Table 2

Summary of epidemiological studies (chronological order) assessing the associations between cleaning occupation, tasks or agents and BHR and UTRS and LTRS

Author, yearCountryYear of data collectionStudy designStudy populationMethod of data collectionCovariatesType of exposureFindings (95% CI in parenthesis)GRADE score
Zock et al, 200223 11 European countries and three outside Europe1990–1994Population-based survey (ECRHS)304 cleaners, 4492 office workersSpirometry, methacholine challenge testAge, gender, smoking, study centreCleaning occupationCase-case analysis: OR=1.60 (p>0.05)Moderate
Delclos et al, 200726 US2003Workforce-based cross-sectional3650 healthcare professionals (862 physicians, 941 nurses, 968 occupational therapists, 879 respiratory therapists)Questionnaire, BHR defined as 8-item, symptom-based predictor of PC20, JEMAge, sex, race/ethnicity, professional group, years as a health professional (‘seniority’), smoking, obesityExposure to cleaning agents/tasksOutcome: BHR related symptoms
General cleaning: OR=1.63 (1.21–2.19)
Cleaning products used on building surfaces: OR=1.74 (1.34–2.26)
Instrument cleaning: OR=1.40 (1.09–1.79)
Adhesives/solvents/gases in patient care: OR=1.86 (1.42–2.44)
Karadzinska-Bislimovska et al, 200735 FYROM2004–2006Cross-sectionalWomen, 43 cleaners,37 cooks, 45 controls (office workers)QuestionnaireSmoking, BMI, baseline FEV1 Female cleanersPrevalence of BHR higher in cleaners than controls though not statistically significant (30.2% vs 17.7%)Moderate
Nielsen and Bach, 199940 Denmark1989–1991Workforce-based cohort1011 female cleaners employed at nursing homes, schools and officesQuestionnaireAge, smokingFemale domestic cleaners
Use of sprayers
Continuous use of sprayers
Eye/nose/throat symptoms: OR=2.1 (1.1–3.8)
Asthma symptoms: OR=3.0 (0.9–10)
Bronchitis: OR=3.2 (1.0–10.4)
Medina-Ramón et al, 200537 Spain2001–2002Case-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 cleanersCombined outcome: asthma/chronic bronchitis symptoms
Bleach use
Intermediate exposure: OR=3.3 (0.9–11)
High exposure: OR=4.9 (1.5–15)
Medina-Ramón et al, 200639 Spain2001–2002Population-based cross-sectional panel43 female domestic cleaners recruited from a previous case-control studyDiary
Lung function and allergy testing
Age, respiratory infections, medicationsDomestic cleanersLRTS more common on working days: OR=3.1 (1.4–7.1)
LRTS predominantly associated with exposure to diluted bleach, degreasing sprays/atomisers and air fresheners
Karadzinska-Bislimovska et al, 200735 FYROM2004–2006Population-based cross-sectionalWomen, 43 cleaners,37 cooks, 45 controls (office workers)QuestionnaireSmoking, BMI, baseline FEV1 Female cleanersSignificantly higher prevalence of phlegm (p=0.019) and dyspnoea (p=0.041) in cleaners compared with the control groupModerate
Obadia et al, 200929 CanadaNot specifiedWorkforce-based case control566 cleaners and 587 other building workersQuestionnaireAge, gender, smokingSchool or racetrack public building cleanersLRTSs in female cleaners: OR=2.59 (1.6–4.3)
LRTSs in male cleaners: OR 1.16 (95% CI 0.7 to 1.9)
Wieslander and Norback, 201038 SwedenNot specifiedPopulation-based cross-sectional21 hospital cleanersQuestionnaireHospital cleanersSignificant increase in nasal symptoms (p<0.001) and throat symptoms (p<0.05)
Significant increase in dyspnoea (p<0.01)
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 visitSex, age, nationality, smoking statusCleaning occupationWheeze without having a cold, current cleaners: OR=1.3 (9 0.5–3.3), former cleaners: OR=2.0 (0.6–6.5)
Chronic cough, current cleaners: OR=1.8 (0.7–4.7), former cleaners: OR=1.9 (0.5–7.8)
Lee et al, 201436 USANot specifiedWorkforce-based cross-sectional183 hospital cleanersQuestionnaire, face to face interviewAge, gender, job titleHospital cleaners. Exposure classified in tasks and cleaning products usedFor chemical-related symptoms (respiratory tract, eye, skin, nervous and gastrointestinal systems):
Medium exposure
Cleaning tasks using sprays: OR=3.16 (1.24–8.04)
Cleaning toilet bowls or sinks: OR=1.71 (0.72–4.01)
Bleach: OR=1.29 (0.55–3.04)
Disinfectants: OR=0.67 (0.28–1.62)
Liquid multi-use cleaning products: OR=0.83 (0.35–1.95)
High exposure
Cleaning tasks using sprays OR=1.98 (0.87–4.51)
Cleaning toilet bowls or sinks: OR=1.96 (0.82–4.69)
Bleach: OR=1.68 (0.70–4.01)
Disinfectants: OR=0.72 (0.30–1.74)
Liquid multi-use cleaning products: OR=2.35 (1.02–5.43)
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 cleanerWheeze last 12 months: OR=1.44 (1.27–1.62)
Asthma symptoms: OR=1.66 (1.46–1.90)
Positive trend with duration of exposure for both outcomes
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
Wheezing OR=0.76 (0.47–1.2)
Woken with dyspnoea OR=0.63 (0.27–1.4)
Whitworth et al, 201941 USA2017Cross-sectional study56 Hispanic female domestic cleanersQuestionnaireAge and ever smokingCleaning tasks and agentsExposure to cleaning tasks was statistically insignificantly associated with BHR symptoms. Exposure to ammonia: OR=7.5 (1.6–35.9). Exposure to solvents and use of sprays for air freshening was also associated with BHR related symptomsMedium
  • BHR, bronchial hyper-responsiveness; ECRHS, European Community Respiratory Health Survey; JEM, job-exposure matrix; LTRS, lower tract respiratory symptom; PR, prevalence ratio; UTRS, upper tract respiratory symptom.