Skip to main content
PMC home page
Occupational and Environmental Medicine logoLink to Occupational and Environmental Medicine
. 2005 Sep;62(9):598–606. doi: 10.1136/oem.2004.017640

Asthma, chronic bronchitis, and exposure to irritant agents in occupational domestic cleaning: a nested case-control study

M Medina-Ramon 1, J Zock 1, M Kogevinas 1, J Sunyer 1, Y Torralba 1, A Borrell 1, F Burgos 1, J Anto 1
PMCID: PMC1741089  PMID: 16109815

Abstract

Background: Women employed in domestic cleaning are at increased risk for symptoms of obstructive lung disease, but the agents responsible are unknown.

Aims: To investigate common tasks and products in occupational domestic cleaning in relation to respiratory morbidity.

Methods: Case-control study in domestic cleaning women nested within a large population based survey of women aged 30–65 years; 160 domestic cleaning women with asthma symptoms, chronic bronchitis symptoms, or both and 386 without a history of respiratory symptoms were identified. Detailed exposures were evaluated for 40 cases who reported still having symptoms at the recruitment interview, and 155 controls who reported not having symptoms. All tasks performed and products used when cleaning houses were determined in a face-to-face interview. Lung function, methacholine challenge, and serum IgE testing were performed. Personal exposure measurements of airborne chlorine and ammonia were performed in a subsample. Associations between asthma, chronic bronchitis, and cleaning exposures were evaluated using multiple logistic regression analysis.

Results: Airborne chlorine (median level 0–0.4 ppm) and ammonia (0.6–6.4 ppm) were detectable during occupational domestic cleaning activities. Cases used bleach more frequently than controls; adjusted odds ratio (OR) for intermediate exposure was 3.3 (95% CI 0.9 to 11) and for high exposure 4.9 (1.5 to 15). Other independent associations included accidental inhalation of vapours and gases from cleaning agents and washing dishes. These associations were more pronounced for cases with asthma symptoms than for those with symptoms of chronic bronchitis, but were not related to sensitisation to common allergens.

Conclusions: Asthma symptoms in domestic cleaning women are associated with exposure to bleach and possibly other irritant agents. The public health impact of the use of irritant cleaning products could be widespread since the use of these products is common both in the workplace and at home.

