Table 1

Summary of epidemiological studies (chronological order) assessing the associations between cleaning occupation, tasks or agents and asthma in population-based and workforce-based studies

Author, yearCountryPeriod of data collectionStudy designStudy populationMethod of data collectionCovariatesType of exposureFindings (95% CI in parenthesis)GRADE score
Kogevinas et al, 199916 26 centres in 12 countries1992Population-based survey
15 637 people randomly selected from the general population (n=443 cleaners)Asthma was assessed by methacholine challenge test and questionnaireAge, sex, smoking status, study centreCleaning occupationBHR and asthma symptoms or medications: OR=1.97 (1.33–2.92)
Asthma symptoms or medication: OR=1.82 (1.44–2.30)
Zock et al, 200122 Spain1998Population-based cross-sectional (ECRHS)67 indoor cleaners, 1272 office workersQuestionnaire, blood samples for serum IgEAge, gender, smoking, study centreConfirmed cleanersBHR and asthma symptoms or medications: OR=2.8 (1.3–6.2)
Asthma symptoms or medication: OR=1.7 (1.1–2.6)
Higher PRs for private home cleaners
Karjalainen et al, 200215 Finland1986–1998Registry-based cohort53 708 cleaners, 202 751 administrative managerial and clerical workersThe Medication Reimbursement Register of the SII of Finland and the Finnish Register of Occupational Diseases (FROD)Age, follow-up periodFemale cleanersWRA: RR=1.50 (1.43–1.57)High
Zock et al, 200223 11 European countries and three outside Europe1990–1994Population-based survey (ECRHS Stage II)304 cleaners, 4492 office workersQuestionnaire, blood samples for serum IgEAge, gender, smoking, study centreCleaning occupationCurrent asthma OR=2.47 (1.7–3.6)Moderate
Jaakkola et al, 200314 Finland1997–2000Population-based case-control521 asthma cases, 932 controlsQuestionnaireAge, gender, smokingFemale cleanersOA: OR=1.42 (0.81–2.48)Moderate
Medina-Ramón et al, 200319 Spain2000–2001Population-based cross-sectional4521 female domestic cleaners, 593 current, 1170 formerQuestionnaireAge, smokingCurrent and former cleaningEver cleaning for current asthma: OR=1.73 (1.44–2.07)
Current cleaner for current asthma: OR=1.32 (1.04–1.69)
Current cleaner for current asthma (domestic only) : OR=1.46 (1.10–1.92)
Former cleaner for current asthma: OR=2.00 (1.63 to 2.43)
Le Moual et al, 200418 France1975Population-based survey404 cleaners, 8428 administrative service workersQuestionnaire
Age, gender, smokingCleaning occupation
Generic asthmagens
WRA, cleaning job: OR=1.04 (0.70–1.54)
WRA, cleaning agents: OR=2.16 (1.12–4.17)
Delclos et al, 200726 USA2003Workforce-based cross-sectional3650 healthcare professionals (862 physicians, 941 nurses, 968 occupational therapists, 879 respiratory therapists)QuestionnaireAge, sex, race/ethnicity, professional group, years as a health professional (‘seniority’), smoking, obesityExposure to cleaning agents/tasks
10–16 years
17–26 years
≥27 years
Medical instrument cleaning: OR=2.22 (1.34–3.67)
General cleaning: OR=2.02 (1.20–3.40)
Use of powdered latex gloves between 1992 and 2000: OR=2.17 (1.27–3.73)
Administration of aerosolised medications: OR=1.72 (1.05–2.83)
OR=2.08 (0.64–6.73)
OR=3.37 (1.10–10.26)
OR=4.10 (1.39–12.11)
Kogevinas et al, 200717 13 countries1998–2003Population-based cohort (ECRHS-II)6837 (358 of them cleaners)ECRHS II questionnaireAge, sex, smoking, centreCleaning and caretaking
Cleaning products using asthma-specific JEM
Cleaning and caretaking occupation: OR=1.71 (0.92–3.17)
Exposure to cleaning products: OR=1.80 (1.01–3.18)
Mirabelli et al, 200720 22 centres located in 10 European countries1998–1999Population-based cohort
332 nurses or employed in nursing-related job, 2481 professional or administrative workersQuestionnaire
Age, country, sex, smoking, study areaExposure to cleaning products, cleaning tasks among healthcare workersNew-onset asthma
Ammonia and/or bleach: OR=2.16 (1.03–4.53)
Liquid multi-use products: OR=1.16 (0.61–2.19)
Washing powders OR=1.65 (0.77–3.53)
Any products in spray form OR=2.36 (0.99–5.64)
Obadia et al, 200929 CanadaNot specifiedWorkforce-based cross-sectional566 cleaners and 587 other building workersQuestionnaireAge, gender, smokingSchool or racetrack public building cleanersOA, males OR=0.93 (0.4–2.3)
OA, females: OR=1.00 (0.4–2.3)
Eng et al, 201012 New Zealand2004–2006Population-based cross-sectional3055 participants (from a random sample of 10,000)Telephone surveyAge, gender, smoking, deprivationCleanersWRA, adult onset: OR=1.3 (0.8–2.1)
WRA, current: OR=1.60 (1.09–2.35
Vizcaya et al, 201130 Spain2007–2008Cross-sectional study on employees of cleaning companies917 employees of 37 cleaning companies: 761 current cleaners, 86 former and 70 never cleaners (referents)Spirometry during clinic visitAge, gender, nationality. smoking statusCleaning occupation
Cleaning products
Current asthma, current cleaners: OR=1.9 (0.5–7.8), former cleaners: OR=1.9 (0.6–5.5)
Adult-onset asthma, current cleaners: OR=1.4 (0.4–4.9), former cleaners: OR=2.5 (0.5–12)
Use of hydrochloric acid: OR=1.7 (1.1–2.6)
Arif and Delclos, 201225 USA2004–2005Workforce-based cross-sectional3650 healthcare professionalsQuestionnaire (exposure to cleaning substances)
In the longest held job
Age, sex, race/ethnicity, BMI, seniority, atopy, smoking statusCleaning agentsWRA symptoms increased in a dose-dependent manner from OR=2.64 (95% CI 0.57 to 12.1) for 1/week exposure to cleaning agents to OR=5.37 (1.43–20.16) for >1/day.
