Volume 29, Issue 166, December 2025

Health Effects of E-Cigarettes and Other Alternative Nicotine Delivery Systems in Sport

Alicja Trybuła^1♦, Krzysztof Pawlikowski², Michał Korpalski³, Maria Pawluczyk⁴, Marek Żygłowicz⁵, Mateusz Marciniak⁶, Adam Torbicki⁷, Piotr Gaworek⁸, Dominik Augustyn⁹

¹Kazimierz Pułaski University of Technology and Humanities in Radom, Jacka Malczewskiego 29 Street, 26-600 Radom, Poland
²University Clinical Center of the Medical University of Warsaw, Banacha 1A Street, 02-097 Warsaw, Poland
³Dr. Tytus Chałubiński Radom Specialist Hospital, Adolfa Tochtermana 1 Street, 26- 610 Radom, Poland
⁴District Hospital in Sochaczew, Batalionów Chłopskich 3/7 Street, 96-500 Sochaczew, Poland
⁵Ludwik Rydygier Specialist Hospital, Złota Jesień 1 Street, 31-826 Kraków, Poland
⁶Mikołaj Kopernik Provincial Multi-Specialist Center of Oncology and Traumatology, Pabianicka 62, 93-513 Łódź, Poland
⁷Nicolaus Copernicus Hospital, COPERNICUS Medical Entity Ltd., Nowe Ogrody 1/6 Street, 80-803 Gdańsk, Poland
⁸Międzyleski Specialist Hospital in Warsaw, Bursztynowa 2 Street, 04-749 Warsaw, Poland
⁹Ludwik Rydygier Specialist Hospital, Złota Jesień 1 Street, 31-826 Kraków, Poland

^♦Corresponding author
Alicja Trybuła, Kazimierz Pułaski University of Technology and Humanities in Radom, Jacka Malczewskiego 29 Street, 26-600 Radom, Poland

ABSTRACT

In recent years, the popularity of alternative nicotine delivery systems (ANDS)— including electronic cigarettes, heated tobacco products (HTPs), nicotine pouches, snus, and nicotine gums—has rapidly increased, particularly among adolescents and young adults. This review summarizes current literature regarding the composition and toxicity of aerosols generated by e-cigarettes and other ANDS, emphasizing their cytotoxic, oxidative, and inflammatory effects. Researchers increasingly discuss the potential of these products to induce both acute conditions (e.g., EVALI) and chronic respiratory diseases (e.g., chronic obstructive pulmonary disease [COPD], asthma). The review places special focus on the toxicity of flavoring agents and the disproportionate risks faced by vulnerable populations, particularly youth. In Europe, approximately 12–15% of adolescents report regular e-cigarette use, with increasing consumption of other products such as snus and nicotine pouches. While ANDS may reduce certain risks compared to combustible cigarettes, accumulating evidence demonstrates that they are not harmless. Further longitudinal and comparative studies are necessary to comprehensively assess the health impacts of these diverse nicotine delivery products.

Keywords: e-cigarettes, respiratory system, oxidative stress, cytotoxicity, EVALI, adolescents, flavoring substances, alternative nicotine delivery systems, snus, nicotine pouches, athletes, sport performance, pulmonary function, physical activity, ENDS.

Medical Science, 2025, 29, e225ms3765

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Published: 16 December 2025