title: Relationship between Exposure to Household Humidifier Disinfectants and Risk of Lung Injury: A Family-Based Study.
abstract: BACKGROUND
  In South Korea, a cluster of acute lung disease patients included lung injury disease suspected of being caused by the use of humidifier disinfectants. We examined the relationship between humidifier disinfectant exposure and clinically diagnosed humidifier disinfectant-associated lung injury (HDLI) in a family-based study.
  
  
  METHODS
  This case-control study included 169 clinically confirmed HDLI cases and 303 family controls who lived with the HDLI patients. A range of information on exposure to humidifier disinfectants was obtained using a structured questionnaire and field investigations. Odds ratios (ORs) and confidence intervals (CIs) were estimated using unconditional logistic regression models that were adjusted for age, sex, presence of a factory within 1 km of residence, and the number of household chemical products used.
  
  
  RESULTS
  HDLI risk increased approximately two-fold or more among the highest quartile compared with the lowest quartile in terms of the hours sleeping in a room with an operating humidifier treated with disinfectant (adjusted OR = 2.0, 95 % CI = 1.1-3.7), average hours of disinfectant-treated humidifier use per day (adjusted OR = 2.1, 95 % CI = 1.0-4.5), airborne disinfectant intensity (adjusted OR = 2.6, 95% CI = 1.2-5.3), and cumulative disinfectant inhalation level (adjusted OR = 2.0, 95% CI = 1.0-4.1). HDLI risk increased as the distance of the bed from humidifier gets shorter; compared with longer distance (> 1 m), the odds ratio was 2.7 for 0.5 to 1 m (95 % CI = 1.5-5.1) and 13.2 for <0.5 m (95 % CI = 2.4-73.0).
  
  
  CONCLUSIONS
  The use of household humidifier disinfectants was associated with HDLI risk in a dose-response manner.
authors.affiliation: Department of Environmental Health, Korea National Open University, Seoul, 110-791, South Korea.
authors.forename: Dong-Uk
authors.initials: DU
authors.lastname: Park
authors.affiliation: Asian Citizen's Center for Environment and Health, Seoul, 110-460, South Korea.
authors.forename: Ye-Yong
authors.initials: YY
authors.lastname: Choi
authors.affiliation: Asian Citizen's Center for Environment and Health, Seoul, 110-460, South Korea.
authors.forename: Jong-Ju
authors.initials: JJ
authors.lastname: Ahn
authors.affiliation: Asian Citizen's Center for Environment and Health, Seoul, 110-460, South Korea.
authors.forename: Heung-Kyu
authors.initials: HK
authors.lastname: Lim
authors.affiliation: Asian Citizen's Center for Environment and Health, Seoul, 110-460, South Korea.
authors.forename: Sun-Kyung
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Data analytics team, tiny Labs, Seoul, 140-822, South Korea.
authors.forename: Hyun-Suk
authors.initials: HS
authors.lastname: Roh
authors.affiliation: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, 440-746, Korea.
authors.forename: Hae-Kwan
authors.initials: HK
authors.lastname: Cheong
authors.affiliation: Department of Occupational & Environmental Medicine, Inha University Hospital, Incheon, South Korea.
authors.forename: Jong-Han
authors.initials: JH
authors.lastname: Leem
authors.affiliation: Department of Occupational and Environmental Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, 210-701, South Korea.
authors.forename: Dong-Hee
authors.initials: DH
authors.lastname: Koh
authors.affiliation: Department of Environmental Health, Korea National Open University, Seoul, 110-791, South Korea.
authors.forename: Hye-Jung
authors.initials: HJ
authors.lastname: Jung
authors.affiliation: Department of Environmental Health, Korea National Open University, Seoul, 110-791, South Korea.
authors.forename: Kyoung-Mu
authors.initials: KM
authors.lastname: Lee
authors.affiliation: Institute of Environmental Safety and Protection, NeoEnBiz Co., Bucheon, 420-806, South Korea.
authors.forename: Jong-Hyeon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Korea Institute of Toxicology, Daejeon, 305-343, South Korea.
authors.forename: Yong-Hwa
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Occupational & Environmental Medicine, College of Medicine, Kyung Hee University, 130-791, Seoul, Korea.
authors.forename: Sin-Ye
authors.initials: SY
authors.lastname: Lim
authors.affiliation: School of Public Health, Seoul National University, Seoul, 151-742, South Korea.
authors.forename: Do-Myung
authors.initials: DM
authors.lastname: Paek
authors.affiliation: Department of Pulmonary Medicine and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Chae-Man
authors.initials: CM
authors.lastname: Lim
authors.affiliation: Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Soo-Jong
authors.initials: SJ
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D004202:Disinfectants / Q000633:toxicity*; D005260:Female; D006795:Household Products / Q000633:toxicity*; D006801:Humans; D000068998:Humidifiers; D055370:Lung Injury / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D056910:Republic of Korea; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D004202:Disinfectants