Exposure characteristics of familial cases of lung injury associated with the use of humidifier disinfectants.

Donguk Park,Kyoungmu Lee,Jongsik Ha,Domyung Paek,Kyungho Choi,Yeyong Choi,Jong-Ju Ahn,Jeongim Park,Naroo Lee,Jonghan Leem,Heungkyu Lim,Sinye Lim,Hyejung Jung

doi:10.1186/1476-069x-13-70

Abstract

BackgroundThis study describes 17 families with 38 lung injury patients (14 males, 24 females; 22 preschool-age children less than six years of age and 16 individuals of 13–50 years) who used disinfectant added to humidifiers in the home.MethodsClinical examination and humidifier disinfectant-use histories were taken, and a thorough home investigation was performed to assess exposure to humidifier disinfectant.ResultsNine of the patients (three pregnant females, six preschool-age children) died soon after they first developed lung damage. Six (16%) were pregnant females and 22 (58%) were preschool-aged children younger than six years. The patients used humidifier disinfectant products containing either polyhexamethylene guanidine phosphate (PHMG, n = 36) or oligo(2-(2-ethoxy)ethoxyethyl guanidinium chloride (PGH, n = 2). Twenty-six patients (68%) used the brand "Oxy"®, which contains PHMG. Of the ten patients with fatal lung injury, nine were found to have used PHMG.ConclusionsOur findings suggest that the use of humidifier disinfectant products containing either PGH or PHMG can cause lung injury, especially in preschool-age children younger than six years and pregnant women.

Highlights

This study describes 17 families with 38 lung injury patients (14 males, 24 females; 22 preschool-age children less than six years of age and 16 individuals of 13–50 years) who used disinfectant added to humidifiers in the home
The objective of this study is to describe the characteristics of humidifier disinfectant exposures among selfreported lung injury patients
Among all pulmonary diseases that may have been related to the use of humidifier disinfectant (n = 95), we selected 38 lung injury patients from the 17 families including a minimum of two lung injury patients in order to focus on cases with a greater possibility for the lung injury symptoms to have been caused by humidifier disinfectant

Summary

Introduction

This study describes 17 families with 38 lung injury patients (14 males, 24 females; 22 preschool-age children less than six years of age and 16 individuals of 13–50 years) who used disinfectant added to humidifiers in the home. Several studies conducted in South Korea have concluded that humidifier disinfectants can cause fatal lung disease including interstitial pneumonitis and wide spread lung fibrosis [3,4,5,6,7]. Two hospital-based case–control studies have reported that the use of humidifier disinfectant was significantly associated with a cluster of interstitial lung disease (unadjusted OR = 47.3, 95% CI = 1.4-5.9) [6] (unadjusted OR = 2.7, 95% CI = 1.4-5.9) [7]. Those studies concluded interstitial lung disease were associated with the use of humidifier disinfectant. Microbiological results concluded that the possibility of an infectious disease was extremely low [3]

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