RT Journal Article SR Electronic T1 Detergent protease exposure and respiratory disease: case-referent analysis of a retrospective cohort JF Occupational and Environmental Medicine JO Occup Environ Med FD BMJ Publishing Group Ltd DO 10.1136/oem.2008.043851 A1 Andrew Brant A1 Susan Upchurch A1 Martie van Tongeren A1 Cornelia Zekveld A1 Janet Helm A1 Fiona Barnes A1 Anthony J Newman Taylor A1 Paul Cullinan YR 2009 UL http://oem.bmj.com/content/early/2009/06/29/oem.2008.043851.abstract AB Objectives: To examine the relationship between protease exposure and respiratory disease in a cohort of detergent enzyme manufacturers. Methods: Case-referent analysis of a cohort of employees working in a European detergent factory between 1989 and 2002. Cases, with new lower or upper respiratory disease were ascertained by examination of occupational health records and matched to referents on date of first employment. Personal exposures to airborne detergent protease were estimated, using a job exposure matrix, from >12,000 measurements made in the factory during the period of study. Results: We found clear, monotonic relationships between estimated protease exposure and both lower and upper respiratory disease. After control for age, sex and smoking the odds ratio of lower respiratory disease was significantly elevated (1.98, 95% confidence interval 1.04-3.79) in those employees working in jobs in the highest quartile of protease exposure (geometric mean 7.9ng.m-3). For employees with upper respiratory disease the risk was significantly elevated at a lower level of estimated protease exposure (geometric mean 2.3ng.m-3). Conclusions: These findings provide strong evidence of an association between detergent enzyme exposure and the development of respiratory disease in an occupational setting. Using the routinely collected information on specific sensitisation and the close attention to workplace exposures that are characteristic of this industry it should be possible to derive meaningful occupational exposure standard for most detergent enzymes.