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Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction
Abstract
Rationale:
Cleaning tasks may imply exposure to chemical agents with potential harmful effects to the respiratory system, and increased risk of asthma and respiratory symptoms among professional cleaners and in persons cleaning at home has been reported. The long-term consequences of cleaning agents on respiratory health are, however, not well described.
Objectives:
This paper aims to investigate long-term effects of occupational cleaning and cleaning at home on lung function decline and chronic airway obstruction.
Methods:
The ECRHS study has investigated a multi-centre population based cohort at three time points over twenty years. 6230 participants with at least one lung function measurements from 22 study centres, who in ECRHS II responded to questionnaire modules concerning cleaning activities between ECRHS I and ECRHS II were included. The data were analysed with mixed linear models adjusting for potential confounders.
Main results:
As compared to women not engaged in cleaning (FEV1=-18.5 ml/year), FEV1 declined more rapidly in women responsible for cleaning at home (-22.1, p=0.01) and occupational cleaners (-22.4, p=0.03). The same was found for decline in FVC (FVC-=8.8 ml/year; -13.1, p=0.02 and -15.9, p=0.002, respectively). Both cleaning sprays and other cleaning agents were associated with accelerated FEV1 decline (-22.0, p=0.04 and -22.9, p=0.004, respectively). Cleaning was not significantly associated with lung function decline in men or with chronic airway obstruction.
Conclusions:
Women cleaning at home or working as occupational cleaners had accelerated decline in lung function, suggesting that exposures related to cleaning activities may constitute a risk to long-term respiratory health.
... Another important pulmonary irritant is sodium hypochlorite (NaClO). The frequent use of this chemical is related to the appearance of asthma symptoms in occupational cleaners [15,16]. Exposure can lead to the development of work-related asthma, which is classified as occupational asthma (OA) when caused by workplace exposure and work-exacerbated asthma (WEA) when the pre-existing disease is worsened by workplace exposure [17,18]. ...
... Work-related asthma [15,16] and other occupational respiratory diseases [19][20][21] are frequent among professional cleaners due the use of chlorine (Cl 2 )-based products [22]. Chlorine is a water-soluble gas, and its toxicity is related to the production of hydrochloric acid (HCl) and hypochlorous acid (HOCl) [23][24][25]. ...
... Chlorine gas is widely used in the chemical industry and for water disinfection and sterilization of materials [23]. Work-related asthma is a frequent respiratory disease in cleaning workers due the use of chlorine-based products [16,22]. Work-related asthma presents with a similar inflammatory profile as patients with asthma, in addition to bronchial hyperresponsiveness, edema, and airway damage [48][49][50]. ...
Pulmonary irritants, such as cigarette smoke (CS) and sodium hypochlorite (NaClO), are associated to pulmonary diseases in cleaning workers. We examined whether their association affects lung mechanics and inflammation in Wistar rats. Exposure to these irritants alone induced alterations in the lung mechanics, inflammation, and remodeling. The CS increased airway cell infiltration, acid mucus production, MMP-12 expression, and alveolar enlargement. NaClO increased the number of eosinophils and macrophages in the bronchoalveolar lavage fluid, with cells expressing IL-13, MMP-12, MMP-9, TIMP-1, and iNOS in addition to increased IL-1β and TNF-α levels. Co-exposure to both irritants increased epithelial and smooth muscle cell area, acid mucus production, and IL-13 expression in the airways, while it reduced the lung inflammation. In conclusion, the co-exposure of CS with NaClO reduced the pulmonary inflammation, but increased the acidity of mucus, which may protect lungs from more injury. A cross-resistance in people exposed to multiple lung irritants should also be considered.
Graphical abstract
... Condicionantes como la economía, geografía, vacunación, lactancia, contaminación y urbanización, contribuyen al balance de inflamación Th2 y no Th2 4 . Las sustancias causantes del asma relacionadas con el trabajo pueden variar entre hombres y mujeres (por ejemplo, exposición a desinfectantes en trabajadoras de la limpieza) 25 . Incluso con una menor exposición acumulada al tabaco las mujeres asmáticas fumadoras presentan más sibilancias que los hombres 1 . ...
... • El asma ocupacional es más común en hombres, pero recientes estudios indican un infradiagnóstico en mujeres debido a la exposición a nuevos agentes. • Las causas varían por sexo: la harina es principal en hombres (asma del panadero), y los persulfatos alcalinos en mujeres (peluquería, enfermeras), por productos de limpieza y desinfectantes 25,33 . ...
ASMA Y ENFOQUE DE GÉNERO
Ninguna de las guías actuales
para el manejo del asma hace recomendaciones específi cas basadas en el sexo del paciente, si bien
existe cada vez más evidencia de
las diferencias en la presentación,
diagnóstico, tratamiento y consecuencias del asma en la mujer1
. La
identifi cación de factores desencadenantes específi cos, el enfoque en
las diferencias biológicas y hormonales y la individualización del manejo, son pues aspectos cruciales
para garantizar una atención adecuada a estas pacientes por parte del médico de Atención Primaria (AP). El presente documento ofrece una perspectiva de los principales aspectos clave sobre las complejidades del asma en la mujer, a través
de un análisis exhaustivo de la literatura científica disponible.
... For example, in Surabaya, Indonesia, a drone for dispersing clouds of disinfectants was used for disinfection purposes over the city (Wardoyo and Geddie, 2020). Unfortunately, disinfectants, such as bleach and glutaraldehyde, increase the risk of progressive lung diseases (Svanes et al., 2018;Dumas et al., 2019). Some compounds used in the disinfectants affect human health in a negative way. ...
... Some compounds used in the disinfectants affect human health in a negative way. These include increased risk for asthma (Kogevinas et al., 2007;Obadia et al., 2009), decreased lung functions (Svanes et al., 2018), and increased risk for chronic obstructive pulmonary disease (Dumas et al., 2019). Many contaminants can reach the drinking water and also affect human health negatively. ...
The COVID-19 pandemic affected public health, economy, social life, and the environment. It infected and killed millions of people around the world. Most of the recent literature has focused on the medications to combat this virus, including antivirals and vaccines, but studies about its effect on the environment are still rare, particularly on the water sector. Most of the studies concentrate on the effect of water availability on COVID-19, the effect of the used medications on the water, and the probability of transmission of SARS-CoV-2 through water. Herein, we have summarized the effects of COVID-19 on the water sector from many perspectives. We show different methods to detect the effect of the pandemic on water and also methods to investigate the presence of the virus or its RNA in the water. We also show the different effects of its presence in the wastewater, the probability of transmission, the detection of different variants, and the prediction of new waves. We also show the disadvantages and advantages of the pandemic in the water sector. We finally suggest some recommendations to face this pandemic and the future pandemics for the governments and water policymakers, water treatment plants, general population, and researchers. The aim of this review is to show the different aspects of the pandemic in order to give a general idea about what must be done in order to minimize its effect and any probable pandemic in the future.
... A U.S. study of short-term effects among 43 female domestic cleaners with asthma and/or chronic bronchitis found increased respiratory complications on working days and days with greater hours spent cleaning-including cleaning at home-particularly from the use of diluted bleach, degreasing sprays and air fresheners. 4 Exposure research specifically among Latinas includes a study of 56 domestic workers in San Antonio, Texas which surveyed participants regarding the types of routine cleaning tasks at work, the cleaning products used and respiratory symptoms experienced. 33 The study on a hard-to-reach, understudied female population found that upper respiratory symptoms were common, along with "frequent use of potentially toxic cleaning products (eg, bleach, toilet bowl cleaners)" while 39.3% reported not using PPE. ...
... All focus group transcripts were translated by a language service serving hospital systems and government agencies and provided letters of accuracy for each transcript. The consent form was translated by Hackensack University Medical Center's translation 4 Environmental Health Insights service, which provided a letter of accuracy, as per guidelines for all patient signed forms. Three focus groups with a total of 15 participants were conducted until saturation was reached, as determined in consultation with the second author. ...
In the U.S., approximately half of maids and housekeeping cleaners are Latino or Hispanic, while the vast majority are women (88.3%). This largely immigrant, underserved workforce faces complex factors, which may contribute to adverse health outcomes. To understand relevant barriers and challenges, this mixed-methods study explored the environmental health needs of a heterogeneous group of Latinas in New Jersey (NJ) who clean occupationally, and consisted of 3 focus groups (N = 15) with a cross-sectional survey (N = 9), both conducted in Spanish. Participants were recruited from community-based English as a Second Language classes in Hackensack, NJ. Analysis of focus group audio recordings included descriptive and in vivo coding followed by inductive coding to explore thematic analysis. The survey responses were evaluated using descriptive statistics. As per the survey results, the environmental health needs of this population include sore muscles, back problems, asthma, other respiratory issues, migraine or headache, and skin issues (rash, etc.). In the group discussions, the roles of genetics, food, and chemical exposures in cancer etiology were of great interest and a variety of opinions on the topic were explored. Both the focus group discussions and survey responses suggested that this population also faces barriers including lack of training, chemical exposures and inadequate personal protective equipment (PPE). These barriers are compounded by daily environmental exposures from personal home cleaning practices. The development of culturally- and linguistically-appropriate interventions are warranted to better protect the health of essential occupational cleaners who keep homes, businesses and schools clean.
... Some studies have suggested that exposition to these substances could cause an activation of immune system that would facilitate allergic sensitization by compromising the function of epithelial barriers [34]. Chronical inflammation in low degree could even lead to a destruction in the pulmonary parenchyma that could mimic and obstructive disease like COPD [35]. ...
Introduction: there is extensive evidence on the harmful respiratory effects of exposure to disinfectants and cleaning products. Methodology: an exploratory systematic review was carried out in five databases: LILACS, PubMed, MEDLINE and BIREME. Twenty articles from 2013 to 2024 were selected for the present review. Results: chemical compounds present in some disinfectants and cleaning products such as Polyhexamethylene guanidine (PHMG) and Chloromethylisothiazolinone/Methylisothiazolinone (CMIT/MIT) influence the development of Humidifier Respiratory Distress Syndrome (HDRS) and increased incidence of asthma and Chronic Obstructive Pulmonary Disease (COPD) in adults. Conclusions: There is a relationship between exposure to chemical compounds in certain disinfectants and lung health impairment. It is imperative to increase the general population’s awareness of the effects of these substances will lead to improved self-care in those who are in daily contact with these elements.
... Numerosos estudios han demostrado que los ingredientes comunes en los limpiadores sanitarios, como el amoníaco y el cloro, pueden causar irritación en la piel, ojos y pulmones cuando se inhalan o entran en contacto con la piel. Además, se ha encontrado que la exposición prolongada a estos productos químicos puede aumentar el riesgo de desarrollar asma y otras enfermedades respiratorias (Zock, 2007). Además de los efectos en la salud humana, el uso de limpiadores sanitarios también puede tener un impacto negativo en el medio ambiente. ...
Los limpiadores sanitarios junto con otros limpiadores se encuentran entre las sustancias químicas más utilizadas en la vida cotidiana, aunque estos productos son de utilidad para la limpieza, muchos de ellos contienen componentes tóxicos que afectan la salud humana, además de que estos terminan en los suelos y cuerpos de agua; causando efectos directos e indirectos en los ecosistemas naturales, como afectar su reproducción, interferir en la respiración de los organismos acuáticos, degradar compuestos orgánicos promoviendo la eutrofización del agua, hasta poder asfixiarlos, llevando a algunos organismos a la muerte. El objetivo del presente estudio es evaluar la toxicidad e impacto de Pato Purific, un limpiador sanitario frecuentemente empleado en México a partir del estudio y análisis de sus componentes y de los efectos que estos conllevan. Además de realizar un análisis comparativo con artículos sobre el efecto de limpiadores, detergentes y demás contaminantes. Para la evaluación de la toxicidad se analizaron los componentes de los diversos productos de Pato purific, el desinfectante en gel, canastilla para sanitario, limpiador antihongos, destructor de sarro y mugre, las pastillas para tanque de baño y los discos activos en gel, de los cuales a partir de sus fichas técnicas se logró determinar sus componentes, entre los que podemos encontrar agentes tensioactivos aniónicos, tensioactivos no-iónicos, ácido fórmico al 85%, cuaternario de amonio, espesante, alcoholes etoxilados, hidróxido de sodio, fragancia y colorantes; su identificación de peligros, información toxicológica, presentando una toxicidad de DL50 rata; información ecológica y efectos crónicos.
... Women reported cooking for longer than men, which may explain the stronger associations seen in females due to increased exposure to gas cooking. Biological sex differences in susceptibility to indoor pollutants on respiratory health may also exist (Svanes et al., 2018;Triebner et al., 2016). ...
... It is, therefore, plausible occupational exposure may act differently on males and females. It has been shown, for example, that females are more likely to develop respiratory disease after lower levels of exposure to tobacco smoke (Silverman et al. 2000;Foreman et al. 2011), cleaning agents (Svanes et al. 2018), and wood dust (Jacobsen et al. 2008) than males. ...
While sex is a biological attribute associated with physical and physiological features, gender refers to socially constructed roles, behaviors, expressions, and identities. On the biological side, males and females differ concerning hormonal and anatomical differences, and It is therefore plausible occupational exposure may act differently on males and females. In contrast, gender may influence the work organization, work environment conditions and exposures, and employment conditions, leading people of different genders to perform different jobs or job tasks, be exposed to different stressors, and work under different employment terms.
Traditionally, occupational exposures have been assessed without considering how exposures may differ by sex or gender. Early research focused on occupations that primarily employed men. However, women have entered occupations historically dominated by men, leading to emerging exploration of gender differences in exposure. Some women-dominated occupations have become the focus of intensive research activity. In the Annals, the number of articles including sex and gender issues has increased dramatically over time, with only two published prior to 1980, and 70 in the 2010s, and with a special issue dedicated to Gender, Work, and Health in 2018 where the editors highlighted a need to improve assessment of gender and sex identities to allow for more nuanced knowledge to elucidate the role of work organization and contextual factors about gender, work exposures, and health.
Females, on average, have different body dimensions than males, which affects how well workplaces and personal protective equipment (PPE) fit females, and there remains a need for further improvements to ensure that females are protected equally well. On the other hand, females tend to comply more frequently with PPE requirements than men highlighting the need for gender-specific initiatives in order to increase PPE performance and compliance.
In conclusion, there is still work to do in order to fill in the existing knowledge gap with regard to sex, gender, and work, but there are promising initiatives and the field is progressing.
... Current wheezing phenotypes at inclusion (2019-2022) will be defined by the inclusion questionnaire, in accordance with definitions used in international studies [28,30,32]: (i) wheezing in the last 12 months (current wheezing); and (ii) recurrent wheezing (at least 3 wheezing episodes in the last 12 months). The severity of wheezing in the last 12 months will be assessed in two ways, based on (i) (a) recurrent wheezing status, (b) discomfort with daily activities, or (c) nocturnal awakening; and (ii) inhaled corticosteroid use and hospitalization (emergency department visit and/or hospitalization due to bronchiolitis, wheezy bronchitis, or asthma attacks) in the last 12 months. ...
