Occupational and work-related respiratory disease attributed to cleaning products

Abstract

ObjectivesExposure to cleaning products has been associated with adverse respiratory outcomes. This study aimed to investigate the medically reported incidence, trends in incidence and occupational determinants of work-related respiratory disorders attributed to cleaning agents and to explore the role of ‘Quantitative Structure Activity Relationships’ (QSAR) in corroborating the identification of chemical respiratory sensitisers.MethodsRespiratory diagnoses attributed to cleaning agents were extracted from The Health and Occupation Research (THOR) surveillance network, 1989–2017. Incidence, trends in incidence and incidence rate ratios by occupation were investigated. Agents were classified by chemical type and QSAR hazard indices were determined for specific organic chemicals.ResultsApproximately 6% (779 cases) of the (non-asbestos) THOR respiratory cases were attributed to cleaning agents. Diagnoses were predominantly asthma (58%) and inhalation accidents (27%) with frequently reported chemical categories being aldehydes (30%) and chlorine/its releasers (26%). No significant trend in asthma incidence (1999–2017) was observed (annual average change of −1.1% (95% CI −4.4 to 2.4)). This contrasted with a statistically significant annual decline in asthma incidence (−6.8% (95% CI −8.0 to −5.6)) for non-cleaning agents. There was a large variation in risk between occupations. 7 of the 15 organic chemicals specifically identified had a QSAR generated hazard index consistent with being a respiratory sensitiser.ConclusionSpecific occupations appear to be at increased risk of adverse respiratory outcomes attributed to cleaning agents. While exposure to agents such as glutaraldehyde have been addressed, other exposures, such as to chlorine, remain important. Chemical features of the cleaning agents helped distinguish between sensitising and irritant agents.

Causes and Phenotypes of Work-Related Asthma

“…It has been well recognized that exposure of professional cleaners and others to cleaning and disinfecting agents can result in the development of IIA from accidental high level exposures [16,17]. However, lower exposures also have been associated with increased risk of asthma (as reviewed by Folletti et al for studies up to 2016 [18]).…”

“…Chlorine or chlorine-releasers were identified in 26% of the implicated cleaning agents, with a small percentage, less than 4%, attributed to chloramines and nitrogen trichloride. Other potential irritants implicated less frequently than chlorine included acids and caustic agents [17]. The main occupational group were cleaners, followed by nurses/nursing assistants.…”

Work-related asthma in the USA: nationally representative estimates with extended follow-up

“…3 8 Many WRA studies are limited to cross-sectional data, 7 prevalence estimates, 8 single occupations or selected occupation groups, 10 small geographical areas, 9 or countries with universal healthcare or well-established population registries, such as the UK. 6 The studies reporting asthma incidence are typically limited to a single occupational group, 16 have few participants in occupational groups, 17 or use surveillance data that can be biased by reporting and data quality limitations, such as relying on voluntary reports from physicians or depending on individuals' healthcare access and use. 18 19 In the USA several multistate asthma prevalence studies used data from the Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS), with response rates typically 40%-50% and with 12-month follow-up.…”

“…Certain occupations with exposures to such triggers have high asthma risks. Examples include agriculture, 5 cleaning, [5][6][7] entertainment, 5 8-10 healthcare, 8 10 manufacturing, construction and wood-working, 5 9 and protective services. 5 WRA may be declining generally, 9 11 but it is increasing in some occupations such as those with cleaning agent exposures.…”

“…5 WRA may be declining generally, 9 11 but it is increasing in some occupations such as those with cleaning agent exposures. 6 About 8.9% of women and 5% of men in the USA have asthma. 12 Women also have more WRA than men, 3 7-9 12 although this may reflect different occupations.…”