For exposures to disinfectants/sterilising agents, WEA increased from 3.75 to 5.06 to 9.02 for at least 1/week, every day and more than once a day, respectively.
OA for every day and >1/day self-reported exposure to cleaning agents:
0.81 (0.17–3.86)
Dumas et al, 201227 France2003–2007Workforce-based case-control179 hospital workers, 545 controls, selected from a previous case-control studyQuestionnaires, expert assessment and the asthma JEMGender, BMIAmong hospital workers: frequency of cleaning tasks: (never,<1, 1–3, 4–7 days/weekIn women, for exposure >1 day/week (expert only):
OR=1.04 (0.64–1.70); high intensity: OR=1.45 (0.81–2.62)
In women, for exposure (expert +JEM) to high intensity cleaning/disinfecting tasks: OR=2.32 (1.11–4.86).
Moderate/high exposure to quaternary ammonium: OR=1.93 (0.85–4.40)
h, 2013Great Britain1991–2000Population-based cohortCleaners unspecified: 156
Domestic helpers and cleaners: 113
Helpers and cleaners in offices, hotels: 516
InterviewGender, smoking, father’s social class, area of residence at 42 years, hay fever/allergic rhinitis in childhoodDomestic cleaners identified and coded using the ISCO-88
Cleaning products using asthma-specific JEM
Adult onset asthma in cleaners unspecified: OR=1.58 (0.95–2.63)
Domestic helpers and cleaners: OR=1.79 (1.02–3.14)
Helpers and cleaners in offices, hotels: OR=1.82 (1.34–2.48)
Cleaning/disinfecting products:
OR=1.67 (1.26–2.22)
Gonzalez et al, 201428 France2006–2007Workforce-based cross-sectional543 healthcare workers (94 cleaners)QuestionnaireAge, gender, smoking, atopy, BMIHospital cleanersWRA, cleaning profession: crude OR=2.38 (0.48–11.85)
OA, crude OR=2.33 (0.52–10.44)
General cleaning tasks: adjusted OR=2.26 (0.95–5.35)
Svanes et al, 201521 Norway, Sweden, Denmark, Iceland, Estonia2010–2012Population-based cross-sectional (RHINE III), extension of ECRHS)2138 ever cleaners (from 13 499 respondents)QuestionnaireAge, gender, smoking, educational level, parent’s educational level, BMI, centreOccupational cleaner (everOA
OR=1.47 (1.22–1.27)
Positive trend with duration of exposure
Abrahamsen et al, 201724 NorwayFebruary to August 2013Population-based cross-sectional study185 cleaners (among 16 099 responders)QuestionnaireAge, gender, area of residence, smoking, home damp/mould, housing conditionsFemale and male cleaners
Current asthma: OR=1.4 (0.61–3.2)
Physician diagnosed asthma (ever): OR=0.92 (0.51–1.60)
Brooks et al, 202031 New Zealand2008–2010Workforce-based cross-sectional425 cleaners, 281 reference workersQuestionnaires, bronchodilatorAge, gender, ethnicity, smokingCleanersCurrent asthma in cleaners: OR=1.83 (1.18–2.85)
Physician-diagnosed asthma ever: OR=0.62 (0.42–0.92)
Dumas et al, 202032 USA2009–2015Workforce-based prospective cohort study (NHSII)116 429 female registered nursesQuestionnairesAge, smoking status and pack-years, race, ethnicity, and BMIDisinfectants
Sprays for cleaning, disinfection, other
Exposure to any disinfectant: HR=1.12 (0.91‐1.38)
Weekly use of sprays: HR=1.10 (0.76‐1.59)
  • ECRHS, European Community Respiratory Health Survey; ISCO, International Standard Classification of Occupations; JEM, job-exposure matrix; NHSII, Nurses’ Health Study II; OA, occupational asthma; PR, prevalence ratio; RHINE, respiratory health In northern Europe; WEA, work-exacerbated asthma; WRA, work-related asthma.