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Humidifier disinfectant-associated children's interstitial lung disease. 2014
Kyung Won Kim, and
Kangmo Ahn, and
Hyeon Jong Yang, and
Sooyoung Lee, and
June Dong Park, and
Woo Kyung Kim, and
Jin-Tack Kim, and
Hyun Hee Kim, and
Yeong Ho Rha, and
Yong Mean Park, and
Myung Hyun Sohn, and
Jae-Won Oh, and
Hae Ran Lee, and
Dae Hyun Lim, and
Ji Tae Choung, and
Man Yong Han, and
Eun Lee, and
Hyung-Young Kim, and
Ju-Hee Seo, and
Byoung-Ju Kim, and
Young Ah Cho, and
Kyung-Hyun Do, and
Sun-A Kim, and
Se-Jin Jang, and
Moo-Song Lee, and
Hwa-Jung Kim, and
Geun-Yong Kwon, and
Ji-Hyuk Park, and
Jin Gwack, and
Seung-Ki Youn, and
Jun-Wook Kwon, and
Byung-Yool Jun, and
Bok Yang Pyun, and
Soo-Jong Hong
1 Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea.
BACKGROUND Beginning in 2006, epidemics of a fatal lung injury of unknown cause in children were observed in Korea every spring. A recent study demonstrated that this type of children's interstitial lung disease (chILD) is associated with humidifier disinfectant use. OBJECTIVE To determine the clinical characteristics of this type of chILD and to assess whether the nationwide suspension of humidifier disinfectant sales in the autumn of 2011 affected its incidence. METHODS The clinical characteristics of suspected cases between 2006 and 2011 were determined by a nationwide retrospective study. The potential causal relationship with humidifier disinfectants was examined by a prospective surveillance study after humidifier disinfectant sales were suspended. RESULTS In total, 138 children were diagnosed with this type of chILD, which was characterized by rapid progression, high mortality, predominance in the spring season, and a familial tendency. The annual incidence increased in 2011 and then dropped to zero in 2012. The children were on average 30.4 months old. The most frequent symptoms at admission were cough and dyspnea. As the disease progressed, the typical complication was spontaneous air leak. Eighty children (58%) died. Two years after humidifier disinfectant-sale suspension, no more new cases were found. CONCLUSIONS This study suggests that humidifier disinfectant inhalation causes an idiopathic type of chILD that is characterized by spontaneous air leak, rapid progression, lack of response to treatment, and high mortality. Further safety studies must be performed on common environmental compounds, particularly those that enter the human body by an unusual route.
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