Although cleaning tasks are frequently performed in daycare, no study has focused on exposures in daycares in relation to respiratory health. The CRESPI cohort is an epidemiological study among workers (n~320) and children (n~540) attending daycares. The purpose is to examine the impact of daycare exposures to disinfectants and cleaning products (DCP) on the respiratory health of workers and children. A sample of 108 randomly selected daycares in the region of Paris has been visited to collect settled dust to analyze semi-volatile organic compounds and microbiota, as well as sample indoor air to analyze aldehydes and volatile organic compounds. Innovative tools (smartphone applications) are used to scan DCP barcodes in daycare and inform their use; a database then matches the barcodes with the products’ compositions. At baseline, workers/parents completed a standardized questionnaire, collecting information on DCP used at home, respiratory health, and potential confounders. Follow-up regarding children’s respiratory health (monthly report through a smartphone application and biannual questionnaires) is ongoing until the end of 2023. Associations between DCP exposures and the respiratory health of workers/children will be evaluated. By identifying specific environments or DCP substances associated with the adverse respiratory health of workers and children, this longitudinal study will contribute to the improvement of preventive measures.
... 21 In 2021, QACs were added to the California Environmental Contaminant Biomonitoring Program's list of priority chemicals, but to date no data have been collected. [84][85][86]91 What we know about human exposure to QACs is mostly from academic studies. QACs have been detected in blood from the general population, with higher levels observed during the pandemic. ...
Quaternary ammonium compounds (QACs), a large class of chemicals that includes high production volume substances, have been used for decades as antimicrobials, preservatives, and antistatic agents and for other functions in cleaning, disinfecting, personal care products, and durable consumer goods. QAC use has accelerated in response to the COVID-19 pandemic and the banning of 19 antimicrobials from several personal care products by the US Food and Drug Administration in 2016. Studies conducted before and after the onset of the pandemic indicate increased human exposure to QACs. Environmental releases of these chemicals have also increased. Emerging information on adverse environmental and human health impacts of QACs is motivating a reconsideration of the risks and benefits across the life cycle of their production, use, and disposal. This work presents a critical review of the literature and scientific perspective developed by a multidisciplinary, multi-institutional team of authors from academia, governmental, and nonprofit organizations. The review evaluates currently available information on the ecological and human health profile of QACs and identifies multiple areas of potential concern. Adverse ecological effects include acute and chronic toxicity to susceptible aquatic organisms, with concentrations of some QACs approaching levels of concern. Suspected or known adverse health outcomes include dermal and respiratory effects, developmental and reproductive toxicity, disruption of metabolic function such as lipid homeostasis, and impairment of mitochondrial function. QACs' role in antimicrobial resistance has also been demonstrated. In the US regulatory system, how a QAC is managed depends on how it is used, for example in pesticides or personal care products. This can result in the same QACs receiving different degrees of scrutiny depending on the use and the agency regulating it. Further, the US Environmental Protection Agency's current method of grouping QACs based on structure, first proposed in 1988, is insufficient to address the wide range of QAC chemistries, potential toxicities, and exposure scenarios. Consequently, exposures to common mixtures of QACs and from multiple sources remain largely unassessed. Some restrictions on the use of QACs have been implemented in the US and elsewhere, primarily focused on personal care products. Assessing the risks posed by QACs is hampered by their vast structural diversity and a lack of quantitative data on exposure and toxicity for the majority of these compounds. This review identifies important data gaps and provides research and policy recommendations for preserving the utility of QAC chemistries while also seeking to limit adverse environmental and human health effects.
... [128][129][130][131] Reduced lung function due to occupational and household cleaning exposure has been found in women, but not men, most likely due to the disproportionate number of women in this study who reported cleaning. 132 The health risks associated with occupational exposure to cleaners go beyond those directly exposed, with one study showing the children of exposed mothers to be at increased risk of developing pulmonary disorders, including asthma, allergies, and wheezing. 133 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 https://mc.manuscriptcentral.com/exposome ...
The health and disease of an individual is mediated by their genetics, a lifetime of environmental exposures, and interactions between the two. Genetic or biological sex, including chromosome composition and hormone expression, may influence both the types and frequency of environmental exposures an individual experiences, as well as the biological responses an individual has to those exposures. Gender identity, which can be associated with social behaviors such as expressions of self, may also mediate the types and frequency of exposures an individual experiences. Recent advances in exposome-level analysis have progressed our understanding of how environmental factors affect health outcomes; however, the relationship between environmental exposures and sex- and gender-specific health remains underexplored. The comprehensive, non-targeted, and unbiased nature of exposomic research provides a unique opportunity to systematically evaluate how environmental exposures interact with biological sex and gender identity to influence health. In this forward-looking narrative review, we provide examples of how biological sex and gender identity influence environmental exposures, discuss how environmental factors may interact with biological processes, and highlight how an intersectional approach to exposomics can provide critical insights for sex- and gender-specific health sciences.
... Knowledge of exposure-response relationships is critical for the design of effective preventive measures. To date, only one epidemiologic study has demonstrated longitudinal declines in lung function associated with the use of cleaning products, but quantitative exposure-response relationships with specific products or chemicals were not assessed (Svanes et al. 2018). Additionally, most of the epidemiologic studies of the health effects of exposure to cleaning and disinfection products have investigated a single product or ingredient at a time, however, workers are exposed to a complex mixture of chemicals which may have synergistic effects. ...
... Further, Vizcaya et al. [19] showed that forced expiratory volume in one second (FEV 1 ) and PEF decreased for asthmatic female cleaning workers (n = 21) during days with a high use of cleaning sprays. Svanes et al. [20] have also shown a long-term association between declining lung function for forced vital capacity (FVC) and FEV 1 and the use of cleaning products, including sprays. ...
Background:
Cleaning workers are exposed to chemicals and high physical workload, commonly resulting in airway problems and pain. In this study the response in the upper airways and the physical workload following airborne and ergonomic exposure of cleaning spray was investigated.
Methods:
A survey was answered by professional cleaning workers to investigate their use of cleaning sprays and the perceived effects on eyes, airways and musculoskeletal pain. A human chamber exposure study was then conducted with 11 professional cleaning workers and 8 non-professional cleaning workers to investigate the airborne exposure, acute effects on eyes and airways, and physical load during cleaning with sprays, foam application and microfiber cloths premoistened with water. All cleaning products used were bleach, chlorine, and ammonia free. The medical assessment included eye and airway parameters, inflammatory markers in blood and nasal lavage, as well as technical recordings of the physical workload.
Results:
A high frequency of spray use (77%) was found among the 225 professional cleaning workers that answered the survey. Based on the survey, there was an eight times higher risk (p < 0.001) of self-experienced symptoms (including symptoms in the nose, eyes and throat, coughing or difficulty breathing) when they used sprays compared to when they cleaned with other methods. During the chamber study, when switching from spray to foam, the airborne particle and volatile organic compound (VOC) concentrations showed a decrease by 7 and 2.5 times, respectively. For the whole group, the peak nasal inspiratory flow decreased (-10.9 L/min, p = 0.01) during spray use compared to using only water-premoistened microfiber cloths. These effects were lower during foam use (-4.7 L/min, p = 0.19). The technical recordings showed a high physical workload regardless of cleaning with spray or with water.
Conclusion:
Switching from a spraying to a foaming nozzle decreases the exposure of both airborne particles and VOCs, and thereby reduces eye and airway effects, and does not increase the ergonomic load. If the use of cleaning products tested in this study, i.e. bleach, chlorine, and ammonia free, cannot be avoided, foam application is preferable to spray application to improve the occupational environment.
... L'accumulation d'expositions aigües et des dommages associés supportent l'idée d'une association entre pollution extérieure et développement de la BPCO, mais cette causalité nécessite d'être expérimentalement démontrée (Schikowski et al., 2014). Enfin, l'exposition domestique ou professionnelle à des produits chimiques tels que les produits de nettoyage a été incriminée dans le déclin de la fonction pulmonaire (Svanes et al., 2018). ...
La broncho-pneumopathie chronique obstructive (BPCO) est une maladie respiratoire chronique associée à une intolérance à l’effort et à des comorbidités cardiovasculaires. Ces éléments apparaissent intimement liés à la structure et la fonction des capillaires sanguins musculaires mais également des artères en amont. Bien que le ré-entrainement à l’effort (REE) ait un effet bénéfique sur la fonction vasculaire chez les sujets sains, cet effet semble émoussé chez les patients BPCO. L’objectif de ces travaux de thèse était ainsi de comprendre les défauts d’adaptation vasculaire chez les patients BPCO en réponse au REE. Dans une première étude, nous avons analysé l’angiogenèse musculaire à l’échelon ultrastructural, chez des patients BPCO et des sujets contrôles sédentaires sains (CSS) au cours d’un REE et avons mis en évidence des défauts d’interaction péricyte/capillaire chez les patients. Dans une deuxième étude, nous avons recherché des anomalies d’adaptation de la couverture péricytaire au cours de l’angiogenèse induite par le REE chez les patients BPCO, ainsi que l’effet de facteurs circulants sur les déterminants de la couverture péricytaire. Nous avons ainsi montré un défaut d’adaptation de la couverture péricytaire durant l’angiogenèse induite par le REE après 10 semaines de REE chez des patients BPCO par rapport à des CSS. De plus, nous avons pu observer que le sérum des patients BPCO perturbait le recrutement péricytaire in vitro. Dans une troisième étude, nous avons étudié l’expression de la voie PGC1-α musculaire et de ses effecteurs pro-angiogéniques, en réponse à une stimulation par l’exercice, chez des patients BPCO et des CSS. Grâce à l’isolement, la différenciation et la stimulation de cellules souches musculaires issues de muscles de patients BPCO et de CSS, nous avons démontré une altération de l’expression de PGC1-α dans les cellules musculaires de patients BPCO sous l’effet d’une stimulation électrique par impulsion. Une réduction de la production de SPP1 par ces cellules a également été trouvée, limitant leur capacité d’orchestration de la maturation capillaire. Dans une quatrième étude nous nous sommes intéressés aux déterminants cliniques, fonctionnels, cellulaires et moléculaires impliqués dans le défaut de réponse de la vasoréactivité artérielle au REE chez le patient BPCO. Pour cela, nous avons mis au point un protocole d’étude clinique multicentrique et démontré sa faisabilité. Au final, ces travaux de thèse ont permis une meilleure compréhension des mécanismes de l’atteinte capillaire et de l’angiogenèse émoussée du patient BPCO. Alors que l’altération du nombre de capillaires sanguins musculaires semblait être un processus tardif, nous avons montré un défaut inédit et précoce de couverture péricytaire chez ces patients. De plus, nous avons pu identifier certains acteurs potentiellement à l’origine de cette altération : les facteurs circulants délétères de la maladie et des anomalies de la cellule musculaire. La perspective de cette thèse sera de mieux comprendre les causes et les conséquences du défaut de couverture péricytaire durant l’angiogenèse musculaire chez le patient BPCO.
... hairdressing and salon-related labour have been demonstrated to trigger asthma symptoms such as airway inflammation, allergies and lung function. Traditional male occupations, such as carpentry, autospray painting and baking, expose one to wood dust, cooling lubricants and flour.60,[62][63][64] Acculturative stress seems to be higher in the first generation, who were less acculturated to their new environment, describing psychological distress such as 'depression', compared to the third generation.59 ...
Background:
Self-management strategies improve asthma outcomes, although interventions for South Asian populations have been less effective than in White populations. Both self-management and culture are dynamic, and factors such as acculturation and generation have not always been adequately reflected in existing cultural interventions. We aimed to explore the perspectives of Bangladeshi and Pakistani people in the United Kingdom, across multiple generations (first, second and third/fourth), on how they self-manage their asthma, with a view to suggesting recommendations for cultural interventions.
Methods:
We purposively recruited Bangladeshi and Pakistani participants, with an active diagnosis of asthma from healthcare settings. Semi-structured interviews in the participants' choice of language (English, Sylheti, Standard Bengali or Urdu) were conducted, and data were analysed thematically.
Results:
Twenty-seven participants (13 Bangladeshi and 14 Pakistani) were interviewed. There were generational differences in self-management, influenced by complex cultural processes experienced by South Asians as part of being an ethnic minority group. Individuals from the first generation used self-management strategies congruent to traditional beliefs such as 'sweating' and often chose to travel to South Asian countries. Generations born and raised in the United Kingdom learnt and experimented with self-management based on their fused identities and modified their approach depending on whether they were in familial or peer settings. Acculturative stress, which was typically higher in first generations who had migration-related stressors, influenced the priority given to asthma self-management throughout generations. The amount and type of available asthma information as well as social discussions within the community and with healthcare professionals also shaped asthma self-management.
Conclusions:
Recognizing cultural diversity and its influence of asthma self-management can help develop effective interventions tailored to the lives of South Asian people.
Patient or public contribution:
Patient and Public Involvement colleagues were consulted throughout to ensure that the study and its materials were fit for purpose.
... Most studies so far have considered the potential impact of the personal use of cleaning products containing irritant agents [9][10][11][12][13] or applied in a spray form. 9,11,[13][14][15][16][17][18] Personal use of these two categories of cleaning products at home has been shown to be associated with the development, 13,18 clinical expression, [10][11][12]14,16 and poor control of asthma. 9,16 The clinical expression of asthma was mainly studied though the evaluation of current asthma 10,12,14,16 and the asthma symptom score. ...
While exposure to irritant and sprayed cleaning products at home is known to have a harmful role in asthma, the potential health effect of other categories or forms has not been investigated. We studied the associations of household use of cleaning products, including green, homemade products, and disinfecting wipes, with asthma based on data from the large French population‐based CONSTANCES cohort. Participants completed standardized questionnaires on respiratory health and household use of cleaning products. Cross‐sectional associations of cleaning products with current asthma, adjusted for gender, age, smoking status, BMI, and educational level, were evaluated by logistic regressions. Analyses were conducted in 41 570 participants (mean age: 47 years, 56% women, weekly use of the six specific products/forms studied varied from 11% to 37%). Weekly use of irritants (OR = 1.23 [1.13–1.35]), scented (OR = 1.15 [1.06–1.26]), green (OR = 1.09 [1.00–1.20]), and homemade products (OR = 1.19 [1.06–1.34]), as well as sprays (OR = 1.18 [1.08–1.29]), disinfecting wipes (OR = 1.21 [1.09–1.34]) were significantly associated with asthma, with significant trends according to the frequency of use. When they were not co‐used with irritants/sprays, associations were reduced and persisted only for disinfecting wipes. Weekly use of disinfecting wipes at home was associated with current asthma, but fewer risks were observed for the use of green and homemade products.
