Major pulmonary clinical manifestations of e-cigarette use by adolescents: a scoping review

It is known that a mix of marketing, lack of regulation, broad accessibility, perceived minimal risk, and flavors appealing to young people may have played a role in the widespread adoption of vaping and, consequently, its harms. Because of that, this review aims to map the spectrum of clinical pulmonary manifestations associated with the use of electronic cigarettes in adolescents, which is the most vulnerable age group. By using PRISMA scoping review guidelines, seven electronic databases were consulted using MeSH terms. Three independent reviewers performed screening and full-text analysis, resulting in 28 articles included in this review and a sample size of 58 participants, most of them without comorbidities. Gastrointestinal prodromes were frequent and followed by dyspnea, cough, and signs of impaired oxygenation, such as hypoxemia and tachypnea. This was also demonstrated by the need for supplemental oxygen use in 97.3 % of cases. In complementary exams, leukocytosis with predominance of neutrophils was the main finding, as well as diffuse bilateral ground-glass opacities on thorax CT. On pulmonary function tests, restrictive lung disease was identified at the same frequency as an obstructive pattern. However, considering the study's limitations, findings from this scoping review indicate that both symptom resolution and radiologic improvement are strongly linked to cessation of e-cigarette use. Future studies should focus on the long-term respiratory consequences and define potential dose-response relationships.