Humidifier disinfectant-associated children's interstitial lung disease

Kyung Won Kim, Kangmo Ahn, Hyeon Jong Yang, Sooyoung Lee, June Dong Park, Woo Kyung Kim, Jin Tack Kim, Hyun Hee Kim, Yeong Ho Rha, Yong Mean Park, Myung Hyun Sohn, Jae Won Oh, Hae Ran Lee, Dae Hyun Lim, Ji-Tae Choung, Man Yong Han, Eun Lee, Hyung Young Kim, Ju Hee Seo, Byoung Ju Kim & 14 others Young Ah Cho, Kyung Hyun Do, Sun A. Kim, Se Jin Jang, Moo Song Lee, Hwa Jung Kim, Geun Yong Kwon, Ji Hyuk Park, Jin Gwack, Seung Ki Youn, Jun Wook Kwon, Byung Yool Jun, Bok Yang Pyun, Soo Jong Hong

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Rationale: Beginning in 2006, epidemics of a fatal lung injury of unknown cause in children were observed in Korea every spring. A recent study demonstrated that this type of children's interstitial lung disease (chILD) is associated with humidifier disinfectant use. Objectives: To determine the clinical characteristics of this type of chILD and to assess whether the nationwide suspension of humidifier disinfectant sales in the autumn of 2011 affected its incidence. Methods: The clinical characteristics of suspected cases between 2006 and 2011 were determined by a nationwide retrospective study. The potential causal relationship with humidifier disinfectants was examined by a prospective surveillance study after humidifier disinfectant sales were suspended. Measurements and Main Results: In total, 138 children were diagnosed with this type of chILD, which was characterized by rapid progression, high mortality, predominance in the spring season, and a familial tendency. The annual incidence increased in 2011 and then dropped to zero in 2012. The children were on average 30.4 months old. The most frequent symptoms at admission were cough and dyspnea. As the disease progressed, the typical complication was spontaneous air leak. Eighty children (58%) died. Two years after humidifier disinfectant-sale suspension, no more new cases were found. Conclusions: This study suggests that humidifier disinfectant inhalation causes an idiopathic type of chILD that is characterized by spontaneous air leak, rapid progression, lack of response to treatment, and high mortality. Further safety studies must be performed on common environmental compounds, particularly those that enter the human body by an unusual route.

Original languageEnglish
Pages (from-to)48-56
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume189
Issue number1
DOIs
Publication statusPublished - 2014 Jan 1

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Disinfectants
Interstitial Lung Diseases
Suspensions
Air
Mortality
Humidifiers
Incidence
Lung Injury
Korea
Human Body
Cough
Dyspnea
Inhalation
Retrospective Studies
Prospective Studies
Safety

Keywords

  • Child
  • Disinfectant
  • Interstitial lung disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Humidifier disinfectant-associated children's interstitial lung disease. / Kim, Kyung Won; Ahn, Kangmo; Yang, Hyeon Jong; Lee, Sooyoung; Park, June Dong; Kim, Woo Kyung; Kim, Jin Tack; Kim, Hyun Hee; Rha, Yeong Ho; Park, Yong Mean; Sohn, Myung Hyun; Oh, Jae Won; Lee, Hae Ran; Lim, Dae Hyun; Choung, Ji-Tae; Han, Man Yong; Lee, Eun; Kim, Hyung Young; Seo, Ju Hee; Kim, Byoung Ju; Cho, Young Ah; Do, Kyung Hyun; Kim, Sun A.; Jang, Se Jin; Lee, Moo Song; Kim, Hwa Jung; Kwon, Geun Yong; Park, Ji Hyuk; Gwack, Jin; Youn, Seung Ki; Kwon, Jun Wook; Jun, Byung Yool; Pyun, Bok Yang; Hong, Soo Jong.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 189, No. 1, 01.01.2014, p. 48-56.

