Humidifier disinfectant-associated lung injury in adults: Prognostic factors in predicting short-term outcome

Koo, Hyun Jung; Do, Kyung-Hyun; Chae, Eun Jin; Kim, Hwa Jung; Song, Joon Seon; Jang, Se Jin; Hong, Sang‐Bum; Huh, Jin Won; Lee, En; Hong, Soo‐Jong

doi:10.1007/s00330-016-4367-6

Cited by 13 publications

(11 citation statements)

References 21 publications

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“…In previous studies, exudates ll the alveolar air space as well as the peribronchial bro-in ammatory lesions in both early and chronic stages in pediatric patients [25]. In adult patients, extensive brosis was also noted in the chronic stage [5]. However, in the previous study, they did not analyze pathologic ndings which correlated with CT ndings in all patients.…”

Section: Discussionmentioning

confidence: 87%

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Polyhexamethylene Guanidine-induced Lung Injuries and Tumorigenesis in a Rat Model: Radiologic Evaluation With Pathologic Correlation and RNA Sequencing

Kim

Jeong

Lee

et al. 2020

Preprint

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Background: Polyhexamethylene guanidine phosphate (PHMG) is was used as humidifier disinfectants. We aimed to evaluate PHMG-induced lung injuries and their chronological changesin a rat model using chest CT with pathologic correlation, to determine whether PHMG exposure causes lung tumors, and to explore genetic alterations according to PHMG exposure under the guidance of CT.Methods: A PHMG solution was intratracheally administrated to 40 male rats. Chest CT was carried out in all rats and both lungs were collected for histopathologic evaluation. At 4 weeks after instillation, one lobe of the right lung from 3 rats was subjected to RNA sequencing.Results: At least one abnormal CT finding was found in all rats at all weeks. The major CT findings were inflammation, fibrosis, and tumors in the pathologic analysis, where significant changes were observed over time.The lung lesions remained persistent after 8 weeks of PHMG exposure. In the pathologic analysis, the extent/severity of inflammation did not show statistically significant changes over time, whereas the extent/severity of fibrosis increased continuously up to 6 weeks after PHMG exposure and then decreased significantly at 8 weeks. Bronchiolar-alveolar adenomas which have malignant potential were found in 50% of rats at 6 and 8 weeks after PHMG exposure. Also, several genes associated with lung cancer, acute lung injury, and pulmonary fibrosis were detected.Conclusions: PHMG-induced lung injury and its changes according to the number of weeks after exposure were demonstrated using chest CT and pathologic evaluation. In addition, we showed that PHMG exposure caused lung tumors and genetic alterations according toPHMG exposure under the guidance of CT.

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Section: Discussionmentioning

confidence: 87%

“…In previous studies, chest CT analysis and pathologic correlations of humidi er disinfectant-associated lung disease were performed in both children and adults [4,5]. However, in these studies, only patients who had rapidly progressive respiratory distress for several days or weeks were included.…”

Section: Introductionmentioning

confidence: 99%

Polyhexamethylene Guanidine-induced Lung Injuries and Tumorigenesis in a Rat Model: Radiologic Evaluation With Pathologic Correlation and RNA Sequencing

Kim

Jeong

Lee

et al. 2020

Preprint

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“…As of 2016, a total of six case series reports detailing the clinical, radiological and pathological patterns of lung injury and its prognosis have been published [6-11]. Five epidemiological studies generating estimates on the association of lung injury with HDs have been published (Table 1) [12-16].…”

Section: Resultsmentioning

confidence: 99%

Evaluation report on the causal association between humidifier disinfectants and lung injury

Lee

Hwang

et al. 2016

Epidemiol Health

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OBJECTIVESAs of November 2011, the Korean government recalled and banned humidifier disinfectants (HDs) from the market, because four case-control studies and one retrospective epidemiological study proved the association between HDs and lung injury of unknown cause. The report reviewed the causal role of HDs in lung injury based on scientific evidences.METHODSA careful examination on the association between the HDs and lung injury was based on the criteria of causality inference by Hill and the US Surgeon General Expert Committee.RESULTSWe found that all the evidences on the causality fulfilled the criteria (strength of association, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, analogy, consideration of alternative explanations, and cessation of exposure), which proved the unknown cause lung injury reported in 2011 was caused by the HDs. In particular, there was no single reported case of lung injury since the ban in selling HDs in November 2011 as well as before the HDs were sold in markets.CONCLUSIONSAlthough only a few epidemiological studies in Korea have evaluated the association between lung injury and the use of HDs, those studies contributed to proving the strong association between the use of the HDs and lung injury, based on scientific evidence.

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“…and E.J.C.) reviewed all HRCT images at the lung (window width, 1,500 Hounsfield unit [HU]; level, −700 HU) and mediastinal window (width, 450 HU; level, 50 HU) settings (5). The consolidation extent, ground-glass opacity, and centrilobular nodules were categorized in 10th-percentile intervals (Fig.…”

Section: Clinical Coursementioning

confidence: 99%

Inhalation Lung Injury Associated with Humidifier Disinfectants in Adults

et al. 2016

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We recently established a novel disease entity presented as progressive respiratory failure associated with the inhalation of humidifier disinfectants. In April 2011, we encountered a series of peripartum patients with complaints of respiratory distress of unknown etiology, which was an uncommon phenomenon. Accordingly, we created a multidisciplinary team comprising intensivists, radiologists, pathologists, epidemiologists, and the Korea Centers for Disease Control and Prevention (KCDC). Further, we defined the disease entity and performed a case-control study, epidemiologic investigation, and animal study to determine the etiology. The study findings indicated that the lung injury outbreak was related to the inhalation of humidifier disinfectants and showed that household chemical inhalation can cause severe respiratory failure. Following the withdrawal of humidifier disinfectants from the Korean market in 2012, no such cases were reported. This tragic event is a warning that appropriate safety regulations and monitoring for potential toxic household chemicals are critical to protect public health.

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Humidifier disinfectant-associated lung injury in adults: Prognostic factors in predicting short-term outcome

Cited by 13 publications

References 21 publications

Polyhexamethylene Guanidine-induced Lung Injuries and Tumorigenesis in a Rat Model: Radiologic Evaluation With Pathologic Correlation and RNA Sequencing

Polyhexamethylene Guanidine-induced Lung Injuries and Tumorigenesis in a Rat Model: Radiologic Evaluation With Pathologic Correlation and RNA Sequencing

Evaluation report on the causal association between humidifier disinfectants and lung injury

Inhalation Lung Injury Associated with Humidifier Disinfectants in Adults

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