S-89 Respiratory health impacts of cleaning and disinfecting exposures: does evidence support a link with COPD?

Introduction Concerns regarding the respiratory health effects of disinfectants and cleaning products (DCP) have been growing in the last two decades. Studies have shown associations between exposure to DCP and asthma. The irritant properties of many chemicals contained in DCP have prompted research on respiratory effects beyond asthma. Objective to review the current evidence for an association between exposure to DCP and Chronic Obstructive Pulmonary Disease (COPD). Methods We will present an overview of the recent epidemiological literature on the association between exposure to DCP at the workplace or at home and COPD. We will discuss challenges and opportunities for future research on this question. Results Increased risk of chronic bronchitis or COPD have been reported among workers regularly exposed to DCP, such as cleaners or healthcare workers in both European and US populations. In a large cohort study of US female nurses, occupational exposure to DCP was significantly associated with an increased risk of developing COPD, independent of asthma. High-level exposure, evaluated by a job-task exposure matrix, to several specific disinfectants (e.g., glutaraldehyde, bleach, hydrogen peroxide) was associated with COPD incidence. An impact of exposure to DCP on lung function outcomes has also been reported in a European population-based study. Exposure to cleaning activities either at work or at home was associated with accelerated FEV1 and FVC decline. Conclusion Despite accumulating evidence for adverse effects of DCP on COPD, specific tasks and substances at risk still need to be elucidated. Exposure assessment methods need to be improved in epidemiological studies. Novel statistical approaches, such as the ones developed in the context of exposome research, may help disentangling the mutual effect of the numerous chemicals contained in DCP, as well as their mixture. The mechanisms underlying the association between DCP and respiratory health outcomes need to be clarified.