Research output: Contribution to journalArticle

Kim, KW, Ahn, K, Yang, HJ, Lee, S, Park, JD, Kim, WK, Kim, JT, Kim, HH, Rha, YH, Park, YM, Sohn, MH, Oh, JW, Lee, HR, Lim, DH, Choung, J-T, Han, MY, Lee, E, Kim, HY, Seo, JH, Kim, BJ, Cho, YA, Do, KH, Kim, SA, Jang, SJ, Lee, MS, Kim, HJ, Kwon, GY, Park, JH, Gwack, J, Youn, SK, Kwon, JW, Jun, BY, Pyun, BY & Hong, SJ 2014, 'Humidifier disinfectant-associated children's interstitial lung disease', American Journal of Respiratory and Critical Care Medicine, vol. 189, no. 1, pp. 48-56. https://doi.org/10.1164/rccm.201306-1088OC
Kim, Kyung Won ; Ahn, Kangmo ; Yang, Hyeon Jong ; Lee, Sooyoung ; Park, June Dong ; Kim, Woo Kyung ; Kim, Jin Tack ; Kim, Hyun Hee ; Rha, Yeong Ho ; Park, Yong Mean ; Sohn, Myung Hyun ; Oh, Jae Won ; Lee, Hae Ran ; Lim, Dae Hyun ; Choung, Ji-Tae ; Han, Man Yong ; Lee, Eun ; Kim, Hyung Young ; Seo, Ju Hee ; Kim, Byoung Ju ; Cho, Young Ah ; Do, Kyung Hyun ; Kim, Sun A. ; Jang, Se Jin ; Lee, Moo Song ; Kim, Hwa Jung ; Kwon, Geun Yong ; Park, Ji Hyuk ; Gwack, Jin ; Youn, Seung Ki ; Kwon, Jun Wook ; Jun, Byung Yool ; Pyun, Bok Yang ; Hong, Soo Jong. / Humidifier disinfectant-associated children's interstitial lung disease. In: American Journal of Respiratory and Critical Care Medicine. 2014 ; Vol. 189, No. 1. pp. 48-56.
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AU - Kim, Kyung Won

AU - Ahn, Kangmo

AU - Yang, Hyeon Jong

AU - Lee, Sooyoung

AU - Park, June Dong

AU - Kim, Woo Kyung

AU - Kim, Jin Tack

AU - Kim, Hyun Hee

AU - Rha, Yeong Ho

AU - Park, Yong Mean

AU - Sohn, Myung Hyun

AU - Oh, Jae Won

AU - Lee, Hae Ran

AU - Lim, Dae Hyun

AU - Choung, Ji-Tae

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AU - Seo, Ju Hee

AU - Kim, Byoung Ju

AU - Cho, Young Ah

AU - Do, Kyung Hyun

AU - Kim, Sun A.

AU - Jang, Se Jin

AU - Lee, Moo Song

AU - Kim, Hwa Jung

AU - Kwon, Geun Yong

AU - Park, Ji Hyuk

AU - Gwack, Jin

AU - Youn, Seung Ki

AU - Kwon, Jun Wook

AU - Jun, Byung Yool

AU - Pyun, Bok Yang

AU - Hong, Soo Jong

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N2 - Rationale: Beginning in 2006, epidemics of a fatal lung injury of unknown cause in children were observed in Korea every spring. A recent study demonstrated that this type of children's interstitial lung disease (chILD) is associated with humidifier disinfectant use. Objectives: To determine the clinical characteristics of this type of chILD and to assess whether the nationwide suspension of humidifier disinfectant sales in the autumn of 2011 affected its incidence. Methods: The clinical characteristics of suspected cases between 2006 and 2011 were determined by a nationwide retrospective study. The potential causal relationship with humidifier disinfectants was examined by a prospective surveillance study after humidifier disinfectant sales were suspended. Measurements and Main Results: In total, 138 children were diagnosed with this type of chILD, which was characterized by rapid progression, high mortality, predominance in the spring season, and a familial tendency. The annual incidence increased in 2011 and then dropped to zero in 2012. The children were on average 30.4 months old. The most frequent symptoms at admission were cough and dyspnea. As the disease progressed, the typical complication was spontaneous air leak. Eighty children (58%) died. Two years after humidifier disinfectant-sale suspension, no more new cases were found. Conclusions: This study suggests that humidifier disinfectant inhalation causes an idiopathic type of chILD that is characterized by spontaneous air leak, rapid progression, lack of response to treatment, and high mortality. Further safety studies must be performed on common environmental compounds, particularly those that enter the human body by an unusual route.

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