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The tobacco can break apart

The majority of e-cigarette users in the US are white

Two examples are a nerve block that stops the phrenic nerve (the major nerve supply for the diaphragm) from sending signals so that the diaphragm stops contracting, and implantation of a pacemaker to make the diaphragm contract in a more rhythmic pattern

The mechanisms by which e-cigarettes cause these changes are not yet well understood, but they are likely related to the composition of the ingredients used in e-cigarette products and the harmful inhaled substances, such as carbonyls, volatile organic compounds, nicotine, trace metals, microbial toxins, and flavorings 33