Early Pulmonary Changes in Adolescents Associated with Cigarette and Vape Use: A Pilot Study Using Impulse Oscillometry

Prolonged tobacco smoking is associated with severe illnesses, whereas the health effects of newer nicotine delivery systems, such as fourth-generation disposable vapes and oral nicotine pouches, remain insufficiently understood despite their rising popularity among adolescents. Marketed as less harmful alternatives, these products feature high nicotine uptake via nicotine salts and diverse flavors, potentially serving as gateway products. This pilot study pursued two aims: to examine whether subtle pulmonary or vascular changes can already be detected after relatively short consumption periods in adolescents, and to identify early physiological markers of harm. Prevention lectures were delivered at two schools in Lübeck and one nearby, targeting grades 7–12. Lung function was assessed with impulse oscillometry (Tremoflo C-100, Thorasys), vascular function via pulse wave analysis. Students also completed anonymous questionnaires on nicotine and cannabis use, parental smoking, and well-being. Although the initial sample was small (n=32), measurable physiological changes were observed. Regular cigarette smokers showed significant increases in small airway stiffness and resistance (X5, AX, Fres), indicating reduced elasticity and impaired function. Similar but weaker trends appeared among regular vape users, not reaching pathological levels. These results support the hypothesis that even limited exposure to combustion smoking may trigger early alterations in lung physiology, while the long-term consequences of vaping remain uncertain. This pilot study demonstrates the feasibility of school-based impulse oscillometry for larger research settings and highlights its sensitivity in detecting subtle early changes in adolescent lung function. Findings underscore the urgent need for larger longitudinal studies to evaluate the impact of cigarettes, vapes, and other nicotine delivery systems on adolescent pulmonary and cardiovascular health. Publication History Article published online: 04 March 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany