Published ahead of print on June 21, 2007, doi:10.1164/rccm.200612-1793OC Am. J. Respir. Crit. Care Med., Volume 176, Number 8, October 2007, 735-741 A more recent version of this article appeared on October 15, 2007
Submitted on December 11, 2006 The Use of Household Cleaning Sprays and Adult Asthma: An International Longitudinal StudyJan-Paul Zock1*,1 ; Centre for Research in Environmental Epidemiology (CREAL), Municipal Institute of Medical Research (IMIM), Barcelona, Spain, 2 ; Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College, London, United Kingdom, 3 ; Centre for Research in Environmental Epidemiology (CREAL), Municipal Institute of Medical Research (IMIM), Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain, 4 ; Environmental Epidemiology Division, Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands, 5 ; School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, BC, Canada, 6 ; Centre for Research in Environmental Epidemiology (CREAL), Municipal Institute of Medical Research (IMIM), Barcelona, Spain; Institucio Catalana de Recerca i Estudis Avancats (ICREA), Barcelona, Spain, 7 ; Department of Health Sciences, Section of Epidemiology and Medical Statistics, University of Pavia, Pavia, Italy, 8 ; Department of Medicine and Public Health, Unit of Occupational Medicine, University of Verona, Verona, Italy, 9 ; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Goteborg, Sweden, 10 ; Institute for Occupational and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany, 11 ; Department of Medical Science, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden, 12 ; Centre for Research in Environmental Epidemiology (CREAL), Municipal Institute of Medical Research (IMIM), Barcelona, Spain; Department of Social Medicine, Medical School, University of Crete, Heraklion, Crete, Greece * To whom correspondence should be addressed. E-mail: jpzock{at}imim.es.
Rationale: Cleaning work and professional use of certain cleaning products have been associated with asthma, but respiratory effects of non-professional home cleaning have rarely been studied. Objectives: To investigate the risk of new-onset asthma in relation to the use of common household cleaners. Methods: Within the follow-up of the European Community Respiratory Health Survey in 10 countries, we identified 3,503 persons doing the cleaning in their homes and free of asthma at baseline. Frequency of use of 15 types of cleaning products was obtained in a face-to-face interview at follow-up. We studied the incidence of asthma defined as physician diagnosis and as symptoms or medication usage at follow-up. Associations between asthma and the use of cleaning products were evaluated usingmultivariable Cox' proportional hazards or logbinomial regression analysis. Main Results: The use of cleaning sprays at least weekly (42% of participants) was associated with the incidence of asthma symptoms or medication (Relative Risk (RR) 1.49; 95% confidence interval 1.12-1.99) and wheeze (RR 1.39; 1.06-1.80). The incidence of physician-diagnosed asthma was higher among those using sprays at least four days per week (RR 2.11; 1.15-3.89). These associations were consistent for subgroups and not modified by atopy. Dose-response relationships (p<0.05) were apparent for the frequency of use and the number of different sprays. Risks were predominantly found for the commonly used glass cleaning, furniture and air refreshing sprays. Cleaning products not applied in spray-form were not associated with asthma. Conclusions: Frequent use of common household cleaning sprays may be an important risk factor for adult asthma. Key words: Airway irritants, Epidemiology, Incidence, ECRHS
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