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expert reaction to study looking at occupational exposure to disinfectants and Chronic Obstructive Pulmonary Disease (COPD) incidence in female nurses in the US

Research, published in JAMA Network Open, reports on an association between exposure to disinfectants and cleaning products at work and risk of new cases of chronic obstructive pulmonary disease (COPD) among a large group of female nurses.


Prof Martie van Tongeren, Professor of Occupational & Environmental Health, University of Manchester, said:

“Respiratory health effects due to exposure to cleaning agents and disinfectants is a persistent and known problem, in particular in the health care sector, where there is a strong focus on prevention of hospital acquired infection.  Previous data from The Health and Occupational Research network (THOR), which is study carried out by the University of Manchester in the UK, suggest that respiratory disease due to cleaning agents in the UK is a persistent problem, and that there is no evidence of any reduction in incidence of respiratory disease such as asthma in the UK.

“This new study is based on a large longitudinal cohort of US female nurses and provides further evidence that cleaning agents in health care workers are associated with increased risk of respiratory disease, in this case chronic obstructive pulmonary disease (COPD).  Using questionnaires linked with a Job Task Exposure Matrix the researchers were able to identify various common components of the disinfection products, such as glutaraldhyde, bleach, hydrogen peroxide, alcohol and quaternary ammonium compounds, that were associated with an increased risk of COPD, although the authors observed that many of these agents often occurred concurrently, so it was difficult to determine which the agents were associated with the COPD risk.  This study had a number of limitations in terms of the assessment of exposure and the use of self-reported COPD, and as with any observational study, it is difficult to prove causality.  However, the study was large and results appeared to be robust following a range of sensitivity analyses that the authors carried out.  In addition, results are similar to those that have been observed by others.

“There is a need to develop effective intervention in health care workers and cleaning staff in health care settings that will reduce and prevent respiratory health problems in staff that use cleaning agents and disinfection products, whilst maintaining effective control / prevention of infectious disease in patients and staff.”


‘Association of occupational exposure to disinfectants with incidence of chronic obstructive pulmonary disease among US female nurses’ by Orianne Dumas et al. was published in JAMA Network Open at 16:00 UK time on Friday 18 October 2019.  

DOI: 10.1001/jamanetworkopen.2019.13563


Declared interests

Prof Martie van Tongeren: “No conflict of interest, although I am the PI of the THOR study that I mention.”

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