Some Hawaii island residents were showing early signs of respiratory illness over the weekend as the lava from Kilauea Volcano expanded its footprint in the Leilani Estates subdivision.

State Sen. Josh Green (D, Kona-­Kau), an emergency room physician, said he treated area residents who were experiencing the effects from vog that blew through a Pahoa shelter as the wind shifted in that direction. Symptoms included thick mucus, heavy cough and burning in the lungs, throat and nose. Some with underlying lung disease even needed to use inhalers, and at least one elderly woman needed an oxygen tank, he said.

“It’s very volatile because when I was holding a sulfur dioxide monitor just upwind 4 to 6 feet from (the lava), it barely registered. But when the wind shifted our direction, we saw immediate spikes to dangerous levels of sulfur dioxide,” said Green, one of the medical volunteers who monitored sulfur dioxide levels along with the Fire Department. “Sulfur dioxide is a serious health threat. When it gets up in the air and if the wind shifts to where people are staying, it can be a serious concern. It is necessary for us to make sure everybody is protected from it, but especially people with chronic lung disease and the young and old.”

The state Health Department warned residents this week that commercial masks sold in stores do not protect against “extremely dangerous gases released from the volcanic eruption.” The gases consist of several different chemicals, dust and particles that include sulfur dioxide.

The state is imploring people to leave areas with volcanic activity, especially residents with asthma or other respiratory illnesses. However, as of Sunday there were 75 to 100 residents holding out in Leilani Estates, according to Green, who treated about 50 to 60 patients for various conditions.

Green said he saw an elderly man sitting on his second-floor lanai just 200 meters away from the lava flow.

“With the active eruption they are at an extreme risk of respiratory injury if (sulfur dioxide) spikes occur near them,” he said. “Extended exposure at high … levels can cause respiratory distress and even fatalities. People need to be very mindful. It’s why we really feel strongly that no one should try to hold out in Leilani Estates.”

He said some of the 250 people in shelters and another 250 in the parking lots living in vans and trucks will likely need a free-standing medical clinic or medical van, which state officials are considering.

“The long-term consequences are not just pulmonary. I also saw many patients who were traumatized psychologically. I treated as much anxiety, depression and mental illness people had already as I did lung disease,” he said. “There needs to be a lot of psychological support. Many people lost everything they had — their homes, farms and pets.”