Occupational risk factors for asthma among nurses and related healthcare professionals in an international study

Mirabelli, Maria C.; Zock, Jan‐Paul; Plana, Estel; Antó, Josep M.; Benke, Geza; Blanc, Paul D.; Dahlman-Höglund, Anna; Jarvis, Déborah; Kromhout, Hans; Lillienberg, Linnéa; Norbäck, Dan; Olivieri, Mario; Radon, Katja; Sunyer, Jordi; Torén, Kjell; Sprundel, Marc van; Villani, Simona; Kogevinas, Manolis

doi:10.1136/oem.2006.031203

Cited by 115 publications

(151 citation statements)

References 25 publications

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“…Our results are consistent with a deleterious effect in the use of cleaning sprays on asthma phenotypes and with previous results on household exposure [6], from nurse cohorts [5] and cleaners in offices or private homes [1]. The lack of association between home cleaning, evaluated both by self-report and by PCA, and asthma phenotypes, is an argument in favour of the specific effect of products in spray form.…”

Section: Domestic Use Of Sprays and Asthma In Femalessupporting

confidence: 81%

“…BELLO et al [4], who studied detailed tasks among hospital cleaners, classified the use of cleaning sprays as high risk for inhalation exposure. The use of cleaning products in spray form, at work and at home, may be an important risk factor for asthma [1,5,6]. One study has reported a dose-response relationship between the frequency of use and number of cleaning sprays used at home and asthma incidence [6].…”

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confidence: 99%

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Domestic use of cleaning sprays and asthma activity in females

et al. 2012

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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.

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Section: Domestic Use Of Sprays and Asthma In Femalessupporting

confidence: 81%

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confidence: 99%

Domestic use of cleaning sprays and asthma activity in females

et al. 2012

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“…The most persuasive evidence for chronic IIA related to chronic moderate irritant exposure asthma is provided by the epidemiologic studies of workers exposed to cleaning agents (47). The frequent use of bleach (hypochlorite), ammonia, and degreasing sprays has been consistently associated with asthma among workers exposed to cleaning agents (42,44,48), although the precise chemical exposures and the mechanisms responsible for the increased incidence of asthma have not been clarified since cleaning materials typically contain a wide variety of ingredients, some of which are respiratory irritants, while others are potential airway sensitizers (Table 6). Other occupations associated with increased risk of asthma that cannot be readily or completely explained on the basis of a clear sensitizing exposure are presented in Table 6 (47,(49)(50)(51)(52)(53)(54)(55)(56).…”

Section: Epidemiological Evidence For Irritant-induced Asthmamentioning

confidence: 99%

EAACI position paper: irritant‐induced asthma

Vandenplas

Wiszniewska

Raulf

et al. 2014

Allergy

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The term irritant-induced (occupational) asthma (IIA) has been used to denote various clinical forms of asthma related to irritant exposure at work. The causal relationship between irritant exposure(s) and the development of asthma can be substantiated by the temporal association between the onset of asthma symptoms and a single or multiple high-level exposure(s) to irritants, whereas this relationship can only be inferred from epidemiological data for workers chronically exposed to moderate levels of irritants. Accordingly, the following clinical phenotypes should be distinguished within the wide spectrum of irritant-related asthma: (i) definite IIA, that is acute-onset IIA characterized by the rapid onset of asthma within a few hours after a single exposure to very high levels of irritant substances; (ii) probable IIA, that is asthma that develops in workers with multiple symptomatic high-level exposures to irritants; and (iii) possible IIA, that is asthma occurring with a delayed-onset after chronic exposure to moderate levels of irritants. This document prepared by a panel of experts summarizes our current knowledge on the diagnostic approach, epidemiology, pathophysiology, and management of the various phenotypes of IIA.Abbreviations IIA, irritant-induced asthma; NSBH, nonspecific bronchial hyperresponsiveness; OA, occupational asthma; RADS, reactive airways dysfunction syndrome; TRP, transient receptor potential.

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“…formaldehyde and isopropylic alcohol) can also be found in many indoor environments. These irritants are recognized as a possible cause of asthma [19][20][21]. Very few cases of IVCD have been described so far [16,22].…”

Section: Discussionmentioning

confidence: 99%

Irritant vocal cord dysfunction and occupational bronchial asthma: differential diagnosis in a health care worker

Tonini¹,

Dellabianca²,

C³

et al. 2009

International Journal of Occupational Medicine and Environmental Health

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Objectives: Vocal cord dysfunction (VCD) is an uncommon respiratory disease characterized by the paradoxical adduction of vocal cords during inspiration, that may mimic bronchial asthma. The pathogenesis of VCD has not been clearly defined but it is possible to recognize non-psychologic and psychologic causes. The majority of patients are female but, interestingly, a high incidence of VCD has been documented in health care workers. A misdiagnosis with asthma leads to hospitalisation, unnecessary use of systemic steroids with related adverse effects, and sometimes tracheostomy and intubation. In a subset of VCD patients, the disease can be attributed to occupational or environmental exposure to inhaled irritants. Materials and Methods: We report the case of a 45-year-old woman, working as a nurse, who complained of wheezing, cough, dyspnoea related to inhalation of irritating agents (isopropylic alcohol, formaldehyde, peracetic acid). She underwent chest radiography, pulmonary function assessment both in the presence and in the absence of symptoms, bronchial provocation with methacholine and bronchodilation test with salbutamol to recognize asthma's features, allergy evaluation by skin prick tests and patch tests and video-laryngoscopy. Results: VCD diagnosis was made on the basis of video-laryngoscopy, that visualized the paradoxical motion of the vocal cords during symptoms, in the absence of other pathologic processes. Conclusions: This case fulfils the proposed criteria for the diagnosis of irritant VCD (IVCD). This is the first report of VCD onset following exposure to several irritants: formaldehyde, glutaraldehyde, isopropylic alcohol, peracetic acid-hydrogen performaldehyde, glutaraldehyde, isopropylic alcohol, peracetic acid-hydrogen perisopropylic alcohol, peracetic acid-hydrogen perisopropylic alcohol, peracetic acid-hydrogen peroxide mixture. These substances are used as cleaning and antiseptic agents in healthcare settings and some ones can also be found in many indoor environments. A correct diagnosis is important both to give the appropriate treatment and for medical legal implications.

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Occupational risk factors for asthma among nurses and related healthcare professionals in an international study

Cited by 115 publications

References 25 publications

Domestic use of cleaning sprays and asthma activity in females

Domestic use of cleaning sprays and asthma activity in females

EAACI position paper: irritant‐induced asthma

Irritant vocal cord dysfunction and occupational bronchial asthma: differential diagnosis in a health care worker

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