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One study found e-cigarette use was associated with lower forced expiratory volume in 1 second ([FEV1] 4.6 versus 5.2, P = 0.007) and lower ratio of FEV1 to forced vital capacity ([FEV1/FVC] 77.4 versus 83.4, P = 0.001).[44] Since smokers of combustible cigarettes were excluded from this study, these results suggest that e-cigarette use may be independently associated with obstructive airway changes