... Also, due to the known effects of ultra-processed food on a number of health parameters, notably lipid profiles in children, their use in institutional catering units should be limited or even inexistent (Rauber et al., 2015). Finally, it has been shown that humans' exposure to most cleaning agents provoke certain clinical problems such as asthma and lung function decline (Svanes et al., 2018;Lemire et al., 2020). Workers in particular are FIGURE 3 | Overview of the methodological approach followed to identify types of ICU transition pathways toward sustainability. ...
Very few studies have dealt with sustainability transitions in the agrifood sector, especially in institutional food services (IFS), and notably at a micro level. Based on 29 interviews with head cooks in France, we characterized the micro-level sustainability transition pathways that institutional catering units have been following, taking essentially four sustainable practices into consideration: organic food use, ultra-processed food use, vegetarian meals and waste management. We identified four transition pathways according to the speed, size, dimensionality and time-period of changes in those practices. We showed how these pathways are linked to the diversity of transition contexts; internal (e.g. skills) and external (e.g. local suppliers) resources and constraints. This original empirical study revealed the diversity and feasibility of sustainability transition pathways in IFS. It also showed that they do not require unreasonable increases in resources. Positive narratives on transitions need developing, together with diagnosis tools to guide them.
... Fixed surface cleaning is one of the major tasks performed in healthcare settings to prevent healthcareassociated infections. Several studies have reported increased risk of adverse health effects such as asthma, rhinitis and dermatitis associated with exposure to cleaning agents used for surfaces, such as ammonia and bleach (Buck et al., 2000;Medina-Ramón et al., 2003;Vizcaya et al., 2015;Svanes et al., 2018;Rosenman et al., 2020). Chloramines released when bleach is mixed with cleaning products containing ammonium salts have also been reported to cause occupational asthma (Thickett et al., 2002;Quirce and Barranco, 2010). ...
Background:
Whilst cleaning agents are commonly used in workplaces and homes, health workers (HWs) are at increased risk of exposure to significantly higher concentrations used to prevent healthcare-associated infections. Exposure assessment has been challenging partly because many are used simultaneously resulting in complex airborne exposures with various chemicals requiring different sampling techniques. The main objective of this study was to characterize exposures of HWs to various cleaning agents in two tertiary academic hospitals in Southern Africa.
Methods:
A cross-sectional study of HWs was conducted in two tertiary hospitals in South Africa (SAH) and Tanzania (TAH). Exposure assessment involved systematic workplace observations, interviews with key personnel, passive personal environmental sampling for aldehydes (ortho-phthalaldehyde-OPA, glutaraldehyde and formaldehyde), and biomonitoring for chlorhexidine.
Results:
Overall, 269 samples were collected from SAH, with 62 (23%) collected from HWs that used OPA on the day of monitoring. OPA was detectable in 6 (2%) of all samples analysed, all of which were collected in the gastrointestinal unit of the SAH. Overall, department, job title, individual HW use of OPA and duration of OPA use were the important predictors of OPA exposure. Formaldehyde was detectable in 103 (38%) samples (GM = 0.0025 ppm; range: <0.0030 to 0.0270). Formaldehyde levels were below the ACGIH TLV-TWA (0.1 ppm). While individual HW use and duration of formaldehyde use were not associated with formaldehyde exposure, working in an ear, nose, and throat ward was positively associated with detectable exposures (P-value = 0.002). Glutaraldehyde was not detected in samples from the SAH. In the preliminary sampling conducted in the TAH, glutaraldehyde was detectable in 8 (73%) of the 11 samples collected (GM = 0.003 ppm; range: <0.002 to 0.028). Glutaraldehyde levels were lower than the ACGIH's TLV-Ceiling Limit of 0.05 ppm. p-chloroaniline was detectable in 13 (4%) of the 336 urine samples (GM = 0.02 ng/ml range: <1.00 to 25.80).
Conclusion:
The study concluded that detectable exposures to OPA were isolated to certain departments and were dependent on the dedicated use of OPA by the HW being monitored. In contrast, low-level formaldehyde exposures were present throughout the hospital. There is a need for more sensitive exposure assessment techniques for chlorhexidine given its widespread use in the health sector.
... Our findings revealed that major complaints, such as wheezing, chest tightness, shortness of breath, coughing, sneezing, runny nose and rhinitis, were present only in the cleaning worker groups. Notably, water-soluble cleaning products can irritate the upper airways [26]. ...
Background
Cleaning workers represent a significant proportion of the active population worldwide, with poor remuneration, particularly in developing countries. Despite this, they remain a relatively poorly studied occupational group. They are constantly exposed to agents that can cause symptoms and respiratory problems. This study aimed to evaluate upper airway inflammation in professional cleaning workers in three different occupational settings by comparing nasal cytology inflammation and clinical profiles.
Methods
We performed a cross-sectional study on the prevalence of upper airway inflammation and symptoms of asthma/rhinitis related to cleaning work, according to workplace. A total of 167 participants were divided into four groups: hospital, university, housekeeper and control. A nasal swab was collected for upper airway inflammation evaluation. Clinical profiles and respiratory symptom employee evaluations were performed using specific questionnaires (European Community Respiratory Health Survey—ECRS and the International Study of Asthma and Allergies in Childhood—ISAAC).
Results
Cleaning workers showed increased neutrophils and lymphocytes; the hospital and university groups showed increased macrophages compared to the housekeeper and control groups. The hospital and housekeeper groups showed increased eosinophils when they performed cleaning services for up to one year and reported having more asthma symptoms than the control group. Cleaning workers showed increased rhinitis symptoms. The university group showed increased rhinitis symptoms aggravated by the workplace compared with the hospital and housekeeper groups. Cleaning workers showed an increased affirmative response when directly asked about rhinitis symptoms compared to the control group.
Conclusions
Cleaning workers showed airway inflammation, asthma symptoms and rhinitis, regardless of the occupational environment to which they were exposed, as well as showed increased rhinitis and asthma symptoms. Hospital cleaning workers showed increased macrophages, lymphocytes and eosinophils compared to the others. The length of time spent performing cleaning work was not related to nasal inflammation or respiratory symptoms in this population. However, there were differences in workplaces. Registered on ClinicalTrials.gov. Trial registration number: NCT03311048. Registration date: 10.16.2017. Retrospectively registered.
... It has become evident that cleaning products cause up to 12% of reported asthma cases in several countries across Europe [9]. In addition, Svannes et al. [10] showed reduced lung capacity among cleaning workers following exposure to chemicals in cleaning products. ...
Background:
Researcher have shown that cleaning workers have an increased risk of asthma and rhinitis, mainly due to exposure to chemical substances present in the cleaning products they use. Among the important substances are glycol ethers, increasingly used as components in cleaning products.
Objective:
To assess exposure levels of glycol ether in professional cleaning products and compare to existing regulatory exposure limit values.
Methods:
Information from safety data sheets of the products is used to identify the glycol ethers present in the cleaning products and their respective concentrations. Other sources used to obtain the relevant data required for use in the tool to generate exposure assessments. Exposure levels for various cleaning work exposure scenarios were estimated using ConsExpo web tool.
Results:
The estimated exposure values are significantly lower than the existing regulatory occupational exposure limits values for the different glycol ethers.
Conclusions:
The study showed that the risk of exposure to glycol ethers by inhalation from the professional cleaning products is minimal as exposure estimates were much below the regulatory occupational exposure limit values.
... Knowledge of exposure-response relationships is critical for the design of effective preventive measures. To date, only one epidemiologic study has demonstrated longitudinal declines in lung function associated with the use of cleaning products, but quantitative exposure-response relationships with specific products or chemicals were not assessed (Svanes et al. 2018). Additionally, most of the epidemiologic studies of the health effects of exposure to cleaning and disinfection products have investigated a single product or ingredient at a time, however, workers are exposed to a complex mixture of chemicals which may have synergistic effects. ...
Healthcare is one of the largest and fastest growing industries worldwide. It is complex and comprises different occupations directly providing healthcare services, and occupations providing other supporting services. The industry is changing rapidly with advances in medical science and new technologies. It faces new challenges stemming from changing demographics, migration, environmental and geopolitical instability, increased demand and cost of health services, and new disease outbreaks, all contributing to new hazards or exacerbating existing ones. A healthy healthcare workforce is central to sustain healthcare systems and for a prosperous society and economy. However, healthcare workers are exposed to a mixture of hazards that can include chemical (anesthetic gases), biological (pathogens), physical (radiation), ergonomic (musculoskeletal), psychosocial (stress), and safety hazards (violence). Chemical hazards arise from sources, such as cleaning, disinfecting and sterilizing agents, solvents, glues, metals, hazardous drugs, laboratory chemical reagents, waste anesthetic gases, surgical smoke, and other indoor air contaminants. Working in healthcare is associated with a spectrum of adverse health outcomes including respiratory, reproductive, dermatologic, neurologic, other systemic outcomes and cancer. These exposures and health hazards are preventable but continue to occur among healthcare workers in part because industry attention is focused on preventing healthcare associated infections in patients caused by pathogens. Healthcare workers’ exposures to chemicals is consequently not well recognized and disease prevention or exposure mitigation measures are not fully implemented. The focus of this review is to highlight inhalation and dermal exposures to chemicals among various occupations and units in healthcare and identify opportunities for exposure mitigation and disease prevention.
... However, links have in particular been made to asthma (Quirce and Barranco, 2010;De Matteis et al., 2020;Archangelidi et al., 2021) but also to chronic obstructive pulmonary disease (Van den Borre and Deboosere, 2018; Archangelidi et al., 2021). Additionally, a recent study found a correlation between the use of cleaning agents at home and airway obstruction in women (Svanes et al., 2018). This highlights risk of products intended for consumer use as well as the frequent use of these by domestic cleaning staff (Carder et al., 2019). ...
Using data from the Swedish Products Register, hosted by the Swedish Chemicals Agency (KemI), national occupational injury and disease statistics, and call records from the Swedish Poisons Information Centre (PIC) we characterize health hazards of marketed cleaning products and recorded injuries, disease, and incidents linked to cleaning or disinfection agents. The results show that cleaning agents pose many kinds of health hazards, although corrosion and irritation hazards dominate, in particular for the eyes (54% of all included products). Few products were recognized as inhalation hazards. The nature of the health hazards is reflected in the occupational disease and injury statistics and PIC records for eyes and skin but not for the respiratory tract. Among occupational disease cases attributed to cleaning or disinfection agents, 61% concern skin and 26% the respiratory tract. Among occupational injury cases 64% concern chemical burns. However, only a small part (<0.5%) of all reported diseases and injuries were explicitly attributed to cleaning or disinfection agents. On average, there were 11 cases of disease attributed to cleaning or disinfection agents per million workers and year. For occupational injuries the corresponding number was 8. The data concern a broad range of sectors and occupations, but notable sectors were healthcare, accommodation and food service, and manufacturing. Women were more likely to suffer from disease, men and women equally likely to suffer from injury. PIC cases were evenly distributed between men and women, but the clear risk cases more frequently involved men. Occupational diseases increased many-fold in 2020 while injuries decreased, which could be due to COVID-19 changing use patterns of cleaning and disinfection agents at work. We conclude that cleaning agents pose a variety of risks to a large part of the workforce, although particular attention for preventive efforts may need to be directed to the healthcare, accommodation and food service, and manufacturing sectors.
... 9 Traditionally female occupations (cleaning, hairdressing, and salons) may result in exposure to chemicals that are implicated in airway inflammation, allergic sensitization, and lung function decline. 34 Smoking. Tobacco smoke can be a powerful trigger of asthma symptoms. ...
An individual’s sex (nominally ‘male’ or ‘female’, based on biological attributes) and gender (a complex term, referring to socially constructed roles, behaviors, and expressions of identity) influences the clinical course of asthma in several ways. The physiological development of the lungs and effects of sex hormones may explain why more boys have asthma than girls, and post-puberty, more women have asthma than men. Female sex hormones have an impact throughout the lifespan and are associated with poor asthma control. Gender may influence exposure to asthma triggers, and sex and gender can influence the prevalence of comorbidities and interactions with healthcare professionals (HCPs). Despite widely reported sex and gender-based differences in asthma and asthma management, these issues are frequently not considered by HCPs. There is also inconsistency around use of ‘sex’ and ‘gender’ in scientific discourse, and research is needed to better define sex and gender-based differences and how they might interact to influence asthma outcomes. This review outlines the impact an individual’s sex and gender can have on the pathogenesis, clinical course, diagnosis, treatment, and management of asthma.
... De plus, l'exposition à des produits chimiques notamment ceux employés dans les produits ménagers a récemment été décrit comme également en cause dans le déclin de la fonction pulmonaire et de l'obstruction bronchique, dans une mesure équivalente à un tabagisme à hauteur de 10 à 20 paquets-année 14 . L'ensemble de ces résultats conforte l'hypothèse d'un panel élargi des facteurs environnementaux dans l'étiologie de la BPCO, bien que le tabagisme reste l'un des facteurs majeurs [15][16][17] . ...
La dysfonction musculaire est l’une des comorbidités les plus handicapantes touchant les patients atteints de bronchopneumopathie chronique obstructive (BPCO) qui, au-delà de la limite physique, est un indicateur du faible taux de survie des patients BPCO. Afin de rétablir les capacités fonctionnelles musculaires et la tolérance à l’effort des patients, le réentraînement à l’effort (REE) dans le cadre d’une réhabilitation respiratoire représente aujourd’hui la meilleure approche thérapeutique. Cependant, les bénéfices musculaires induits par le REE sont limités tant en amplitude qu’en durée. Cette limitation est ainsi un enjeu majeur dans le traitement des patients BPCO. Parmi les hypothèses pouvant expliquer ces limites, le débordement (Spill-over) de molécules pro-inflammatoires provenant des poumons, et empruntant la circulation systémique, pourrait être à l’origine d’une détérioration du microenvironnement musculaire qui limiterait ces effets bénéfiques du REE.L’objectif de ce travail de thèse est d’étudier le rôle du microenvironnement BPCO de la cellule musculaire dans les défauts de régénération musculaire et d’évaluer son implication dans la limite des effets bénéfiques du REE.Nous avons ainsi montré que l’autophagie, modulée par le stress oxydant, était impliquée dans l’altération des cellules musculaires BPCO en culture. Nous avons alors étudié si le microenvironnement BPCO (c’est-à-dire le sérum BPCO) pouvait participer à l’altération de la différenciation/régénération de myoblastes humains sains. Après avoir mis en place une méthodologie in vitro permettant l’étude du microenvironnement BPCO sur la différenciation de myoblastes humains sains, nous avons mis en évidence que la sévérité de la maladie influait sur la composition du microenvironnement, avec des répercussions sur la différenciation des myoblastes sains. Il est d’ailleurs probable que le microenvironnement BPCO épuise le potentiel myogénique des myoblastes. Le REE semble d’ailleurs inefficace à rétablir une composition du microenvironnement propice au processus de différenciation, en favorisant l’expression de marqueurs du catabolisme. Nous avons également observé que les myoblastes de patients BPCO présentaient des défauts d’adaptation à une stimulation électrique (induisant des réponses adaptatives similaires à celle d’un REE) suggérant que les myoblastes BPCO possèdent un potentiel myogénique altéré.L’ensemble de ces travaux suggère que le microenvironnement BPCO véhicule des molécules qui pourraient épuiser le potentiel myogénique des myoblastes humains sains. Cet effet du microenvironnement pourrait à terme altérer les processus de régénération musculaire et limiter les effets bénéfiques du REE chez le patient BPCO.
