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This review examines the disruption of microbial ecosystems by smoking, with a focus on the imbalance between beneficial and pathogenic microorganisms

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of note, the proportion of non-smokers who started using electronic smoking devices was rather low.7 Recent data from the Behavioural Risk Factor Surveillance System (BRFSS) suggest that the use of electronic cigarettes is increasing among never-smokers, to nearly 2 million US adults in 2016.8 The mean prevalence of never-smokers who smoked electronic cigarettes at least once ranges from 0.1 to 3.8%.7,9,10 Those electronic cigarette users who have never smoked conventional cigarettes are defined as sole electronic cigarettearette users in the literature