Abstract
BackgroundIn South Korea, a cluster of acute lung disease patients included lung injury disease suspected of being caused by the use of humidifier disinfectants. We examined the relationship between humidifier disinfectant exposure and clinically diagnosed humidifier disinfectant-associated lung injury (HDLI) in a family-based study.MethodsThis case-control study included 169 clinically confirmed HDLI cases and 303 family controls who lived with the HDLI patients. A range of information on exposure to humidifier disinfectants was obtained using a structured questionnaire and field investigations. Odds ratios (ORs) and confidence intervals (CIs) were estimated using unconditional logistic regression models that were adjusted for age, sex, presence of a factory within 1 km of residence, and the number of household chemical products used.ResultsHDLI risk increased approximately two-fold or more among the highest quartile compared with the lowest quartile in terms of the hours sleeping in a room with an operating humidifier treated with disinfectant (adjusted OR = 2.0, 95 % CI = 1.1-3.7), average hours of disinfectant-treated humidifier use per day (adjusted OR = 2.1, 95 % CI = 1.0-4.5), airborne disinfectant intensity (adjusted OR = 2.6, 95% CI = 1.2-5.3), and cumulative disinfectant inhalation level (adjusted OR = 2.0, 95% CI = 1.0-4.1). HDLI risk increased as the distance of the bed from humidifier gets shorter; compared with longer distance (> 1 m), the odds ratio was 2.7 for 0.5 to 1 m (95 % CI = 1.5-5.1) and 13.2 for <0.5 m (95 % CI = 2.4-73.0).ConclusionsThe use of household humidifier disinfectants was associated with HDLI risk in a dose-response manner.
Highlights
Several types of disinfectants were used to prevent microbial contamination in humidifiers in South Korea from 1994, but their use has been banned since 2011 due to the occurrence of a series of cases diagnosed with humidifier disinfectant-associated lung injury (HDLI) [1]
humidifier disinfectantassociated lung injury (HDLI) risk increased approximately two-fold or more among the highest quartile compared with the lowest quartile in terms of the hours sleeping in a room with an operating humidifier
The Risk of Lung Injury Due to Household Humidifier Disinfectants treated with disinfectant, average hours of disinfectant-treated humidifier use per day, airborne disinfectant intensity, and cumulative disinfectant inhalation level
Summary
Several types of disinfectants were used to prevent microbial contamination in humidifiers in South Korea from 1994, but their use has been banned since 2011 due to the occurrence of a series of cases diagnosed with humidifier disinfectant-associated lung injury (HDLI) [1]. More than ten humidifier disinfectant products featuring several different types of components were marketed in South Korea without toxicological testing for inhalation health effects. PHMG and PGH are well-known disinfectants for the treatment of various medical conditions. They have been classified as nontoxic crystalline compounds for oral intake or skin application [2]. There has been no study reporting inhalation health effects due to the use of disinfectants for humidifier. We examined the relationship between humidifier disinfectant exposure and clinically diagnosed humidifier disinfectantassociated lung injury (HDLI) in a family-based study
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