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Generation of Electronic Cigarette Aerosol by a Third-Generation Machine-Vaping Device: Application to Toxicological Studies

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E-Cigarette Use, Small Airway Fibrosis, and Constrictive Bronchiolitis.

Lida P Hariri^1,2,3, Bess M Flashner^2,3, David J Kanarek^2,3

¹Department of Pathology, Massachusetts General Hospital, Boston.

|May 1, 2023

Summary

Vaping is linked to chronic lung disease, including small airway-centered fibrosis and constrictive bronchiolitis. Cessation of electronic cigarette use may partially reverse these vaping-associated lung conditions.

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Area of Science:

Pulmonology
Pathology
Toxicology

Background:

Electronic cigarette (e-cigarette) use is rising, but long-term health effects remain unclear.
Adolescent vaping prevalence necessitates understanding potential chronic lung disease risks.

Purpose of the Study:

To investigate chronic lung disease in patients with a history of e-cigarette use.
To identify clinical, imaging, and histopathologic features associated with vaping.

Main Methods:

Case series of four patients with chronic lung disease and e-cigarette use history.
Evaluations included pulmonary function tests (PFTs), chest HRCT, EB-OCT, and surgical lung biopsy.
Histopathologic assessment focused on small airway pathology.

Main Results:

Patients presented with dyspnea and chest pain, correlating with 3-8 years of vaping.
Pulmonary function tests and HRCT showed mild airway obstruction, air trapping, and bronchial wall thickening.
Histopathology revealed small airway-centered fibrosis, constrictive bronchiolitis, and MUC5AC overexpression; partial symptom reversal occurred after vaping cessation.

Conclusions:

Vaping was identified as the likely cause of chronic lung disease in these patients.
A distinct histopathologic pattern of small airway-centered fibrosis is associated with vaping.
This study suggests a potential clinical and pathologic entity linked to e-cigarette use.