Full Text

The Full Text of this article is available as a PDF (112.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alberts W. M., do Pico G. A. Reactive airways dysfunction syndrome. Chest. 1996 Jun;109(6):1618–1626. doi: 10.1378/chest.109.6.1618. [DOI] [PubMed] [Google Scholar]
  2. Arif Ahmed A., Delclos George L., Whitehead Lawrence W., Tortolero Susan R., Lee Eun S. Occupational exposures associated with work-related asthma and work-related wheezing among U.S. workers. Am J Ind Med. 2003 Oct;44(4):368–376. doi: 10.1002/ajim.10291. [DOI] [PubMed] [Google Scholar]
  3. Balmes John R. Occupational airways diseases from chronic low-level exposures to irritants. Clin Chest Med. 2002 Dec;23(4):727-35, vi. doi: 10.1016/s0272-5231(02)00031-x. [DOI] [PubMed] [Google Scholar]
  4. Brooks S. M., Hammad Y., Richards I., Giovinco-Barbas J., Jenkins K. The spectrum of irritant-induced asthma: sudden and not-so-sudden onset and the role of allergy. Chest. 1998 Jan;113(1):42–49. doi: 10.1378/chest.113.1.42. [DOI] [PubMed] [Google Scholar]
  5. Brooks S. M., Weiss M. A., Bernstein I. L. Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures. Chest. 1985 Sep;88(3):376–384. doi: 10.1378/chest.88.3.376. [DOI] [PubMed] [Google Scholar]
  6. Burney P. G., Luczynska C., Chinn S., Jarvis D. The European Community Respiratory Health Survey. Eur Respir J. 1994 May;7(5):954–960. doi: 10.1183/09031936.94.07050954. [DOI] [PubMed] [Google Scholar]
  7. Chang-Yeung M., Lam S., Kennedy S. M., Frew A. J. Persistent asthma after repeated exposure to high concentrations of gases in pulpmills. Am J Respir Crit Care Med. 1994 Jun;149(6):1676–1680. doi: 10.1164/ajrccm.149.6.8004329. [DOI] [PubMed] [Google Scholar]
  8. Chinn S., Burney P., Jarvis D., Luczynska C. Variation in bronchial responsiveness in the European Community Respiratory Health Survey (ECRHS). Eur Respir J. 1997 Nov;10(11):2495–2501. doi: 10.1183/09031936.97.10112495. [DOI] [PubMed] [Google Scholar]
  9. Chinn S., Jarvis D., Burney P., Luczynska C., Ackermann-Liebrich U., Antó J. M., Cerveri I., De Marco R., Gislason T., Heinrich J. Increase in diagnosed asthma but not in symptoms in the European Community Respiratory Health Survey. Thorax. 2004 Aug;59(8):646–651. doi: 10.1136/thx.2004.021642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Das R., Blanc P. D. Chlorine gas exposure and the lung: a review. Toxicol Ind Health. 1993 May-Jun;9(3):439–455. doi: 10.1177/074823379300900304. [DOI] [PubMed] [Google Scholar]
  11. Hendrick D. J. Occupational and chronic obstructive pulmonary disease (COPD) Thorax. 1996 Sep;51(9):947–955. doi: 10.1136/thx.51.9.947. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Karjalainen A., Kurppa K., Martikainen R., Klaukka T., Karjalainen J. Work is related to a substantial portion of adult-onset asthma incidence in the Finnish population. Am J Respir Crit Care Med. 2001 Aug 15;164(4):565–568. doi: 10.1164/ajrccm.164.4.2012146. [DOI] [PubMed] [Google Scholar]
  13. Kennedy S. M., Le Moual N., Choudat D., Kauffmann F. Development of an asthma specific job exposure matrix and its application in the epidemiological study of genetics and environment in asthma (EGEA). Occup Environ Med. 2000 Sep;57(9):635–641. doi: 10.1136/oem.57.9.635. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kipen H. M., Blume R., Hutt D. Asthma experience in an occupational and environmental medicine clinic. Low-dose reactive airways dysfunction syndrome. J Occup Med. 1994 Oct;36(10):1133–1137. doi: 10.1097/00043764-199410000-00017. [DOI] [PubMed] [Google Scholar]
  15. Kogevinas M., Antó J. M., Sunyer J., Tobias A., Kromhout H., Burney P. Occupational asthma in Europe and other industrialised areas: a population-based study. European Community Respiratory Health Survey Study Group. Lancet. 1999 May 22;353(9166):1750–1754. doi: 10.1016/s0140-6736(98)07397-8. [DOI] [PubMed] [Google Scholar]
  16. Medina-Ramón M., Zock J. P., Kogevinas M., Sunyer J., Antó J. M. Asthma symptoms in women employed in domestic cleaning: a community based study. Thorax. 2003 Nov;58(11):950–954. doi: 10.1136/thorax.58.11.950. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Ng T. P., Hong C. Y., Goh L. G., Wong M. L., Koh K. T., Ling S. L. Risks of asthma associated with occupations in a community-based case-control study. Am J Ind Med. 1994 May;25(5):709–718. doi: 10.1002/ajim.4700250510. [DOI] [PubMed] [Google Scholar]
  18. Pascuzzi T. A., Storrow A. B. Mass casualties from acute inhalation of chloramine gas. Mil Med. 1998 Feb;163(2):102–104. [PubMed] [Google Scholar]
  19. Quirce S., Gala G., Pérez-Camo I., Sánchez-Fernández C., Pacheco A., Losada E. Irritant-induced asthma: clinical and functional aspects. J Asthma. 2000 May;37(3):267–274. doi: 10.3109/02770900009055449. [DOI] [PubMed] [Google Scholar]
  20. Racioppi F., Daskaleros P. A., Besbelli N., Borges A., Deraemaeker C., Magalini S. I., Martinez Arrieta R., Pulce C., Ruggerone M. L., Vlachos P. Household bleaches based on sodium hypochlorite: review of acute toxicology and poison control center experience. Food Chem Toxicol. 1994 Sep;32(9):845–861. doi: 10.1016/0278-6915(94)90162-7. [DOI] [PubMed] [Google Scholar]
  21. Reilly M. J., Rosenman K. D. Use of hospital discharge data for surveillance of chemical-related respiratory disease. Arch Environ Health. 1995 Jan-Feb;50(1):26–30. doi: 10.1080/00039896.1995.9955009. [DOI] [PubMed] [Google Scholar]
  22. Roca J., Burgos F., Sunyer J., Saez M., Chinn S., Antó J. M., Rodríguez-Roisin R., Quanjer P. H., Nowak D., Burney P. References values for forced spirometry. Group of the European Community Respiratory Health Survey. Eur Respir J. 1998 Jun;11(6):1354–1362. doi: 10.1183/09031936.98.11061354. [DOI] [PubMed] [Google Scholar]
  23. Rosenman Kenneth D., Reilly Mary Jo, Schill Donald P., Valiante David, Flattery Jennifer, Harrison Robert, Reinisch Florence, Pechter Elise, Davis Letitia, Tumpowsky Catharine M. Cleaning products and work-related asthma. J Occup Environ Med. 2003 May;45(5):556–563. doi: 10.1097/01.jom.0000058347.05741.f9. [DOI] [PubMed] [Google Scholar]
  24. Strachan D. P., Butland B. K., Anderson H. R. Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort. BMJ. 1996 May 11;312(7040):1195–1199. doi: 10.1136/bmj.312.7040.1195. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Sunyer J., Muñoz A. Concentrations of methacholine for bronchial responsiveness according to symptoms, smoking and immunoglobulin E in a population-based study in Spain. Spanish Group of the European Asthma Study. Am J Respir Crit Care Med. 1996 Apr;153(4 Pt 1):1273–1279. doi: 10.1164/ajrccm.153.4.8616553. [DOI] [PubMed] [Google Scholar]
  26. Thickett K. M., McCoach J. S., Gerber J. M., Sadhra S., Burge P. S. Occupational asthma caused by chloramines in indoor swimming-pool air. Eur Respir J. 2002 May;19(5):827–832. doi: 10.1183/09031936.02.00232802. [DOI] [PubMed] [Google Scholar]
  27. Zock J. P., Kogevinas M., Sunyer J., Almar E., Muniozguren N., Payo F., Sánchez J. L., Antó J. M., Spanish working group of the European Community Respiratory Health Survey Asthma risk, cleaning activities and use of specific cleaning products among Spanish indoor cleaners. Scand J Work Environ Health. 2001 Feb;27(1):76–81. doi: 10.5271/sjweh.590. [DOI] [PubMed] [Google Scholar]
  28. Zock J. P., Kogevinas M., Sunyer J., Jarvis D., Torén K., Antó J. M., European Community Respiratory Health Survey Asthma characteristics in cleaning workers, workers in other risk jobs and office workers. Eur Respir J. 2002 Sep;20(3):679–685. doi: 10.1183/09031936.02.00279702. [DOI] [PubMed] [Google Scholar]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES