June 17, 2022 – A study that looked at four patients with chronic lung disease found that e-cigarette use was the most likely cause.
Senior author of the study, published May 13, 2022 in NEJM Evidence, was David Christiani, Elkan Blout Professor of Environmental Genetics.
Each patient in the study—all former smokers—had a 3- to 8-year history of e-cigarette use, using different vape devices and different kinds of vape fluids. Lung biopsies on the patients showed evidence of small airway-centered fibrosis, including constrictive bronchiolitis. Although researchers evaluated other potential causes for the patients’ disease, they concluded that vaping was likely to blame because all of the patients experienced partial improvement of their symptoms after they stopped using e-cigarettes.
The study authors noted that although constrictive bronchiolitis has not been linked with cigarette smoking, it wasn’t clear whether the patients’ disease was the result of vaping alone or the combination of vaping after quitting smoking. They wrote that large-scale studies are needed to further assess the issue—especially important given the large effort to use vaping as a tool to help people quit smoking tobacco, as well as the Food and Drug Administration’s recent authorization allowing the marketing of tobacco-flavored e-cigarette products.
NEJM Evidence also published an editorial and a comment about the study. The editorial noted that while four cases of airway disease don’t establish definitive proof of chronic disease related to vaping, the study does provide circumstantial evidence for a causal relationship, and that the authors “have taken an admirable first step in unraveling this complex issue.” The comment included a recommendation that clinicians “remember to inquire about e-cigarette use when we encounter patients with otherwise unexplained progressive pulmonary symptoms.”
Weighing benefit vs. risk of newly authorized e-cig products (Harvard Chan School feature)