Publisher : Korean Society of Environmental Health
DOI : 10.5668/JEHS.2016.42.3.147
Title & Authors
Characteristics of Exposure to Humidifier Disinfectant by Lung Injury Patients Park, Dong-Uk; Ryu, Seung-Hun; Lim, Heung-Kyu; Kim, Sun-Kyung; Ahn, Jongju; Roh, Hyun-Suk; Choi, Ye-Yong; Cha, Won-Seok; Lee, Eun; Hong, Sang-Bum; Do, Kyung-Hyun; Cho, Jae-lim; Bae, Mun-Joo; Shin, Dong-Chun; Paek, Domyung; Hong, Soo-Jong;
In South Korea, many cases of humidifier disinfectant-associated lung injury (HDLI) have been reported among people who used humidifier products containing humidifier disinfectant (HD). The objective of this study is to characterize exposure to HD among a total of 221 HDLI patients who used HD. Information and data on the HDs used were collected through a structured questionnaire and home environmental investigations. The conditions of these 221 HDLI patients were clinically confirmed to be caused by the use of HD. Children aged under 5 years old made up the highest proportion of HDLI cases (n=125, 56.6 %), followed by pregnant women (n=35, 15.8%). Forty-three percent (n=95) of the victims died. There were three cases of fetuses and 35 pregnant women among the victims. The number of HDLI patients who used only the Oxy Saksak brand of HD was found to be 85 (38.5%), followed by the HD brands Cefu (n=24, 10.9%), Lottemart Wiselect (n=9, 4.1%) and Aekyung (n=3). Patients who exclusively used HD brands containing polyhexamethylene guanidine phosphate (PHMG) (n=13, 55.7%) as an active ingredient made up the largest share, followed by those who exclusively used HD containing only oligo(2-(2-ethoxy) ethoxyethyl guanidinium (PGH) (n=24, 10.9%) and by those who only used a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) (n=3, 1.4%). HD products containing PHMG were found to be the most commonly used among the confirmed HDLI patients. Three exposed fetuses who never used HD after birth developed lung injuries, indicating a probability of exposure to HD during gestation. All HDLI patients responded that they used HD while sleeping and for longer than 10 hours per day. In conclusion, the development of HDLI was clinically found to be associated with the use of several HD products containing PHMG, PGH and CMIT/MIT.
Korea Center for Disease Control and Prevention (KCDC). 1st Study on the relationship between the use of humidifier disinfectant and lung injury; 2014. p.6-9.
Korea Environmental Protection Agency. 2nd Study on the relationship between the use of humidifier disinfectant and lung injury. 1st ed. 2015.
Asian Citizen's Center for Environment and Health, Report on the diaster by the use of humidfier disinfectatnt; 2016.
Park DU, Choi YY, Ahn JJ, Lim HK, Kim SK, Roh HS, et al. Relationship between Exposure to Household Humidifier Disinfectants and Risk of Lung Injury: A Family-Based Study. PloS one. 2015; 10(5): e0124610.
Park DU, Friesen MC, Roh HS, Choi YY, Ahn JJ, Lim HK, et al. Estimating retrospective exposure of household humidifier disinfectants. Indoor air. 2015; 25(6): 631-640.
KCDC(Korea Center for Disease Control and Prevention). Analytical results of the chemical components of various humidifier disinfectant brands from KCDC's parliamentary inspection. Department of epidemiology research, Korea Center for Disease Control and Prevention; 2011.
Jeon CK, Jin HS, Kang EK, Kim HB, Kim BJ, et al. Epidemic acute interstitial pneumonia in children occurred during the early 2006s. Korean journal of pediatrics. 2008; 51(4): 383-390.
EPA. Use and Care of Home Humidifiers. Indoor Air Facts, No.8. Research and Development; 1991.
Yang HJ, Kim HJ, Yu J, Lee E, Jung YH, Kim HY, et al. Inhalation toxicity of humidifier disinfectants as a risk factor of children's interstitial lung disease in Korea: a case-control study. PloS one. 2013; 8(6): e64430.
Kim KW, Ahn K, Yang HJ, Lee S, Park JD, Kim WK, et al. Humidifier disinfectant-associated children's interstitial lung disease. American journal of respiratory and critical care medicine. 2014; 189(1): 48-56.
Kim HJ, Lee MS, Hong SB, Huh JW, Do KH, Jang SJ, et al. A cluster of lung injury cases associated with home humidifier use: an epidemiological investigation. Thorax. 2014; 69(8): 703-708.
Park D, Leem J, Lee K, Lim H, Choi Y, Ahn JJ, et al. Exposure characteristics of familial cases of lung injury associated with the use of humidifier disinfectants. Environmental health : a global access science source. 2014; 13(1): 70.
Park DU, Ryu SH, Lim HK, Kim SK, Roh HS, et al., Estimation of humidifier disinfectant amounts absorbed into the respiratory system. Submission. Korea Society for Environmental Health. 2016; 42(3): 141-146.
Ng CK, Tay P. Two case reports of delayed skin burns from methylisothiazolines used in water treatment. Singapore medical journal. 1996; 37(6): 577-578.
Primka EJ, 3rd, Taylor JS. Three cases of contact allergy after chemical burns from methylchloroisothiazolinone/methylisothiazolinone: one with concomitant allergy to methyldibromoglutaronitrile/phenoxyethanol. American journal of contact dermatitis : official journal of the American Contact Dermatitis Society. 1997; 8(1): 43-46.
Eurupean Chemicals Agency(ECHA). Comments and Response to Comments on CLH: Proposal and Justification. Available: http://echa.europa.eu/documents/10162/13626/clh_comment_cmit_en.pdf [accessed 22 May 2016].
Institute for Occupational Safety and Health(IFA), GESTIS Substance Database. Available: http://gestis-en.itrust.de/nxt/gateway.dll?f=templates$fn=default.htm$vid=gestiseng:sdbeng$3.0 [accessed 22 May 2016].