ASHEVILLE - Two cases of vaping-related lung illness have been confirmed in Buncombe County, according to the county Department of Health and Human Services.

The Centers for Disease Control and Prevention has identified 530 cases of lung injury associated with vaping, as of Sept. 17, with five total in North Carolina.

Seven deaths have been confirmed to date, "and we do expect others," Dr. Anne Schuchat, principal deputy director of the CDC, said on a Sept. 19 conference call about the emergency investigation.

"The e-cigarette or vaping-related lung injuries we have been describing are serious. People are dying," she said.

5 cases in North Carolina

Three more "confirmed or probable" cases of the disease have been identified in North Carolina, in addition to the Buncombe cases. Health department spokeswoman Stacey Wood confirmed the local incidents on Sept. 19.

According to a report on the North Carolina cases in the CDC's Morbidity and Mortality Weekly Report for Sept. 13, the five patients are 18-35 years old and all experienced "several days of worsening dyspnea (or shortness of breath), nausea, vomiting, abdominal discomfort and fever."

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All five had recently used marijuana oils or concentrates in e-cigarettes, although other patients who only used nicotine vape products have been diagnosed with the disease nationwide.

The North Carolina patients were hospitalized for respiratory failure and low levels of oxygen in the blood. One patient required intubation and mechanical ventilation. All five survived.

Which products are dangerous?

Exactly which aspect of vaping causes the lung disease has proven difficult to tease out.

"No consistent e-cigarette or vaping product, substance, additive, or brand has been identified in all cases, nor has any one product or substance been conclusively linked to lung injury in patients," Schuchat emphasized.

Initial reports indicate that most patients affected by the disease have used e-cigarette products containing THC, though some patients only used nicotine products.

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"Anyone who uses an e-cigarette or vaping product should not use or buy these products off the street and should not modify or add any substances to these products," Schuchat said.

"Patients may have been exposed to a variety of products and substances, may not know the contents or sources of these products, and in some instances may be reluctant or too ill to fully disclose all the details of interest," Schuchat said.

Why do we care, if tobacco kills so many every year?

Doctors worry the public may not take warnings about vape-related disease seriously — after all, the seven confirmed vape-related deaths pale in comparison to the 450,000 people who die yearly due to tobacco use in the U.S.

What's so frightening about the lung disease associated with vaping is the timescale. While it can take a lifetime of pack-a-day smoking to develop lung cancer, the patients diagnosed with vape-related lung disease have been generally young and otherwise healthy, according to the CDC.

Over half of all cases are in people under 25 years old, according to the latest CDC data. About 16% are in people under 18.

What are officials doing?

The CDC has activated its emergency protocols and is researching "24/7," Schuchat said.

"FDA has now collected more than 150 vaping product samples from a number of states for analysis ... for the presence of a broad range of chemicals, including nicotine, THC and other cannabinoids, along with opioids, cutting agents or dilutants and other additives, pesticides, poisons and toxins," said Mitch Zeller, director of the FDA center for tobacco products.

The FDA also encourages the public to report any health-related issues with e-cigarette products on their online safety reporting portal at www.safetyreporting.hhs.gov.

Should I stop vaping? Should I start?

According to health officials, some people shouldn't be vaping under any circumstances — don't vape if you're under 25, or if you may be pregnant.

If you're an adult who started vaping nicotine products to quit cigarettes, don't return to smoking cigarettes.

If you don't use tobacco products, now is not the time to start vaping.

Perhaps above all, don't buy any vaping products off the street — particularly those with THC and CBD oils — and don't modify or add substances to e-liquid before vaping.