Association of high-level humidifier disinfectant exposure with lung injury in preschool children

Abstract Background Children aged ≤ 6 years reportedly account for 52% of victims of humidifier disinfectant-associated lung injuries. Objectives To evaluate the association of humidifier disinfectants with lung injury risk among children aged ≤ 6 years. Methods Patients with humidifier disinfectant-associated lung injuries (n = 214) who were clinically evaluated to have a definite (n = 108), probable (n = 49), or possible (n = 57) association with humidifier disinfectants as well as control patients (n = 123) with lung injury deemed unlikely to be associated with humidifier disinfectant use were evaluated to determine factors associated with increased risk of humidifier disinfectant-associated lung injury using unconditional multiple logistic regression analysis. Results For estimated airborne humidifier disinfectant concentrations, risk of humidifier disinfectant-associated lung injury increased ≥ two-fold in a dose-dependent manner in the highest quartile (Q4, 135–1443 μg/m 3 ) compared with that in the lowest quartile (Q1, ≤ 33 μg/m 3 ). Registered patients using more than two humidifier disinfectant brands were at an increased risk of humidifier disinfectant-associated lung injury (adjusted OR, 2.2; 95% confidence interval, 1.3–3.8) compared with those using only one brand. With respect to the duration of humidifier disinfectant use, risk of humidifier disinfectant-associated lung injury increased ≥ two-fold in the lowest quartile (≤ 5 months) compared with that in the highest quartile (≥ 14 months; adjusted OR 0.3; 95% confidence interval, 0.2–0.6). Conclusions Younger children are more vulnerable to HDLI when exposed to HD chemicals within short period in early life.