Humidifier Disinfectant Consumption and Humidifier Disinfectant-Associated Lung Injury in South Korea: A Nationwide Population-Based Study

Jeonggyo Yoon,Min Jae Ju,Yoon-Hyeong Choi,Jaehun Jung,Wonho Yang,Sung Hwan Jeong,Minsun Kang

doi:10.3390/ijerph18116136

Abstract

Humidifier disinfectant (HD) is a household biocidal product used in humidifier water tanks to prevent the growth of microorganisms. In 2011, a series of lung injury cases of unknown causes emerged in children and pregnant women who had used HD in Korea. This study investigated changes in the nationwide number of cases of humidifier disinfectant-associated lung injury (HDLI) in concordance with nationwide HD consumption using data covering the entire Korean population. More than 25 kinds of HD products were sold between 1994 and 2011. The number of diagnosed HDLI, assessed by S27.3 (other injuries of lungs) of the Korea National Health Insurance Service (NHIS) data, sharply increased by 2005, subsequently decreased after 2005, and almost disappeared after 2011 in concordance with the annual number of HD sales. The number of self-reported HDLIs, assessed using data from all suspected HDLI cases registered in the Korea Ministry of Environment, changed with the annual number of HD sales, with a delay pattern, potentially induced by the late awareness of lung injury diseases. The present study suggests that changes in the nationwide annual consumption of HD products were consistent with changes in the annual number of HDLI cases in Korea.

Highlights

In the spring of 2011, a series of lung injury cases of unknown cause emerged inSouth Korea, identified by their association with the use of household chemicals, namely humidifier disinfectant (HD) [1,2]
The major chemical ingredients used as HDs are polyhexamethylene guanidine (PHMG), chloromethylisothiazolinone/methylisothiazolinone (CMIT/MIT), and oligo-(2-(2-ethoxy)ethoxyethyl) guanidine chloride (PGH), major chemicals may differ depending on the product [4,5,6]
HD sales, we evaluated the nationwide annual incidence of (1) diagnosed humidifier disinfectant-associated lung injury (HDLI) cases, which was recorded in the Korea National Health Insurance Service (NHIS) database, which covers the entire Korean population, and (2) self-reported HDLI cases using the exposure assessment database of all suspected cases registered in the Korea Ministry of Environment

Summary

Introduction

In the spring of 2011, a series of lung injury cases of unknown cause emerged in. South Korea, identified by their association with the use of household chemicals, namely humidifier disinfectant (HD) [1,2]. A total of 4114 people with HD-associated diseases (e.g., lung disease, asthma, and pneumonia), including 997 deaths, have been reported [3], which is known to be one of the worst environmental catastrophes to ever have occurred in Korea. HD is a biocidal product used in humidifier water tanks to prevent the growth of microorganisms, harmful bacteria, mold, and white dust. The major chemical ingredients used as HDs are polyhexamethylene guanidine (PHMG), chloromethylisothiazolinone/methylisothiazolinone (CMIT/MIT), and oligo-(2-(2-ethoxy)ethoxyethyl) guanidine chloride (PGH), major chemicals may differ depending on the product [4,5,6].

Methods

Results

Conclusion