Lung function in patients with lung injury due to household chemical inhalation: Post hoc analysis of a prospective nationwide cohort

Kim, Youn-Jung; Park, Soonyoung; Kim, Hwa Jung; Chae, Eun Jin; Do, Kyung-Hyun; Huh, Jin Won; Lim, Chae‐Man; Koh, Younsuck; Hong, Sang‐Bum

doi:10.1111/resp.12918

Cited by 6 publications

(9 citation statements)

References 21 publications

(36 reference statements)

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“…Notably, peripheral airway dysfunction in X5 and AX was not related to bronchodilator response in the present study. These results are compatible with prior publications’ results on HDLI addressing small airway involvement on computed tomography (CT) and a restrictive pattern on spirometry in adults [13, 42]. In addition, a previous study showed that bronchiolar destruction and a centrilobular distribution of alveolar destruction following HD exposure were documented by lung biopsy [9].…”

Section: Discussionsupporting

confidence: 92%

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Effects of a mixture of chloromethylisothiazolinone and methylisothiazolinone on peripheral airway dysfunction in children

et al. 2017

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BackgroundChildren who were only exposed to a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) as humidifier disinfectant (HD) components were evaluated for humidifier disinfectant-associated lung injury (HDLI) from 2012. This study was to evaluate the pulmonary function using, impulse oscillometry (IOS) for children exposed to a mixture of CMIT/MIT from HD.MethodsTwenty-four children who were only exposed to a mixture of CMIT/MIT, with no previous underlying disease, were assessed by IOS. Diagnostic criteria for HDLI were categorized as definite, probable, possible, or unlikely. Home visits and administration of a standardized questionnaire were arranged to assess exposure characteristics.ResultsDefinite and probable cases showed higher airborne disinfectant exposure intensity during sleep (32.4 ± 8.7 μg/m3) and younger age at initial exposure (3.5 ± 3.3 months) compared with unlikely cases (17.3 ± 11.0 μg/m3, p = 0.026; 22.5 ± 26.2 months, p = 0.039, respectively). Reactance at 5 Hz was significantly more negative in those with high-density exposure during sleep (mean, -0.463 kPa/L/s vs. low density, -0.296, p = 0.001). The reactance area was also higher with high-density exposure during sleep (mean, 3.240 kPa/L vs. low density, 1.922, p = 0.039). The mean bronchodilator response with high-density exposure was within the normal range for reactance.ConclusionsSignificant peripheral airway dysfunction were found in children with high levels of inhalation exposure to a mixture of CMIT/MIT during sleep. Strict regulation of a mixture of CMIT/MIT exposure were associated with positive effects on lung function of children.

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Section: Discussionsupporting

confidence: 92%

“…However, adult cases of all HDLI, regardless of the strand of HD, had only a restrictive pattern on spirometry [13, 42]. Restrictive lung diseases will result in a decrease in reactance because the elastic recoil, and therefore the ability of the lung parenchyma to reflect the signal back, will be decreased [29].…”

Section: Discussionmentioning

confidence: 99%

Effects of a mixture of chloromethylisothiazolinone and methylisothiazolinone on peripheral airway dysfunction in children

et al. 2017

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“…Many chemical airborne exposures are associated with a decrement in lung function in adults, including in cases of large man-made disasters, such as the 1984 Bhopal Union Carbide methyl isocyanate gas release, the 2005 chlorine gas release from the Graniteville train accident, and current 2006 epidemic HD exposure (Additional file 1: Table S1). HD inhalation causing HDLI has been found to be characterized by restrictive lung defect in adults [10, 11]. Despite the associations observed in HDLI adults, the potential effects and the long-term consequences of HDLI children on lung function have not been explored, although children’s lungs are more susceptible to airborne exposures than those of adults [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Early-life exposure to humidifier disinfectant determines the prognosis of lung function in children

et al. 2019

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BackgroundUse of humidifier disinfectants (HD) at home leads to chemical airborne exposure, causing HD associated lung injury (HDLI) with high mortality. However, the lung function in children diagnosed with HDLI is not well studied. We investigated the effect of HD exposure on lung function, prognosis, and exposure characteristics associated with the lung function phenotype in children.MethodsEighty-one children diagnosed with HDLI in a nationwide cohort were tested for spirometry and diffusing capacity of the lung for carbon monoxide (DLco) from July 2013 and followed up with at five time points over 2 years. The results were compared with 122 children without HD exposure as controls. Home investigation and questionnaire analysis were conducted to assess HD inhalation exposure.ResultsHDLI survivor’s mean percent of predicted forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and corrected DLco were significantly lower compared with the control group. On longitudinal assessment, FVC was within the normal range, but flattened, and spirometry showed a predominantly restrictive pattern. Corrected DLco did not normalize above 80% despite increasing age. The persistently low phenotype of lung function was associated with initial exposure age, especially less than 12 months of age. Higher density HD exposure during sleep and close distance between the bed and the humidifier were significantly associated with persistently low corrected DLco.ConclusionsHD exposure affects prolonged decrement in lung function, especially DLco, particularly among children who are exposed within the first year of life. These results suggested that early-life HD exposure determines long-term prognosis of lung function in children.

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“…In patients with drug‐induced acute lung injury, BAL thrombomodulin levels were independently predictive of respiratory failure, while inhibition of neutrophil elastase and chemotaxis was beneficial in acute respiratory distress syndrome (ARDS) in humans and in a mouse model, respectively . Acute lung injury following household chemical inhalation was associated with a permanent restrictive defect in half of the patients …”

Section: Interstitial Lung Diseasementioning

confidence: 99%

Year in review 2017: Interstitial lung disease, pulmonary vascular disease and sleep

et al. 2018

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Lung function in patients with lung injury due to household chemical inhalation: Post hoc analysis of a prospective nationwide cohort

Abstract: Half of the patients with inhalation injury exhibited stabilization of lung function within several years of onset. However, lung function was impaired in the remaining patients. This impairment associated with lung function at onset and exposure intensity.

Cited by 6 publications

References 21 publications

Effects of a mixture of chloromethylisothiazolinone and methylisothiazolinone on peripheral airway dysfunction in children

Effects of a mixture of chloromethylisothiazolinone and methylisothiazolinone on peripheral airway dysfunction in children

Early-life exposure to humidifier disinfectant determines the prognosis of lung function in children

Year in review 2017: Interstitial lung disease, pulmonary vascular disease and sleep

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