The N.C. Department of Health and Human Services issued a recommendation Friday that consumers of vaping products should stop using them while it investigates three cases involving a severe lung disease possibly linked to vaping.

Three people in North Carolina have been hospitalized since late July, with the causes of their illnesses still unknown.

On Thursday, The Associated Press reported that “as many as 50 people in at least six states have come down with breathing illnesses that may be linked to electronic cigarettes or other vaping products” during the past three months.

No deaths have been reported.

Symptoms reported by patients include shortness of breath, fever, cough, and nausea or vomiting.

The DHHS said the symptoms are similar to pneumonia caused by bacterial or viral infections. The severity of the disease has varied among patients, with some requiring treatment in the intensive care unit and help breathing.

The DHHS said anyone who has vaped in the past three months and experienced these symptoms should contact their doctor or seek medical care.

“We encourage all North Carolinians to avoid vaping products and e-cigarettes,” Dr. Elizabeth Tilson, the state’s health director, said in a statement. “Although the causes of the recently reported cases are still under investigation, this is a reminder of the potentially severe health consequences of vaping.”

No specific brand name or source has been identified as the cause of illness at this time. Juul is the top-selling U.S. e-cigarette with a 74.5% market share, according to Nielsen data.

The products reported include nicotine, marijuana, THC or a combination of these substances.

The notice comes as federal regulators continue to de-emphasize electronic cigarettes and vaporizers as smoking-cessation options even while acknowledging increased use of the products for that purpose.

The U.S. Centers for Disease Control and Prevention released in April 2017 a 26-month study of 15,943 adult cigarette smokers. It was published in the journal Preventing Chronic Disease.

The goal was determining what may be the most effective ways of quitting smoking among 10 common methods.

“Giving up cigarettes all at once (65.3%) and reducing the number of cigarettes smoked (62%) were the most prevalent methods,” the CDC said.

When it came to a potential smoking-cessation device, substituting some cigarettes with e-cigarettes (35.3%) was used by a greater percentage of smokers than the nicotine patch or gum (25.4%) or other stop-smoking aids approved by the U.S. Food and Drug Administration.

And 24.7% tried to stop smoking by switching completely from cigarettes to e-cigarettes.

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RIchard Craver is a reporter with the Winston-Salem Journal.

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