... In particular, incidence of invasive cancers among U.S. Latinos is projected to increase 142% by 2030 [5]. Therefore, studying the population health of cleaning professionals and occupational chemical exposure means engaging an understudied population which faces multiple social barriers and health challenges [2,[6][7][8][9][10][11][12][13][14][15][16][17][18][19]. ...
Background
In the United States, 88.3% of all 1,163,000 maids and housekeeping cleaners are female, and approximately half of them Latinas. Latinas are understudied and underrepresented in health research, particularly involving chemical exposure in cleaning practices, lack of job training, and inadequate access to personal protective equipment. The purpose of this study is twofold: 1) to examine the knowledge (via training experiences), attitudes and behaviors of a heterogeneous group of Latinas who clean occupationally and 2) to assess their cleaning practices at work and at home.
Methods
This mixed-method study consisted of two phases: 1) three focus groups to explore knowledge (via training experiences), attitudes, and behaviors regarding cleaning practices ( N = 15) and 2) a 43-question cross-sectional survey. Focus group audio recordings were analyzed using descriptive and in vivo coding and then coded inductively to explore thematic analysis. Statistical analysis of the survey evaluated means, frequency and percentage for each of the responses.
Results
Participants ( n = 9) were women (mean age = 48.78 and SD = 6.72) from South America ( n = 5), Mexico ( n = 1), El Salvador ( n = 1) and Dominican Republic ( n = 2). The mean length of time living in the US was 18.78 years and over half (55.6%) worked in the cleaning industry for 10 or more years.
Findings from the three focus groups ( n = 15) included that training in cleaning often occurred informally at a very young age at home. Participants reported cleaning in groups where tasks are rotated and/or shared. Most were the primary person cleaning at home, suggesting increased exposure. Gloves and masks were the most frequently used PPE, but use was not consistent. For participants who purchase their own products, driving factors included price, smell and efficacy. Some participants used products supplied or preferred by the employer.
Conclusions
Latinas in cleaning occupations face a range of social and health barriers including lack of safety and health training, inadequate PPE and low literacy. To address these issues, the development of an intervention is warranted to provide training and resources for this critical population of essential workers.
... Two patients in our series were housekeepers. Studies have shown that regular use of certain detergents may be harmful to the lungs, the American Journal of Respiratory and Critical Care Medicine (Svanes et al., 2018). For example, a recent Norwegian study that followed 6,000 people for nearly 20 years found that housewives had lung function similar to that of women who smoked the equivalent of 20 cigarettes per day over 10 to 20 years (Strand et al., 2018). ...
... [3][4][5][6][7][8][9] In addition, it has been suggested that exposures related to cleaning activities may constitute a risk to long-term respiratory health. 10 A dose-response pattern with increased risk of respiratory symptoms and diseases by increased dose and duration of exposure has been reported. 5,6,9 Cleaning products and disinfectants comprise a wide range of ingredients that are irritants and/or potential sensitizers. ...
Background: Emerging research suggests health effects in offspring after parental chemical exposures before conception. Many future mothers are exposed to potent chemicals at work, but potential offspring health effects are hardly investigated.
Objective: We sought to investigate childhood asthma in relation to mother's occupational exposure to cleaning products and disinfectants before conception.
Methods: The multicenter Respiratory Health In Northern Europe/Respiratory Health In Northern Europe, Spain and Australia generation study investigated asthma and wheeze starting at age less than 10 years in 3318 mother-offspring pairs. From an asthma-specific Job-Exposure Matrix and mothers' occupational history, we defined maternal occupational exposure to indoor cleaning agents (cleaning products/detergents and disinfectants) starting before conception, in the 2-year period around conception and pregnancy, or after birth. Never-employed mothers were excluded. Exposed groups include cleaners, health care workers, cooks, and so forth. Associations were analyzed using mixed-effects logistic regression and ordinary logistic regression with clustered robust SEs and adjustment for maternal education.
Results: Maternal occupational exposure to indoor cleaning starting preconception and continuing (n = 610) was associated with offspring's childhood asthma: odds ratio 1.56 (95% CI, 1.05-2.31), childhood asthma with nasal allergies: 1.77 (1.13-2.77), and childhood wheeze and/or asthma: 1.71 (95% CI, 1.19-2.44). Exposure starting around conception and pregnancy (n = 77) was associated with increased childhood wheeze and/or asthma: 2.25 (95% CI, 1.03-4.91). Exposure starting after birth was not associated with asthma outcomes (1.13 [95% CI, 0.71-1.80], 1.15 [95% CI, 0.67-1.97], 1.08 [95% CI, 0.69-1.67]).
Conclusions: Mother's occupational exposure to indoor cleaning agents starting before conception, or around conception and pregnancy, was associated with more childhood asthma and wheeze in offspring. Considering potential implications for vast numbers of women in childbearing age using cleaning agents, and their children, further research is imperative.
Keywords: Job-Exposure Matrix (JEM); Occupational exposures; RHINESSA; childhood asthma; cleaning products; disinfectants; generation study; mother; preconception exposures.
... [3][4][5][6][7][8][9] In addition, it has been suggested that exposures related to cleaning activities may constitute a risk to long-term respiratory health. 10 A dose-response pattern with increased risk of respiratory symptoms and diseases by increased dose and duration of exposure has been reported. 5,6,9 Cleaning products and disinfectants comprise a wide range of ingredients that are irritants and/or potential sensitizers. ...
Background
Emerging research suggests health effects in offspring after parental chemical exposures before conception. Many future mothers are exposed to potent chemicals at work, but potential offspring health effects are hardly investigated.
Objective
We sought to investigate childhood asthma in relation to mother’s occupational exposure to cleaning products and disinfectants before conception.
Methods
The multicenter Respiratory Health In Northern Europe/Respiratory Health In Northern Europe, Spain and Australia generation study investigated asthma and wheeze starting at age less than 10 years in 3318 mother-offspring pairs. From an asthma-specific Job-Exposure Matrix and mothers’ occupational history, we defined maternal occupational exposure to indoor cleaning agents (cleaning products/detergents and disinfectants) starting before conception, in the 2-year period around conception and pregnancy, or after birth. Never-employed mothers were excluded. Exposed groups include cleaners, health care workers, cooks, and so forth. Associations were analyzed using mixed-effects logistic regression and ordinary logistic regression with clustered robust SEs and adjustment for maternal education.
Results
Maternal occupational exposure to indoor cleaning starting preconception and continuing (n = 610) was associated with offspring’s childhood asthma: odds ratio 1.56 (95% CI, 1.05-2.31), childhood asthma with nasal allergies: 1.77 (1.13-2.77), and childhood wheeze and/or asthma: 1.71 (95% CI, 1.19-2.44). Exposure starting around conception and pregnancy (n = 77) was associated with increased childhood wheeze and/or asthma: 2.25 (95% CI, 1.03-4.91). Exposure starting after birth was not associated with asthma outcomes (1.13 [95% CI, 0.71-1.80], 1.15 [95% CI, 0.67-1.97], 1.08 [95% CI, 0.69-1.67]).
Conclusions
Mother’s occupational exposure to indoor cleaning agents starting before conception, or around conception and pregnancy, was associated with more childhood asthma and wheeze in offspring. Considering potential implications for vast numbers of women in childbearing age using cleaning agents, and their children, further research is imperative.
... B. zu Dampfexpositionen mit Formaldehyd, Glutaraldehyd oder 2-Butoxyethanol, welche akut toxisch wirken bzw. zu einer Sensibilisierung der Atemwege und zu einer Einschränkung der Lungenfunktion führen können [12,27]. Im Friseurgewerbe kann es aufgrund von z. ...
Background
Inhalation of occupation-related noxious agents (vapors, gases, dusts, fumes) can lead to a wide variety of health problems. Healthcare and welfare workers are exposed, for example, to inhalative anesthetics, disinfectants, cleaning agents and surgical fumes.Objective
The purpose of this study is to determine the extent to which healthcare and welfare workers are aware of their exposure to inhalative noxious agents.Material and methodsFrom the baseline sample (n = 10,000) of the Hamburg City Health Study (HCHS), all those subjects were selected who were employed in the healthcare and welfare services. Subjective questionnaire data on workplace-related exposure to fumes, gases, dusts and vapors were matched with the categorization generated by a job-exposure matrix (JEM).ResultsThe sample (N = 1176) included 78% women, with a mean age of 61 years. Subjects employed in physician and practice assistance (60.5%) made up the largest occupational group. The agreement between subjective exposure data and the JEM was low (Cohen’s kappa 0.18). The sensitivity of the subjective data on inhalative noxious agents in comparison to the JEM was 49.5%, and the specificity was 81.7%. Underreporting of the inhalation of noxious agents was only observed among employees in cleaning and body care.DiscussionThe results indicate that 50% of exposed workers in this sample are unaware of this exposure. This applies especially to workers in cleaning and personal care. The underreporting of inhalative noxious agents in the workplace indicates an increased need for prevention in this industry. Since there are already existing rules and regulations for the occupational health and safety system, it remains to be clarified to what extent knowledge transfer and prevention rules regarding inhalative noxious agents at the workplace are actually implemented in companies.
... Building on the studies of respiratory effect of disinfectant exposure, 5,39 we hypothesized that the potential risks associated with different nursing jobs would reflect exposure to disinfectants and/or surgical smoke. We found that long-term (Ն15 years) OR employment (exposure to both surgical smoke and disinfectants) was associated with a 69% increased risk of COPD compared with 31% increased risk among those who never worked in an OR but were currently employed in an emergency department or an inpatient unit (exposure to disinfectants but no or little exposure to surgical smoke). ...
Question Is there an association between a history of operating room (OR) employment, as proxy for exposure to inhaled agents such as surgical smoke and disinfectants, and incidence of chronic obstructive pulmonary disease among female nurses in the US?
Findings In this cohort study of 75 011 US female nurses, nurses with 15 or more years of OR employment had a 69% greater risk of developing chronic obstructive pulmonary disease compared with those who never worked in an OR and had an administrative or nursing education function or nonnursing job.
Meaning These findings suggest that exposure to inhaled agents in the OR may be associated with independent health risks to the respiratory system.
... 78 Another study among cleaners also reported an increased risk of asthma symptoms in workers who used: A number of studies have demonstrated a positive association between the use of cleaning sprays and asthma or respiratory symptoms. 38,79,80 The use of sprays generates more aerosols and therefore facilitates inhalational exposure. ...
As differential exposure to airport-generated aerosols may affect employee lung function, the main objective of this study was to longitudinally evaluate spirometry measures among Air France employees. In addition, an exploratory exposure assessment to airport aerosol was performed in a small cohort of workers using personal monitoring devices. Change in lung function over a ~6.6-yr period was documented for office workers (n = 68) and mechanics (n = 83) at Paris-Roissy airport, France and terminal (n = 29), or apron (n = 35) workers at Marseille airport, France. Overall, an excessive decline in lung function was found for 24.75% of airport workers; excessive decline occurred more often for terminal workers (44.83%) as compared to mechanics (14.47%; P = 0.0056), with a similar tendency for apron workers (35.29%) as compared to mechanics (P = 0.0785). Statistically significant differences/tendencies were detected among the yearly rates of change for %-predicted values of forced expiratory volume in 1 s, forced vital capacity, peak expiratory flow, and from 25% to 75% forced expiratory flow. For the latter variables, the terminal and/or apron workers at Marseille generally had significantly faster lung function decline as compared to office workers and/or mechanics in Paris, although the latter were exposed to a higher level of elemental carbon. No relation between lung function decline and exposure to airport tarmac environments was evidenced. Multivariate exploration of individual variables representing sex, smoking, atopy, respiratory disease, residential PM2.5 pollution, the peak size of particles in lung exhalates or exhaled carbon monoxide at the time of follow-up failed to explain the observed differences. In conclusion, this study documents the first evidence of excessive lung function decline among certain airport workers in France, although the identification of emission sources (environmental factors, aircraft exhaust, etc) remains challenging.
Background and Purpose
To examine the respiratory and functional benefits of manual diaphragmatic release for Cleaning‐Laborers Exposed to Occupational Hazards.
Methods
A randomized controlled trial of 36 participants aged 35–45 years was randomly allocated into two groups. The experimental group (n = 18); received manual diaphragm release along with respiratory training exercises, and the control group (n = 18); received respiratory training exercises only. Three times/week for 12 consecutive weeks. The serum immunoglobulin E level, pulmonary functions [forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), FEV 1 /FVC, and peak expiratory flow (PEF) rate (PEF)], chest wall mobility, and 6 min walk‐test performance were assessed pre‐ and post‐intervention.
Results
There was a greater decline in serum immunoglobulin levels ( p = 0.003; Partial η ² = 0.23) and enhancement in pulmonary functions [FEV 1 ( p = 0.025, Partial η2 = 0.14), FVC ( p = 0.017, Partial η ² = 0.16), FEV 1 /FVC ( p = 0.028, Partial η ² = 0.13), and PEF ( p = 0.012, Partial η2 = 0.17) in the experimental group. Further, there was a greater increase in chest mobility at the xiphoid level ( p = 0.002, Partial η ² = 0.25) in the experimental group, but this was not the case at the axillary level ( p = 0.29, Partial η ² = 0.03). Still, the 6 min walk‐test performance improved more significantly in the experimental group ( p = 0.002, Partial η ² = 0.24).
Conclusion
The diaphragmatic release technique may offer a promising approach for mitigating distressing respiratory symptoms, enhancing immune function, and improving 6 min walk‐test performance among cleaning laborers with work‐related respiratory hazards.
Trial registration
The study was retrospectively registered at XXX (ID: NCT05802355).
