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, year | Country | Year of data collection | Study design | Study population | Method of data collection | Covariates | Type of exposure | Findings (95% CI in parenthesis) | GRADE score |
| Rhinitis | |||||||||
| Medina-Ramón et al, 200319 | Spain | 2000–2001 | Population-based cross-sectional | 4521 female domestic cleaners, 593 current, 1170 former | Questionnaire | Age, smoking | Current domestic cleaners Former domestic cleaners | Current cleaner: OR=1.08 (0.92–1.28) Former cleaner: OR=1.27 (1.12–1.47) | High |
| de Fátima Maçãira et al, 200734 | Brazil | December 2002 to May 2003 | Workforce-based cross-sectional | 341 cleaners | Questionnaire, skin prick test | Age, gender, smoking, atopy, number of years employment in non-domestic cleaning, inhalation accidents | Employment 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 | Moderate |
| Radon et al, 200842 | Europe, 27 centres | 1998–2003 | Population-based cohort study (ECRHS II) | 4994 (294 of them cleaners and caretakers) | Face-to-face interviews | Country, age at first survey, smoking, parental allergies, level of education | Occupations, asthmagens JEM | 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). | High |
| COPD | |||||||||
| Svanes et al, 201521 | Norway, Sweden, Denmark, Iceland, Estonia | 2010–2012 | Population-based cross-sectional (Respiratory Health In Northern Europe, part of ECRHS) | 2138 ever cleaners (from 13 499 respondents) | Questionnaire | Age, gender, smoking, educational level, parent’s educational level, BMI, centre | Occupational 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) | High |
| De Matteis et al, 20164 | UK | 2006–2010 | Population-based cross-sectional (within the Biobank Cohort) | 228 614 participants adults, 2017 cleaners | Self-administered questionnaires, face-to-face interviews and physical health measurements | Sex, age, recruitment centre, lifetime tobacco smoking | Domestic cleaners | COPD 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) | High |
| Dumas et al, 201943 | US | 2009–2015 | Workforce-based prospective cohort study (NHSII) | 73 262 female registered nurses | Questionnaires | Age, smoking status and pack-years, race, ethnicity, and BMI | Highest exposure level to disinfectants, and sprays | Incident 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) | High |
| Lung function and other health outcomes | |||||||||
| Zock et al, 200222 | 11 European countries and three outside Europe | 1990–1994 | Population-based survey (ECRHS) | 82 cleaners, 543 office workers | Spirometry, methacholine challenge test | Age, gender, smoking, study centre | Cleaning occupation | Not 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) | High |
| Medina-Ramón et al, 200537 | Spain | 2000–2001 | Case-control, nested within a large population-based survey | Domestic 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 cleaning | Female domestic cleaners | No difference between cases and controls with regards to FEV1 | Moderate |
| Corradi et al, 201244 | Italy | Not specified | Workforce-based cross-sectional | 40 hospital cleaners, 40 controls | Spirometry | Age, gender, ethnicity, height | Hospital cleaners | Predicted FEV1%: similar in cleaners and controls. No difference in FeNO among cleaners compared with controls. | Moderate |
| Vizcaya et al201346 | Spain | 2008–2009 | Workforce-based case-control nested in a cross-sectional study among cleaning company employees | 42 asthma cases, 53 controls | Spirometry during clinic visit | Age, gender, smoking | Female cleaners | Most 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 | Spain | 2008–2009 | Workforce-based cross-sectional panel | 21 female cleaners with current asthma | Spirometry | Age, smoking, having a cold or influenza, use of respiratory medication | Cleaning agents | FEV1 reduction after exposure to hydrochloric acid, solvents, and sprays among current cleaners with asthma | Low |
| Casimirri et al, 201648 | Italy | Not specified | Workforce-based cross-sectional | 40 hospital cleaners, 40 non-exposed controls | Spirometry | Age, smoking, BMI | Chlorinated agents | Higher EBC biomarkers of oxidative stress and inflammation in cleaners. | Moderate |
| Svanes et al, 201847 | Many European countries | 1992–1994 (ECRHS I), 1998–2002 (ECRHS II), 2010–2012 (ECRHS III) | Population-based longitudinal study | 6235 subjects ECHRS I and II, 3804 subjects (ECHRS III) | Spirometry/bronchodilator test | Age, smoking pack-years, BMI, parents’ education and SES | Cleaning occupation, cleaning at home, use of sprays and other agents | More 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) | High |
| Brooks et al, 202031 | New Zealand | 2008–2010 | Workforce based cross-sectional | 425 cleaners, 281 reference workers | Questionnaires, bronchodilator | Age, gender, ethnicity, smoking | Cleaners | Mean 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) | High |
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.