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

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.