title: Estimating retrospective exposure of household humidifier disinfectants.
abstract: We conducted a comprehensive humidifier disinfectant exposure characterization for 374 subjects with lung disease who presumed their disease was related to humidifier disinfectant use (patient group) and for 303 of their family members (family group) for an ongoing epidemiological study. We visited the homes of the registered patients to investigate disinfectant use characteristics. Probability of exposure to disinfectants was determined from the questionnaire and supporting evidence from photographs demonstrating the use of humidifier disinfectant, disinfectant purchase receipts, any residual disinfectant, and the consistency of their statements. Exposure duration was estimated as cumulative disinfectant use hours from the questionnaire. Airborne disinfectant exposure intensity (μg/m(3)) was estimated based on the disinfectant volume (ml) and frequency added to the humidifier per day, disinfectant bulk level (μg/ml), the volume of the room (m(3)) with humidifier disinfectant, and the degree of ventilation. Overall, the distribution patterns of the intensity, duration, and cumulative exposure to humidifier disinfectants for the patient group were higher than those of the family group, especially for pregnant women and patients ≤6 years old. Further study is underway to evaluate the association between the disinfectant exposures estimated here with clinically diagnosed lung disease.
  
  
  CONCLUSIONS
  Retrospective exposure to household humidifier disinfectant as estimated here can be used to evaluate associations with clinically diagnosed lung disease due to the use of humidifier disinfectant in Korea. The framework, with modifications to account for dispersion and use patterns, can also be potentially adapted to assessment of other household chemical exposures.
authors.affiliation: Department of Environmental Health, Korea National Open University, Seoul, South Korea.
authors.forename: D U
authors.initials: DU
authors.lastname: Park
authors.affiliation: Division of Cancer Epidemiology and Genetics, Occupational and Environmental Epidemiology Branch, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Friesen
authors.affiliation: Data Analytics Team, Tiny Labs, Seoul, South Korea.
authors.forename: H S
authors.initials: HS
authors.lastname: Roh
authors.affiliation: Asian Citizen's Center for Environment and Health, Seoul, South Korea.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Choi
authors.affiliation: Asian Citizen's Center for Environment and Health, Seoul, South Korea.
authors.forename: J J
authors.initials: JJ
authors.lastname: Ahn
authors.affiliation: Asian Citizen's Center for Environment and Health, Seoul, South Korea.
authors.forename: H K
authors.initials: HK
authors.lastname: Lim
authors.affiliation: Asian Citizen's Center for Environment and Health, Seoul, South Korea.
authors.forename: S K
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Department of Occupational and Environmental Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, South Korea.
authors.forename: D H
authors.initials: DH
authors.lastname: Koh
authors.affiliation: Department of Environmental Health, Korea National Open University, Seoul, South Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Jung
authors.affiliation: Institute of Environmental Safety and Protection, NeoEnBiz Co., Bucheon, South Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.
authors.forename: H K
authors.initials: HK
authors.lastname: Cheong
authors.affiliation: Department of Occupational & Environmental Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: S Y
authors.initials: SY
authors.lastname: Lim
authors.affiliation: Department of Occupational & Environmental Medicine, Inha University Hospital, Incheon, South Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Leem
authors.affiliation: Korea Institute of Toxicology, Daejeon, South Korea.
authors.forename: Y H
authors.initials: YH
authors.lastname: Kim
authors.affiliation: School of Public Health, Seoul National University, Seoul, South Korea.
authors.forename: D M
authors.initials: DM
authors.lastname: Paek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D004202:Disinfectants / Q000009:adverse effects / Q000032:analysis*; D005260:Female; D006801:Humans; D000068998:Humidifiers; D008171:Lung Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D004202:Disinfectants
keywords: Aerosol; Exposure assessment; Humidifier disinfectant; Nano-particle; PGH; PHMG