Occupational exposure to disinfectants and asthma control in US nurses

Abstract

Disinfectant use has been associated with adverse respiratory effects among healthcare workers. However, the specific harmful agents have not been elucidated. We examined the association between occupational exposure to disinfectants and asthma control in the Nurses’ Health Study II, a large cohort of female nurses. Nurses with asthma were invited in 2014 to complete two questionnaires on their current occupation and asthma (response rate: 80%). Asthma control was defined by the Asthma Control Test (ACT). Exposure to major disinfectants was evaluated by a Job-Task-Exposure Matrix (JTEM). Analyses included 4,102 nurses with asthma (mean age: 58 years). Asthma control was poor (ACT=16–19) in 12% of nurses and very poor (≤15) in 6%. Use of disinfectants to clean medical instruments (19% exposed) was associated with poorly (odds ratio 1.37; 95%CI: [1.05–1.79]) and very poorly (1.88 [1.38–2.56]) controlled asthma (P-trend 0.004, after adjustment for potential confounders). Using JTEM estimates, exposure to formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide and enzymatic cleaners was associated with poor asthma control (all P-trend<0.05); exposure to quaternary ammonium compounds and alcohol was not. Use of several disinfectants was associated with poor asthma control. Our findings suggest targets for future efforts to prevent worsening of asthma control in healthcare workers.

Occupational exposure to disinfectants and asthma incidence in U.S. nurses: A prospective cohort study

“…Several cross‐sectional studies have established an association between exposure to cleaning products and disinfectants and current asthma or asthma symptoms/exacerbations . However, in such studies, it is difficult to determine whether the observed associations are driven by occupational asthma (new‐onset asthma caused by occupational exposure) or work‐exacerbated asthma (pre‐existing asthma worsened by occupational exposure).…”

“…However, the use of a JTEM, that assigns exposure level based not only on nursing job types but also on disinfection tasks, is likely to reduce exposure misclassification (as compared to a job‐exposure matrix). Moreover, using the same methods for occupational exposure assessment, we recently found in NHSII that exposure to cleaning products and disinfectants was significantly associated with COPD incidence, and with poor asthma control among participants with asthma …”

“…In biennial questionnaires, participants were asked to report any condition(s) with which they were diagnosed since the last questionnaire cycle, including asthma. Between 2014 and 2017, we sent a supplemental questionnaire on asthma to participants who reported a physician's diagnosis of asthma in any past biennial questionnaire (80% response rate). Based on information collected on the supplemental questionnaire, we selected participants who reiterated that a physician had diagnosed her as having asthma and who reported use of any asthma medication in the past year.…”

“…Detailed data on occupational exposure were collected in 2009, when nurses were at a late‐career stage (age 45‐65 years). Based on a cross‐sectional analysis among nurses with asthma (mean age: 58 years), we recently reported that occupational exposure to cleaning products and disinfectants was associated with poor asthma control . Here, we investigated the prospective association between occupational exposure to disinfectants and incident asthma in late‐career nurses.…”

Risk of asthma onset after natural and surgical menopause: Results from the French E3N cohort

“…However, these associations were not at all significant. Differences in population and work-related exposure (such as exposure to cleaning disinfectants, which have been found to be associated with asthma in hospital workers) might partly explain the different findings [21].…”