For many women, house cleaning is an important way to participate in the labor market. In Brazil, there are 2 types of domestic workers: housekeepers have relatively secure employment and house cleaners are day laborers. The aim of this hypothesis-generating study was to describe the sociodemographic, occupational and health profile of a sample of domestic workers in Brazil. House cleaners received lower wages, had longer daily working hours and worked in a larger number of homes each week in comparison to housekeepers. About 51% of the domestic workers in this sample reported the use of pain medication and 34% reported spinal problems. Musculoskeletal symptoms were frequent in the lower back and upper limbs. Forty-seven percent reported high blood pressure. This study highlights the vulnerability of domestic workers, especially house cleaners, regarding workload, salary, and health conditions. Level of education is a contributing factor to this vulnerability.
Quaternary ammonium compounds are a class of chemicals commonly used as disinfectants in household and healthcare settings. Their usage has significantly increased in recent years due to the COVID-19 pandemic. In addition, quaternary ammonium compounds have replaced the recently banned disinfectants triclosan and triclocarban in consumer products. Quaternary ammonium compounds are found in daily antimicrobial and personal care products such as household disinfectants, mouthwash, and hair care products. Due to the pervasiveness of quaternary ammonium compounds in daily use products, humans are constantly exposed. However, little is known about the health effects of everyday quaternary ammonium compound exposure, particularly effects on human reproduction and development. Studies that investigate the harmful effects of quaternary ammonium compounds on reproduction are largely limited to high-dose studies, which may not be predictive of low-dose, daily exposure, especially as quaternary ammonium compounds may be endocrine-disrupting chemicals. This review analyzes recent studies on quaternary ammonium compound effects on reproductive health, identifies knowledge gaps, and recommends future directions in quaternary ammonium compound–related research.
Summary Sentence
Quaternary ammonium compounds, a class of disinfecting compounds that have skyrocketed in usage during the COVID-19 pandemic, are emerging as reproductive and developmental toxicants.
Research conducted both prior to and after the emergence of the COVID-19 pandemic reveals a notable rise in human exposure to cleaning products, hand sanitizers, and personal care items. Moreover, there has been a corresponding increase in the environmental release of these chemicals. Cleaning and disinfecting products often contain quaternary ammonium compounds (QACs) with alkyl chains as long as 8–12 carbon atoms. The attachment of quaternary ammonium surfactants to the membrane resulted in the deformation of the bilayer and membrane disruption. Before interactions with cell membranes, these surfactant molecules may form different aggregates depending on their architecture. Interaction of surfactant monomers or clusters with the cell membrane changes the physiochemical properties of the biomembranes. To investigate this interaction and its influence on membrane properties, we conducted molecular dynamics simulations of cationic quaternary ammonium surfactants interacting with dipalmitoylphosphatidylcholine (DPPC) membranes. Our simulations revealed significant interactions between the surfactants and the phospholipids, leading to substantial alterations in the structure of the bilayer. The results are compared with the simulated anionic (SDS) and nonionic surfactants/bilayer systems. Various aspects were considered, including the aggregation process, migration behavior, and eventual equilibrium of these molecules at the interface between the membrane and water. This analysis used various techniques such as density profiles, distribution functions, cluster analysis, order parameters, hydrogen bonding (H-bonding), and mean-square displacements. The results indicate that while surfactants with shorter alkyl tails (N-(2-hydroxyethyl)-N,N-dimethyloctan-1-aminium chloride (HEDMOAC)) make strong hydrogen bonds with the phosphate group and ester oxygen of the phosphatidylcholine bilayer and enter toward the bilayer in the monomer form, surfactants of longer alkyl tails aggregated on the membrane head-water interface and interact minimally with the head groups of the DPPC bilayer. For DDEDMEAC, a quaternary ammonium surfactant with a hydrophobic alkyl chain consisting of two decanoate groups, alteration of the structural and dynamical properties of the bilayer is expected to be governed by two different factors. First, the structural order of DPPC increases as surfactant aggregates interact with the membrane head group. Second, the decrease in the order of the bilayer occurs due to the insertion of surfactant monomers within the hydrophobic region of the bilayer. Strong interactions between constituents of tetraoctylammonium bromide (TOABr) and lipid head groups lead to a reduction in interlipid interactions and order, which further results in increased porosity of cellular membranes. Understanding the extent of these interactions plays a pivotal role in the toxicological assessment of these surfactants.
Poorly controlled asthma is especially common in low resource countries. Aside from lack of access to, or poor technique with, inhaled beta-2 agonists and corticosteroids, the most problematic forms of asthma are frequently associated with both fungal allergy and exposure, especially in adults leading to more asthma exacerbations and worse asthma. The umbrella term 'fungal asthma' describes many disorders linked to fungal exposure and/or allergy to fungi. One fungal asthma endotype, ABPA, is usually marked by a very high IgE and its differential diagnosis is reviewed. Both ABPA and fungal bronchitis in bronchiectasis are marked by thick excess airway mucus production. Dermatophyte skin infection can worsen asthma and eradication of the skin infection improves asthma. Exposure to fungi in the workplace, home and schools, often in damp or water-damaged buildings worsens asthma, and remediation improves symptom control and reduces exacerbations. Antifungal therapy is beneficial for fungal asthma as demonstrated in nine of 13 randomised controlled studies, reducing symptoms, corticosteroid need and exacerbations while improving lung function. Other useful therapies include azithromycin and some biologics approved for the treatment of severe asthma. If all individuals with poorly controlled and severe asthma could be 'relieved' of their fungal allergy and infection through antifungal therapy without systemic corticosteroids, the health benefits would be enormous and relatively inexpensive, improving the long term health of over 20 million adults and many children. Antifungal therapy carries some toxicity, drug interactions and triazole resistance risks, and data are incomplete. Here we summarise what is known and what remains uncertain about this complex topic.
Introduction:
Epidemiological studies demonstrated that cleaning work and frequent use of cleaning products are risk factors for asthma. Laundry detergents have been reported to have epithelial barrier-opening effects. However, whether laundry detergents directly induce airway inflammation and its mechanisms in vivo remain to be elucidated.
Methods:
Two commercial laundry detergents and two commonly-used surfactants for cleaning and cosmetics (sodium lauryl sulfate and sodium dodecyl benzene sulfonate) were intranasally administered to mice. Lungs were analyzed using flow cytometry, histology, ELISA, and quantitative PCR. Human bronchial epithelial cells were stimulated with laundry detergents and analyzed using quantitative PCR and western blotting. Involvement of oxidative stress was assessed using an antioxidant. Dust samples from homes were analyzed to determine their detergent content by measuring their critical micelle concentration (CMC).
Results:
The administered laundry detergents and surfactants induced eosinophilic airway inflammation accompanied by increased IL-33 expression and activation of group 2 innate lymphoid cells (ILC2s). Detergent-induced eosinophilic airway inflammation was significantly attenuated in Rag2-/- Il2rg-/- , Il33-/- mice, and also in wild-type mice treated with NAC. Detergent-induced IL-33 expression in airways was attenuated by NAC treatment, both in vivo and in vitro. CMCs were found in all of the tested dust extracts, and they differed significantly among the homes.
Conclusion:
The laundry detergents and surfactants induced eosinophilic airway inflammation in vivo through epithelial cell and ILC2 activation. They induced IL-33 expression in airway epithelial cells through oxidative stress. Furthermore, detergent residues were present in house dust and are presumably inhaled into the airway in daily life.
Background: Asthma is a leading cause of childhood morbidity in the U.S. and a significant public health concern. The prenatal period is a critical window during which environmental influences, including maternal occupational exposures, can shape child respiratory health. Cleaning chemicals are commonly encountered in occupational settings, yet few studies have examined the potential link between prenatal occupational exposures to cleaning chemicals and risk of childhood wheeze and asthma.
Methods: We evaluated the potential influence of maternal occupational exposure to cleaning chemicals during pregnancy on pediatric asthma and wheeze at child age 4–6 years in 453 mother-child pairs from two longitudinal pregnancy cohorts, TIDES and GAPPS, part of the ECHO prenatal and early childhood pathways to health (ECHO-PATHWAYS) consortium. Maternal occupational exposure to cleaning chemicals was defined based on reported occupation and frequency of occupational use of chemicals during pregnancy. Child current wheeze and asthma outcomes were defined by parental responses to a widely-used, standardized respiratory outcomes questionnaire administered at child age 4–6 years. Multivariable Poisson regression with robust standard errors was used to estimate relative risk (RR) of asthma in models adjusted for confounding. Effect modification by child sex was assessed using product interaction terms.
Results: Overall, 116 mothers (25.6%) reported occupational exposure to cleaning chemicals during pregnancy, 11.7% of children had current wheeze, and 10.2% had current asthma. We did not identify associations between prenatal exposure to cleaning chemicals and current wheeze [RRadjusted 1.03, 95% confidence interval (CI): 0.56, 1.90] or current asthma (RRadjusted 0.89, CI: 0.46, 1.74) in the overall sample. Analyses of effect modification suggested an adverse association among females for current wheeze (RR 1.82, CI: 0.76, 4.37), compared to males (RR 0.68, CI: 0.29, 1.58), though the interaction p-value was >0.05.
Conclusion: We did not observe evidence of associations between maternal prenatal occupational exposure to cleaning chemicals and childhood wheeze or asthma in the multi-site ECHO-PATHWAYS consortium. We leveraged longitudinal U.S. pregnancy cohorts with rich data characterization to expand on limited and mixed literature. Ongoing research is needed to more precisely characterize maternal occupational chemical exposures and impacts on child health in larger studies.
Background:
Occupational exposure to various types of cleaning agents may increase the risk of adverse respiratory health among cleaners. This study investigated the relationship between exposure to cleaning and disinfecting agents, using a job-task and exposure intensity metric, and respiratory outcomes among cleaners.
Methods:
A sample of 174 cleaners was selected from three public hospitals in Durban. A questionnaire was used to collect demographic and occupational information, and spirometry, including post-bronchodilator measures, was conducted according to the American Thoracic Society guidelines and skin prick testing were performed. Exposure metrics for job tasks and chemical exposures were created using frequency and employment-lifetime duration of exposure. Multivariate analysis regression models used job task and exposure intensity metrics.
Results:
Doctor-diagnosed asthma prevalence was 9.8%. Breathlessness with wheeze (22.4%) was the prevalent respiratory symptom. Positive responses to skin prick testing were seen in 74 (43.2%). There was a statistically significant increased risk for shortness of breath with exposure to quaternary ammonium compounds (odds ratio [OR]: 3.44; 95% confidence interval [CI]: 1.13-10.5) and breathlessness with exposure to multipurpose cleaner (OR: 0.34; CI: 0.12-0.92). The losses in percent-predicted forced expiratory volume in 1 s (FEV1) ranged from 0.3%-6.7%. Results among the bronchodilator-positive (8.6%) showed lung function losses twofold greater when compared to the total study population with percentage predicted FEV1 (-22.6 %; p < 0.000).
Conclusion:
Exposure to certain cleaning and disinfectant agents adversely affects respiratory health, particularly lung function. This effect, while seen generally among cleaning workers, is more pronounced among those with pre-existing reversible obstructive lung disease.
Sex (whether one is ‘male’ or ‘female’, based on biological characteristics) and gender (defined by socially constructed roles and behaviors) influence asthma diagnosis and management. For example, women generally report more severe asthma symptoms than men; men and women are exposed to different asthma-causing triggers; men tend to be more physically active than women. Furthermore, implicit, often unintended gender bias by healthcare professionals (HCPs) is widespread, and may result in delayed asthma diagnosis, which can be greater in women than men. The sex and gender of the HCP can also impact asthma management. Pregnancy, menstruation, and menopause can all affect asthma in several ways and may be associated with poor asthma control. This review provides guidance for considering sex- and gender-associated impacts on asthma diagnosis and management and offers possible approaches to support HCPs in providing personalized asthma care for all patients, regardless of their sex or gender.
Precarious employment, such as housecleaning, is one important structural contributor to health inequities. We used an employment quality (EQ) framework to characterize the impact of employment conditions on mental and self-reported ill-health among Latinx housecleaners in the New York City metropolitan area. Using a community-based participatory research approach, we collected cross-sectional survey data from 402 housecleaners between August 2019 and February 2020 to characterize housecleaners’ EQ and its association with depression, perceived stress, and self-reported health. We also measured work-related irritant eye, skin, and respiratory symptoms, which have been shown in previous research to be associated with housecleaners’ exposure to chemical components of cleaning products. Our housecleaner cohort was largely female and immigrant and most had worked at least five years. Survey items capturing the EQ dimensions of unbalanced interpersonal relations, low material resources, and violations of workers’ rights were associated with increased odds of depression, perceived stress, and self-reported ill-health. Work-related irritant eye, skin, and respiratory symptoms were also independently associated with mental and self-reported ill-health and some of the effects of EQ on health were potentially partially mediated through their association with work-related irritant symptoms. Findings can inform directions for community-based educational and policy initiatives to improve housecleaners’ employment quality.
Dans les bronchopathies chroniques, représentées majoritairement par l’asthme, la bronchopneumopathie chronique obstructive (BPCO) et la dilatation de bronches (non mucoviscidose), la production excessive de mucus est à l’origine d’une obstruction aigue et/ou chronique des voies aériennes et représente un marqueur d’exacerbation de ces pathologies. Partant de ce constat, nous avons articulé notre projet autour des axes suivants :I)Etudier les déterminants biologiques de la variation de la rhéologie des expectorations dans les bronchopathies chroniques. Via une étude dont le promoteur est le CHU de Montpellier, nous avons recueilli des échantillons d’expectorations chez des patients atteints d’asthme, de BPCO et de dilatation de bronches (non mucoviscidosiques), et en avons étudié les caractéristiques microbiologiques (examen cytobactériologique), biophysiques (rhéologie) et biochimiques (dosage des constituants protéïques, ions, etc…). La partie "rhéologie" de l'étude s'est appuyée sur un dispositif de paillasse (Rhéomuco© - Rhéonova Grenoble) permettant de réaliser une analyse rapide dans l'heure, sur site, de l'expectoration. Cette première partie nous a permis d'établir des liens entre l'éosinophilie dans l'expectoration et certaines variables rhéologiques , mais aussi entre la concentration de mucines évaluée en spectrométrie de masse et ces mêmes variables rhéologiques. II)Evaluer l’impact de l’AZITHROMYCINE prescrite en fonction des caractéristiques biophysiques (rhéologie) des expectorations des patients, sur la prévention des exacerbations de BPCO Premièrement, afin de s'assurer de la reproductibilité du dispositif d'analyse rhéologique des expectorations, nous avons conduit dans différents centres (Bordeaux, Grenoble et Montpellier) plusieurs analyses de reproductibilité intra- et -inter opérateur, sur différents échantillons aux valeurs rhéologiques extrêmes". Cette étape nous a permis de confirmer la fiabilité de la méthode de mesure Deuxièmement, dans une volonté de faire le lien entre la paillasse et la clinique, nous avons élaboré un protocole qui s’inscrit dans le cadre du PHRC GIRCI/SOHO 2018. Celui- ci aura pour objectif d’explorer l’impact d’une stratégie thérapeutique basée non pas sur l’évaluation clinique standard, mais sur les propriétés biophysiques de l’expectoration et en particulier du mucus des patients atteints de BPCO. Cette étude nous permettra également de réaliser une collecte d’échantillons biologiques (sang, expectorations) sur lesquels sont prévus des analyses secondaires afin de déterminer finement les endotypes des patients inclus.
