Electronic Cigarettes: A Catalyst for Viral and Bacterial Pneumonia in Hospitalized Patients

Sunday, March 22, 2026

2:45 PM - 3:45 PM Central Time

Location: Connections Central Theater 1

Faiq Aldarabah, N/A

Disclosure(s): No relevant financial relationship(s) to disclose.
JM

Juan Martinez Ortega, n/a

Resident Physician MD
Lincoln Hospital, New York

Disclosure information not submitted.
MO

Maria Ortega Abad, N/A

MD
Cleveland Clinic

Disclosure information not submitted.
DA

Dania Abu Zahra, n/a

MBBS
Lincoln Medical Center

Disclosure information not submitted.
EA

Esra'A Alshdifat, N/A

Fellow Physician MD
Lincoln Medical and Mental Health Center/NYCHHC

Disclosure information not submitted.
RA

Reyad Al Jabiri, N/A

Resident Physician MD
Lincoln Medical and Mental Health Center/NYCHHC

Disclosure information not submitted.
NC

Nail Cemalovic, N/A

Attending Physician MD
Montefiore Medical Center

Disclosure information not submitted.

Introduction: Over the past decade, electronic cigarette use has been linked to worsening asthma and COPD, with growing evidence of effects on infectious respiratory diseases. E-cigarette vapor impairs viral clearance in influenza, increases pneumococcal adherence to airway epithelium, and enhances virulence of pathogens such as Haemophilus, Staphylococcus, and Pseudomonas, highlighting the urgent need for further research into these infectious risks.

Methods: We conducted a retrospective analysis using data from the 2020–2022 National Inpatient Sample (NIS) database. Patients with viral and bacterial pneumonia and concurrent e-cigarette use were identified via validated ICD-10 codes. Multivariate logistic regression adjusted for confounders including sex, age, race, cigarette smoking, obesity, and comorbidity burden (Charlson and Elixhauser Indices). Statistical analyses were performed using STATA 18.

Results: A total of 319,100 patients were admitted with a primary diagnosis of pneumonia, of whom 0.87% (n = 2,792) had concurrent e-cigarette use. The mean age was 68 years in both groups, and females accounted for 48.4% of the e-cigarette user group. Patients who used e-cigarettes had significantly worse in-hospital outcomes, including higher mortality (OR: 3.12; 95% CI: 2.39–4.09; p < 0.001), increased use of high-flow nasal cannula (OR: 3.12; 95% CI: 2.05–4.75; p < 0.001), non-invasive mechanical ventilation (OR: 1.32; 95% CI: 1.02–1.71; p = 0.035), invasive mechanical ventilation (OR: 2.63; 95% CI: 2.03–3.41; p < 0.001), and extracorporeal membrane oxygenation (OR: 3.50; 95% CI: 2.45–5.01; p < 0.001). Additionally, this group had longer hospital stays (mean: 9.10 vs. 4.92 days; 95% CI: 3.98–4.38; p < 0.001) and higher hospitalization costs (mean: $87,713 vs. $49,648; p < 0.001).

Conclusions: E-cigarette use is associated with more severe outcomes in patients hospitalized with pneumonia, including increased mortality, greater need for respiratory support, prolonged hospital stays, and higher healthcare costs. It should be recognized as a potential risk factor in the clinical management of pneumonia, highlighting the need for further research into its underlying mechanisms, harmful effects, and targeted prevention strategies.