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Clin Exp Pediatr > Accepted Articles
DOI: https://doi.org/10.3345/cep.2019.01326    [Accepted]
Published online December 9, 2019.
The past, present and future of humidifier disinfectant-associated interstitial lung diseases in children
Eun Lee1, So-Yeon Lee2, Soo-Jong Hong2 
1Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
2Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence: 
Soo-Jong Hong, Tel: +82-2-3010-3379, Fax: +82-2-473-3725, Email: sjhong@amc.seoul.kr
Received: 15 October 2019   • Revised: 15 November 2019   • Accepted: 3 December 2019
Abstract
Exposure to environmental factors can cause interstitial lung diseases (ILDs); however, such types of ILDs are rare. From 2007 to 2011, an ILD epidemic occurred in South Korea owing to inhalational exposure to toxic chemicals in humidifier disinfectants (HDs). HD-associated ILDs (HD-ILDs) are characterized by rapidly progressing respiratory failure with pulmonary fibrosis and a high mortality rate of 43.8-58.0%. Although 18.1-31.1% of the general population used HDs, only a small proportion of HD users were diagnosed with HD-ILDs. This finding suggests that investigation of the pathophysiologies underlying HD-ILDs is needed in addition to the identification of susceptibility to HD-ILDs. Further, there have been several concerns regarding the diverse health effects of exposure to toxic chemicals in HDs, including those that have not been identified, and long-term prognoses in terms of pulmonary function and residual pulmonary lesions observed on follow-up chest images. In this review, we summarize the clinical features, pathologic findings, and changes in radiologic findings over time in patients with HD-ILDs and the results of previous experimental research on the mechanisms underlying the effects of toxic chemicals in HDs. Studies are currently underway to identify the pathophysiologies of HD-ILDs and possible health effects of exposure to HDs along with the development of targeted therapeutic strategies. The experience of identification of HD-ILDs has encouraged stricter control of safe chemicals in everyday life.
Key Words: Children, Humidifier disinfectants, Interstitial lung diseases




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