Electronic Nicotine Delivery Systems (ENDS), commonly referred to as "e-cigs," were first introduced in the United States in 2007. Since then, their use has grown substantially, with the largest market among adolescents and young adults. ENDS are often perceived by the public as safe alternatives to traditional cigarettes and as aids in smoking cessation. Little is known about inhalational hazards of e-cigs. We describe the case of a 45-year-old man who developed acute respiratory symptoms associated with onset of severe fixed airways obstruction 9 months after he quit traditional cigarettes and began high-dose vaping. Lung biopsy showed respiratory bronchiolitis. Analysis of his heated e-cigarette solution identified a mixture containing vanillin, aldehydes, alcohols and other chemicals, the inhalation effects of which have not been well-studied. This case report adds to the growing literature describing potentially severe lung health effects of vaping and provides a framework for taking a clinical vaping history so that the health consequences of e-cigarettes may be better understood.
• Long-term health consequences of vaping are unknown and claims that ENDS are a safer alternative to traditional cigarettes require further investigation.
• This clinical vignette raises concern that ENDS use may be linked to chronic irreversible obstructive lung disease.
• With the rise in ENDS use, particularly among adolescents and young adults, clinicians should elicit a brief vaping history to better understand potential exposures and lung health risks in their patients who vape.