한빛사 논문
Abstract
Kyung Won Kim1*, Kangmo Ahn2*, Hyeon Jong Yang3, Sooyoung Lee4, June Dong Park5, Woo Kyung Kim6, Jin-Tack Kim7, Hyun Hee Kim8, Yeong Ho Rha9, Yong Mean Park10, Myung Hyun Sohn1, Jae-Won Oh11, Hae Ran Lee12, Dae Hyun Lim13, Ji Tae Choung14, Man Yong Han15, Eun Lee16, Hyung-Young Kim17, Ju-Hee Seo18, Byoung-Ju Kim19, Young Ah Cho20, Kyung-Hyun Do20, Sun-A Kim21, Se-Jin Jang21, Moo-Song Lee22, Hwa-Jung Kim23, Geun-Yong Kwon24, Ji-Hyuk Park24, Jin Gwack24, Seung-Ki Youn24, Jun-Wook Kwon25, Byung-Yool Jun24, 25, Bok Yang Pyun3† and Soo-Jong Hong16†
1Department of Pediatrics, Yonsei University College of Medicine, Seoul; 2Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; 3Department of Pediatrics, Soonchunhyang University College of Medicine, Seoul; 4Department of Pediatrics, Ajou University School of Medicine, Suwon; 5Department of Pediatrics, Seoul National University College of Medicine; 6Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul; 7Department of Pediatrics, The Catholic University of Korea School of Medicine, Uijeongbu; 8Department of Pediatrics, The Catholic University of Korea School of Medicine, Bucheon; 9Department of Pediatrics, Kyung Hee University School of Medicine, Seoul; 10Department of Pediatrics, Konkuk University School of Medicine, Seoul; 11Department of Pediatrics, Hanyang University Guri Hospital, Guri; 12Department of Pediatrics, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang; 13Department of Pediatrics, Inha University School of Medicine, Incheon; 14Department of Pediatrics, Korea University, Seoul; 15Department of Pediatrics, Bundang CHA Hospital, CHA University School of Medicine, Seongnam; 16Department of Pediatrics, University of Ulsan College of Medicine, Seoul; 17Department of Pediatrics, Kosin University College of Medicine, Busan; 18Department of Pediatrics, Korea Cancer Center Hospital, Seoul; 19Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan; 20Department of Radiology, University of Ulsan College of Medicine, Seoul; 21Department of Pathology, University of Ulsan College of Medicine, Seoul; 22Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul; 23Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul; 24Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Osong; and 25Center for Infectious Disease Surveillance and Response, Korea Centers for Disease Control and Prevention, Osong, South Korea
*These authors contributed equally to this work and should be considered as co-first authors.
†These authors contributed equally to this work and should be considered as co-corresponding authors.
Correspondence and request for reprints should be addressed to Soo-Jong Hong, M.D. and Bok Yang Pyun
Abstract
Rationale: Beginning of 2006, epidemics of a fatal lung injury of unknown cause in children were observed in Korea every spring. A recent study demonstrated that this type of children’s interstitial lung disease (chILD) is associated with humidifier disinfectant use.
Objectives: To determine the clinical characteristics of this type of chILD and to assess whether the nationwide suspension of humidifier disinfectant sales in the autumn of 2011 affected its incidence.
Methods: The clinical characteristics of suspected cases between 2006 and 2011 were determined by a nationwide retrospective study. The potential causal relationship with humidifier disinfectants was examined by a prospective surveillance study after humidifier disinfectant sales were suspended.
Measurements and Main Results: In total, 138 children were diagnosed with this type of chILD, which was characterized by rapid progression, high mortality, predominance in the spring season, and a familial tendency. The annual incidence increased in 2011 and dropped to zero in 2012. The children were on average 30.4 months old. The most frequent symptoms at admission were cough and dyspnea. As the disease progressed, the typical complication was spontaneous air leak. Eighty children (58%) died. Two years after humidifier disinfectant-sale suspension, no more new cases were found.
Conclusions: This study suggests that humidifier disinfectant inhalation causes an idiopathic type of chILD that is characterized by spontaneous air leak, rapid progression, lack of response to treatment, and high mortality. Further safety studies must be performed on common environmental compounds, particularly those that enter the human body by an unusual route.
KEYWORDS: disinfectant, lung disease, interstitial, child
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