RT Journal Article
SR Electronic
T1 A cluster of lung injury cases associated with home humidifier use: an epidemiological investigation
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 703
OP 708
DO 10.1136/thoraxjnl-2013-204132
VO 69
IS 8
A1 Hwa Jung Kim
A1 Moo-Song Lee
A1 Sang-Bum Hong
A1 Jin Won Huh
A1 Kyung-Hyun Do
A1 Se Jin Jang
A1 Chae-Man Lim
A1 Eun Jin Chae
A1 Hanyi Lee
A1 Miran Jung
A1 Young-Joon Park
A1 Ji-Hyuk Park
A1 Geun-Yong Kwon
A1 Jin Gwack
A1 Seung-Ki Youn
A1 Jun-Wook Kwon
A1 Byung-Guk Yang
A1 Byung-Yool Jun
A1 Yangho Kim
A1 Hae-Kwan Cheong
A1 Byung Chul Chun
A1 Heon Kim
A1 Kyuhong Lee
A1 Younsuck Koh
YR 2014
UL http://thorax.bmj.com/content/69/8/703.abstract
AB 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.