What question did this study set out to answer?

To examine current and emerging methods for assessing lung function in young e-cigarette users and identify function alterations post-exposure.

February 9, 2026Open Access

Systematic review of lung function assessment among youth and young adults e-cigarette users: Current tools and emerging methods

Key Points

To examine current and emerging methods for assessing lung function in young e-cigarette users and identify function alterations post-exposure.
Systematic review following PRISMA guidelines
Searched six databases for articles between 2016 and 2025
Conducted quality appraisal using JBI Critical Appraisal Tools
Synthesized findings using narrative analysis
Included 7 studies that used spirometry for lung function assessment
Acute e-cigarette exposure decreased FEV₁, FVC, PEF, and MEF₇₅, while raising EBT
Chronic exposure caused additional reductions in FEV 1, FEV 1 /FVC, and increased HbCO levels
Emerging methods like FeNO, DLCO, and MRI detected early dysfunction missed by spirometry

Abstract

Introduction This review focuses on the need to identify the lung function assessment tools used for young EC users. The objectives are to examine the current and emerging methods used in assessing lung function among young EC users, besides identifying the alterations in lung function following EC exposure measured by those tools. Methodology This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow checklist. Six databases (Web of Science, PubMed, Scopus, Taylor however, it is unable to detect subclinical lung alterations, as observed through ventilation-perfusion (V/Q) MRI and fractional exhaled nitric oxide (FeNO). Acute exposure to EC results in a decrease of FEV₁, FVC, PEF, and MEF₇₅ spirometric parameters, as well as reducing FeNO levels, while concurrently increasing exhaled breath temperature (EBT). Besides, an increase in V/Q mismatch and heterogeneity in ventilation is observed, with a reduction in perfusion heterogeneity. Chronic EC exposure causes a reduction in FEV 1 , PEF, FEV 1 /FVC, and FEF 25–75% , besides an increment of Carboxyhaemoglobin (HbCO) level. The assessment of the lung function post-EVALI in association with EC cessation revealed lung function improvement and increased diffusing capacity of the lung for carbon monoxide (DLCO). Conclusions Spirometry remains the first-line tool for assessing the lung function of young EC users; however, it often misses early lung dysfunction. Emerging methods (FeNO, DLCO, EBT, MRI, HbCO) increasingly complement this limitation. Tailoring multimodal assessment to exposure context, alongside screening and monitoring programs, may assist in early disease detection and prevent long-term respiratory effects.

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