DOI QR코드

DOI QR Code

Review of Humidifier Lung Cases Caused by Use of Humidifier - Focusing on Probable Environmental Causal Agents -

가습기 폐질환(Humidifier Lung)의 환경적 원인 인자 고찰

  • Park, Donguk (Department of Environmental Health, Korea National Open University)
  • 박동욱 (한국방송통신대학교 환경보건학과)
  • Received : 2013.04.04
  • Accepted : 2013.04.19
  • Published : 2013.04.30

Abstract

Background: In Korea, there is low awareness of the respiratory health problems caused by the use of humidifiers, leading to a lack of governmental measures. Objectives: The objectives of this study were to review cases of varying degrees of humidifier lung and fever in connection with the use of humidifiers and to summarize the probable environmental agents causing these cases. Methods: We searched all articles reporting on humidifier lung, humidifier fever, and humidifier diseases caused by the use of a humidifier both at home and in the workplace. Results: We summarized a number of cases of varying degrees of respiratory diseases resulting from inhalation of water mist of humidifiers containing various species of bacteria and fungi and their toxins. Type of respiratory disease connected with humidifier lung includes interstitial pneumonitis, hypersensitivity pneumonitis, fever and several respiratory symptoms. Non-tuberculous mycobacteria (NTM), Actinomycetes, endotoxins and contaminated humidifier water were the most commonly suspected probable environmental agents causing humidifier lung. In Korea, the use of humidifier biocide is suspected as a likely cause of fatal lung injury including death and lung transplantation. Conclusion: Governmental policy should be devised and measures including a national surveillance system should be taken to prevent humidifier lung caused by the use of humidifiers.

