A comprehensive study of deaths due to exposure to humidifier disinfectant in Korea: focusing on medical records, assessment of exposure to humidifier disinfectants, and causes of death

Abstract

OBJECTIVES We aimed to determine the characteristics of the deceased victims of deaths caused by exposure to humidifier disinfectants, and present the distribution of the victims’ data submitted for damage application, demographic characteristics, imaging findings, characteristics of humidifier disinfectant exposure, and distribution of the causes of death. METHODS An integrated database of victims was established using the medical records data of 1,413 victims submitted during the application for death damage caused by exposure to humidifier disinfectants, and the demographic characteristics, medical records, imaging findings, exposure characteristics, and cause of death were examined. RESULTS The average numbers of data submissions of each applicant for death damage were 3.0 medical use records. A total of 608 (43.0%) victims had more than one finding of acute, subacute, or chronic interstitial lung diseases. The average daily and cumulative use times of the victims were 14.40 and 24,645.81 hours, respectively, indicating greater exposure in this group than in the survivors. The humidifier disinfectants’ components comprised polyhexamethylene guanidine (72.8%), chloromethylisothiazolinone/methylisothiazolinone (10.5%), other components (15.0%), and oligo-[2-(2-ethoxy)-ethoxyethyl] guanidine chloride (1.5%). The components’ distribution was 67.8% for single-component use, which was higher than that in the survivors (59.8%). The distribution of the causes of death were: respiratory diseases (54.4%), neoplasms (16.8%), and circulatory diseases (6.3%). Other interstitial lung diseases (65.5%) were the most common cause of death among those who died due to respiratory diseases. CONCLUSIONS Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.

Health Effects Associated With Humidifier Disinfectant Use: A Systematic Review for Exploration

“…For group 1, studies published on humans, a total of 49 articles were selected ( Table 2 ). 1 2 3 4 5 6 7 9 10 11 12 13 14 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 The suspicion that humidifier disinfectant might be a cause of lung damage was suggested in 2011. Studies in international journals began to appear in 2013.…”

“…Only a small percentage of the patients were identified as having diseases caused by a humidifier disinfectant, but the possibility of adverse health effects by a humidifier disinfectant other than HDLI was raised. 14 …”

Antiseptic drugs and disinfectants with experience of the second year of COVID-19 pandemic-related side effects

“…Respiratory : Further evidence was collected on the association of the disinfectant PHMG with lung disease (see ( Lachenmeier, 2014 [R]; Lachenmeier, 2015 [R]; Lachenmeier, 2016 [R]; Lachenmeier, 2017 [R]; Lachenmeier, 2018 [R]; Lachenmeier, 2020 [R]; Lachenmeier, 2021 [R]) for a description of the cases). An integrated database of victims of death caused by exposure to humidifier disinfectants (72.8% PHMG-based) in Korea ( n = 1,413) showed average daily and cumulative use times of 14 and 24 645 h, and respiratory diseases as the most common cause of death (54.4%) ( Ju et al, 2021 ) [MC]. The limitations of exposure assessment of PHMG from humidifier disinfectants may include recall bias and various other causes such as the recovery of injury and psychological anxiety, which may have led to over and underestimation in past studies, so that a questionnaire-based exposure assessment methodology to overcome the limitations was proposed ( Ryu et al, 2021 ) [C].…”

Polyhexamethylene Guanidine Phosphate Enhanced Procoagulant Activity through Oxidative-Stress-Mediated Phosphatidylserine Exposure in Platelets

“…PHMG was misused as a major component of humidifier disinfectants (HDs), which had tragic effects in South Korea [ 11 , 12 , 13 ]. Epidemiological studies have shown its close association with lung injury, lung fibrosis, and pulmonary diseases in HD-exposed groups [ 14 , 15 , 16 ].…”

“…From the survey data of 4179 claimants for compensation from the Korea government, 203 (4.9%) claimants suffered from cardiovascular diseases including hypertension, heart failure, myocardial infarction, angina pectoris, peripheral vascular diseases, thrombosis, and atherosclerosis [ 18 ]. Moreover, in a comprehensive study with 1341 deceased victims, circulatory system diseases (84, 6.3%) were one of the most common causes of death after respiratory diseases and neoplasms [ 11 ]. However, few studies have focused on the effects in the cardiovascular system caused by major components of HD, PHMG [ 19 ], and chloromethylisothiazolinone/methylisothiazolinone mixture [ 20 , 21 ].…”