TY - JOUR T1 - A cluster of lung injury cases associated with home humidifier use: an epidemiological investigation JF - Thorax JO - Thorax SP - 703 LP - 708 DO - 10.1136/thoraxjnl-2013-204132 VL - 69 IS - 8 AU - Hwa Jung Kim AU - Moo-Song Lee AU - Sang-Bum Hong AU - Jin Won Huh AU - Kyung-Hyun Do AU - Se Jin Jang AU - Chae-Man Lim AU - Eun Jin Chae AU - Hanyi Lee AU - Miran Jung AU - Young-Joon Park AU - Ji-Hyuk Park AU - Geun-Yong Kwon AU - Jin Gwack AU - Seung-Ki Youn AU - Jun-Wook Kwon AU - Byung-Guk Yang AU - Byung-Yool Jun AU - Yangho Kim AU - Hae-Kwan Cheong AU - Byung Chul Chun AU - Heon Kim AU - Kyuhong Lee AU - Younsuck Koh Y1 - 2014/08/01 UR - http://thorax.bmj.com/content/69/8/703.abstract N2 - Background In April 2011 a tertiary hospital in Seoul, Korea reported several cases of severe respiratory distress of unknown origin in young adults. Methods To find the route of transmission, causative agent and patient risk factors of the outbreak, an investigation of the epidemic was initiated. Clinicopathological conferences led to the suspicion that the cases related to an inhalation injury. An age- and sex-matched case–control study was therefore performed to examine the inhalation exposure of the patients to various agents. Results Of the 28 confirmed cases, 18 agreed to participate. A total of 121 age- and sex-matched controls with pulmonary, allergic or obstetric disease were selected. All patients and controls completed questionnaires with questions about exposure to various inhalants. The crude ORs for patient exposure to indoor mould, humidifier use, humidifier detergent use and insecticide use were 4.4 (95% CI 1.5 to 13.1), 13.7 (95% CI 1.8 to 106.3), 47.3 (95% CI 6.1 to 369.7) and 3.9 (95% CI 1.3 to 11.7), respectively. However, when considered concurrently, indoor mould and insecticide use lost statistical significance. Moreover, humidifier use was ruled out as the cause because of a lack of biological plausibility and the weak strength of the association. This suggested that humidifier disinfectant was the cause of the outbreak. This information led the Korean government to order the removal of humidifier detergents from the market. In the years following the ban, no additional cases were detected. Conclusions Epidemiological evidence strongly suggests that the lung injury outbreak was caused by humidifier detergent use at home. ER -