Cleaning products are among the most widely used consumer products. The associated risks should be better understood. The health risk assessment (HRA) approach was applied to household uses of cleaning products, with nineteen products of various types and formats tested under typical indoor environmental parameters in an experimental house. The targeted substances included volatile organic compounds (VOCs) and carbonyl compounds. The generic “Common Use” and “Reasonable Worst-Case” scenarios under consideration were based on full cleaning sessions. These sessions were elaborated from data available in the technical and scientific literature, combined with stakeholder participation. The Common Use scenario included a 1 1/2-h cleaning session once per week, followed by manual ventilation; the Reasonable Worst-Case scenario included a 4-h session twice per week without manual ventilation. No situation of concern was found regarding chronic inhalation exposures associated with Common Use. For the Reasonable Worst-Case scenario, the assessed chronic inhalation risks were low. Assessed acute inhalation exposures (1-h exposures) could exceed the selected health values, mainly for acrolein (exposures up to 12 μg/m³) and formaldehyde (exposures up to ∼140 μg/m³). Associated first observed effects could include nasal, throat, and eye irritation. These results suggest that the highest exposures should be reduced and, to this end, that the emissions of the most emissive products should be reduced. Since the identified priority substances of concern are not specific to cleaning product emissions, multisource cumulative exposures are expected with the use of other consumer products, e.g., paints, incense, scented candles, furniture, and fragrance diffusers.
Aim
The biological mechanisms of work-related asthma induced by irritants remain unclear. We investigated the associations between occupational exposure to irritants and respiratory endotypes previously identified among never asthmatics (NA) and current asthmatics (CA) integrating clinical characteristics and biomarkers related to oxidative stress and inflammation.
Methods
We used cross-sectional data from 999 adults (mean 45 years old, 46% men) from the case-control and familial Epidemiological study on the Genetics and Environments of Asthma (EGEA) study. Five respiratory endotypes have been identified using a cluster-based approach: NA1 (n=463) asymptomatic, NA2 (n=169) with respiratory symptoms, CA1 (n=50) with active treated adult-onset asthma, poor lung function, high blood neutrophil counts and high fluorescent oxidation products level, CA2 (n=203) with mild middle-age asthma, rhinitis and low immunoglobulin E level, and CA3 (n=114) with inactive/mild untreated allergic childhood-onset asthma. Occupational exposure to irritants during the current or last held job was assessed by the updated occupational asthma-specific job-exposure matrix (levels of exposure: no/medium/high). Associations between irritants and each respiratory endotype (NA1 asymptomatic as reference) were studied using logistic regressions adjusted for age, sex and smoking status.
Results
Prevalence of high occupational exposure to irritants was 7% in NA1, 6% in NA2, 16% in CA1, 7% in CA2 and 10% in CA3. High exposure to irritants was associated with CA1 (adjusted OR aOR, (95% CI) 2.7 (1.0 to 7.3)). Exposure to irritants was not significantly associated with other endotypes (aOR range: 0.8 to 1.5).
Conclusion
Occupational exposure to irritants was associated with a distinct respiratory endotype suggesting oxidative stress and neutrophilic inflammation as potential associated biological mechanisms.
Despite the European Union’s declared commitment to gender equality, women are invisible in the EU’s flagship European Green Deal, which risks turning the gender gap into a chasm and delaying the transition to sustainability, concludes our new report Why the European Green Deal needs ecofeminism. The report, launched by WECF and the European Environmental Bureau (EEB) last Friday, collects analyses and recommendations from experts representing 23 organizations and institutions.
Rationale:
There is some evidence that maternal smoking increases susceptibility to personal smoking's detrimental effects. One might question whether early life disadvantage might influence susceptibility to occupational exposure.
Objectives:
In this cross-sectional study we investigated respiratory symptoms, asthma and self-reported chronic obstructive pulmonary disease (COPD) as related to working as a cleaner in Northern European populations, and whether early life factors influenced susceptibility to occupational cleaning's unhealthy effects.
Methods:
The RHINE III questionnaire study assessed occupational cleaning in 13,499 participants. Associations with respiratory symptoms, asthma and self-reported COPD were analysed with multiple logistic regressions, adjusting for sex, age, smoking, educational level, parent´s educational level, BMI and participating centre. Interaction of occupational cleaning with early life disadvantage (maternal smoking, severe respiratory infection <5 years, born during winter months, maternal age at birth >35 years) was investigated.
Main results:
Among 2138 ever-cleaners the risks of wheeze (OR 1.4, 95% CI 1.3-1.6), adult-onset asthma (1.5 [1.2-1.8]) and self-reported COPD (1.7 [1.3-2.2]) were increased. The risk increased with years in occupational cleaning (adult-onset asthma: ≤1 year 0.9 [0.7-1.3]; 1-4 years 1.5 [1.1-2.0]; ≥4 years 1.6 [1.2-2.1]). The association of wheeze with cleaning activity ≥4 years was significantly stronger for those with early life disadvantage than in those without (1.8 [1.5-2.3] vs. 1.3 [0.96-1.8]; pinteraction 0.035).
Conclusions:
Occupational cleaners had increased risk of asthma and self-reported COPD. Respiratory symptom risk was particularly increased in persons with factors suggestive of early life disadvantage. We hypothesize that early life disadvantage may increase airway vulnerability to harmful exposure from cleaning agents later in life.
Professional and domestic cleaning is associated with work-related asthma (WRA). This position paper reviews the literature linking exposure to cleaning products and the risk of asthma and focuses on prevention. Increased risk of asthma has been shown in many epidemiological and surveillance studies, and several case reports describe the relationship between exposure to one or more cleaning agents and WRA. Cleaning sprays, bleach, ammonia, disinfectants, mixing products, and specific job tasks have been identified as specific causes and/or triggers of asthma. Because research conclusions and policy suggestions have remained unheeded by manufactures, vendors, and commercial cleaning companies, it is time for a multifaceted intervention. Possible preventive measures encompass the following: substitution of cleaning sprays, bleach, and ammonia; minimizing the use of disinfectants; avoidance of mixing products; use of respiratory protective devices; and worker education. Moreover, we suggest the education of unions, consumer, and public interest groups to encourage safer products. In addition, information activities for the general population with the purpose of improving the knowledge of professional and domestic cleaners regarding risks and available preventive measures and to promote strict collaboration between scientific communities and safety and health agencies are urgently needed.
The aim of the Task Force was to derive continuous prediction equations and their lower limits of normal for spirometric indices, which are applicable globally. Over 160,000 data points from 72 centres in 33 countries were shared with the European Respiratory Society Global Lung Function Initiative. Eliminating data that could not be used (mostly missing ethnic group, some outliers) left 97,759 records of healthy nonsmokers (55.3% females) aged 2.5–95 yrs.
Lung function data were collated and prediction equations derived using the LMS method, which allows simultaneous modelling of the mean (mu), the coefficient of variation (sigma) and skewness (lambda) of a distribution family.
After discarding 23,572 records, mostly because they could not be combined with other ethnic or geographic groups, reference equations were derived for healthy individuals aged 3–95 yrs for Caucasians (n=57,395), African–Americans (n=3,545), and North (n=4,992) and South East Asians (n=8,255). Forced expiratory value in 1 s (FEV 1 ) and forced vital capacity (FVC) between ethnic groups differed proportionally from that in Caucasians, such that FEV 1 /FVC remained virtually independent of ethnic group. For individuals not represented by these four groups, or of mixed ethnic origins, a composite equation taken as the average of the above equations is provided to facilitate interpretation until a more appropriate solution is developed.
Spirometric prediction equations for the 3–95-age range are now available that include appropriate age-dependent lower limits of normal. They can be applied globally to different ethnic groups. Additional data from the Indian subcontinent and Arabic, Polynesian and Latin American countries, as well as Africa will further improve these equations in the future.
Household cleaning products are associated with adverse respiratory health outcomes, but the cardiovascular health effects are largely unknown.
We determined if long-term use of household sprays and scented products at home was associated with reduced heart rate variability (HRV), a marker of autonomic cardiac dysfunction.
We recorded 24-hr electrocardiograms in a cross-sectional survey of 581 Swiss adults, ≥ 50 years of age, who answered a detailed questionnaire regarding their use of household cleaning products in their homes. The adjusted average percent changes in standard deviation of all normal-to-normal intervals in 24 hr (24-hr SDNN) and total power (TP) were estimated in multiple linear regression in association with frequency [< 1, 1-3, or 4-7 days/week, unexposed (reference)] of using cleaning sprays, air freshening sprays, and scented products.
Decreases in 24-hr SDNN and TP were observed with frequent use of all product types, but the strongest reductions were associated with air freshening sprays. Compared with unexposed participants, we found that using air freshening sprays 4-7 days/week was associated with 11% [95% confidence interval (CI): -20%, -2%] and 29% (95% CI: -46%, -8%) decreases in 24-hr SDNN and TP, respectively. Inverse associations of 24-SDNN and TP with increased use of cleaning sprays, air freshening sprays, and scented products were observed mainly in participants with obstructive lung disease (p < 0.05 for interactions).
In predominantly older adult women, long-term frequent use of household spray and scented products was associated with reduced HRV, which suggests an increased risk of cardiovascular health hazards. People with preexisting pulmonary conditions may be more susceptible.
We aimed to study the associations between the household use of cleaning sprays and asthma symptoms and control of asthma, in females from the Epidemiological Study on the Genetics and Environment of Asthma (EGEA).
Data were available for 683 females (mean age 44 yrs, 55% never smokers, 439 without asthma and 244 with current asthma). Both domestic exposures and asthma phenotypes (asthma symptom score, current asthma, poorly-controlled asthma (56%)) were evaluated as previously described in the European Community Respiratory Health Survey. Associations between the use of sprays and asthma phenotypes were evaluated using logistic and nominal regressions, adjusted for age, smoking, body mass index and occupational exposures.
Significant associations were observed between the weekly use of at least two types of sprays and a high asthma symptom score (OR (95% CI) 2.50 (1.54–4.03)) compared with a null score. Consistent results were observed for current asthma (1.67 (1.08–2.56)) and poorly-controlled asthma (2.05 (1.25–3.35)) compared with females without asthma. The association for current asthma was higher in females not reporting avoidance of polluted places (2.12 (1.27–3.54)) than in those reporting such avoidance (0.99 (0.53–1.85)).
The common use of household cleaning sprays is positively associated with a high asthma symptom score, current asthma and poorly-controlled asthma in females.
Specific occupations are associated with adverse respiratory health. Inhalation exposures encountered in these jobs may place workers at risk of new-onset respiratory disease.
We analyzed data from 8,967 participants from the Atherosclerosis Risk in Communities (ARIC) study, a longitudinal cohort study. Participants included in this analysis were free of chronic cough and phlegm, wheezing, asthma, chronic bronchitis, emphysema, and other chronic lung conditions at the baseline examination, when they were aged 45-64 years. Using data collected in the baseline and first follow-up examination, we evaluated associations between occupation and the three-year incidence of cough, phlegm, wheezing, and airway obstruction and changes in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) measured by spirometry. All associations were adjusted for age, cigarettes per day, race, smoking status, and study center.
During the approximately three-year follow-up, the percentage of participants developing chronic cough was 3%; chronic phlegm, 3%; wheezing, 3%; and airway obstruction, defined as FEV1 < lower limit of normal (LLN) and FEV1/FVC < LLN, 2%. The average annual declines in FEV1 and FVC were 56 mL and 66 mL, respectively, among men and 40 mL and 52 mL, respectively, among women. Relative to a referent category of managerial and administrative support occupations, elevated risks of new-onset chronic cough and chronic phlegm were observed for mechanics and repairers (chronic cough: RR: 1.81, 95% CI: 1.02, 3.21; chronic phlegm: RR: 2.10, 95% CI: 1.23, 3.57) and cleaning and building service workers (chronic cough: RR: 1.85, 95% CI: 1.01, 3.37; chronic phlegm: RR: 2.28, 95% CI: 1.27, 4.08). Despite the elevated risk of new-onset symptoms, employment in cleaning and building services was associated with attenuated lung function decline, particularly among men, who averaged annual declines in FEV1 and FVC of 14 mL and 23 mL, respectively, less than the declines observed in the referent population.
Employment in mechanic and repair jobs and cleaning and building service occupations are associated with increased incidence of respiratory symptoms. Specific occupations affect the respiratory health of adults without pre-existing respiratory health symptoms and conditions, though long-term health consequences of inhalation exposures in these jobs remain largely unexplored.
Despite being a large part of the workforce, cleaners remain a relatively understudied occupational group in the USA.
The aims of this focus group study were to identify and characterize occupational exposures, symptoms and job tasks among domestic and industrial professional cleaners.
Twelve focus group sessions were conducted in Lubbock, TX, and Houston, TX. Participants were asked about their job tasks, type of products they use to clean, bodily symptoms, job training and work environment.
Out of 99 attendees, 79 domestic and industrial cleaners participated actively in the focus group sessions. Three general themes emerged regarding cleaning professionals' work experiences: (i) job training, (ii) chemical exposure and use and (iii) competence. Domestic cleaners demonstrated significant skills deficit across each of these three themes as compared to industrial cleaners. Domestic cleaners reported more frequent exposure to respiratory irritants and sensitizers and also reported adverse respiratory symptoms as compared to industrial cleaners.
The results from this qualitative study are consistent with earlier findings from quantitative studies placing domestic cleaners at risk of exposure to chemicals that are respiratory irritants and/or sensitizers.
The characterization of young adults who develop late-onset diseases may augment the detection of novel genes and promote new pathogenic insights.
We analyzed data from 2,500 individuals of African and European ancestry in the COPDGene Study. Subjects with severe, early-onset chronic obstructive pulmonary disease (COPD) (n=70, age < 55 yr, FEV1 < 50% predicted) were compared with older subjects with COPD (n =306, age >64 yr, FEV1 <50% predicted).
Subjects with severe, early-onset COPD were predominantly females (66%), P =0.0004. Proportionally,early-onset COPD was seen in 42% (25 of 59) of African Americans versus 14% (45 of 317) of non-Hispanic whites, P <0.0001. Other risk factors included current smoking (56 vs. 17%, P < 0.0001) and self-report of asthma (39 vs. 25%, P =0.008). Maternal smoking (70 vs. 44%, P=0.0001) and maternal COPD (23 vs.12%, P=0.03) were reported more commonly in subjects with early-onset COPD. Multivariable regression analysis found association with African American race, odds ratio (OR), 7.5 (95% confidence interval [CI], 2.3–24; P ¼=0.0007); maternal COPD, OR, 4.7 (95% CI,1.3–17; P=0.02); female sex, OR, 3.1 (95% CI, 1.1–8.7; P=0.03); and each pack-year of smoking, OR, 0.98 (95% CI, 0.96–1.0; P ¼ 0.03).
