Exposure to humidifier disinfectants is associated with upper and lower airway diseases

Yon, Dong Keon; Lee, Seungwon; Woo, Ara; Koh, Hyun Yong; Jee, Hye Mi; Ha, Eun Kyo; Lee, Kee Jae; Shin, Youn Ho; Han, Man Yong

doi:10.1111/pai.13233

Cited by 9 publications

(11 citation statements)

References 11 publications

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“…12 The region of residence was classified as rural (ie, Gyeonggi, Gangwon, Gyeongsangbuk, Gyeongsangnam, Chungcheongbuk, Chungcheongnam, Jeollabuk, Jeollanam and Jeju) or urban (eg, Seoul, Sejong, Busan, Incheon, Daegu, Gwangju, Daejeon and Ulsan). [13][14][15] The current use of selected drugs taken within 30 days before the index date included systemic steroids, metformin and aspirin. 16…”

Section: Study Populationmentioning

confidence: 99%

Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching

Lee

Yeniova

et al. 2020

Gut

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ObjectiveThe adverse effects of proton pump inhibitors (PPIs) have been documented for pneumonia; however, there is no consensus regarding whether the use of PPIs might be harmful regarding the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this regard, we aimed to measure the potential associations of the current use of PPIs with the infection rates of COVID-19 among patients who underwent SARS-CoV-2 testing.DesignData were derived from a Korean nationwide cohort study with propensity score matching. We included 132 316 patients older than 18 years who tested for SARS-CoV-2 between 1 January and 15 May 2020. Endpoints were SARS-CoV-2 positivity (primary) and severe clinical outcomes of COVID-19 (secondary: admission to intensive care unit, administration of invasive ventilation or death).ResultsIn the entire cohort, there were 111 911 non-users, 14 163 current PPI users and 6242 past PPI users. After propensity score matching, the SARS-CoV-2 test positivity rate was not associated with the current or past use of PPIs. Among patients with confirmed COVID-19, the current use of PPIs conferred a 79% greater risk of severe clinical outcomes of COVID-19, while the relationship with the past use of PPIs remained insignificant. Current PPI use starting within the previous 30 days was associated with a 90% increased risk of severe clinical outcomes of COVID-19.ConclusionPatients taking PPIs are at increased risk for severe clinical outcomes of COVID-19 but not susceptible to SARS-CoV-2 infection. This suggests that physicians need to assess benefit–risk assessments in the management of acid-related diseases amid the COVID-19 pandemic.

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Section: Study Populationmentioning

confidence: 99%

Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching

Lee

Yeniova

et al. 2020

Gut

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200

230

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“…Recently, the Panel Study on Korean Children reported a correlation between the use of HDs and diagnosis of allergic rhinitis, 12 24 and also revealed a correlation with upper respiratory disease, which is a precursor to lower respiratory disease. 12 In addition to respiratory disease, there have also been experimental results demonstrating the possibility of systemic toxic effects. 25 Moreover, it has been suggested that the various adverse health effects associated with HDs should be called Humidifier Disinfectant Syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…There are a number of epidemiological 8 9 10 11 12 13 and toxicological 14 15 16 17 studies to assess the causal relationship of HDs exposure with HDLI. 10 11 12 13 16 17 There are also several studies on asthma showing causality. 18 19 20 However, little is known about other non-specific respiratory injuries.…”

Section: Introductionmentioning

confidence: 99%

“… 10 11 12 13 16 17 There are also several studies on asthma showing causality. 18 19 20 However, little is known about other non-specific respiratory injuries. 21 Judgment on injury due to HDs should be based not only on whether the patient meets certain criteria for acknowledgment but also on the diverse clinical circumstances experienced by each individual victim.…”

Section: Introductionmentioning

confidence: 99%

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Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries

Kim

Mun

Lee

et al. 2021

Ann Occup Environ Med

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Background Injuries caused by humidifier disinfectants (HDs) can no longer be grouped under the concept of HD lung injury. Focusing on individual cases, we were able to evaluate the relevance not only of diseases for which epidemiological correlation is recognized but also all diseases and symptoms that the victims complain of. Methods In-depth interviews and reassessment of 113 HD-exposed patients who had not been acknowledged as victims by the government were conducted, and their medical records were reviewed. Based on these processes, an assessment questionnaire for the injuries related to HDs was completed and the involvement of HDs was assessed either as “strong association,” “association,” or “no association.” Results In this study, of the 113 patients included who claimed damages, 78 (69.0%) had HD-related injuries. Among the cases of 22 patients who applied for injury acknowledgment due to upper respiratory inflammation that was not included among the acknowledged diseases, 17 (77.3%) were judged to be HD-related injuries (strong association vs. association: 10 [45.5%] vs. 7 [31.8%]). When the cases of 12 rhinitis patients were reassessed, 9 were HD-related injuries (strong association vs. association: 4 [33.3%] vs. 5 [41.7%]). When the cases of 18 asthma patients unacknowledged as a victim were reassessed, 17 (94.4%) were humidifier-related injuries (strong association vs. association: 12 [66.6%] vs. 5 [27.8%]). Among 4 interstitial lung disease patients unacknowledged as a victim, 2 (50.0%) were HD-related injuries. Conclusions HD-related health injuries should be assessed through both individual interviews and detailed chart reviews for more accurate injury acknowledgment. In the future, efforts should go beyond existing methods based on the adherence to acknowledgment criteria to directly listen to the victims.

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“…Exposure to humidifier disinfectant (HD) in South Korea — the ‘humidifier disinfectant scandal’ — caused multiple social and health-related problems that are still ongoing [ 11 – 13 ]. Nation-wide epidemiologic and animal studies confirmed that the outbreak of interstitial lung disease (ILD) in children and adults was caused by HD exposure.…”

Section: Introductionmentioning

confidence: 99%

Association between humidifier disinfectant exposure during infancy and subsequent neuropsychiatric outcomes during childhood: a nation-wide cross-sectional study

Kim

Park

et al. 2021

BMC Pediatr

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Background The purpose was to determine the association between infant exposure to humidifier disinfectant (HD) with neuropsychiatric problems in pre-school children. Methods A total of 2,150 children (age 4–11 months) were enrolled in the Panel Study of Korean Children (PSKC) study. The Korean version of the Child Behavior Checklist (CBCL) was used for assessments of neuropsychiatric problems. 1,113 children who participated in all the first to third PSKC studies and answered a question about HD exposure were finally enrolled. Results There were 717 (64.5%) children in non-HD group who were not exposed to HD and 396 (35.5%) in HD group with former exposure to HD. Exposure to HD was associated with total neuropsychiatric problems (adjusted odds ratio, aOR = 1.54, 95% CI = 1.15–2.06), being emotionally reactive (aOR = 1.55, 95% CI = 1.00–2.39), having attention problems (aOR = 1.96, 95% CI = 1.10–3.47), having oppositional defiant problems (aOR = 1.70, 95% CI = 1.07–2.71), and having attention deficit/hyperactivity problems (aOR = 11.57, 95% CI = 1.03–2.38). The risks for neuropsychiatric problems were clearly increased in boy, firstborn, and secondary smoker. Conclusions Exposure to HD during early childhood had a potential association with subsequent behavioral abnormalities.

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Exposure to humidifier disinfectants is associated with upper and lower airway diseases

Cited by 9 publications

References 11 publications

Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching

Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching

Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries

Association between humidifier disinfectant exposure during infancy and subsequent neuropsychiatric outcomes during childhood: a nation-wide cross-sectional study

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