Keywords

References

  1. Korea CDC. Interim Report of Epidemiological Investigation on Lung Injury with Unknown Cause in Korea. Public Health Weekly Report. KCDC. 2011; 4: 1-2.
  2. Choi YY, Lim HK, Lim SY, Paek DM. Health Damages and Lessons of the Use of Humidifier Disinfectants in Korea. Korean Society for Environmental Health. 2012; 38: 166-172. https://doi.org/10.5668/JEHS.2012.38.2.166
  3. KSEH. Cases Of health Problems due to the Use of Humidifier Biocide. Korean Society for Environmental Health. 2012.
  4. Banaszak EF, Thiede WH, Fink JN. Hypersensitivity Pneumonitis due to Contamination of an Air Conditioner. New England Journal of Medicine. 1970; 283: 271-276. https://doi.org/10.1056/NEJM197008062830601
  5. Fink JN, Banaszak EF, Thiede WH, Barboriak JJ. Interstitial Pneumonitis due to Hypersensitivity to an Organism Contaminating a Heating System. Annals of Internal Medicine. 1971; 74: 80-83. https://doi.org/10.7326/0003-4819-74-1-80
  6. Pickering C, Moore W, Lacey J, HOLFORD? STREVENS VC, Pepys J. Investigation of a Respiratory Disease Associated with an Air?conditioning System. Clinical & Experimental Allergy. 1976; 6: 109-118. https://doi.org/10.1111/j.1365-2222.1976.tb01888.x
  7. Van Assendelft A, Forsen K, Keskinen H, Alanko K. Humidifier-Associated Extrinsic Allergic Alveolitis. Scand J Work Environ Health. 1979; 5: 35-41. https://doi.org/10.5271/sjweh.2673
  8. Miller MM, Patterson R, Fink JN, Roberts M. Chronic Hypersensitivity Lung Disease with Recurrent Episodes of Hypersensitivity Pneumonitis due to a Contaminated Central Humidifier. Clinical & Experimental Allergy. 1976; 6: 451-462. https://doi.org/10.1111/j.1365-2222.1976.tb01929.x
  9. Anderson K, Watt A, Sinclair D, Lewis C, McSharry C, Boyd G. Climate, Intermittent Humidification, and Humidifier Fever. British Journal of Industrial Medicine. 1989; 46: 671-674.
  10. Ohinishi H, Yokoyama A, Hamada H, Manabe S, Ito R, Watanabe A, et al. Humidifier Lung: Possible Contribution of Endotoxin-Induced Lung Injury. Internal Medicine. 2002; 41: 1179-1182. https://doi.org/10.2169/internalmedicine.41.1179
  11. Rylander R, Haglind P. Airborne Endotoxins and Humidifier Disease. Clinical & Experimental Allergy. 1984; 14: 109-112. https://doi.org/10.1111/j.1365-2222.1984.tb02197.x
  12. Rylander R, Haglind P, Lundholm M, Mattsby I, Stenqvist K. Humidifier Fever and Endotoxin Exposure. Clinical & Experimental Allergy. 1978; 8: 511-516. https://doi.org/10.1111/j.1365-2222.1978.tb01504.x
  13. Flaherty DK, Deck F, Hood M, Liebert C, Singleton F, Winzenburger P, et al. A Cytophaga Species Endotoxin as a Putative Agent of Occupation-Related Lung Disease. Infection and Immunity. 1984; 43: 213-216.
  14. Daftary AS, Deterding RR. Inhalational Lung Injury Associated with Humidifier "White Dust". Pediatrics. 2011; 127: e509-e512. https://doi.org/10.1542/peds.2010-1312
  15. Sweet LC, Anderson JA, Callies QC, Coates EO. Hypersensitivity Pneumonitis Related to a Home Furnace Humidifier. Journal of Allergy and Clinical Immunology. 1971; 48: 171-178. https://doi.org/10.1016/0091-6749(71)90013-3
  16. Suda T, Sato A, Ida M, Gemma H, Hayakawa H, Chida K. Hypersensitivity Pneumonitis Associated with Home Ultrasonic Humidifiers. Chest. 1995; 107: 711-717. https://doi.org/10.1378/chest.107.3.711
  17. Burke GW, Carrington CB, Strauss R, Fink JN, Gaensler EA. Allergic Alveolitis Caused by Home Humidifiers. JAMA: The Journal of the American Medical Association. 1977; 238: 2705-2708. https://doi.org/10.1001/jama.1977.03280260035013
  18. Tourville D, Weiss W, Werfake P, Leudemann G. Hypersensitivity Pneumonitis due to Contamination of Home Humidifier. Journal of Allergy and Clinical Immunology. 1972; 49: 245-251. https://doi.org/10.1016/0091-6749(72)90087-5
  19. Friend J, Palmer K, Gaddie J, Pickering C, Pepys J. Extrinsic Allergic Alveolitis and Contaminated Cooling-Water in a Factory Machine. The Lancet. 1977; 309: 297-300. https://doi.org/10.1016/S0140-6736(77)91839-6
  20. Fink JN, Banaszak EF, Baroriak JJ, Hensley GT, Kurup VP, Scanlon GT, et al. Interstitial Lung Disease due to Contamination of Forced Air Systems. Annals of Internal Medicine. 1976; 84: 406-413. https://doi.org/10.7326/0003-4819-84-4-406
  21. Marras TK, Wallace Jr RJ, Koth LL, Stulbarg MS, Cowl CT, Daley CL. Hypersensitivity Pneumonitis Reaction to Mycobacterium Avium in Household Water*. Chest. 2005; 127: 664-671. https://doi.org/10.1378/chest.127.2.664
  22. Flaherty DK, Deck F, Cooper J, Bishop K, Winzenburger P, Smith L, et al. Bacterial Endotoxin Isolated from a Water Spray Air Humidification System as a Putative Agent of Occupation-Related Lung Disease. Infection and Immunity. 1984; 43: 206-212.
