The past, present, and future of humidifier disinfectant-associated interstitial lung diseases in children

Abstract

<jats:p>Exposure to environmental factors can cause interstitial lung diseases (ILDs); however, such types of ILDs are rare. From 2007 to 2011, an ILD epidemic occurred in South Korea owing to inhalational exposure to toxic chemicals in humidifier disinfectants (HDs). HD-associated ILDs (HD-ILDs) are characterized by rapidly progressing respiratory failure with pulmonary fibrosis and a high mortality rate of 43.8%−58.0%. Although 18.1%−31.1% of the general population used HDs, only a small proportion of HD users were diagnosed with HD-ILDs. This finding suggests that investigation of the pathophysiologies underlying HD-ILDs is needed in addition to the identification of susceptibility to HD-ILDs. Further, there have been several concerns regarding the diverse health effects of exposure to toxic chemicals in HDs, including those that have not been identified, and long-term prognoses in terms of pulmonary function and residual pulmonary lesions observed on follow-up chest images. In this review, we summarize the clinical features, pathologic findings, and changes in radiologic findings over time in patients with HD-ILDs and the results of previous experimental research on the mechanisms underlying the effects of toxic chemicals in HDs. Studies are currently underway to identify the pathophysiologies of HD-ILDs and possible health effects of exposure to HDs along with the development of targeted therapeutic strategies. The experience of identification of HD-ILDs has encouraged stricter control of safe chemicals in everyday life.</jats:p>

Exposure to humidifier disinfectants is associated with upper and lower airway diseases

“…1,2 Research indicates that approximately 30% of Korean children were exposed to a HD from 1994 to 2011 and HD products were only sold in Korea market before withdrawal of these products from Korea market in 2011. 3 Many researchers have examined the relationship of exposure to HDs with lung injury, 4,5 although there is insufficient evidence supporting a relationship between exposure to HD and childhood asthma, 1 asthma-related parameters (oscillometric lung function 6 and fraction of exhaled nitric oxide [FeNO]), allergic rhinitis (AR), and The presence of parental asthma, AR, and atopic dermatitis was based on diagnoses by physicians. An olfactory threshold score below the 10th percentile was defined as hyposmia, depending on age and sex.…”

“…To the Editor, Subcutaneous allergen immunotherapy (SCIT) is an effective treatment of respiratory allergy, 1 but injections in children may cause pain, 2 fear, 3 and sometimes systemic adverse events. [4][5][6] Needlefree injectors, who generate a "liquid needle" with a sufficient force to pass through the skin and enter the subcutaneous tissue, The clinician administering the SCIT was required to fill a procedural difficulty rate (PDR) questionnaire immediately after the administration of each dose, rating the difficulties on a VAS and describing them in a specific, free-writing sheet. We also evaluated the PPR 20' after every administration, the number and severity of allergenic adverse reactions to the treatment, 8 and their effect on changes in treatment schedule.…”

Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries

“…In previous studies, researchers did not conduct individual patient interviews but only reviewed the submitted medical records and applied strict criteria to identify lung diseases related to HDs. 3 29 30 31 …”

Humidifier Disinfectant Consumption and Humidifier Disinfectant-Associated Lung Injury in South Korea: A Nationwide Population-Based Study

“…The most important pathological feature of HDLI cases is lung injury accompanied by inflammation and fibrosis, leading to various pulmonary diseases (e.g., asthma, pneumonia, and interstitial lung diseases) [ 20 , 21 , 22 ]. The major chemical components of HD products were reported as PHMG, CMIT/MIT, or PGH, although they may differ depending on the products, and recent experimental evidence has suggested that exposure to each of these chemicals is capable of inducing inflammation and leading to elevation in the fibrotic response.…”