Humidifier disinfectant and use characteristics associated with lung injury in Korea.

Abstract

Since around the year 2000, hundreds of people in Korea have developed humidifier disinfectant-associated lung injury (HDLI). We collected all HD exposure-related information from the field investigations into the locations in which the 1199 registered patients had used HD. Among the people who registered, 38% (1st round=214, 2nd=73, 3rd=166) were confirmed as HDLI patients. Children aged under eight years old made up the highest proportion of HDLI cases (N=279, 62%), followed by pregnant women (N=31, 7%). One hundred thirty-three (29%) of the confirmed HDLI patients died. Fifty-seven percent of HDLI patients (N=259) developed HDLI after <1year of HD use. The number of HDLI patients who used only the Oxy Saksak HD brand was found to be 176 (39%), followed by the brands Cefu (N=27, 6%) and Aekyung (N=22, 5%). HD products containing only polyhexamethylene guanidine phosphate (PHMG-P) were the most frequently used among HDLI patients (N=234, 52%), followed by oligo (2-(2-ethoxy)ethoxyethyl) guanidinium (PGH) (N=27, 6%) and a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) (N=26, 6%). The average PHMG-P inhalation level estimated from the patient group classified as suffering lung injury definitely associated with HD use was 145.1μg/m3 (N=91, SD=395.1μg/m3 ), higher than levels estimated from both the probable and possible HDLI patient groups. In conclusion, HD exposure-related variables, including type of HD brand and estimated inhalation HD level, were associated with the risk of HDLI.