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Hammond and colleagues found increased rates of e-cigarette use among adolescents in Canada, the US, and the UK (from 2017 to 2018) but increased rates of combustible cigarette smoking only among Canadian adolescents, which, as per the authors conclusions, suggests that e-cigarette use may not be causally related to increased smoking uptake.[3] E-cigarettes may indeed be a gateway to combustible cigarette smoking, and this is a valid concern, but there is not yet enough evidence to state a conclusive causal association

Hot smoke can irritate the lungs leading to coughing, so the stronger the perc the gentler the experience