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An abiding feature of current occupational epidemiology has been the observation—in Europe and North America—of high rates of asthma-like symptoms in professional cleaners.1 In comparison with ‘referent’ occupational groups such as office workers, risk estimates of around 1.5 have repeatedly been reported.2 Since there are very large numbers of people who work as cleaners one might expect these to be reflected in the experience of clinicians who see patients with asthma and in particular those with a special interest in work-related disease. This does not, however, appear to be the case. In the past decade, for example, fewer than 200 cases of occupational asthma (OA) in cleaners, most of them female, were reported to the UK national surveillance scheme for occupational respiratory diseases (SWORD).
In this context ‘OA’ refers to disease that is believed to have been induced de novo by an exposure encountered at work; it is distinguished from ‘work-exacerbated’ asthma, a term used to describe pre-existing or coincident disease that is provoked by one or more exposures in the workplace. OA usually reflects an immune response to an airborne sensitising agent and a small number of cleaning materials—notably so-called quaternary ammonium compounds—are recognised to be respiratory sensitisers. However, the clinical pattern of asthma among cleaners appears to deviate from the traditional picture of immune-mediated OA: there is a low prevalence of atopy, scarce bronchial reversibility and no evidence of eosinophilic airaway …
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