August 26, 2019

Missouri DHSS monitors recent severe pulmonary disease among e-cigarette users

For Immediate Release:
Aug. 26, 2019

Media Contact:
Lisa Cox
Chief, Office of Public Information
Missouri DHSS of Health and Senior Services

JEFFERSON CITY, Mo. – On Aug. 20, DHSS issued a health advisory to providers and partners regarding severe lung disease associated with vaping. The Centers for Disease Control and Prevention (CDC) reports there have now been 193 potential cases of severe lung illness associated with vaping in 22 states from June 28-Aug.20. The CDC is assisting several states in investigations of clusters of pulmonary illnesses linked to e-cigarette product use, or “vaping,” primarily among adolescents and young adults.

The Illinois Department of Public Health reported on Friday the death of a patient who contracted a serious lung illness after vaping, and it is being considered the first death in the United States linked to e-cigarette usage. 

While some cases in each of the 22 states are similar and appear to be linked to e-cigarette product use, more information is needed to determine what is causing the illnesses. Even though no recent severe lung disease associated with vaping has been confirmed in Missouri to date, the Missouri Poison Center has received over 600 calls with various complaints related to e-cigarettes over the last 10 years, and has managed over 30 cases with breathing difficulties associated with vaping over the last 5 years. 

Patients presented with cough, shortness of breath, chest pain, and fatigue, which became worse over days or weeks before hospital admission. According to the CDC, in many cases, patients have acknowledged to health care personnel recent use of tetrahydrocannabinol (THC)-containing products. However, no specific product has been identified in all cases, nor has any product been conclusively linked to illnesses. Even though cases appear similar, it is not clear if these cases have a common cause or if they are different diseases with similar symptoms.

“We are engaged with the CDC and other state health departments throughout the U.S. and are monitoring the recent trend of severe acute pulmonary disease associated with e-cigarettes,” said Dr. Randall Williams, director of the Missouri Department of Health and Senior Services (DHSS). “In an abundance of caution, we want to share this information with not only providers but also the general public, even though at this time, it is unclear what the etiology of the disease is in these affected patients.”  

Missouri DHSS recommends: 

  1. Any person, particularly young people, experiencing unexplained chest pain or difficulty breathing after vaping in the days or weeks prior to their symptom onset should seek medical attention. 
  2. Health care providers caring for patients with respiratory or pulmonary illness, especially of unclear etiology, should ask about the use of e-cigarette products for “vaping” and inquire about the types of drugs (legal or illicit) used and methods of drug use (e.g., smoking, “vaping”). 
  3. Clinicians should report cases of significant respiratory illness of unclear etiology in patients with a history of vaping to the local public health agency (LPHA), or to DHSS. 
  4. Evaluation for common infectious etiologies when also suspected should be pursued, and less common infections, and rheumatologic or neoplastic processes, considered as clinically indicated. 
  5. If an e-cigarette product is suspected as a possible etiology of a patient’s illness, it is important to inquire, and when possible document, what type of product as well as if the patient is: - using commercially available devices and/or liquids (i.e. bottles, cartridges, or pods); - sharing e-cigarette products (devices, liquids, refill pods, and/or cartridges) with other people; - re-using old cartridges or pods (with homemade or commercially bought products); or - heating the drug to concentrate it and then using a specific type of device to inhale the product (i.e., “dabbing”). 


Helpful information for teens, parents and health care providers can be found at these resources:


About the Missouri Department of Health and Senior Services: The department seeks to be the leader in protecting health and keeping people safe. More information about DHSS can be found at or find us on Facebook and Twitter @HealthyLivingMo.