Title

Humidifier disinfectant-associated children's interstitial lung disease

Authors

Kyung Won Kim, Yonsei University College of Medicine
Kangmo Ahn, SungKyunKwan University, School of Medicine
Hyeon Jong Yang, Soonchunhyang University, College of Medicine
Sooyoung Lee, Ajou University, School of Medicine
June Dong Park, Seoul National University College of Medicine
Woo Kyung Kim, Inje University Paik Hospital
Jin Tack Kim, The Catholic University of Korea
Hyun Hee Kim, The Catholic University of Korea
Yeong Ho Rha, Kyung Hee University
Yong Mean Park, Konkuk University, College of Medicine
Myung Hyun Sohn, Yonsei University College of Medicine
Jae Won Oh, Hanyang University Guri Hospital
Hae Ran Lee, Hallym University, College of Medicine
Dae Hyun Lim, Inha University, College of Medicine
Ji Tae Choung, Korea University
Man Yong Han, College of Medicine, Pochon CHA University
Eun Lee, University of Ulsan, College of Medicine
Hyung Young Kim, Kosin University, College of Medicine
Ju Hee Seo, Korea Cancer Center Hospital
Byoung Ju Kim, Inje University Paik Hospital
Young Ah Cho, University of Ulsan, College of Medicine
Kyung Hyun Do, University of Ulsan, College of Medicine
Sun A. Kim, University of Ulsan, College of Medicine
Se Jin Jang, University of Ulsan, College of Medicine
Moo Song Lee, University of Ulsan, College of Medicine
Hwa Jung Kim, University of Ulsan, College of Medicine
Geun Yong Kwon, Division of Epidemic Intelligence Service
Ji Hyuk Park, Division of Epidemic Intelligence Service
Jin Gwack, Division of Epidemic Intelligence Service
Seung Ki Youn, Division of Epidemic Intelligence Service
Jun Wook Kwon, Korea Centers for Infectious Disease Control
Byung Yool Jun, Korea Centers for Disease Control & Prevention
Bok Yang Pyun, Soonchunhyang University, College of Medicine

Document Type

Journal Article

Publication Date

1-1-2014

Journal

American Journal of Respiratory and Critical Care Medicine

Volume

189

Issue

1

DOI

10.1164/rccm.201306-1088OC

Keywords

Child; Disinfectant; Interstitial lung disease

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. Copyright © 2014 by the American Thoracic Society.

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