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B26-11 How Vaping Shapes Pulmonary Function and Feno: A Meta-analysis of Users Versus Non-users

A. Jaén, R. Leong, I. Tan, R. Rolle, L. Espino, L. Hankins, M. Arlos, D. Jaleco et al.

American Journal of Respiratory and Critical Care Medicine, 2026

Abstract

WHO estimates 1.3 billion smokers globally, with 8.9 million smoking-related diseases and deaths anually. E-cigarettes were initially marketed as an alternative and smoking cessation tool. This led to the decline of combustible cigarettes and the rise of vaping, from 1% (2017) to 9% in 2023 per country. However, it attracted never-smokers, especially those aged 15-24 years. Despite reports of E-cigarette or vaping product use-associated lung injuries(EVALI) and other pulmonary problems, little is known about the long-term effects of ENDS. Aim: To assess the lung function and fractional exhaled nitric oxide (FeNO) of ENDS users versus non-ENDS and non-tobacco users.

Authors followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2009 checklist. A systematic search was performed with academic databases EMBASE, Medline, Scopus, Ovid, Web of Science, Cochrane Library, Pubmed, and John Hopkins Library. Search range started from 2004, when e-cigarette was developed, until March 18, 2025. FEV1, FVC, FEV1/FVC and FeNO levels of ENDS users versus Non-ENDS users were measured. Stata v18/SE meta-analysis library was used in all analyses. Risk of Bias assessments were performed using the ROB 2 and ROB-I tools.

Search returned 19,881 studies, of which 271 studies were included for quality assessment. Ten studies were eventually included. A decline in lung function was seen among ENDS users as evidenced by a statistically significant lower FEV1/FVC (%) by…

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