These observations support the hypothesis that severe, early-onset COPD is prevalent in females and is influenced by maternal factors. Future genetic studies should evaluate (1) gene-by-sex interactions to address sex-specific genetic contributions and (2) gene-by-race interactions.
Although cleaners represent a significant part of the working population worldwide, they remain a relatively understudied occupational group. Epidemiological studies have shown an association between cleaning work and asthma, but the risk factors are uncertain. Cleaning workers are exposed to a large variety of cleaning products containing both irritants and sensitizers, as well as to common indoor allergens and pollutants. Thus, the onset or aggravation of asthma in this group could be related to an irritant-induced mechanism or to specific sensitization. The main sensitizers contained in cleaning products are disinfectants, quaternary ammonium compounds (such as benzalkonium chloride), amine compounds, and fragrances.The strongest airway irritants in cleaning products are bleach (sodium hypochlorite), hydrochloric acid, and alkaline agents (ammonia and sodium hydroxide), which are commonly mixed together. Exposure to the ingredients of cleaning products may give rise to both new-onset asthma, with or without a latency period, and work-exacerbated asthma. High-level exposure to irritants may induce reactive airways dysfunction syndrome. Cleaning workers may also have a greater relative risk of developing asthma due to prolonged low-to-moderate exposure to respiratory irritants. In addition, asthma-like symptoms without confirmed asthma are also common after exposure to cleaning agents. In many cleaners, airway symptoms induced by chemicals and odors cannot be explained by allergic or asthmatic reactions. These patients may have increased sensitivity to inhaled capsaicin, which is known to reflect sensory reactivity, and this condition is termed airway sensory hyperreactivity.
Studies investigating the relation between respiratory symptoms and change in ventilatory function have been limited by use of reported symptoms at a single point in time. To assess the relation between the longitudinal pattern of reported cough, phlegm, wheeze, and dyspnea and ventilatory loss, we prospectively investigated changes in FVC and FEV1 associated with development, resolution, or persistence of these symptoms over a 3- to 5-year period in 446 asbestos-exposed workers. Longitudinally reported symptoms changed frequently, with 52 to 61% of subjects reporting a specific symptom noting resolution or development of that symptom during follow-up. Initially reported symptoms were not predictive of accelerated loss of FVC or FEV1. In contrast, development of any new respiratory symptom, and to a lesser extent persistence of symptoms during follow-up, were associated with significantly greater ventilatory losses compared with asymptomatic individuals, ranging from 28 mL/yr in FEV1 for newly developed dyspnea, to 67 mL/yr in FVC for developed wheeze (p < 0.01). We conclude that development or persistence of respiratory symptoms over time, rather than the presence of symptoms per se, is predictive of future ventilatory loss. Recognition of interval changes in symptom reporting during surveillance of asbestos-exposed workers may effectively identify groups at risk for progressive ventilatory impairment.
Although the prevalence of asthma and morbidity related to asthma are increasing, little is known about the natural history of lung function in adults with this disease.
We used data from a longitudinal epidemiologic study of the general population in a Danish city, the Copenhagen City Heart Study, to analyze changes over time in the forced expiratory volume in one second (FEV1) in adults with self-reported asthma and adults without asthma. The study was conducted between 1976 and 1994; for each patient, three measurements of lung function were obtained over a 15-year period. The final data set consisted of measurements from 17,506 subjects (8136 men and 9370 women), of whom 1095 had asthma.
Among subjects who participated in all three evaluations, the unadjusted decline in FEV1 among subjects with asthma was 38 ml per year, as compared with 22 ml per year in those without asthma. The decline in FEV1 normalized for height (FEV1 divided by the square of the height in meters) was greater among the subjects with asthma than among those without the disease (P<0.001). Among both men and women, and among both smokers and nonsmokers, subjects with asthma had greater declines in FEV1 over time than those without asthma (P<0.001). At the age of 60 years, a 175-cm-tall nonsmoking man without asthma had an average FEV1 of 3.05 liters, as compared with 1.99 liters for a man of similar age and height who smoked and had asthma.
In a sample of the general population, people who identified themselves as having asthma had substantially greater declines in FEV1 over time than those who did not.
The aim of this prospective study was to detect subjects in the general population with objective signs of chronic obstructive pulmonary disease (COPD) or asthma at an early stage. This was done by means of a two-stage protocol involving screening and a subsequent 2-yr monitoring of all subjects with positive results of screening. The study was done in 10 general practices located in the eastern part of the Netherlands. A random sample was taken from the general population aged 25 to 70 yr. All known COPD and asthma patients were excluded. A total of 1,749 subjects met the inclusion criteria: 1,155 subjects (66%) agreed to participate in the screening stage of the study. A total of 604 subjects (52.3%) showed symptoms or objective signs of COPD or asthma during the screening and were considered "positive." Of those with positive screening results, 384 subjects (64%) agreed to participate in the second, 2-yr monitoring stage of the study. The costs involved in detection were calculated for three different scenarios, as follows: (1) The detection of subjects with persistently decreased lung function or an increased level of bronchial hyperresponsiveness (BHR) during 6 mo of monitoring; (2) Scenario 1 plus the detection of subjects with a rapid decline in lung function with signs of BHR during 12 mo of monitoring; (3) Scenario 2 plus the detection of subjects with a moderate increase in the decline in lung function or signs of BHR during 24 mo of monitoring. The costs of lung function assessments, organization, transportation, and patient time were included. The costs were converted to United States dollars on the basis of purchasing power (1 United States dollar = 2.08 Netherlands guilders). During the second stage, 252 subjects were detected with objective signs of COPD or asthma at an early stage. Smoking status as a screening criterion was neither sensitive nor specific. Because there was no evidence of biased recruitment or selection during the program, the proportions of subjects found to have objective signs of COPD or asthma at an early stage could be extrapolated to the general population. Of the general population, 7.7% showed persistently reduced lung function or increased BHR. Another 12.5 % of the general population showed a rapid decline in lung function (> 80 ml/yr) in combination with signs of BHR, and a further 19.4% of the general population showed mild objective signs of COPD or asthma. The average costs per detected case varied from US469 (Scenario 3). In conclusion, detection of COPD or asthma at an early stage by means of a two-stage protocol was feasible at relatively little expense in comparison with other mass screening programs. Persistently decreased lung function or a rapid decline in lung function (Scenario 2) was observed in approximately 20% of the general adult population.
Spirometric reference values for Caucasians, African-Americans, and Mexican-Americans 8 to 80 yr of age were developed from 7,429 asymptomatic, lifelong nonsmoking participants in the third National Health and Nutrition Examination Survey (NHANES III). Spirometry examinations followed the 1987 American Thoracic Society recommendations, and the quality of the data was continuously monitored and maintained. Caucasian subjects had higher mean FVC and FEV1 values than did Mexican-American and African-American subjects across the entire age range. However, Caucasian and Mexican-American subjects had similar FVC and FEV1 values with respect to height, and African-American subjects had lower values. These differences may be partially due to differences in body build: observed Mexican-Americans were shorter than Caucasian subjects of the same age, and African-Americans on average have a smaller trunk:leg ratio than do Caucasians. Reference values and lower limits of normal were derived using a piecewise polynomial model with age and height as predictors. These reference values encompass a wide age range for three race/ethnic groups and should prove useful for diagnostic and research purposes.
Epidemiological studies have shown an association between cleaning work and asthma, but the risk factors are uncertain. The aim of this study was to assess the risk of asthma in women employed in domestic cleaning.
A cross sectional study was conducted in 4521 women aged 30 to 65 years. Information on respiratory symptoms and cleaning work history was obtained using a postal questionnaire with telephone follow up. Asthma was defined as reported symptoms in the last year or current use of drugs to treat asthma. Odds ratios (OR) with 95% confidence intervals (CI) for asthma in different cleaning groups were estimated using adjusted unconditional logistic regression models.
593 women (13%) were currently employed in domestic cleaning work. Asthma was more prevalent in this group than in women who had never worked in cleaning (OR 1.46 (95% CI, 1.10 to 1.92)). Former domestic cleaning work was reported by 1170 women (26%), and was strongly associated with asthma (OR 2.09 (1.70 to 2.57)). Current and former non-domestic cleaning work was not significantly associated with asthma. Consistent results were obtained for other respiratory symptoms. Twenty five per cent of the asthma cases in the study population were attributable to domestic cleaning work.
Employment in domestic cleaning may induce or aggravate asthma. This study suggests that domestic cleaning work has an important public health impact, probably involving not only professional cleaners but also people undertaking cleaning tasks at home.
The authors assessed the association between asthma prevalence and socioeconomic status at both the individual and center levels simultaneously.by using data from 32 centers in 15 countries. Included were 10,971 subjects aged 20-44 years selected from the general population and interviewed in 1991-1992. Socioeconomic status at both the individual and aggregated levels was measured on the basis of occupation and educational level. Associations were assessed by using multilevel models adjusted for age, sex, body mass index, parental asthma, childhood respiratory infections, presence of immunoglobulin E to common allergens, rhinitis, smoking, and occupational exposure to irritants. Asthma prevalence was higher in lower socioeconomic groups, whether defined by educational level (odds ratio for finishing full-time studies-<16 vs. >19 years = 1.28, 95% confidence interval: 1.00, 1.64) or social class (odds ratio for semiskilled and unskilled manual workers vs. professional/managerial = 1.51, 95% confidence interval: 1.20, 1.90), regardless of atopic status. The relation was consistent between centers. Irrespective of individual socioeconomic status, subjects living in areas in which educational levels were lower had a higher risk of asthma (p < 0.05). This center-level association partially explained geographic differences in asthma prevalence, but considerable heterogeneity still remained. The authors concluded that community influences of living in a low-educational area are associated with asthma, independently of subjects' own educational level and social class.
The aim of this study was to quantify the global prevalence of chronic obstructive pulmonary disease (COPD) by means of a systematic review and random effects meta-analysis.
PubMed was searched for population-based prevalence estimates published during the period 1990–2004. Articles were included if they: 1) provided total population or sex-specific estimates for COPD, chronic bronchitis and/or emphysema; and 2) gave method details sufficiently clearly to establish the sampling strategy, approach to diagnosis and diagnostic criteria.
Of 67 accepted articles, 62 unique entries yielded 101 overall prevalence estimates from 28 different counties. The pooled prevalence of COPD was 7.6% from 37 studies, of chronic bronchitis alone (38 studies) was 6.4% and of emphysema alone (eight studies) was 1.8%. The pooled prevalence from 26 spirometric estimates was 8.9%. The most common spirometric definitions used were those of the Global Initiative for Chronic Obstructive Lung Disease (13 estimates). There was significant heterogeneity, which was incompletely explained by subgroup analysis ( e.g. age and smoking status).
The prevalence of physiologically defined chronic obstructive pulmonary disease in adults aged ≥40 yrs is ∼9–10%. There are important regional gaps, and methodological differences hinder interpretation of the available data. The efforts of the Global Initiative for Chronic Obstructive Lung Disease and similar groups should help to standardise chronic obstructive pulmonary disease prevalence measurement.
Cleaning work and professional use of certain cleaning products have been associated with asthma, but respiratory effects of nonprofessional home cleaning have rarely been studied.
To investigate the risk of new-onset asthma in relation to the use of common household cleaners.
Within the follow-up of the European Community Respiratory Health Survey in 10 countries, we identified 3,503 persons doing the cleaning in their homes and who were free of asthma at baseline. Frequency of use of 15 types of cleaning products was obtained in a face-to-face interview at follow-up. We studied the incidence of asthma defined as physician diagnosis and as symptoms or medication usage at follow-up. Associations between asthma and the use of cleaning products were evaluated using multivariable Cox proportional hazards or log-binomial regression analysis.
The use of cleaning sprays at least weekly (42% of participants) was associated with the incidence of asthma symptoms or medication (relative risk [RR], 1.49; 95% confidence interval [CI], 1.12-1.99) and wheeze (RR, 1.39; 95% CI, 1.06-1.80). The incidence of physician-diagnosed asthma was higher among those using sprays at least 4 days per week (RR, 2.11; 95% CI, 1.15-3.89). These associations were consistent for subgroups and not modified by atopy. Dose-response relationships (P < 0.05) were apparent for the frequency of use and the number of different sprays. Risks were predominantly found for the commonly used glass-cleaning, furniture, and air-refreshing sprays. Cleaning products not applied in spray form were not associated with asthma.
Frequent use of common household cleaning sprays may be an important risk factor for adult asthma.
The aim of the present study was to investigate the relationship between change in lung function and cumulative exposure to wood dust.
In total, 1,112 woodworkers (927 males, 185 females) and 235 reference workers (104 males, 185 females) participated in a 6-yr longitudinal study. Forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), height and weight were measured, and questionnaire data on respiratory symptoms, wood dust exposure and smoking habits were collected. Cumulative inhalable wood dust exposure was assessed using a study-specific job exposure matrix and exposure time.
The median (range) for cumulative wood dust exposure was 3.75 (0–7.55) mg·year·m ⁻³ . A dose–response relationship between cumulative wood dust exposure and percent annual decrease in FEV 1 was suggested for female workers. This was confirmed in a linear regression model adjusted for confounders, including smoking, height and age. An additional difference of -14.50 mL·yr ⁻¹ and −27.97 mL·yr ⁻¹ was revealed for females exposed to 3.75–4.71 mg·yr·m ⁻³ or to >4.71 mg·yr·m ⁻³ , respectively, compared with non-/low-exposed females. For females, a positive trend between wood dust exposure and the cumulative incidence proportion of FEV 1 /FVC <70% was suggested.
In conclusion, in the present low-exposed cohort, female woodworkers had an accelerated decline in lung function, which may be clinically relevant.
With the looming expansion of the elderly population of the US, a thorough understanding of "normal" aging-related changes on the respiratory system is paramount. The respiratory system undergoes various anatomical, physiological and immunological changes with age. The structural changes include chest wall and thoracic spine deformities which impairs the total respiratory system compliance leading to increase work of breathing. The lung parenchyma loses its supporting structure causing dilation of air spaces: "senile emphysema". Respiratory muscle strength decreases with age and can impair effective cough, which is important for airway clearance. The lung matures by age 20-25 years, and thereafter aging is associated with progressive decline in lung function. The alveolar dead space increases with age, affecting arterial oxygen without impairing the carbon dioxide elimination. The airways receptors undergo functional changes with age and are less likely to respond to drugs used in younger counterparts to treat the same disorders. Older adults have decreased sensation of dyspnea and diminished ventilatory response to hypoxia and hypercapnia, making them more vulnerable to ventilatory failure during high demand states (ie, heart failure, pneumonia, etc) and possible poor outcomes.
