Abstract

Objectives
The impact of chronic occupational exposures to irritants on asthma remains discussed. We studied the associations between occupational exposures and asthma, with specific interest for chronic exposure to irritants, including disinfectants and cleaning products (DCPs) and solvents.

Methods
Cross-sectional analyses included 115?540 adults (55%?women, mean age 43 years, 10% current asthma) working at inclusion in the French population-based CONSTANCES cohort (2012–2020). Current asthma was defined by ever asthma with symptoms, medication or asthma attacks (past 12 months), and the asthma symptom score by the sum of 5 respiratory symptoms (past 12 months). Both lifetime and current occupational exposures were assessed by the Occupational Asthma-specific Job-Exposure Matrix. Associations were evaluated by gender using logistic and binomial negative regressions adjusted for age, smoking status and body mass index.

Results
In women, associations were observed between current asthma and lifetime exposure to irritants (OR 1.05, 95% CI 1.00 to 1.11), DCPs (1.06, 95% CI 1.00 to 1.12) and solvents (1.06, 95% CI 0.98 to 1.14). In men, only lifetime exposure to DCPs (1.10, 95% CI 1.01 to 1.20) was associated with current asthma. Lifetime exposure to irritants was associated with higher asthma symptom score both in women (mean score ratio: 1.08, 95% CI 1.05 to 1.11) and men (1.11, 95% CI 1.07 to 1.15), especially for DCPs (women: 1.09, 95% CI 1.06 to 1.13, men: 1.21, 95% CI 1.15 to 1.27) and solvents (women 1.14, 95% CI 1.10 to 1.19, men: 1.10, 95% CI 1.05 to 1.15). For current exposures, no consistent associations were observed with current asthma and asthma symptom score.

Conclusions
Lifetime occupational exposures to irritants were associated with current asthma and higher asthma symptom score. These exposures should be carefully considered in asthma management.

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Comments

A difficult study from which to draw conclusions about irritant induced occupational asthma, which is not defined and seems to include many of the agents (particularly cleaning agents and biocides) for which there are positive specific challenge tests (the SIC data is ignored in this publication). The odds ratios for current asthma were very low, both for high molecular weight sensitisers (1.05-1.16) and their irritant group (1.1), with no increased risk for low molecular weight sensitisers (probably mainly isocyanates). The data on solvent exposure is difficult to interpret. I wonder whether the use of the JEM is not sufficiently specific to identify the known increased risks for occupational asthma from many high and low molecular weight agents which are more likely acting as sensitisers.

3/28/2024