title: Humidifier Disinfectants Are a Cause of Lung Injury among Adults in South Korea: A Community-Based Case-Control Study.
abstract: BACKGROUND
  An outbreak of lung injury among South Korean adults was examined in a hospital-based case-control study, and the suspected cause was exposure to humidifier disinfectant (HD). However, a case-control study with community-dwelling controls was needed to validate the previous study's findings, and to confirm the exposure-response relationship between HD and lung injury.
  
  
  METHODS
  Each case of lung injury was matched with four community-dwelling controls, according to age (±3 years), sex, residence, and history of childbirth since 2006 (for women). Environmental risk factors, which included type and use of humidifier and HD, were investigated using a structured questionnaire during August 2011. The exposure to HD was calculated for both cases and controls, and the corresponding risks of lung injury were compared.
  
  
  RESULTS
  Among 28 eligible cases, 16 patients agreed to participate, and 60 matched controls were considered eligible for this study. The cases were more likely to have been exposed to HD (odds ratio: 116.1, 95% confidence interval: 6.5-2,063.7). All cases were exposed to HDs containing polyhexamethyleneguanidine phosphate, and the risk of lung injury increased with the cumulative exposure, duration of exposure, and exposure per day.
  
  
  CONCLUSIONS
  This study revealed a statistically significant exposure-response relationship between HD and lung injury. Therefore, continuous monitoring and stricter evaluation of environmental chemicals' safety should be conducted.
authors.affiliation: Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju-si, Gyeongsangbuk-do, South Korea.|Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, South Korea.
authors.forename: Ji-Hyuk
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Hwa Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, South Korea.
authors.forename: Geun-Yong
authors.initials: GY
authors.lastname: Kwon
authors.affiliation: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, South Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: Gwack
authors.affiliation: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, South Korea.
authors.forename: Young-Joon
authors.initials: YJ
authors.lastname: Park
authors.affiliation: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, South Korea.
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Youn
authors.affiliation: Center for Infectious Disease Control, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, South Korea.
authors.forename: Jun-Wook
authors.initials: JW
authors.lastname: Kwon
authors.affiliation: Bureau of Public Health Policy, Ministry of Health and Welfare, Sejong, South Korea.
authors.forename: Byung-Guk
authors.initials: BG
authors.lastname: Yang
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.|Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Moo-Song
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Miran
authors.initials: M
authors.lastname: Jung
authors.affiliation: Department of Nursing, Hanyang University, Seoul, South Korea.
authors.forename: Hanyi
authors.initials: H
authors.lastname: Lee
authors.affiliation: Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, South Korea.
authors.forename: Byung-Yool
authors.initials: BY
authors.lastname: Jun
authors.affiliation: Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju-si, Gyeongsangbuk-do, South Korea.
authors.forename: Hyun-Sul
authors.initials: HS
authors.lastname: Lim
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004196:Disease Outbreaks; D004202:Disinfectants / Q000009:adverse effects*; D004781:Environmental Exposure; D005260:Female; D006785:Hospitals, University; D006801:Humans; D000068998:Humidifiers; D055370:Lung Injury / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D056910:Republic of Korea; D012307:Risk Factors
chemical_list: D004202:Disinfectants