In recent decades, multiple efforts have been made to reduce population exposure to cigarettes, given that smoking is responsible for thousands of deaths annually. These actions have been effective, as evidenced by a reduction in the number of smokers worldwide in recent decades and by a slight reduction in the incidence of lung cancer.¹ Conversely, a new form of nicotine exposure has become popular through electronic cigarettes, first commercially available in the early 2000s in China.² Currently, the electronic cigarette industry generates $2.5 billion annually.³

Recent studies have shown that 4.9% of elementary school students and 20.8% of high school students in the United States report having used electronic cigarettes in the last 30 days. Between 2017 and 2018, there was a 78% increase in electronic cigarette use among American high school students.³ In Brazil, a national survey conducted in 2022 estimated that the prevalence of electronic cigarette use was 12.2%, with the predominant age group being 25-34 years.⁴ In southern Brazil, this rate is even more concerning, corresponding to 21.9% of the school-age population.⁵

Electronic cigarettes work by heating a liquid to create an aerosol that typically contains solvents such as propylene glycol and vegetable glycerin, as well as nicotine and flavorings; it can also contain chemicals such as tetrahydrocannabinol. Although the medium-term and long-term health effects of inhaling these substances into the lungs are still unknown, there have been numerous reports of patients who develop acute lung damage caused by inhaling the vapor produced by electronic cigarettes. E-cigarette, or vaping, product use-associated lung injury (EVALI) is a term that is used in order to describe lung injury caused by the use of electronic cigarettes. Symptoms include cough, dyspnea, chest pain, and hemoptysis. In severe cases, invasive ventilatory support such as mechanical ventilation and extracorporeal membrane oxygenation (ECMO) may be required; in extreme cases, lung transplantation may be required.