Humidifier Disinfectant–associated Children’s Interstitial Lung Disease

Kim, Kyung Won; Ahn, Kangmo; Yang, Hyeon Jong; Lee, Soo Young; Park, June Dong; Kim, Woo Kyung; Kim, Jin Tack; Kim, Hyun Hee; Rha, Yeong Ho; Park, Yong Mean; Sohn, Myung Hyun; Oh, Jae Won; Lee, Hae Ran; Lim, Dae Hyun; Choung, Ji Tae; Han, Man Yong; Lee, Eun; Kim, Hyung Young; Seo, Ju Hee; Kim, Byoung Ju; Cho, Young Ah; Hyun, Kyung; Kim, Sun A.; Jang, Se Jin; Lee, Moo Song; Kim, Hwa Jung; Kwon, Geun Yong; Park, Ji-Hyuk; Gwack, Jin; Youn, Seung Ki; Kwon, Jun-Hun; Jun, Byung Yool; Pyun, Bok Yang; Hong, Soo Jong

doi:10.1164/rccm.201306-1088oc

Cited by 114 publications

(121 citation statements)

References 33 publications

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“…This result is similar to high mortality including 80 deaths (58%) among 138 child interstitial lung disease patients in Korea who were reported to be associated with use of humidifier disinfectant [13]. Preschool-age children definitely develop higher exposure in the home environment than do other family members because they spend much of their time at home.…”

Section: Discussionsupporting

confidence: 73%

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Exposure characteristics of familial cases of lung injury associated with the use of humidifier disinfectants

et al. 2014

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BackgroundThis study describes 17 families with 38 lung injury patients (14 males, 24 females; 22 preschool-age children less than six years of age and 16 individuals of 13–50 years) who used disinfectant added to humidifiers in the home.MethodsClinical examination and humidifier disinfectant-use histories were taken, and a thorough home investigation was performed to assess exposure to humidifier disinfectant.ResultsNine of the patients (three pregnant females, six preschool-age children) died soon after they first developed lung damage. Six (16%) were pregnant females and 22 (58%) were preschool-aged children younger than six years. The patients used humidifier disinfectant products containing either polyhexamethylene guanidine phosphate (PHMG, n = 36) or oligo(2-(2-ethoxy)ethoxyethyl guanidinium chloride (PGH, n = 2). Twenty-six patients (68%) used the brand "Oxy"®, which contains PHMG. Of the ten patients with fatal lung injury, nine were found to have used PHMG.ConclusionsOur findings suggest that the use of humidifier disinfectant products containing either PGH or PHMG can cause lung injury, especially in preschool-age children younger than six years and pregnant women.

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Section: Discussionsupporting

confidence: 73%

“…Recently, this assumption was confirmed by Kim et al [13] who concluded through a nationwide surveillance study in Korea assessing the clinical characteristics of 138 children’s interstitial lung diseases registered between 2006 and 2011, no more new cases had been found two years after the ban of humidifier disinfectant sales.…”

Section: Discussionmentioning

confidence: 75%

Exposure characteristics of familial cases of lung injury associated with the use of humidifier disinfectants

et al. 2014

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“…Humidifier disinfectant-associated chILD, outbreaks of which were originally observed among Korean children in spring 2006, [83][84][85] is characterized by spontaneous air leak, rapid progression, and high mortality. 86,87 Radiologic abnormalities include diffuse or patchy GGO, dense consolidation, and diffuse centrilobular nodules. Lung biopsy reveals a temporally homogeneous pathologic process characterized by variable degrees of bronchiolar injury associated with bronchiolocentric acute lung damage and relative sparing of the lobular periphery, consistent with an inhalation injury.…”

Section: Humidifi Er Disinfectant-associated Childmentioning

confidence: 99%

“…Lung biopsy reveals a temporally homogeneous pathologic process characterized by variable degrees of bronchiolar injury associated with bronchiolocentric acute lung damage and relative sparing of the lobular periphery, consistent with an inhalation injury. 86 Humidifier disinfectant-associated chILD has been eradicated on withdrawal of humidifier disinfectants from the market in November 2011. However, thousands of potentially toxic chemicals (to which children are far more vulnerable than adults) are used worldwide.…”

