# Pathobiologic profile and outcomes of critically ill children and adolescents exposed to vaping and e-cigarettes

> **NIH NIH R01** · CHILDREN'S HOSPITAL OF LOS ANGELES · 2020 · $445,024

## Abstract

Project Summary
 E-cigarette or Vaping Associated Lung Injury (EVALI) is a severe, life-threatening lung disease with16%
of cases occurring in patients less than 18 year of age. Unfortunately, over 10% of high school students vape
nicotine or THC daily, and nearly 30% of adolescents have vaped in the last month. Given the recent
discovery of this disease, we lack crucial information regarding mechanistic pathways of injury, physiologic
characteristics, or the long-term health effects of EVALI, particularly in adolescents. It is also unclear if the
pathobiology or outcomes of adolescents with EVALI are different than patients who have lung injury triggered
by more common causes, such as pneumonia or sepsis.
 While EVALI represents the most severe form of injury related to e-cigarettes, other significant health
consequences from primary or secondary exposure to e-cigarettes or vaping likely exist. E-cigarette exposure
is associated with asthma and other respiratory disease, increased airway resistance, and changes in lung
function. Nicotine, a component of both combustible and e-cigarettes, has a direct effect on lung and brain
development for children and adolescents. There are limited data regarding secondary exposure to e-
cigarettes, although they suggest adverse health outcomes. Therefore, there is strong biological plausibility
that children and adolescents with primary or secondary e-cigarette exposure will be more susceptible to
severe lung injury and adverse health outcomes when they develop lung injury from other causes, such as
pneumonia or sepsis. No studies have evaluated this specifically, or whether there is a differential impact of
primary or secondary exposure to vaping as a function of age or pre-existing cardio-respiratory comorbidities.
 We are currently enrolling a cohort of children (< 19 years) admitted to the intensive care unit (ICU)
with lung injury and testing whether a ventilator management strategy improves outcomes. We have begun to
collect detailed e-cigarette and cigarette exposure history from all participants and have discovered several
cases of EVALI. Furthermore, we anticipate nearly 20% of children have significant secondary exposure to e-
cigarettes. We will leverage the existing physiologic and outcome data being collected as part of this
randomized controlled trial, and combine it with biomarker and RNA sequencing data, and serial 2-year follow-
up of pulmonary, neurocognitive, emotional health, and quality of life of all patients who survive to ICU
discharge. This will provide an unprecedented opportunity to: (a) understand mechanistic pathways which
may be important in the pathogenesis of EVALI, (b) measure the long-term health effects of EVALI in children
and adolescents, (c) discover if secondary exposure to e-cigarettes increases susceptibility to more severe
disease or poor outcome when children develop lung injury from other causes like pneumonia or sepsis, and
(d) determine if continued exposure to e-...

## Key facts

- **NIH application ID:** 10115413
- **Project number:** 3R01HL134666-04S1
- **Recipient organization:** CHILDREN'S HOSPITAL OF LOS ANGELES
- **Principal Investigator:** Robinder Khemani
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $445,024
- **Award type:** 3
- **Project period:** 2017-08-15 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10115413

## Citation

> US National Institutes of Health, RePORTER application 10115413, Pathobiologic profile and outcomes of critically ill children and adolescents exposed to vaping and e-cigarettes (3R01HL134666-04S1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10115413. Licensed CC0.

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