Humidifier disinfectant-associated children's interstitial lung disease.

Abstract

RATIONALE: 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. OBJECTIVES: 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.

MEASUREMENTS AND MAIN 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.