Paek D.,Seoul National University |
Koh Y.,University of Ulsan |
Park D.-U.,Korea University |
Cheong H.-K.,Sungkyunkwan University |
And 17 more authors.
Annals of the American Thoracic Society | Year: 2015
Rationale: Humidifier disinfectant lung injury is an acute lung disease attributed to recurrent inhalation of certain disinfectant aerosols emitted from room humidifiers. An outbreak of this toxic lung injury occurred in South Korea from 1995 until all humidifier disinfectant products were recalled from the consumer market by the government in 2011. Objectives: A nationwide study was conducted to ascertain and classify all potential cases of humidifier disinfectant lung injury in Korea and to assess dose-response relationships. Methods: By several mechanisms, clinicians and the general public were invited to report all suspected cases of humidifier disinfectant lung injury to public health officials in South Korea. A committee was convened to define diagnostic criteria based on pathologic, radiologic, and clinical findings for index cases, combined with assessment of environmental exposure to humidifier disinfectants. Clinical review and environmental assessments were performed and later combined to determine overall likelihood of disease for each study participant, classified as definite, probable, possible, or unlikely. Survival time from exposure to onset of symptoms was analyzed to assess dose-response relationships. Three broad categories of risk factors were examined: (1) biological susceptibility, (2) temporal cycle of exposure and recovery, and (3) spatial conditions and density of disinfectant. Measurements and Main Results: Of 374 possible cases identified and reviewed, 329 were unanimously classified by the diagnostic committee, as follows: 117 definite, 34 probable, 38 possible and 140 unlikely cases. A total of 62 individuals with definite or probable disease died. Risk factors examined for polyhexamethyleneguanidine phosphate exposure that were found to be significant in shortening survival included age 4 years or younger at onset, use of disinfectant for 7 days per week, airborne density of 800 mg/m3 or more of disinfectant, and daily exposure 11 or more hours in duration. Conclusions: Dose-response analysis indicated that development of humidifier disinfectant lung injury and death were associated strongly with recurrent, intense, acute exposure without sufficient recovery time between exposures, more so than longterm cumulative exposure. These findings may explain some reversible or clinically unapparent cases among coexposed family members. Copyright © 2015 by the American Thoracic Society.
Park D.,Korea University |
Leem J.,Inha University |
Lee K.,Korea University |
Lim H.,Asian Citizens Center for Environment and Health |
And 9 more authors.
Environmental Health: A Global Access Science Source | Year: 2014
Background: This 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.Methods: Clinical examination and humidifier disinfectant-use histories were taken, and a thorough home investigation was performed to assess exposure to humidifier disinfectant.Results: Nine 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.Conclusions: Our 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. © 2014 Park et al.; licensee BioMed Central Ltd.
Park D.-U.,Korea University |
Choi Y.-Y.,Asian Citizens Center for Environment and Health |
Ahn J.-J.,Asian Citizens Center for Environment and Health |
Lim H.-K.,Asian Citizens Center for Environment and Health |
And 13 more authors.
PLoS ONE | Year: 2015
Background: In South Korea, a cluster of acute lung disease patients included lung injury disease suspected of being caused by the use of humidifier disinfectants. We examined the relationship between humidifier disinfectant exposure and clinically diagnosed humidifier disinfectantassociated lung injury (HDLI) in a family-based study. Methods: This case-control study included 169 clinically confirmed HDLI cases and 303 family controls who lived with the HDLI patients. A range of information on exposure to humidifier disinfectants was obtained using a structured questionnaire and field investigations. Odds ratios (ORs) and confidence intervals (CIs) were estimated using unconditional logistic regression models that were adjusted for age, sex, presence of a factory within 1 km of residence, and the number of household chemical products used. Results: HDLI risk increased approximately two-fold or more among the highest quartile compared with the lowest quartile in terms of the hours sleeping in a room with an operating humidifier treated with disinfectant (adjusted OR = 2.0, 95%CI = 1.1-3.7), average hours of disinfectant- treated humidifier use per day (adjusted OR = 2.1, 95%CI = 1.0-4.5), airborne disinfectant intensity (adjusted OR = 2.6, 95% CI = 1.2-5.3), and cumulative disinfectant inhalation level (adjusted OR = 2.0, 95% CI = 1.0-4.1). HDLI risk increased as the distance of the bed from humidifier gets shorter; compared with longer distance (> 1 m), the odds ratio was 2.7 for 0.5 to 1 m (95% CI = 1.5-5.1) and 13.2 for <0.5 m (95 %CI = 2.4-73.0). Conclusions: The use of household humidifier disinfectants was associated with HDLI risk in a doseresponse manner. © 2015 Park et al.
Park D.U.,Korea University |
Friesen M.C.,U.S. National Institutes of Health |
Roh H.S.,Data Analytics Team |
Choi Y.Y.,Asian Citizens Center for Environment and Health |
And 11 more authors.
Indoor Air | Year: 2015
We conducted a comprehensive humidifier disinfectant exposure characterization for 374 subjects with lung disease who presumed their disease was related to humidifier disinfectant use (patient group) and for 303 of their family members (family group) for an ongoing epidemiological study. We visited the homes of the registered patients to investigate disinfectant use characteristics. Probability of exposure to disinfectants was determined from the questionnaire and supporting evidence from photographs demonstrating the use of humidifier disinfectant, disinfectant purchase receipts, any residual disinfectant, and the consistency of their statements. Exposure duration was estimated as cumulative disinfectant use hours from the questionnaire. Airborne disinfectant exposure intensity (μg/m3) was estimated based on the disinfectant volume (ml) and frequency added to the humidifier per day, disinfectant bulk level (μg/ml), the volume of the room (m3) with humidifier disinfectant, and the degree of ventilation. Overall, the distribution patterns of the intensity, duration, and cumulative exposure to humidifier disinfectants for the patient group were higher than those of the family group, especially for pregnant women and patients ≤6 years old. Further study is underway to evaluate the association between the disinfectant exposures estimated here with clinically diagnosed lung disease. © 2015 John Wiley & Sons A/S.
