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An alternative hypothesis is depicted on the right, in which inhalation of chemicals common in e-cigarette aerosols (propylene glycol, glycerin, nicotine, or THC) alters the inflammatory state of the lungs, including changing alveolar macrophages to a proinflammatory phenotype with the release of inflammatory cytokines (indicated by yellow circles), such that a second hit causes a pathologic inflammatory response

Nonetheless, the anonymised data on which this manuscript was based could be made available to other investigators upon bona fide request and following all the necessary approvals (including ethics approval) of the detailed study proposal and statistical analyses plan

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