Nebraska health officials confirmed Tuesday that they are investigating several possible cases of severe pulmonary disease associated with using e-cigarette products, or vaping.

Four possible cases of the disease have been reported to the state, according to the Nebraska Department of Health and Human Services.

The agency sent a notice to health care providers Tuesday advising them to consider vaping-related illness in patients presenting with respiratory symptoms and a history of vaping. They should report suspected cases to their local health department or the state.

Further details regarding the ages and locations of the possible Nebraska cases were not immediately available. As of a week ago, about 215 possible cases were under investigation in 25 states, including four in Iowa, and additional reports of pulmonary illness were suspected.

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Vaping refers to the increasingly popular practice of inhaling vapor from an e-cigarette device, which works by heating a liquid that can contain nicotine, marijuana or other drugs.

Generally, patients have been mostly healthy and in their late teens and 20s and have experienced respiratory symptoms such as coughing, shortness of breath or chest pain. Some have experienced nausea and vomiting. In most cases, symptoms have come on suddenly, but in some cases, they’ve manifested over several weeks.

Federal and state health officials have been investigating the cases. So far, they have not identified any specific substance or e-cigarette product linked to all cases.

The Centers for Disease Control and Prevention is working with states to collect product specimens for testing.

Federal officials have advised those concerned about specific health risks to consider refraining from using e-cigarette products. Those who use them should not buy them off the street or modify them or add substances to them.

Youths, young adults, pregnant women and adults who don’t currently use tobacco products should not use such e-cigarette products.

This report includes material from the Washington Post.

Julie Anderson is a medical reporter for The World-Herald. She covers health care and health care trends and developments, including hospitals, research and treatments. Follow her on Twitter @JulieAnderson41. Phone: 402-444-1066.

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