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Association between cleaning-related chemicals and work-related asthma and asthma symptoms among healthcare professionals
  1. Ahmed A Arif1,
  2. George L Delclos2,3
  1. 1Department of Public Health Sciences, UNC Charlotte, Charlotte, North Carolina, USA
  2. 2Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA
  3. 3Center for Research in Occupational Health (CiSAL), Pompeu Fabra University, Barcelona, Spain and CIBER Epidemiología y Salud Pública, Barcelona, Spain
  1. Correspondence to Ahmed A Arif, Associate Professor, UNC Charlotte, Department of Public Health Sciences, CHHS 429, 9201 University City Blvd, Charlotte, NC 28223, USA; aarif{at}


Objectives Work-related asthma (WRA) is an important public health problem affecting one quarter of adults with asthma. Although cleaning substances are routinely used in hospitals, few studies have addressed their potential adverse respiratory health effects on healthcare professionals (HCPs). This study attempts to identify relationship between work-related exposure to cleaning-related chemicals and development of WRA among HCPs.

Methods Of 5600 HCPs surveyed, 3650 responded to a validated questionnaire about their occupation, asthma diagnosis, variability of asthma symptoms at and away from work, and exposure to individual cleaning substances. Workplace asthma was defined as a categorical variable with four mutually exclusive categories: work-related asthma symptoms (WRAS), work-exacerbated asthma (WEA), occupational asthma (OA) and none. Multivariable logistic regression analysis was used to evaluate the association between self-reported use of cleaning substances and asthma outcomes among HCPs.

Results Prevalences of WRAS, WEA and OA were 3.3%, 1.1% and 0.8%, respectively. The prevalence estimates were generally higher among female than male HCPs. The odds of WRAS and WEA increased in a dose-dependent manner for exposure in the longest job to cleaning agents and disinfectants/sterilants, respectively. For exposure in any job, the odds of WRAS were significantly elevated for both factor 1 (bleach, cleaners/abrasives, toilet cleaners, detergents and ammonia) and factor 2 (glutaraldehyde/ortho-phtaldehyde, chloramines and ethylene oxide). Significantly elevated odds of WEA were observed for exposure to bleach, factor 2 and formalin/formaldehyde. Exposure to chloramines was significantly associated with an almost fivefold elevated odds of OA.

Conclusions HCPs are at risk of developing WRA from exposure to cleaning substances.

  • Occupational asthma
  • work-exacerbated asthma
  • work-related asthma
  • healthcare professionals
  • chemical substances
  • occupational exposures
  • epidemiology
  • asthma
  • occupational asthma

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  • Funding This work was supported in part by grant nos. 5R01OH03945-01A1 and T42CCT610417 from the National Institute for Occupational Safety and Health/Centers for Disease Control and Prevention.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Texas at Houston, School of Public Health, Houston, Texas.

  • Provenance and peer review Not commissioned; externally peer reviewed.