Severe Lung Disease and Vaping Health Alert - 08/16/19

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Health Alert
August 19, 2019

Severe Lung Disease Among Persons Who Report Vaping
August 16, 2019


The Texas Department of State Health Services (DSHS) is investigating suspected cases of pulmonary disease among individuals who report vaping. Similar cases have occurred in multiple other states, some resulting in hospitalization. All suspect cases reported vaping with products including nicotine and/or tetrahydrocannabinol (THC). Evaluation for infectious diseases was negative in all patients.

DSHS is working with other states and the Centers for Disease Control and Prevention to better characterize case demographics, clinical characteristics, and exposures.

Clinical Presentation

Individuals experienced respiratory symptoms including cough, shortness of breath, and fatigue. Some also experienced nausea, vomiting, and diarrhea. Symptoms worsened over a period of days or weeks before admission to the hospital. Illness severity has varied, and in some cases, severe lung disease has been reported.

On imaging, chest radiographs have demonstrated bilateral opacification, and CT imaging has demonstrated diffuse ground glass opacification.

Recommendations for Clinicians

Health care providers should:

  • Ask patients presenting with respiratory symptoms about vaping history. If possible, inquire about the types of products used and methods of use.
  • If vaping fluid commonly used by the patient is available, ask that it be set aside (not used) in case it is needed for testing.
  • Be aware that some suspect cases have required high-level intensive care and respiratory support.

Suspected cases should be reported to the Texas Department of State Health Services at 512-776-7268.

Suspected cases include those with inhalation drug use* within 90 days prior to symptom onset AND clinical signs and symptoms** of respiratory dysfunction.

* Includes vaping or smoking of any plant or chemical, including nicotine, marijuana, THC concentrate, CBD,synthetic cannabinoids, or other.

** Includes shortness of breath, pleuritic chest pain (i.e., pain with inspiration), cough with or without hemoptysis,hypoxia (pulse oximetry <=95%), with or without fever.

Recommendations for the Public

People who experience difficulty breathing, cough, or other symptoms in the days or months after vaping should seek immediate medical attention.

For More Information

For questions:
DSHS Environmental Surveillance and Toxicology Branch

Get the facts about electronic cigarettes:

Information for health care providers on adolescents and E-cigarette use: