NEW ORLEANS -- A life-threatening condition known simply as "vaping illness" has appeared across the U.S., with over 200 cases reported this summer.
Louisiana has now joined the count: Nine people have reported cases of pulmonary illness after e-cigarette use, the state Department of Health confirmed on Wednesday.
All were reported in the last two weeks, but symptoms began appearing in some cases as early as June.
State officials said the patients ranged in age from 20 to 33. They declined to provide locations but said that cases had been found throughout the state.
"As the word gets out more, we anticipate that we'll have more cases reported to us," said Dr. Joseph Kanter, assistant state health officer at the Department of Health.
The state-level data come amid recent reports that otherwise healthy teens and young adults who vape are suffering from lung problems and other issues nationally.
Louisiana and 25 other states have reported at least 215 such cases since late June, according to an advisory from the Centers for Disease Control and Prevention released Friday. Patients reported symptoms including coughing, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, fever and weight loss.
In Louisiana, chronic respiratory disease is the fourth-leading cause of death after heart disease, cancer and accidents.
In the advisory issued Wednesday that echoed the CDC recommendations, state officials advised physicians to ask all patients who report using e-cigarettes within the past 90 days about signs and symptoms of pulmonary illness. Patients experiencing symptoms should seek medical attention, the advisory said.
Dr. Scott Davis, a pediatric pulmonologist in New Orleans, had a patient who sought treatment earlier this summer. The adolescent came in with what looked like acute pneumonitis? -- inflammation of the lungs associated with irritants like pollution, mold or certain drug reactions.
Tests ruled out infection and inflammatory diseases. The patient, who was healthy otherwise, had to be admitted to the hospital and put on supplemental oxygen. It wasn't until other potential causes were ruled out that Davis connected the illness with the patient's history of vaping.
The patient "fit the profile that the CDC has been talking about -- that it's primarily involving older adolescents who have been otherwise pretty healthy," said Davis, who added that his patient recovered. "They show up with acute, significant lung injury."
At least one patient in Illinois died after being hospitalized with severe pulmonary symptoms. Others have been placed on oxygen and ventilators.
Investigators are trying to figure out what's behind the surge in illnesses. Health officials believe vaping is to blame, but they're not able to pin down a specific product or substance. People can inhale a variety of substances when vaping, including nicotine, cannabinoids like THC and CBD and synthetic cannabinoids like K2 and hash.
"To date, no single substance or e-cigarette product has been consistently associated with illness," the CDC said.
The agency warned e-cigarette users to stop buying bootleg products and not to modify products to allow for additional substances not intended by the manufacturer.
Dr. Scott Gottlieb, who was commissioner of the Food and Drug Administration in 2017 when the FDA began enforcing tightened regulations on e-cigarettes, pointed to illicit black market substances and delivery products as a potential cause of the illnesses.
"These tragedies point to illegal vapes and THC," he said on social media last week.
But doctors who study vaping said it's too soon to know whether the outbreak is related to vaping in general or whether a certain product is behind the lung injuries.
"There's reason to suspect it may be a combination," said Dr. Karen Wilson, chief of general pediatrics at the Icahn School of Medicine at Mount Sinai in New York City.
Many teens use both nicotine and THC products in vaping pens, said Wilson, who recently treated a 17-year-old who was hospitalized for a vaping-related lung injury and who was representative of a national trend that Wilson said is "terrifying to watch."
"The increase of young people using electronic cigarettes, especially since Juul came on the market, has been exponential," she said, referring to a popular brand of e-cigarettes. "Electronic cigarette companies have been able to use marketing campaigns that are very appealing to young people. And they look like high-tech flash drives. You can hide them in your hand, use them in the back of a classroom, and your teacher doesn't know."
In Louisiana, e-cigarette use is increasing rapidly among children and young adults. From 2017 to 2018, it increased by almost 80% among high school students and 50% among middle school students, according to a report by the state Tobacco Cessation and Prevention Program. One of every eight high school students in Louisiana regularly used e-cigarettes in 2017, according to the Louisiana Youth Tobacco Survey.
Vaping works by heating up a liquid with a chemical in it -- usually propylene glycol or vegetable glycerin? -- and an additional chemical like THC or nicotine. It's then turned into a vapor, which is inhaled.
And while it doesn't have as many chemicals as a cigarette, it does have toxic chemicals tied to cancer, and it can still be inhaled secondhand like cigarette smoke, said Wilson.
Proponents of vaping, including the companies selling e-cigarettes, say it is a safer alternative to smoking cigarettes. But the long-term effects of vaping, particularly on the lungs of young people, have not been studied.
"I'm not sure anything you inhale into the lungs is safe," said Davis, the New Orleans doctor. "My first recommendation would be: Don't inhale anything -- cigarettes, cigars, pipe, e-cigarettes."
If people do choose to vape, they should not buy anything off the street and shouldn't modify e-cigarettes in any way, he said.