E-Cigarette and Vape use-Associated Lung Injury: A Systematic Review of a global Respiratory Crisis (2016-2024)

Abstract

Introduction
E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) is a rising global concern, particularly among adolescents and young adults. First recognised after a spike in cases in the United States, it has since been reported worldwide, raising alarms over the safety of vaping products and their potential for severe lung toxicity. Individuals aged 16 to 28 are disproportionately affected, often presenting with acute respiratory symptoms requiring hospitalisation or intensive care. Despite growing awareness, the pathophysiology, imaging, and laboratory features of EVALI remain inconsistently reported. This systematic review aims to synthesise current evidence on EVALI, focusing on pathophysiological patterns, clinical presentation, imaging characteristics, and laboratory findings from 2016 to 2024.

Methods
A systematic review was conducted in accordance with PRISMA guidelines. Literature searches were performed across five databases: PubMed, Cochrane Library, Embase, Scopus, and Google Scholar, covering publications from January 2016 to March 2024. The search strategy included terms related to vaping, EVALI, lung injury, radiological findings, and pathophysiology. Eligible studies included observational studies, case series, and case-controlled studies involving individuals aged 16 to 60 diagnosed with EVALI or vaping-associated pulmonary injury. Titles and abstracts were screened independently by two reviewers, with full texts assessed using predefined criteria. Risk of bias was evaluated using the Newcastle-Ottawa Scale.

Results
A total of 23 studies were included, comprising 6 case series, 12 literature reviews, and 5 observational studies. Most patients were male and aged 16 to 28. Common symptoms included dyspnoea, cough, fever, and gastrointestinal issues. Radiological findings frequently showed bilateral ground-glass opacities and diffuse alveolar damage. Laboratory results often revealed elevated CRP and ESR, with occasional leukocytosis and hypoxaemia. Pathophysiology involved direct alveolar injury, lipid-laden macrophages, and immune-mediated responses.

Conclusion
EVALI remains a serious and evolving threat. This review highlights consistent clinical, radiological, and laboratory features, underscoring the need for early recognition and further research.