E-Cigarette/Vape-Associated Lung Injury as a Cause of Interstitial Lung Disease

Sana Ullah; Muhammad Asif Khan Afrid

doi:10.70749/ijbr.v3i5.1448

Authors

Sana Ullah Department of Pulmonology, Hayatabad Medical Complex Peshawar, Pakistan
Muhammad Asif Khan Afrid Department of Pulmonology, Hayatabad Medical Complex Peshawar, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v3i5.1448

Keywords:

EVALI, Interstitial Lung Disease, Vaping, E-Cigarettes, Organizing Pneumonia, Diffuse Alveolar Damage, THC

Abstract

Background: The increasing prevalence of e-cigarette and vaping product use has introduced new pulmonary risks, including e-cigarette or vaping-associated lung injury (EVALI). Initially recognized as an acute lung injury, EVALI has raised concern due to emerging evidence of long-term respiratory complications, particularly interstitial lung disease (ILD). Despite various case reports, the exact relationship between vaping and ILD remains underexplored in clinical cohorts. Objective: To investigate the association between EVALI and the development of ILD, examining clinical features, radiological patterns, and histopathological findings among patients presenting with recent vaping exposure. Methods: This prospective observational study was conducted from 8 January to 8 April 2025 at Hayatabad Medical Complex Peshawar, Pakistan. Patients with respiratory symptoms and a history of vaping within the preceding 90 days were enrolled. Diagnostic assessments included high-resolution computed tomography (HRCT), pulmonary function tests (PFTs), and lung biopsies when indicated. Data were analyzed for demographic trends, vaping exposure characteristics, and lung injury patterns. Results: Of the 60 patients included, 45 (75%) showed HRCT findings suggestive of ILD, predominantly organizing pneumonia (OP) and diffuse alveolar damage (DAD). Histopathological analysis in 15 cases confirmed interstitial inflammation with early fibrotic changes. Most patients (80%) with ILD patterns reported the use of THC-containing vaping products. A statistically significant association (p<0.05) was found between THC exposure and ILD development. Conclusion: Our findings support a compelling link between vaping—particularly products containing THC—and the development of interstitial lung disease. Enhanced surveillance, public awareness, and stricter product regulation are crucial to mitigate these emerging pulmonary risks.

Downloads

Download data is not yet available.

References

Layden, J. E., Ghinai, I., Pray, I. W., et al. (2020). Pulmonary illness related to e-cigarette use in Illinois and Wisconsin — final report. New England Journal of Medicine, 382(10), 903–916.

https://doi.org/10.1056/nejmoa1911614

Ghosh, A., Coakley, R. D., Ghio, A. J., et al. (2018). Chronic e-cigarette exposure alters the human bronchial epithelial proteome. American Journal of Respiratory and Critical Care Medicine, 198(1), 67–76.

https://doi.org/10.1164/rccm.201710-2033oc

Gotts, J. E., Jordt, S. E., McConnell, R., et al. (2019). What are the respiratory effects of e-cigarettes? BMJ, 366, l5275.

https://doi.org/10.1136/bmj.l5275

Blagev, D. P., Harris, D., Dunn, A. C., et al. (2019). Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping. The Lancet, 394(10214), 2073–2083.

https://doi.org/10.1016/s0140-6736(19)32679-0

Triantafyllou, G. A., Tiberio, P. J., Zou, R. H., et al. (2019). Vaping-associated acute lung injury: A case series. American Journal of Respiratory and Critical Care Medicine, 200(11), 1430–1431.

https://doi.org/10.1164/rccm.201909-1809le

Henry, T. S., Kanne, J. P., & Kligerman, S. J. (2019). Imaging of vaping-associated lung disease. New England Journal of Medicine, 381(15), 1486–1487.

https://doi.org/10.1056/nejmc1911995

Travis, W. D., Costabel, U., Hansell, D. M., et al. (2013). An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. American Journal of Respiratory and Critical Care Medicine, 188(6), 733–748.

