Table 3

Summary of epidemiological studies (chronological order) assessing the associations between cleaning occupation, tasks or agents and rhinitis, COPD, lung function and other health outcomes

Author, yearCountryYear of data collectionStudy designStudy populationMethod of data collectionCovariatesType of exposureFindings (95% CI in parenthesis)GRADE score
Medina-Ramón et al, 200319 Spain2000–2001Population-based cross-sectional4521 female domestic cleaners, 593 current, 1170 formerQuestionnaireAge, smokingCurrent domestic cleaners
Former domestic cleaners
Current cleaner: OR=1.08 (0.92–1.28)
Former cleaner: OR=1.27 (1.12–1.47)
de Fátima Maçãira et al, 200734 BrazilDecember 2002 to May 2003Workforce-based cross-sectional341 cleanersQuestionnaire, skin prick testAge, gender, smoking, atopy, number of years employment in non-domestic cleaning, inhalation accidentsEmployment in non-domestic cleaning:
0.92–3 years
3–6.5 years
>6.5 years
WRA/rhinitis OR=1.09 (1.00–1.18)
WRA/rhinitis OR=1.28 (1.01–1.63
WRA/rhinitis OR=1.71 (1.02–2.89
Radon et al, 200842 Europe, 27 centres1998–2003Population-based cohort study (ECRHS II)4994 (294 of them cleaners and caretakers)Face-to-face interviewsCountry, age at first survey, smoking, parental allergies, level of educationOccupations, asthmagens
New-onset allergic rhinitis, cleaners and caretakers: OR=1.25 (0.86–1.81)
Perennial rhinitis, cleaners and caretakers: OR=1.43 (0.99–2.06).
Svanes et al, 201521 Norway, Sweden, Denmark, Iceland, Estonia2010–2012Population-based cross-sectional (Respiratory Health In Northern Europe, part of ECRHS)2138 ever cleaners (from 13 499 respondents)QuestionnaireAge, gender, smoking, educational level, parent’s educational level, BMI, centreOccupational cleaner (ever)
Duration of exposure:
≤1 year
1–4 years
≥4 years
Self-reported COPD: OR=1.69(1.29–2.20)
OR=1.41 (0.85–2.33)
OR=1.80 (1.14–2.85)
OR=1.65 (1.14–2.42)
De Matteis et al, 20164 UK2006–2010Population-based cross-sectional (within the Biobank Cohort)228 614 participants adults, 2017 cleanersSelf-administered questionnaires, face-to-face interviews and physical health measurementsSex, age, recruitment centre, lifetime tobacco smokingDomestic cleanersCOPD defined as FEV1/FVC<LLN)
PR=1.43 (1.28 1.59)
Never smokers: PR=1.38 (1.15 1.66)
Non-asthmatics: PR=1.46 (1.29 1.65)
Dumas et al, 201943 US2009–2015Workforce-based prospective cohort study (NHSII)73 262 female registered nursesQuestionnairesAge, smoking status and pack-years, race, ethnicity, and BMIHighest exposure level to disinfectants, and spraysIncident physician-diagnosed COPD
Weekly use of any disinfectant: HR=1.35 (1.14–1.59)
Weekly use of sprays: HR=1.27 (0.97–1.66)
Lung function and other health outcomes
Zock et al, 200222 11 European countries and three outside Europe1990–1994Population-based survey (ECRHS)82 cleaners, 543 office workersSpirometry, methacholine challenge testAge, gender, smoking, study centreCleaning occupationNot significantly associated with changes in FEV1, FVC or FEV1/FVC but was significantly associated with a decrease in PEF (p<0.05)
Lower atopy in cleaners compared with office workers (38.3% vs 60.9%; p<0.05)
Medina-Ramón et al, 200537 Spain2000–2001Case-control, nested within a large population-based surveyDomestic cleaning women, 40 cases (with asthma and/or chronic bronchitis symptoms, 155 controls)Questionnaire
Lung function, methacholine challenge, serum IgE testing
Personal measurements of airborne chlorine and ammonia
Age, smoking, bleach, cleaning products, washing dishes, inhalation accidents, non-domestic cleaningFemale domestic cleanersNo difference between cases and controls with regards to FEV1 Moderate
Corradi et al, 201244 ItalyNot specifiedWorkforce-based cross-sectional40 hospital cleaners, 40 controlsSpirometryAge, gender, ethnicity, heightHospital cleanersPredicted FEV1%: similar in cleaners and controls.
No difference in FeNO among cleaners compared with controls.
Vizcaya et al201346 Spain2008–2009Workforce-based case-control nested in a cross-sectional study among cleaning company employees42 asthma cases, 53 controlsSpirometry during clinic visitAge, gender, smokingFemale cleanersMost irritant products and sprays were more often used by asthmatic cleaners. The use of multiuse products, glass cleaners and polishes at work was associated with higher FeNO, particularly in controls. No differences between cases and controls in levels of FeNO, or biomarkers of oxidative stress.Moderate
Vizcaya et al, 201545 Spain2008–2009Workforce-based cross-sectional panel21 female cleaners with current asthmaSpirometryAge, smoking, having a cold or influenza, use of respiratory medicationCleaning agentsFEV1 reduction after exposure to hydrochloric acid, solvents, and sprays among current cleaners with asthmaLow
Casimirri et al, 201648 ItalyNot specifiedWorkforce-based cross-sectional40 hospital cleaners, 40 non-exposed controlsSpirometryAge, smoking, BMIChlorinated agentsHigher EBC biomarkers of oxidative stress and inflammation in cleaners.Moderate
Svanes et al, 201847 Many European countries1992–1994 (ECRHS I),
1998–2002 (ECRHS II),
2010–2012 (ECRHS III)
Population-based longitudinal study6235 subjects ECHRS I and II, 3804 subjects (ECHRS III)Spirometry/bronchodilator testAge, smoking pack-years, BMI, parents’ education and SESCleaning occupation, cleaning at home, use of sprays and other agentsMore rapid FEV1 decline in women cleaning at home (−22.1 mL/year, p=0.01) and occupational cleaners (−22.4, p=0.03), compared with women not engaged in cleaning (−18.5)
More rapid FVC decline in women cleaning at home (−13.1 mL/year, p=0.02) and occupational cleaners (−15.9, p=0.002), compared with women not engaged in cleaning (−8.8)
Cleaning sprays: FEV1 −22.0 mL/year, p=0.04)
Other cleaning agents: FEV1 −22.9 mL/year, p=0.004)
Brooks et al, 202031 New Zealand2008–2010Workforce based cross-sectional425 cleaners, 281 reference workersQuestionnaires, bronchodilatorAge, gender, ethnicity, smokingCleanersMean differences between cleaners and referents:
FEV1=−0.20 L (−0.29 to −0.10)
FEV1 % predicted=−3.12% (−5.68 to −0.57)
FVC=−0.25 L (−0.36 to −0.14)
FVC % predicted=−3.25% (−5.55 to −0.96)
  • COPD, chronic obstructive pulmonary disease; EBC, exhaled breath condensate; ECRHS, European Community Respiratory Health Survey; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; GMR, geometric mean ratio; JEM, job-exposure matrix; LLN, lower-limit of normal; MEF25, maximal expiratory flow at 25% of vital capacity; MEF50, maximal expiratory flow at 50% of vital capacity; OASYS, occupational asthma expert system; PD20, administered cumulative dose of methacholine which results in a drop in FEV1 by 20%; PEF, peak expiratory flow; PR, prevalence ratio.