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What the Cotinine test is great for, is confirming any nicotine use in the previous 5 days, so when a person claims to have not smoked, vaped, or used replacement products, then a negative cotinine test proves this

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Respiratory Effects of Cigarette Smoke Airway and Lung Damage Repeated exposure leads to: Chronic irritation of the throat and bronchial tubes Scarring and narrowing of airways Reduced ability to clear mucus and pathogens Over time, this damage can develop into chronic obstructive pulmonary disease (COPD) , including: Chronic bronchitis (persistent cough with mucus) Emphysema (difficulty exhaling due to damaged air sacs) These conditions significantly reduce oxygen delivery to the bloodstream and heart

Some e-liquids contain additional flavorings or additives that might further irritate vascular linings, exacerbating the problem beyond just nicotine exposure

Being very careful when priming your coil can help