Occupational Asthma Reference

Walters GI, Burge PS, Moore VC, Robertson AS, Cleaning agent occupational asthma in the West Midlands, UK: 2000-16., Occup Med, 2018;68:530-536,10.1093/occmed/kqy113

Keywords: UK, cleaning, chloramine, aldehyde, benzalkonium, quarternaty ammonium

Known Authors

Sherwood Burge, Oasys Sherwood Burge

Vicky Moore, Oasys Vicky Moore

Alastair Robertson, Selly Oak Hospital Alastair Robertson

Gareth Walters, Heartlands Gareth Walters

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Cleaning agents are now a common cause of occupational asthma (OA) worldwide. Irritant airway and sensitization mechanisms are implicated for a variety of old and new agents.

To describe the exposures responsible for cleaning agent OA diagnosed within a UK specialist occupational lung disease service between 2000 and 2016.

The Birmingham NHS Occupational Lung Disease Service clinical database was searched for cases of OA caused by cleaning agents, and data were gathered on age, gender, atopic status, smoking history, symptom onset, diagnostic investigations (including Occupational Asthma SYStem analysis of workplace serial peak expiratory flow measurements and specific inhalational challenge), proposed mechanism, industry, occupation and causative agent.

Eighty patients with cleaning agent OA (77% female, 76% arising de novo) were identified. The median annual number of cases was 4 (interquartile range = 2-7). The commonest cleaning agents causing OA were chloramines (31%), glutaraldehyde (26%) and quaternary ammonium compounds (11%) and frequently implicated industries were healthcare (55%), education (18%) and leisure (8%).

Certain cleaning agents in common usage, such as chlorine-releasing agents, quaternary ammonium compounds and aldehydes, are associated with sensitization and asthma. Their use alters over time, and this is particularly evident in UK healthcare where cleaning and decontamination practice and policy have changed. Vigilance for OA in workplaces such as hospitals, nursing homes, leisure centres and swimming pools, where these cleaning agents are regularly used, is therefore essential.

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This database review shows how commonly cleaning agents cause occupational asthma. There has been a move away from aldehydes used in hospital for sterilisation to chlorine-releasing compounds and quarternary ammonium compounds (benzalkonium chloride) used in homes and schools. Aldehydes have been replaced in hospitals, it is time to consider safer alternatives in schools and homes.

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