Doctors in Wisconsin have confirmed new cases of lung disease tied to vaping, officials with the state Department of Health Services said Thursday.

The new cases included older people in addition to teens, all of whom reported vaping or “dabbing,” which is vaping marijuana oils, extracts or concentrates.

Officials have confirmed a total of 12 cases and are investigating 13 other cases.

“We are continuing to interview patients so we can identify a possible cause,” said Department of Health Services Secretary-designee Andrea Palm. “All patients reported vaping prior to their hospitalization, but we don’t know all the products they used at this time. The products used could include a number of substances, including nicotine, THC, synthetic cannabinoids, or a combination of these.”

Patients with confirmed cases range in age from teens to 30 years old and have come from Dodge, Door, Kenosha, Racine, Walworth, Waukesha and Winnebago counties, officials said.

Cases under investigation include patients in their 50s, according to Wisconsin health department officials.

Symptoms include shortness of breath, fatigue, chest pain, cough and weight loss.

Some of the teens reported having trouble doing routine tasks such as washing their hair and tying their shoes.

“The severity of the disease has varied among patients, with some needing assistance to breathe,” officials wrote in a Thursday news release. “While patients have improved with treatment, it is not known if there will be long-term health effects.”

The Illinois Department of Public Health is also investigating the cases of three young people from the northeastern part of the state who have recently been hospitalized with severe breathing problems after vaping.

Officials with the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration are assisting in the investigation. Nailing down a culprit is more complicated than it might seem, officials with state health departments said.

“People aren’t always forthcoming with where they got the product and exactly what the product was,” said Melaney Arnold, spokeswoman for the Illinois Department of Public Health. “We’re still working on that.”