Introduction: Occupational and regular cleaning at home is associated with excess risk of asthma and respiratory symptoms, but little is known about long term effects on lung function decline.
Aim: To study whether occupational cleaning and/or cleaning at home causes accelerated lung function decline.
Methods: Lung function (FVC and FEV1) was measured in the ECRHS multicentre population-based study in 1992-94 and at two follow-ups in 1998-02 and 2010-12. In ECRHS II 3462 women responded to the questions “since the last survey, have you been the person doing the cleaning and/or washing in your home?” and “since the last survey, have you worked as a cleaner?” respectively. Decline in FVC and FEV1 between ECRHS I and III was analysed by mixed effect models adjusted for FEV1, age and height at baseline, number of years between each follow-up, BMI at each survey, pack years at last survey, age at completed education, social class and centre.
Results: Between the first and last survey, women not working as cleaners or doing the cleaning at home had an adjusted mean decline in FVC and FEV1 of 19.5 (95% CI [15.4-23.6]) and 29.6 [26.8-32.3] ml/yr, respectively. Women cleaning at home had an adjusted mean decline in FVC and FEV1 of 24.6 [23.4-25.5] and 33.6 [32.9-34.3] ml/yr, whereas the decline in occupational cleaners was 27.6 [24.2-31.0] and 34.6 [32.2-36.7] ml/yr, respectively. Lung function decline was significantly more rapid in both groups of cleaners as compared to the reference group (p<0.001).
Conclusion: Women who work as cleaners and/or regularly clean their home had accelerated lung function decline and are thus at increased risk for the development of obstructive and/or restrictive lung disease.
Objectives:
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Exposure to occupational hazards is an important preventable risk factor but the contribution of specific occupations to COPD risk in a general population is uncertain. Our aim was to investigate the association of COPD with occupation in the UK population.
Methods:
In 2006-2010, the UK Biobank cohort recruited 502 649 adults aged 40-69 years. COPD cases were identified by prebronchodilator forced expiratory volume in 1 s/forced vital capacity<lower limit of normal according to American Thoracic Society (ATS)/ European Respiratory Society (ERS) guidelines. Current occupations were coded using the Standard Occupational Classification (SOC) 2000. Prevalence ratios (PRs) and 95% CIs of COPD for each SOC-coded job were estimated using a robust Poisson model adjusted for sex, age, recruitment centre and lifetime tobacco smoking. Analyses restricted to never-smokers and non-asthmatics were also performed.
Results:
Of the 353 occupations reported by 228 614 current working participants, several showed significantly increased COPD risk. Those at highest COPD risk were seafarers (PR=2.64; 95% CI 1.59 to 4.38), coal mine operatives (PR=2.30; 95% CI 1.00 to 5.31), cleaners (industrial: PR=1.96; 95% CI 1.16 to 3.31 and domestic: PR=1.43; 95% CI 1.28 to 1.59), roofers/tilers (PR=1.86; 95% CI 1.29 to 2.67), packers/bottlers/canners/fillers (PR=1.60; 95% CI 1.15 to 2.22), horticultural trades (PR=1.55; 95% CI 0.97 to 2.50), food/drink/tobacco process operatives (PR=1.46; 95% CI 1.11 to 1.93), floorers/wall tilers (PR=1.41; 95% CI 1.00 to 2.00), chemical/related process operatives (PR=1.39; 95% CI 0.98 to 1.97), postal workers/couriers (PR=1.35; 95% CI 1.15 to 1.59), labourers in building/woodworking trades (PR=1.32; 95% CI 1.04 to 1.68), school mid-day assistants (PR=1.32; 95% CI 1.01 to 1.74) and kitchen/catering assistants (PR=1.30; 95% CI 1.10 to 1.53). Associations were similar in analyses restricted to never-smokers and non-asthmatics.
Conclusions:
Selected occupations are associated with increased COPD risk in a large cross-sectional population-based UK study. Further analyses should confirm the extent to which these associations reflect exposures still of concern and where strengthened preventive action may be needed.
Rationale Cleaning work and professional use of certain cleaning products have been associated with asthma, but respiratory effects of nonprofessional home cleaning have rarely been studied. Objectives: To investigate the risk of new-onset asthma in relation to the use of common household cleaners. Methods: Within the follow-up of the European Community Respiratory Health Survey in 10 countries, we identified 3,503 persons doing the cleaning in their homes and who were free of asthma at baseline. Frequency of use of 15 types of cleaning products was obtained in a face-to-face interview at follow-up. We studied the incidence of asthma defined as physician diagnosis and as symptoms or medication usage at follow-up. Associations between asthma and the use of cleaning products were evaluated using multivariable Cox proportional hazards or log-binomial regression analysis. Measurements and Main Results: The use of cleaning sprays at least weekly (42 70 of participants) was associated with the incidence of asthma symptoms or medication (relative risk [RR], 1.49; 95070 confidence interval [Cl], 1.12-1.99) and wheeze (RR, 1.39; 95 % Cl, 1.06-1.80). The incidence of physician-diagnosed asthma was higher among those using sprays at least 4 days per week (RR, 2.11; 95% Cl, 1.15-3.89). These associations were consistent for subgroups and not modified by atopy. Dose-response relationships (P < 0.05) were apparent for the frequency of use and the number of different sprays. Risks were predominantly found for the commonly used glass-cleaning, furniture, and air-refreshing sprays. Cleaning products not applied in spray form were not associated with asthma. Conclusions: Frequent use of common household cleaning sprays may be an important risk factor for adult asthma.
There is increasing evidence on the deleterious role in asthma of the use of household cleaning products in spray forms in adults. Household help might induce misclassification errors. The aim of the present analysis was to study associations between household exposure to cleaning sprays and current asthma in elderly women, taking into account household help.
A nested case-control survey on respiratory health was undertaken among a random sample of French women from the E3N study. Data were available for 570 women (235 with current asthma and 335 without asthma history; 68 years old on average, 59% never smokers). Three estimates of domestic exposure were used: 1) self-reported, 2) using principal component analysis, 3) a composite score for sprays. Associations between domestic exposures and asthma were assessed by logistic regression, adjusted for age, educational level, BMI and smoking status. Analyses were further stratified on household help in order to evaluate a potential misclassification bias.
Among women without household help (n = 325), a significant association was observed between weekly use of at least one spray and current asthma (OR [95% CI]: 1.86[1.04-3.33]). No association was observed among women with household help.
Weekly household use of cleaning sprays may have a deleterious effect on asthma. It is important to take into account household help to limit misclassification bias.
Many studies show a link between forced expiratory volume in 1 s (FEV(1)) and survival in the general population and this has been interpreted as a link between airway obstruction and survival. However, the observation that vital capacity is also associated with survival weakens this interpretation.
Data on spirometry and survival were taken from the Atherosclerosis Risk in Communities (ARIC) limited access dataset. Survival among 7489 participants with usable spirometry and complete data was regressed against measures of ventilatory function after controlling for many other factors likely to be associated with survival.
Survival was strongly associated with forced vital capacity (FVC) after adjustment for FEV(1), but not the other way round. The fully adjusted hazard ratio (HR) associated with high FVC was 0.90 in men (95% CI 0.80 to 1.00; p=0.049) and 0.82 in women (95% CI 0.70 to 0.95; p=0.01). This compares with 0.98 for FEV(1) in men (95% CI 0.90 to 1.07; p.0.72) and 1.01 in women (95% CI 0.89 to 1.15; p=0.84). There was no association between survival and airway obstruction as measured by the FEV(1)/FVC ratio.
FVC but not airway obstruction predicts survival in asymptomatic adults without chronic respiratory diagnoses or persistent respiratory symptoms. The association is not explained by age, anthropometry, smoking, income occupation or blood pressure. As FVC later in life, cardiovascular risk, type II diabetes mellitus and low-grade systemic inflammation are all associated with poor fetal growth, these other conditions may be partly responsible for the poor survival in those with low FVC.
The present study summarizes the recent literature on the relation between cleaning exposures and respiratory health, in particular asthma, including reviews, epidemiological surveys, surveillance programmes and exposure studies. The authors also aimed to identify gaps in the current knowledge and to recommend future research on the topic.
A large international general population study showed an increased risk of new-onset asthma associated with cleaning work, with professional use of cleaning products and with domestic use of cleaning sprays. Three surveillance studies confirm the recognition of occupational asthma cases among cleaners and among others who use cleaning products at work. Six workforce-based studies show that respiratory symptoms are partly work-related, and are associated with certain specific exposures including sprays, chlorine bleach and other disinfectants.
Recent studies have strengthened the evidence of asthma and other adverse respiratory effects in cleaning workers. Similar effects are seen in other settings in which cleaning products are used such as healthcare professionals and homemakers. Both new-onset asthma and work-exacerbated asthma due to cleaning exposures may play a role. Exposure to cleaning sprays, chlorine bleach and other disinfectants may be particularly relevant. The predominant effect mechanisms remain largely unclear and may include both specific sensitization and irritant-related features.
Background
There are no large population-based studies on occupational asthma, and few estimates of the proportion of asthma attributed to occupation, even though asthma is the most common occupational respiratory disorder in industrialised countries.
Methods
We assessed data on 15637 people aged 20–44, randomly selected from the general population of 26 areas in 12 industrialised countries. Asthma was assessed by methacholine challenge test and by questionnaire data on respiratory symptoms and use of medication. Occupation was defined by job-titles and a job exposure matrix was constructed.
Findings
Highest risk of asthma, defined as bronchial hyperresponsiveness and reported asthma symptoms or medication, was shown for farmers (odds ratio 2·62 [95% CI 1·29–5·35]), painters (2·34 [1·04–5·28]), plastic workers (2·20 [0·59–8·29]), cleaners (1·97 [1·33–2·92]), spray painters (1·96 [0·72–5·34]), and agricultural workers (1·79 [1·02–3·16]). Similar risks were shown for asthma defined as reported asthma symptoms or medication. The most consistent results across countries were shown for farmers and cleaners. Excess asthma risk was associated with high exposure to biological dusts, mineral dusts, and gases and fumes. The proportion of asthma among young adults attributed to occupation was 5%–10%.
Interpretation
The prevalence of occupational asthma in women and in specific occupations has been underestimated. Given a mean prevalence of asthma of about 5%, about 0·2%–0·5% of young adults become asthmatics or have their asthma exacerbated because of their occupations.
There are no large population-based studies on occupational asthma, and few estimates of the proportion of asthma attributed to occupation, even though asthma is the most common occupational respiratory disorder in industrialised countries.
We assessed data on 15,637 people aged 20-44, randomly selected from the general population of 26 areas in 12 industrialised countries. Asthma was assessed by methacholine challenge test and by questionnaire data on respiratory symptoms and use of medication. Occupation was defined by job-titles and a job exposure matrix was constructed.
Highest risk of asthma, defined as bronchial hyperresponsiveness and reported asthma symptoms or medication, was shown for farmers (odds ratio 2.62 [95% CI 1.29-5.35]), painters (2.34 [1.04-5.28]), plastic workers (2.20 [0.59-8.29]), cleaners (1.97 [1.33-2.92]), spray painters (1.96 [0.72-5.34]), and agricultural workers (1.79 [1.02-3.16]). Similar risks were shown for asthma defined as reported asthma symptoms or medication. The most consistent results across countries were shown for farmers and cleaners. Excess asthma risk was associated with high exposure to biological dusts, mineral dusts, and gases and fumes. The proportion of asthma among young adults attributed to occupation was 5%-10%.
The prevalence of occupational asthma in women and in specific occupations has been underestimated. Given a mean prevalence of asthma of about 5%, about 0.2%-0.5% of young adults become asthmatics or have their asthma exacerbated because of their occupations.
Men have higher prevalence rates of chronic obstructive pulmonary disease (COPD) than women, which has been attributed to the historically higher rates of cigarette smoking in males. However, the increased rates of cigarette smoking in females within the last several decades have been associated with steadily increasing rates of COPD in women. As part of a study of the genetics of severe, early-onset COPD, we assembled a group of 84 probands with severe, early-onset COPD (without severe alpha(1)-antitrypsin deficiency) and 348 of their first-degree relatives. We found a markedly elevated prevalence (71.4%) of females among the early-onset COPD probands. Among the entire group of first-degree relatives of early-onset COPD probands, univariate analysis demonstrated similar spirometric values and bronchodilator responsiveness in males and females; however, among current or ex-smokers, female first-degree relatives had significantly lower FEV(1)/ FVC (81.4 +/- 17.2% in females versus 87.0 +/- 12.9% in males, p = 0.009) and significantly greater bronchodilator responsiveness (expressed as percentage of baseline FEV(1)) (7.7 +/- 9.4% pred in females versus 4.1 +/- 6.4% pred in males, p = 0.002). Female smoking first-degree relatives were significantly more likely to demonstrate profound reductions in FEV(1) (< 40% pred) than male smoking first-degree relatives (p = 0. 03). Multivariate analysis, performed with generalized estimating equations, demonstrated that current or ex-smoking female first-degree relatives had significantly greater risk of FEV(1) < 80% pred (OR 1.91, 95% CI 1.03- 3.54), FEV(1) < 40% pred (OR 3.56, 95% CI 1.08-11.71), and bronchodilator response greater than 10% of baseline FEV(1) (OR 4.74, 95% CI 1.91-11.75). These results suggest that women may be more susceptible to the development of severe COPD.
Several studies have demonstrated an excess risk for asthma among cleaning workers. The aim of this analysis was to compare clinical, immunological and functional characteristics associated with asthma in cleaners and other occupational groups.
Cleaners, workers exposed to high molecular weight (MW) agents, workers exposed to low MW agents, and office workers were identified from an international community-based epidemiological study. Influence of sex, smoking, age and atopy on the relationships with asthma was investigated. Rates of respiratory symptoms, bronchial hyperresponsiveness, atopic sensitisation and lung function were compared between asthmatics from the four groups (case-case analysis).
The risk for asthma in workers exposed to low MW agents was higher among nonatopics than among atopics. Case-case analysis showed no major differences in asthma characteristics between cleaners and workers exposed to high or low MW agents. Asthmatic cleaners had less atopy, more chronic bronchitis and a lower lung function as compared to office workers.
Asthma in cleaning workers showed many similarities with that in workers known to be at risk for occupational asthma. Atopic sensitisation did not seem to play an important role in cleaning-related asthma.
The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents.
We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre.
A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4, 1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2, 1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year.
Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.
Spirometric reference values from a sample of the general U.S. population
- J L Hankinson
- J R Odencrantz
- K B Fedan
Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample
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