by Todd Neale

Although inhalant abuse has become less prevalent since the early 1990s in all age groups, it remains a source of injury and death, particularly among teenagers, researchers have found.

From 1993 to 2008, intentional exposure to 3,410 different inhalants was reported to U.S. poison control centers, Toby Litovitz, MD, of the National Capital Poison Center in Washington, and colleagues reported in the May issue of Pediatrics.

The highest rate of abuse was among children ages 12 to 17, with about 47.28 cases per million reported to poison control.

The risk of having a life-threatening outcome or dying was significantly higher for cases of inhalant abuse than with both pharmaceutical and nonpharmaceutical exposures (P<0.0001 for both).

That finding “likely reflects the occurrence of sudden death with inhalants, and is troubling in the context of data showing that teenagers increasingly perceive inhalant use to be less harmful or less risky to one’s health,” the researchers asserted.

Three ongoing national surveys have identified a decline in inhalant abuse in recent years, although 10% to 15% of all U.S. teens are estimated to use inhalants at some point.

These surveys have had various shortcomings, however, and the surveillance of health hazards associated with inhalant abuse and the risks associated with specific products has been limited, according to Litovitz and colleagues.

To explore the issue, the researchers turned to the National Poison Data System, which collects information from 60 U.S. poison centers.

From 1993 through 2008, there were 35,453 inhalant abuse cases reported to the centers, with prevalence peaking among 14-year-olds.

In the first 10 years of the study period, the rate of abuse among those ages 12 to 17 decreased from 73 per million to 33.2 per million (P<0.0001), with little change after that.

About three-quarters of the cases (73.5%) involved boys, which appears to contrast with national survey data showing similar amounts of abuse among girls and boys.

The findings “suggest that boys may pursue riskier usage behaviors,” according to the researchers, “such as inhaling larger doses and more concentrated substances, prolonging usage episodes, selecting more hypoxic delivery methods, and using more toxic inhalants.”

Of the cases for which a definitive outcome could be determined, 0.9% died, 4.5% had a life-threatening or disabling outcome, 30.7% had a moderate outcome, 38.4% had a minor outcome, and 25.4% were not affected.

More than 200 inhalant product categories were implicated, with propellants such as aerosol dusters (15.6%), gasoline (13.1%), and paint (10.4%) being the most frequently abused inhalants.

The overall rate of death from inhalant abuse was 5.5 per 1,000 exposures, which was much higher than for exposures from pharmaceuticals (0.4) and nonpharmaceuticals (0.14). The deadliest substance was butane (58.1 deaths per 1,000), followed by propane (25.9), air fresheners (21.8), and nitrous oxide (13.7).

Paint and gasoline both had a low fatality rate of 1.6 per 1,000 exposures.

Propellants were the only product category for which abuse substantially increased over time.

“Focusing inhalant prevention efforts on the most hazardous products and most seriously affected users may improve and facilitate strategic prevention, enabling interventions such as targeted education, product reformulation, repackaging, relabeling, or prohibition of sales of especially hazardous inhalant products to youth,” Litovitz and colleagues concluded.

They said that the study had limited generalizability because of the passive data collection, known under-reporting, and limitations of telephone data-gathering. In addition, the medical outcome was unknown for more than a third of the cases.

Todd Neale is a MedPage Today staff writer.

Originally published in MedPage Today. Visit MedPageToday.com for more pediatrics news.