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Case Report and Representative Radiographs: Strengths : First cluster identified within a large catchment zone Retrospective chart review identified treatment, course, disposition, and outcome Interviews with cases determined exact exposures For the first time, provided a strict case definition of VALI, including a comprehensive negative infectious workup Limitations : Under-Reporting: Surveillance studies are limited by under-reporting, particularly as patients may not be routinely asked about vaping exposures

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While overall rates of emphysema were about the same between the marijuana smokers (75%) and the cigarette-only smokers (67%), the age-matched subgroup of marijuana smokers had higher rates of emphysema 93% compared to 67% of those who only smoked tobacco