More than 20 people have been hospitalized across the midwestern United States due to severe breathing problems linked to vaping.

The hospitalizations occurred to individuals in three different states: four in Minnesota, 12 in Wisconsin and six in Illinois.

The exact reasons for the illnesses aren’t yet clear. Doctors are still determining what devices were used, where they were purchased, or what was in them. But many of the patients were apparently young adults–little surprise given the popularity of e-cigarettes like Juul. And some were vaping both nicotine and THC.

“We know there are certain characteristics in common with these cases, but we have not been able to get to the bottom of exactly what aspect of the vaping habit or product or solvent or oil is causing the injury,” Dr. Emily Chapman, chief medical officer for Children’s Minnesota, a pediatric health system headquartered in Minneapolis, told NBC News. 

Chapman said that the four teenaged patients who were admitted to Children’s Minnesota were originally diagnosed as having a respiratory infection like pneumonia, but that they got worse when given treatment.

“They have progressed to have significant difficulty with their breathing and increasing lung distress,” Chapman told NBC. “They’ve ended up

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