Mukhopadhyay, S., Mehrad, M., Dammert, P., et al. (2020). Lung biopsy findings in severe pulmonary illness associated with e-cigarette use. American Journal of Clinical Pathology, 153(1), 30–39.

https://doi.org/10.1093/ajcp/aqz182

Maddock, S. D., Cirulis, M. M., Callahan, S. J., et al. (2019). Pulmonary lipid-laden macrophages and vaping. New England Journal of Medicine, 381(15), 1488–1489.

https://doi.org/10.1056/nejmc1912038

Siegel, D. A., Jatlaoui, T. C., Koumans, E. H., et al. (2019). Interim guidance for healthcare providers evaluating patients with suspected EVALI. MMWR Morbidity and Mortality Weekly Report, 68(41), 919–927.

https://doi.org/10.15585/mmwr.mm6841a2

Butt, Y. M., Smith, M. L., Tazelaar, H. D., et al. (2019). Pathology of vaping-associated lung injury. New England Journal of Medicine, 381(18), 1780–1781.

https://doi.org/10.1056/nejmc1913069

Wang, Q., Sundar, I. K., Li, D., et al. (2020). E-cigarette-induced pulmonary inflammation and dysregulated repair are mediated by Nrf2 in mouse lungs. Redox Biology, 37, 101620.

https://doi.org/10.1186/s12931-020-01396-y

Kligerman, S., Raptis, C., Larsen, B. T., et al. (2020). Radiologic, pathologic, clinical, and physiologic findings of EVALI: Evolving knowledge and remaining questions. Radiology, 294(3), 491–505.

https://doi.org/10.1148/radiol.2020192585

Reddy, T. L., Tominaga, M., Hansell, D. M., et al. (2021). High-resolution CT in the diagnosis of diffuse lung disease. Radiologic Clinics of North America, 59(2), 301–317.

Miller, R., Breen, D., Cummings, K. J., et al. (2019). EVALI: Case series and diagnostic approach. The Lancet Respiratory Medicine, 7(12), 1017–1026.

Akpa, B. (2025). Management of severe SARS-CoV-2-associated organizing pneumonia with immunoglobulins. Cureus.

https://doi.org/10.7759/cureus.77120

Shibahara, T., Yamanaka, K., Matsuoka, M., et al. (2025). A case of neuromyelitis optica spectrum disorder complicated with aquaporin-4-antibody-associated organizing pneumonia. Multiple Sclerosis Journal.

https://doi.org/10.1177/13524585241310397

Valero, C., Valenzuela, C., Baldivieso-Achá, J. P., et al. (2025). Clinical profiles, survival, and lung function outcomes in ANCA-associated interstitial lung disease. Stomatology.

https://doi.org/10.3390/jcm14010229

Tsarkova, S. A., Leshchenko, I. V., Ivanova, A. I., et al. (2024). E-cigarette, or vaping, product use-associated lung injury: A diagnosis of exclusion. Pul’monologiâ.

https://doi.org/10.18093/0869-0189-2024-4604

Nielsen, M., Jensen, J.-U. S., Sivapalan, P., et al. (2025). E-cigarette or vaping product use-associated lung injury: A case report. European Clinical Respiratory Journal.

https://doi.org/10.1080/20018525.2024.2445868

Yagi, M., Yoneto, T., Yanagihara, K., et al. (2024). Organizing pneumonia associated with Pneumocystis jirovecii. Journal of Nippon Medical School.

https://doi.org/10.1272/jnms.jnms.2024_91-605

Alabrudziński, K., Wilewska, A., Pomirski, B., et al. (2024). EVALI: Epidemic of 2019 and how to prevent it again. Journal of Education, Health and Sport.

https://doi.org/10.12775/jehs.2024.75.56493

Shiu, P., Iriza, S. E., & Templeton, S. F. (2025). Diffuse alveolar hemorrhage associated with anti-PL-7 antisynthetase syndrome: A case report. Case Reports in Pulmonology.

https://doi.org/10.1155/crpu/3715449

Silva-García, J., García-Grimaldo, A., Rodríguez-Moguel, N. C., et al. (2025). Malnutrition is associated with clinical outcomes in mechanically ventilated patients with pneumonia. Nutrition in Clinical Practice.

https://doi.org/10.1002/ncp.11269

Cherian, S. V., Kumar, A., & Estrada-Y-Martin, R. M. (2020). E-cigarette or vaping product-associated lung injury: a review. The American journal of medicine, 133(6), 657-663.

https://doi.org/10.1016/j.amjmed.2020.02.004