title: Evaluation report on the causal association between humidifier disinfectants and lung injury.
abstract: OBJECTIVE
  As of November 2011, the Korean government recalled and banned humidifier disinfectants (HDs) from the market, because four case-control studies and one retrospective epidemiological study proved the association between HDs and lung injury of unknown cause. The report reviewed the causal role of HDs in lung injury based on scientific evidences.
  
  
  METHODS
  A careful examination on the association between the HDs and lung injury was based on the criteria of causality inference by Hill and the US Surgeon General Expert Committee.
  
  
  RESULTS
  We found that all the evidences on the causality fulfilled the criteria (strength of association, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, analogy, consideration of alternative explanations, and cessation of exposure), which proved the unknown cause lung injury reported in 2011 was caused by the HDs. In particular, there was no single reported case of lung injury since the ban in selling HDs in November 2011 as well as before the HDs were sold in markets.
  
  
  CONCLUSIONS
  Although only a few epidemiological studies in Korea have evaluated the association between lung injury and the use of HDs, those studies contributed to proving the strong association between the use of the HDs and lung injury, based on scientific evidence.
authors.affiliation: Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea.
authors.forename: Mina
authors.initials: M
authors.lastname: Ha
authors.affiliation: Department of Preventive Medicine & Public Health, Ajou University School of Medicine, Suwon, Korea.|Academic Committee, Korean Society of Epidemiology.
authors.forename: Soon Young
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea.|Academic Committee, Korean Society of Epidemiology.
authors.forename: Seung-Sik
authors.initials: SS
authors.lastname: Hwang
authors.affiliation: Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea.|Academic Committee, Korean Society of Epidemiology.
authors.forename: Hyesook
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Pulmonology, Ajou University School of Medicine, Suwon, Korea.|Academic Committee, Korean Society of Epidemiology.
authors.forename: Seungsoo
authors.initials: S
authors.lastname: Sheen
authors.affiliation: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.
authors.forename: Hae Kwan
authors.initials: HK
authors.lastname: Cheong
authors.affiliation: Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Bo Youl
authors.initials: BY
authors.lastname: Choi
mesh_terms: D015984:Causality; D004202:Disinfectants / Q000009:adverse effects*; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D000068998:Humidifiers; D019570:Inhalation Exposure / Q000009:adverse effects*; D055370:Lung Injury / Q000139:chemically induced*; D011159:Population Surveillance; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D004202:Disinfectants
keywords: Association; Causality; Disinfectants; Hill’s criteria; Humidifiers; Lung injury