PubMed | Korea University, Seoul National University, Asian Citizens Center for Environment and Health, Korea Institute of Toxicology and 7 more.
Type: Journal Article | Journal: Indoor air | Year: 2015
We conducted a comprehensive humidifier disinfectant exposure characterization for 374 subjects with lung disease who presumed their disease was related to humidifier disinfectant use (patient group) and for 303 of their family members (family group) for an ongoing epidemiological study. We visited the homes of the registered patients to investigate disinfectant use characteristics. Probability of exposure to disinfectants was determined from the questionnaire and supporting evidence from photographs demonstrating the use of humidifier disinfectant, disinfectant purchase receipts, any residual disinfectant, and the consistency of their statements. Exposure duration was estimated as cumulative disinfectant use hours from the questionnaire. Airborne disinfectant exposure intensity (g/m(3)) was estimated based on the disinfectant volume (ml) and frequency added to the humidifier per day, disinfectant bulk level (g/ml), the volume of the room (m(3)) with humidifier disinfectant, and the degree of ventilation. Overall, the distribution patterns of the intensity, duration, and cumulative exposure to humidifier disinfectants for the patient group were higher than those of the family group, especially for pregnant women and patients 6 years old. Further study is underway to evaluate the association between the disinfectant exposures estimated here with clinically diagnosed lung disease.Retrospective exposure to household humidifier disinfectant as estimated here can be used to evaluate associations with clinically diagnosed lung disease due to the use of humidifier disinfectant in Korea. The framework, with modifications to account for dispersion and use patterns, can also be potentially adapted to assessment of other household chemical exposures.
Bahk J.,Seoul National University |
Choi Y.,Asian Citizens Center for Environment and Health |
Lim S.,Kyung Hee University |
Paek D.,Seoul National University
International Journal of Occupational and Environmental Health | Year: 2013
Background: Out of 143 countries that consumed asbestos between 2003 and 2007, only 44 have banned asbestos. This study tried to explain why some countries have banned asbestos while others have not, based on a synthesis that asbestos ban policy of a country will rely on a process of cognition of threats and exploration of safer alternatives. Method: As we hypothesized that increased social cost of mesothelioma, capacity of health-related infrastructures, and policy diffusion from adjacent countries were related to asbestos ban adoption, published databases of asbestos ban years, mesothelioma mortality, country rankings in health care and human rights standings, and distribution of banning countries over 14 regions were analyzed accordingly. Results: The average mesothelioma death rate was significantly higher for countries with asbestos bans than in those with no ban (4.59 versus 1.83/million). No-ban countries had less well-developed healthrelated infrastructures. Among European countries, there was a tendency toward geographical diffusion of asbestos ban policy from Nordic to Western and then other European countries over the years. Even though aberrant cases were also noted where bans were instituted even without mesothelioma database, these were rather exceptions than rules. Conclusion: Risk cognition is a complex process, but the presence of well-functioning health infrastructures, as well as the increased social cost of mesothelioma, that can make the plight of asbestos victims visible to the eyes of public and policy makers, may have contributed to this process. Asbestos ban policy from adjacent countries might have facilitated the adoption of alternative solutions. © W. S. Maney & Son Ltd 2013.
PubMed | Asian Citizens Center for Environment and Health and Seoul National University
Type: | Journal: Environmental health and toxicology | Year: 2016
Once released into the air, humidifier disinfectants became tiny nano-size particles, and resulted in chemical bronchoalveolitis. Families had lost their most beloved members, and even some of them became broken. Based on an estimate of two million potential victims who had experienced adverse effects from the use of humidifier disinfectants, we can say that what we have observed was only the tip of the iceberg. Problems of entire airways, as well as other systemic effects, should be examined, as we know these nano-size particles can irritate cell membranes and migrate into systemic circulation. The story of humidifier disinfectant is not finished yet.
PubMed | Dankook University, Environmental Health Center, Asian Citizens Center for Environment and Health, Korea Electronics Technology Institute and Chungbuk National University
Type: | Journal: Environmental health and toxicology | Year: 2014
As public concern on possible harmful effects of mobile phone in children has been raised, information of epidemiological characteristics of mobile phone use in children and adolescents will be essential for public health policy.Using three databases (n=21,693) collected from 2008 to 2011, we examined characteristics of mobile phone ownership and use, and socioeconomic positions (SEP) in Korean children and adolescents.The ownership rate and the amount of mobile phone use were higher in females than males, in higher school grades than lower grades, and at 2011 than 2008. The average age of first mobile phone ownership was shown to decrease from 12.5 years in currently high school students to 8.4 years in currently elementary school students at 2011. More than 90% of children in the 5th grade owned a mobile phone. More children owned a mobile phone in lower SEP communities than in higher SEP. Children with parents educated less than those with parents educated more were more likely to own and use mobile phone.Considering the epidemiological characteristics of mobile phone use, precautionary measures to prevent unnecessary exposure to mobile phones are needed in children and adolescents.