Dr. Raymond and colleagues diagnosed their patient's illness as bronchiolitis: an inflammatory condition affecting the smallest air passages in the lungs (bronchioles). Most often caused by viral infections in infants, bronchiolitis has also been linked to high levels of endotoxin ”for example, in dusty rooms. Bronchiolitis and exposure to high levels of endotoxin have both been linked to the development of asthma.

Although the patient's illness was moderately severe and lasting, Dr. Raymond and colleagues point out that it was very unusual ”it would not likely result from using normal tap water in a CPAP machine. The recommendation to use distilled water in CPAP machines is related to preventive maintenance, rather than avoiding contamination. Infections related to CPAP machines are rare, and most often related to poor cleaning of the machine.

However, the case report shows that, in unusual circumstances, using contaminated water in CPAP machines has the potential to cause respiratory illness. Dr. Raymond and co-authors conclude, "We do believe that caution is warranted in CPAP humidification using tap water from wells in remote locations such as the North Carolina mountains."

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