Humidifier disinfectant lung injury, how do we approach the issues?

Abstract

A large portion of the Korean population has been exposed to toxic humidifier disinfectants (HDs), and considering that the majority of the victims are infants, the magnitude of the damage is expected to be considerably larger than what has currently been revealed. The current victims are voicing problems caused by various diseases, including but not limited to lung, upper respiratory tract, cardiovascular, kidney, musculoskeletal, eye, and skin diseases, etc. However, there has been difficulty in gaining validation for these health problems and identifying causal relationships due to lack of evidence proving that toxic HD is the specific causes of extrapulmonary diseases such as allergic rhinitis. Furthermore, the victims and bereaved families of the HD case have not received any support for psychological distress such as post-traumatic stress disorder, depression, feelings of injustice, and anger caused by the trauma. In addition, because the underlying mechanisms of the toxic materials within the HDs such as polyhexamethylene guanidine phosphate, poly(oxyalkylene guanidine) hydrochloride, chloromethylisothiazolinone/methylisothiazolinone have yet to be determined, the demand for information regarding the HD issue is growing. The victims of the HD cases require support that goes beyond financial aid for medical costs and living expenses. There is a desperate need for government-led integrated support centers that provide individualized support through health screenings; in other words, we need an integrated facility that provides the appropriate social support to allow the victims to recover their physical and mental health, so as to well prepare them to return to a normal life. The implementation of such a plan requires not only the close cooperation between those departments already directly involved such as the Ministry of Environment and the Ministry of Health and Welfare, but also active support on a national scale from pan-governmental consultative bodies.

Cognitive Emotion Regulation Strategies and Insomnia or Other Psychiatric Symptoms among Humidifier Disinfectant Victims

“…Forty subjects (13 males and 27 females) with mean age of 40.3 ± 6.3 years (range, 28-62 years) were included in this study (Table 1). The likelihood of their HDLI was classified by a referral to archetypal confirmed cases as follows: definite (n = 16), probable (n = 10), possible (n = 10), and unlikely (n = 4) according to the classification criteria of the Health Environmental Center of Asan Medical Center [22]. Three subjects underwent lung transplantation after lung injury.…”

“…We were unaware and unprepared to evaluate these victims, support them psychologically, and manage their coping strategy at the beginning. Henceforth, we should design a system to support these victims [22].…”

Characteristics of a new respiratory syndrome associated with the use of a humidifier disinfectant: humidifier disinfectant-related respiratory syndrome (HDRS)

“…nation of the HD-relatedness of lung diseases, these criteria focused on rapidly progressive damage and severe interstitial lung disease with interstitial fibrosis on the terminal bronchioles and alveoli that can be differentiated from other interstitial lung diseases, such as acute interstitial pneumonia and hypersensitivity pneumonitis (HP). However, these criteria are likely too restrictive to cover the whole spectrum of HD-related respiratory symptoms, which likely include mild or atypical forms of interstitial lung disease and lung parenchymal diseases other than interstitial lung diseases, or upper airway injuries [12]. The authors examined the clinical features of family members of patients with definite or probable HDLI (referred to as index cases) to clarify the whole spectrum of respiratory symptoms and signs related to exposure to HD.…”

“…The aerosol form of PHMG (nano-sized PHMG) that is released by humidifiers can penetrate and accumulate deep in the lungs [10]. The analysis of the pathological, radiological and clinical features of HDLI cases, and lung histopathology of HD-exposed experimental animals, led to the refinement of the diagnostic criteria for HDLI in 2013 [11,12] (Tables 1 and 2). In the determi-carbon monoxide was reduced in 9 of 12 children (data not available for 1 child), and in 4 of 5 adults (data not available for 6 adults).…”

“…Classification of injuries in patients with different levels of humidifier disinfectant-related lung injury (HDLI)[12] …”