Annals of Occupational and Environmental Medicine

Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries: Hyeong-Cheol Kim, Hyunil Kim, Eun-Chan Mun, Yesung Lee, Soyoung Park; Ann Occup Environ Med 2021;33:e21. Published online June 18, 2021; DOI: https://doi.org/10.35371/aoem.2021.33.e21

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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.

Citations

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Health Effects Associated With Humidifier Disinfectant Use: A Systematic Review for Exploration
Ji-Hun Song, Joonho Ahn, Min Young Park, Jaeyoung Park, Yu Min Lee, Jun-Pyo Myong, Jung-Wan Koo, Jongin Lee
Journal of Korean Medical Science.2022;[Epub] CrossRef

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Mental health impact on a humidifier disinfectant disaster victim: a case report: Ye-Sung Lee, Min-Woo Nam, Hyun-Il Kim, Hyeong-Cheol Kim, Eun-Chan Mun, So-Young Park; Ann Occup Environ Med 2020;32:e15. Published online June 1, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e15

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In Korea, the cause of lung disease of unknown origin was identified as humidifier disinfectants in November 2011. In February 2017, the ‘Special Act on Remedy for Damage Caused by Humidifier Disinfectants’ was promulgated. Even though emotional and mental injuries caused by humidifier disinfectants have been reported, the focus of the special act has been on physical injury only, and criteria for recognizing mental health impact have not been considered. This case considers emotional and mental injury caused by humidifier disinfectants. After a humidifier disinfectant was used from January 2005 to April 2006, the patient's son aged 20 months was hospitalized with respiratory symptoms, and he died within two weeks. Also, the patient was hospitalized for a month with the same symptoms, and then she led a normal life with no symptoms. After both mother and son were diagnosed with definite (level 1) humidifier disinfectant lung injury (HDLI) in 2017, she took to drinking alcohol because of extreme guilt over her son's death. In March 2018 she died from acute liver failure due to alcohol use disorder. The patient's death was caused by continuous alcoholism, due to emotional and mental trauma caused by her son's death after HDLI was revealed as the cause. The government did not acknowledge her death was due to humidifier disinfectants, but the company that sold the humidifier disinfectants recognized her as a victim and compensated the family of the victim. There are still lots of psychological responses among humidifier disinfectant disaster victims. Mental health impact on humidifier disinfectant victims should be considered more carefully, and institutional improvements should be made into establish psychological interventions and measures.

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Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries
Hyeong-Cheol Kim, Hyunil Kim, Eun-Chan Mun, Yesung Lee, Soyoung Park
Annals of Occupational and Environmental Medicine.2021;[Epub] CrossRef

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Problems with diagnostic criteria for humidifier disinfectant lung injury (HDLI): two cases of radiologically improved HDLI: Min-Woo Nam, So-Young Park, Byung-Seong Suh, Soo-Youn Ham, Kyung-Hun Son, Hyunil Kim, Hyeong-Cheol Kim; Ann Occup Environ Med 2020;32:e1. Published online January 2, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e1

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Background

In Korea, to investigate the casual relationship between humidifier disinfectant and lung disease, four rounds of investigation and judgment were conducted. During this investigation, two adults who performed lung biopsy were recognized for their relevance between humidifier disinfectants and lung disease. At first, we did not think of the relationship to humidifier disinfectant because chest computed tomography (CT) finding of 2 cases were improved. However, they performed lung biopsy and it showed typical humidifier disinfectant lung injury (HDLI) pathologic findings, they could be recognized as HDLI. We report these cases here.

Case presentation

We selected 2 cases from the fourth-round investigation at Kangbuk Samsung Hospital. Patient of case 1 used humidifier disinfectants since September 2010. The patient was admitted 6 months later to the intensive care unit (ICU) due to severe dyspnea. Pathology following a lung biopsy revealed typical HDLI finding which was determined to be due to humidifier disinfectant exposure. Patient of case 2 used humidifier disinfectant from 2001 to 2008 for about 3 months each winter. The patient's cough and sputum production symptoms began in December of 2007. The patient was admitted to the respiratory medicine department due to worsening dyspnea. Pathology following a lung biopsy revealed typical HDLI finding. This was determined to have been caused by humidifier disinfectant exposure.

Conclusions

Because the typical radiologic findings associated with HDLI can improve over time, it is necessary to consider the revision of current diagnostic criteria that the presence of radiologic findings is important.

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International Journal of Environmental Health Research.2024; : 1. CrossRef
Health Effects Associated With Humidifier Disinfectant Use: A Systematic Review for Exploration
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Journal of Korean Medical Science.2022;[Epub] CrossRef
A comprehensive study of deaths due to exposure to humidifier disinfectant in Korea: focusing on medical records, assessment of exposure to humidifier disinfectants, and causes of death
Yeong Jun Ju, Seungho Lee, Seungsoo Sheen, Dong-Woo Choi, Jong-Han Leem, Soon Young Lee
Epidemiology and Health.2021; 43: e2021091. CrossRef

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A Case of Lung Injury due to Acute Exposure to Oxides of Nitrogen: Jeong Ho Kim, Dae Hwan Kim, Byung Chul Son, Chang Hee Lee, Jung Won Kim, Doeg Hwan Moon, Chae Un Lee, Joo In Kim; Korean Journal of Occupational and Environmental Medicine 2000;12(2):302-309. Published online June 30, 2000; DOI: https://doi.org/10.35371/kjoem.2000.12.2.302

Abstract PDF: OBJECTIVES
Lung injuries due to exposure to nitrogen oxides can occur in various process in industry. We experienced a case of chemical pneumonitis induced by accidental inhalation of nitrogen oxides emitted from the bath in an acid dipping operation.
CASE
Dyspnea, cough and blood-tinged sputum production, cyanosis, and tachypnea occurred after exposure to oxides of nitrogen. There were bilateral diffuse ground glass opacities in simple chest radiography and high resolutional computed tomography, hypoxemia in arterial blood gas analysis, mixed ventilation defect and reduced diffusion capacity in spirometry. As an oxygen and supportive therapy, after hospitalization, was given, the patient recovered completely from the lung injury on the 8th day after admission. There was no evidence of delayed onset of bronchiolitis obliterance or pulmonary edema in a follow-up for about 6 months.
CONCLUSIONS
Acid dip operation require more efficient hooding and exhausting system for the prevention of lung injuries caused by inhalation of nitrogen oxides. Also health education for worker need.

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Expression of Interleukin-6 in Radiation Induced Lung Damage: Sung Sook Kirn, Eun Hee Ha, Duck Ja Han; Korean Journal of Occupational and Environmental Medicine 1996;8(1):119-126. Published online February 29, 1996; DOI: https://doi.org/10.35371/kjoem.1996.8.1.119

Abstract PDF: Ionizing radiation has proved to be most valuable in clinical diagnosis and radiotherapy. And also it is used very common in industries especially such as industrial radiography, atomic energy plant, inspectoring by gamma-ray, etc. However, inadvertent exposure to relatively high doses of ionizing radiation is capable of injuring and killing cells. The lungs, because of their rich vascularization, are vulnerable to radiation injury. It is now known that IL-6 is a pleiotrophic cytokine produced by various cells that regulates the immune reponses, acute phage reactions. We performed the immunohistochemical staining of IL-6 on radiation induced lung injury by duration, to clarify the role of IL-6 in tissue damage. IL-6 was strongly expressed in early phase of radiation from alveolar macrophages and damaged endothelial cells. These findings not only have important implications for increasing our understanding of mechanisms of radiation lung injury but they also have an impact on strategies for diagnosis and therapy of radiation damage.

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