Section: Humidifi Er Disinfectant-associated Childmentioning

confidence: 99%

Interstitial Lung Disease in Children Younger Than 2 Years

Spagnolo

Bush

2016

Pediatrics

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Childhood interstitial lung disease (chILD) represents a highly heterogeneous group of rare disorders associated with substantial morbidity and mortality. Although our understanding of chILD remains limited, important advances have recently been made, the most important being probably the appreciation that disorders that present in early life are distinct from those occurring in older children and adults, albeit with some overlap. chILD manifests with diffuse pulmonary infiltrates and nonspecific respiratory signs and symptoms, making exclusion of common conditions presenting in a similar fashion an essential preliminary step. Subsequently, a systematic approach to diagnosis includes a careful history and physical examination, computed tomography of the chest, and some or all of bronchoscopy with bronchoalveolar lavage, genetic testing, and if diagnostic uncertainty persists, lung biopsy. This review focuses on chILD presenting in infants younger than 2 years of age and discusses recent advances in the classification, diagnostic approach, and management of chILD in this age range. We describe novel genetic entities, along with initiatives that aim at collecting clinical data and biologic samples from carefully characterized patients in a prospective and standardized fashion. Early referral to expert centers and timely diagnosis may have important implications for patient management and prognosis, but effective therapies are often lacking. Following massive efforts, international collaborations among the key stakeholders are finally starting to be in place. These have allowed the setting up and conducting of the first randomized controlled trial of therapeutic interventions in patients with chILD.

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“…The article will help in increasing the awareness of ILD in infants and children, and the use of correct diagnostic pathways. We still have much to learn; the recent severe ILD described in Korea [5], attributed to humidifier disinfectant, underscores the need for the pediatric pulmonologist to be aware of new conditions. The lung is exposed to thousands of litres of polluted air per day, and it is small wonder we are still learning new things about what can go wrong.…”

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confidence: 99%

Editorial: New Techniques for Old and New Diseases

Bush

Kabra

2015

Indian J Pediatr

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Pediatric Pulmonology is an emerging and increasingly important sub-specialty of Pediatrics. The Indian Journal of Pediatrics accordingly planned a special symposium to provide updated information on this specialty. In this issue of the Journal the third and final part of this special symposium, four more articles, are published.Bronchoscopy is evolving as one of the most important part of the diagnostic workup in airway diseases. The technique provides important information on anatomical airway abnormalities and helps in the diagnosis of respiratory problems by delineating underlying infection and the nature of any inflammation. Therapeutic uses include foreign body removal, reversal of mucus plugging, and more novel interventions such as airway stenting. In the developed countries, bronchoscopy is available to all those who need it. There are several challenges in the resource limited settings; and indeed, Dr. Varinder Singh is an internationally recognized expert in using flexible bronchoscopy to remove endobronchial foreign body; in the developed world, usually the prerogative of the thoracic surgeon with a rigid bronchoscope. This illustrates the vital principle that solutions in one context may need alterations in another part of the world. Singh and Singhal have discussed details of bronchoscopy and how it can be utilized effectively in resource limited settings [1]. They also highlight an important theme emerging from this symposium, namely the dynamic nature of the specialty; there are emerging indications for new techniques, including antenatal bronchoscopy.Bronchiectasis is a pathological diagnosis, resulting from multiple underlying causes. The epidemiology varies in different geographic regions. Once very common, the prevalence now seems to be decreasing in some regions, it is still a cause of concern in many parts of the world. Identification of the underlying cause for bronchiectasis is dependent on prevalence of infections and the availability of diagnostic facilities in that particular region. In a significant proportion the cause remains unknown. In this issue, Gupta et al. reviewed the epidemiology, clinical features and underlying causes of bronchiectasis in different parts of the world with more emphasis on the developing countries [2]. It will help in creating awareness among pediatricians about management of bronchiectasis. In particular, it is important for the developing world to avoid following the developed world into uncritically equating cough, in particular chronic productive cough, with asthma, and deploying unnecessary, often expensive and potentially hazardous asthma treatments while lung damage progresses from want of antibiotics and airway clearance. If ever, there was an area where prevention of many cases is possible, by immunization and aggressive early antibiotic treatment of acute and chronic infection, this is it.Sleep is an integral part of life for all age groups (and for Professors in particular!). Disorders of sleep manifest in many different organ systems; the snoring...

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Humidifier Disinfectant–associated Children’s Interstitial Lung Disease

Cited by 114 publications

References 33 publications

Exposure characteristics of familial cases of lung injury associated with the use of humidifier disinfectants

Exposure characteristics of familial cases of lung injury associated with the use of humidifier disinfectants

Interstitial Lung Disease in Children Younger Than 2 Years

Editorial: New Techniques for Old and New Diseases

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