  23. Asan Medical Center. Hospital Based Case-Control Study on the Lung Injury with Unknown Causes. Public Health Wkly Rep. KCDC. 2011; 4: 825-829.
  24. Kane GC, Marx J, Prince D. Hypersensitivity Pneumonitis Secondary to Klebsiella Oxytoca. A New Cause of Humidifier Lung. CHEST Journal. 1993; 104: 627-629. https://doi.org/10.1378/chest.104.2.627
  25. Baur X, Behr J, Dewair M, Ehret W, Fruhmann G, Vogelmeier C, et al. Humidifier Lung and Humidifier Fever. Lung. 1988; 166: 113-124. https://doi.org/10.1007/BF02714035
  26. Edwards J, Griffiths A, Mullins J. Protozoa as Sources of Antigen in 'humidifier Fever'. 1976.
  27. Seabury J, Salvaggio J, Domer J, Fink J, Kawai T. Characterization of Thermophilic Actinomycetes Isolated from Residential Heating and Humidification Systems. Journal of Allergy and Clinical Immunology. 1973; 51: 161-173. https://doi.org/10.1016/0091-6749(73)90021-3
  28. Pal T, Kaufmann H, Monchy JGR, Vries K. Lung Function of Workers Exposed to Antigens from a Contaminated Air-Conditioning System. International Archives of Occupational and Environmental Health. 1985; 55: 253-266. https://doi.org/10.1007/BF00383758
  29. Kahana LM, Kay JM, Yakrus MA, Waserman S. Mycobacterium Avium Complex Infection in an Immunocompetent Young Adult Related to Hot Tub Exposure. Chest. 1997; 111: 242-245. https://doi.org/10.1378/chest.111.1.242
  30. Speizer FE. Occupational and Environmental Lung Diseases: An Overview. Environmental Health Perspectives. 2000; 108: 603. https://doi.org/10.1289/ehp.00108s4603
  31. Weiss L, Pue C, Lewis R, Rossmoore J, Fink J, Harney J, et al. Respiratory Illness in Workers Exposed to Metalworking Fluid Contaminated with Nontuberculous Mycobacteria-Ohio, 2001. JAMA. 2002; 287: 3073-3074. https://doi.org/10.1001/jama.287.23.3073
  32. Embil J, Warren P, Yakrus M, Stark R, Corne S, Forrest D, et al. Pulmonary Illness Associated with Exposure to Mycobacterium-Avium Complex in Hot Tub Water. Chest. 1997; 111: 813-816. https://doi.org/10.1378/chest.111.3.813
  33. Falkinham JO. Impact of Human Activities on the Ecology of Nontuberculous Mycobacteria. Future Microbiology. 2010; 5: 951-960. https://doi.org/10.2217/fmb.10.53
  34. Falkinham III JO. Mycobacterial Aerosols and Respiratory Disease. Emerging Infectious Diseases. 2003; 9: 763. https://doi.org/10.3201/eid0907.020415
  35. Falkinham Iii J. Surrounded by Mycobacteria: Nontuberculous Mycobacteria in the Human Environment. Journal of Applied Microbiology. 2009; 107: 356-367. https://doi.org/10.1111/j.1365-2672.2009.04161.x
  36. Falkinham III JO. Nontuberculous Mycobacteria in the Environment. Clinics in Chest Medicine. 2002; 23: 529-552. https://doi.org/10.1016/S0272-5231(02)00014-X
  37. Lacey J, Dutkiewicz J. Bioaerosols and Occupational Lung Disease. Journal of Aerosol Science. 1994; 25: 1371-1404. https://doi.org/10.1016/0021-8502(94)90215-1
  38. Douwes J, Thorne P, Pearce N, Heederik D. Bioaerosol Health Effects and Exposure Assessment: Progress and Prospects. Annals of Occupational Hygiene. 2003; 47: 187-200. https://doi.org/10.1093/annhyg/meg032
  39. Rylander R. The Role of Endotoxin for Reactions After Exposure to Cotton Dust. American Journal of Industrial Medicine. 1987; 12: 687-697. https://doi.org/10.1002/ajim.4700120607
  40. Heederik D, Douwes J. Towards an Occupational Exposure Limit for Endotoxin? ANNALS OF AGRICULTURAL AND ENVIRONMENTAL MEDICINE. 1997; 4: 17-19.
  41. Douwes J, Thorne P, Pearce N, Heederik D. Bioaerosol Health Effects and Exposure Assessment: Progress and Prospects. Annals of Occupational Hygiene. 2003; 47: 187-200. https://doi.org/10.1093/annhyg/meg032
  42. Jacek D. Bacteria and Fungi in Organic Dust as Potential Health Hazard. Annals of Agricultural and Environmental Medicine. 1997; 4: 11-16.
  43. Freeman A, Lockey J, Hawley P, Biddinger P, Trout D. Hypersensitivity Pneumonitis in a Machinist. Am J Ind Med. 1998; 34: 387-92. https://doi.org/10.1002/(SICI)1097-0274(199810)34:4<387::AID-AJIM13>3.0.CO;2-Z
  44. Rosenman KD. Asthma, Hypersensitivity Pneumonitis and Other Respiratory Diseases Caused by Metalworking Fluids. Current Opinion in Allergy and Clinical Immunology. 2009; 9: 97. https://doi.org/10.1097/ACI.0b013e3283229f96
  45. Rosenman KD, Reilly MJ, Kalinowski D. Work- Related Asthma and Respiratory Symptoms among Workers Exposed to Metal-Working Fluids. Am J Ind Med. 1997; 32: 325-31. https://doi.org/10.1002/(SICI)1097-0274(199710)32:4<325::AID-AJIM1>3.0.CO;2-T
