik dan konvensional terhadap histopatologi paru tkus putih (Rattus norvegicus). J Respir Indo. 2019;39(2):88–91.

Reinikovaite V, Rodriguez IE, Karoor V, Rau A, Trinh BB, Deleyiannis FWB, et al. The effects of electronic cigarette vapour on the lung: direct comparison to tobacco smoke. Eur Respir J. 2018;51(4):1701661.

Taylor M, Carr T, Oke O, Jaunky T, Breheny D, Lowe F, et al. E-cigarette aerosols induce lower oxidative stress in vitro when compared to tobacco smoke. Toxicol Mech Methods. 2016;26(6):465–76.

Zhang Y, Huang W, Zheng Z, Wang W, Yuan Y, Hong Q, et al. Cigarette smoke-inactivated SIRT1 promotes autophagy-dependent senescence of alveolar epithelial type 2 cells to induce pulmonary fibrosis. Free Radic Biol Med. 2021;166:116–27.

Kosmider B, Lin CR, Karim L, Tomar D, Vlasenko L, Marchetti N, et al. Mitochondrial dysfunction in human primary alveolar type II cells in emphysema. EBioMedicine. 2019 Aug 1;46:305–16.

Fishbein MC. Smoker’s lung: Pathology photo essay [Internet]. MedicineNet. 2021 [cited 2021 Mar 12]. Available from:

Shields PG, Berman M, Brasky TM, Freudenheim JL, Mathe E, McElroy JP, et al. A review of pulmonary toxicity of electronic cigarettes in the context of smoking: A focus on inflammation. Cancer Epidemiol Biomarkers Prev. 2017;26(8):1175–91.

Hopkins RJ, Duan F, Chiles C, Greco EM, Gamble GD, Aberle D, et al. Reduced expiratory flow rate among heavy smokers increases lung cancer risk. Results from the National Lung Screening Trial-American college of radiology imaging network cohort. Ann Am Thorac Soc. 2017;14(3):392–402.

Lerner CA, Sundar IK, Yao H, Gerloff J, Ossip DJ, McIntosh S, et al. Vapors produced by electronic cigarettes and e-juices with flavorings induce toxicity, oxidative stress, and inflammatory response in lung epithelial cells and in mouse lung. PLoS One. 2015;10(2):e0116732.

Landman ST, Dhaliwal I, MacKenzie CA, Martinu T, Steele A, Bosma KJ. Life-threatening bronchiolitis related to electronic cigarette use in a Canadian youth. CMAJ. 2019;191(48):E1321–31.

Fonseca Fuentes X, Kashyap R, Hays JT, Chalmers S, Lama von Buchwald C, Gajic O, et al. VpALI-vaping-related acute lung injury: A new killer around the block. Mayo Clin Proc. 2019;94(12):2534–45.

Fedan JS, Dowdy JA, Fedan KB, Hubbs AF. Popcorn worker’s lung: In vitro exposure to diacetyl, an ingredient in microwave popcorn butter flavoring, increases reactivity to methacholine. Toxicol Appl Pharmacol. 2006;215(1):17–22.

Krishna R, Anjum F, Oliver TI. Bronchiolitis obliterans. StatPearls. StatPearls Publishing; 2022.

Rose CS. Early detection, clinical diagnosis, and management of lung disease from exposure to diacetyl. Toxicology. 2017;388:9–14.



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Jurnal Respirologi Indonesia
pISSN: 0853-7704 - eISSN: 2620-3162
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