Division of Pulmonology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Divisions of Preventive, Occupational & Aerospace Medicine and Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
J Korean Med Sci. 2022 Nov 14;37(44):e319. doi: 10.3346/jkms.2022.37.e319.
Humidifier disinfectant-related lung injury (HDLI) is a severe form of toxic inhalational pulmonary parenchymal damage found in residents of South Korea previously exposed to specific guanidine-based compounds present in humidifier disinfectants (HD). HD-associated asthma (HDA), which is similar to irritant-induced asthma, has been recognized in victims with asthma-like symptoms and is probably caused by airway injury. In this study, diffusing capacity of the lung for carbon monoxide (DL) in individuals with HDA was compared to that in individuals with pre-existing asthma without HD exposure.
We retrospectively compared data, including DL values, of 70 patients with HDA with that of 79 patients having pre-existing asthma without any known exposure to HD (controls). Multiple linear regression analysis and logistic regression analysis were performed to confirm the association between HD exposure and DL after controlling for confounding factors. The correlation between DL and several indicators related to HD exposure was evaluated in patients with HDA.
The mean DL was significantly lower in the HDA group than in the control group (81.9% vs. 88.6%; = 0.021). The mean DL of asthma patients with definite HD exposure was significantly lower than that of asthma patients with lesser exposure ( for trend = 0.002). In multivariable regression models, DL in the HDA group decreased by 5.8%, and patients with HDA were 2.1-fold more likely to have a lower DL than the controls. Pathway analysis showed that exposure to HD directly affected DL values and indirectly affected its measurement through a decrease in the forced vital capacity (FVC). Correlation analysis indicated a significant inverse correlation between DL% and cumulative HD exposure time.
DL was lower in patients with HDA than in asthma patients without HD exposure, and decreased FVC partially mediated this effect. Therefore, monitoring the DL may be useful for early diagnosis of HDA in patients with asthma symptoms and history of HD exposure.
加湿器消毒剂相关肺损伤（HDLI）是一种严重的毒吸入性肺实质损伤，曾在接触过加湿器消毒剂（HD）中特定胍基化合物的韩国居民中发现。与刺激性哮喘相似的 HD 相关哮喘（HDA）已在具有哮喘样症状的患者中得到承认，可能是由气道损伤引起的。在这项研究中，我们比较了 HDA 患者的一氧化碳弥散量（DL）与无 HD 暴露的既往存在哮喘的患者的弥散量。进行了多元线性回归分析和逻辑回归分析，以在控制混杂因素后确认 HD 暴露与 DL 之间的关联。还评估了 HDA 患者中 DL 与与 HD 暴露相关的几个指标之间的相关性。
我们回顾性比较了 70 例 HDA 患者和 79 例无已知 HD 暴露的既往存在哮喘的患者（对照组）的数据，包括 DL 值。进行了多元线性回归分析和逻辑回归分析，以在控制混杂因素后确认 HD 暴露与 DL 之间的关联。还评估了 HDA 患者中 DL 与与 HD 暴露相关的几个指标之间的相关性。
HDA 组的平均 DL 明显低于对照组（81.9%对 88.6%； = 0.021）。有明确 HD 暴露的哮喘患者的平均 DL 明显低于暴露较少的哮喘患者（趋势检验 = 0.002）。在多变量回归模型中，HDA 组的 DL 降低了 5.8%，与对照组相比，HDA 患者的 DL 降低的可能性高 2.1 倍。途径分析表明，HD 暴露直接影响 DL 值，并通过降低用力肺活量（FVC）间接影响其测量。相关性分析表明，DL%与累积 HD 暴露时间之间存在显著的负相关。
与无 HD 暴露的哮喘患者相比，HDA 患者的 DL 较低，而 FVC 的降低部分介导了这种作用。因此，监测 DL 可能有助于对有 HD 暴露史和哮喘症状的患者的 HDA 进行早期诊断。