  46. Hodgson MJ, Bracker A, Yang C, Storey E, Jarvis BJ, Milton D, et al. Hypersensitivity Pneumonitis in a Metal working Environment. American Journal of Industrial Medicine. 2001; 39: 616-628. https://doi.org/10.1002/ajim.1061
  47. Trout D, Weissman DN, Lewis D, Brundage RA, Franzblau A, Remick D. Evaluation of Hypersensitivity Pneumonitis among Workers Exposed to Metal Removal Fluids. Applied Occupational and Environmental Hygiene. 2003; 18: 953-960. https://doi.org/10.1080/10473220390237683
  48. Thorne PS, Adamcakova-Dodd A, Kelly KM, O'Neill M E, Duchaine C. Metalworking Fluid with Mycobacteria and Endotoxin Induces Hypersensitivity Pneumonitis in Mice. Am J Respir Crit Care Med. 2006; 173: 759-68. https://doi.org/10.1164/rccm.200405-627OC
  49. US EPA. Use and Care of Home Humidifier. 1991; Indoor Air Facts No 8:ANR-445-W: .
  50. US CPSC. Dirty humidifier may cause health problems. Available: www.cpsc.gov [accessed March 2013].
  51. Alvarez-Fernandez J, Quirce S, Calleja J, Cuevas M, Losada E. Hypersensitivity Pneumonitis due to an Ultrasonic Humidifier. Allergy. 1998; 53: 210-212. https://doi.org/10.1111/j.1398-9995.1998.tb03873.x
  52. Shiue S, Scherzer H, DeGraff Jr A, Cole S. Hypersensitivity Pneumonitis Associated with the use of Ultrasonic Humidifiers. New York State Journal of Medicine. 1990; 90: 263-265.
  53. Park Du, Choi YY. Comprehensive review for acute respiratory failure after inhalation exposure to water-proofing agent. Korean Society for Environmental Health. 2012; 38: 451-459. https://doi.org/10.5668/JEHS.2012.38.6.451
  54. Miller MM, Patterson R, Fink JN, Roberts M. Chronic Hypersensitivity Lung Disease with Recurrent Episodes of Hypersensitivity Pneumonitis due to a Contaminated Central Humidifier. Clinical & Experimental Allergy. 1976; 6: 451-462. https://doi.org/10.1111/j.1365-2222.1976.tb01929.x
  55. Kohler PF, Gross G, Salvaggio J, Hawkins J. Humidifier Lung Hypersensitivity Pneumonitis Related to Thermotolerant Bacterial Aerosols. CHEST Journal. 1976; 69: 294-296. https://doi.org/10.1378/chest.69.2_Supplement.294
  56. Suda T, Sato A, Ida M, Gemma H, Hayakawa H, Chida K. Hypersensitivity Pneumonitis Associated with Home Ultrasonic Humidifiers. Chest. 1995; 107: 711-717. https://doi.org/10.1378/chest.107.3.711
  57. Marras TK, Wallace Jr RJ, Koth LL, Stulbarg MS, Cowl CT, Daley CL. Hypersensitivity Pneumonitis Reaction to Mycobacterium Avium in Household Water*. Chest. 2005; 127: 664-671. https://doi.org/10.1378/chest.127.2.664
  58. Friend J, Palmer K, Gaddie J, Pickering C, Pepys J. Extrinsic Allergic Alveolitis and Contaminated Cooling-Water in a Factory Machine. The Lancet. 1977; 309: 297-300. https://doi.org/10.1016/S0140-6736(77)91839-6
  59. Edwards J. Microbial and Immunological Investigations and Remedial Action After an Outbreak of Humidifier Fever. British Journal of Industrial Medicine. 1980; 37: 55-62.
  60. Cockcroft A, Edwards J, Bevan C, Campbell I, Collins G, Houston K, et al. An Investigation of Operating Theatre Staff Exposed to Humidifier Fever Antigens. British Journal of Industrial Medicine. 1981; 38: 144-151.
  61. Flaherty DK, Deck F, Cooper J, Bishop K, Winzenburger P, Smith L, et al. Bacterial Endotoxin Isolated from a Water Spray Air Humidification System as a Putative Agent of Occupation-Related Lung Disease. Infection and Immunity. 1984; 43: 206-212.
  62. Burge PS, Finnegan M, Horsfield N, Emery D, Austwick P, Davies P, et al. Occupational Asthma in a Factory with a Contaminated Humidifier. Thorax. 1985; 40: 248-254. https://doi.org/10.1136/thx.40.4.248
  63. Robertson A, Burge P, Wieland G, Carmalt M. Extrinsic Allergic Alveolitis Caused by a Cold Water Humidifier. Thorax. 1987; 42: 32-37. https://doi.org/10.1136/thx.42.1.32
  64. Pal TM, de Monchy JGR, Groothoff JW, Post D. The Clinical Spectrum of Humidifier Disease in Synthetic Fiber Plants. American Journal of Industrial Medicine. 1997; 31: 682-692. https://doi.org/10.1002/(SICI)1097-0274(199706)31:6<682::AID-AJIM3>3.0.CO;2-T
  65. Kateman E, Heederik D, Pal TM, Smeets M, Smid T, Spitteler M. Relationship of Airborne Microorganisms with the Lung Function and Leucocyte Levels of Workers with a History of Humidifier Fever. Scandinavian Journal of Work, Environment & Health. 1990; 428-433.

Cited by

  1. Review of Exposure Assessment to Obtain Exposure Factors of Consumer Products vol.39, pp.6, 2013, https://doi.org/10.5668/JEHS.2013.39.6.532
  2. Health Risk Assessment on Hazardous Ingredients in Household Deodorizing Products vol.15, pp.4, 2018, https://doi.org/10.3390/ijerph15040744