Understanding e-cigarette adverse symptoms is essential for clinicians who guide patients through tobacco cessation. A recent secondary analysis of the ESTxENDS trial examined how these symptoms change over six months. Researchers followed 622 participants to determine the safety and tolerability of nicotine freebase e-cigarettes. Notably, the study focused on exclusive e-cigarette users to track specific health outcomes and their impact on long-term abstinence.

Managing E-cigarette Adverse Symptoms in Clinical Practice

The trial revealed that many users experience initial discomfort when switching from tobacco. After the first week, 34% of exclusive users reported dry mouth. Additionally, 23% noted mouth or throat irritation, while 25% experienced a cough. Consequently, these side effects represent common barriers during the early stages of smoking cessation. However, the data suggests that these issues generally resolve with continued use.

By the six-month mark, the proportion of reported symptoms decreased significantly. Dry mouth reports fell to 18%, and cough decreased to 12%. Furthermore, mouth and throat irritation affected only 11% of users. This trend suggests that the body adapts to the aerosolized nicotine or propylene glycol over time. Specifically, continuous use of the device helped resolve dry mouth in a significant number of participants.

Interestingly, the study identified a link between persistent symptoms and smoking re-initiation. Specifically, participants who struggled with mouth or throat irritation were more likely to return to tobacco cigarettes. Therefore, addressing these early side effects is crucial for long-term cessation success. Clinicians should monitor these symptoms closely to prevent patients from relapsing. Moreover, providing clear expectations about initial discomfort may improve patient adherence to cessation programs.

Frequently Asked Questions

What are the most common e-cigarette adverse symptoms?

During the first week of use, the most frequent reports include dry mouth, mouth or throat irritation, and coughing. These are often attributed to the propylene glycol and nicotine content in the e-liquid.

Do vaping-related side effects improve over time?

Yes, research shows that most symptoms decrease significantly over six months. For instance, the prevalence of cough and mouth irritation halved during the study period for exclusive users.

Can side effects cause people to start smoking tobacco again?

Notably, the trial found that mouth and throat irritation were primary drivers for smoking re-initiation. Patients experiencing these symptoms may require adjusted devices or e-liquids to remain smoke-free.

Disclaimer: This content is for informational and educational purposes only... Refer to the latest local and national guidelines for clinical practice.

References

1. Güttinger E et al. Adverse symptoms attributed to e-cigarettes over six months among participants of a randomized controlled trial testing nicotine freebase e-cigarettes for smoking cessation - Secondary analysis of the ESTxENDS trial. Nicotine Tob Res. 2026 Feb 20. doi: undefined. PMID: 41717789.


2. Polosa R et al. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health. 2011;11:786.


3. National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes. Washington, DC: The National Academies Press; 2018.