title: Humidifier disinfectant-associated children's interstitial lung disease.
abstract: 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.
authors.affiliation: 1 Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyung Won
authors.initials: KW
authors.lastname: Kim
authors.forename: Kangmo
authors.initials: K
authors.lastname: Ahn
authors.forename: Hyeon Jong
authors.initials: HJ
authors.lastname: Yang
authors.forename: Sooyoung
authors.initials: S
authors.lastname: Lee
authors.forename: June Dong
authors.initials: JD
authors.lastname: Park
authors.forename: Woo Kyung
authors.initials: WK
authors.lastname: Kim
authors.forename: Jin-Tack
authors.initials: JT
authors.lastname: Kim
authors.forename: Hyun Hee
authors.initials: HH
authors.lastname: Kim
authors.forename: Yeong Ho
authors.initials: YH
authors.lastname: Rha
authors.forename: Yong Mean
authors.initials: YM
authors.lastname: Park
authors.forename: Myung Hyun
authors.initials: MH
authors.lastname: Sohn
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Oh
authors.forename: Hae Ran
authors.initials: HR
authors.lastname: Lee
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Lim
authors.forename: Ji Tae
authors.initials: JT
authors.lastname: Choung
authors.forename: Man Yong
authors.initials: MY
authors.lastname: Han
authors.forename: Eun
authors.initials: E
authors.lastname: Lee
authors.forename: Hyung-Young
authors.initials: HY
authors.lastname: Kim
authors.forename: Ju-Hee
authors.initials: JH
authors.lastname: Seo
authors.forename: Byoung-Ju
authors.initials: BJ
authors.lastname: Kim
authors.forename: Young Ah
authors.initials: YA
authors.lastname: Cho
authors.forename: Kyung-Hyun
authors.initials: KH
authors.lastname: Do
authors.forename: Sun-A
authors.initials: SA
authors.lastname: Kim
authors.forename: Se-Jin
authors.initials: SJ
authors.lastname: Jang
authors.forename: Moo-Song
authors.initials: MS
authors.lastname: Lee
authors.forename: Hwa-Jung
authors.initials: HJ
authors.lastname: Kim
authors.forename: Geun-Yong
authors.initials: GY
authors.lastname: Kwon
authors.forename: Ji-Hyuk
authors.initials: JH
authors.lastname: Park
authors.forename: Jin
authors.initials: J
authors.lastname: Gwack
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Youn
authors.forename: Jun-Wook
authors.initials: JW
authors.lastname: Kwon
authors.forename: Byung-Yool
authors.initials: BY
authors.lastname: Jun
authors.forename: Bok Yang
authors.initials: BY
authors.lastname: Pyun
authors.forename: Soo-Jong
authors.initials: SJ
authors.lastname: Hong
mesh_terms: D002675:Child, Preschool; D004202:Disinfectants / Q000009:adverse effects*; D058872:Epidemics; D005260:Female; D006794:Household Articles; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012621:Seasons
chemical_list: D004202:Disinfectants