10/18/2019

Association of Occupational Exposure to Disinfectants With Incidence of Chronic Obstructive Pulmonary Disease (COPD) Among US Female Nurses

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753247

http://web.archive.org/web/20191216104505/https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2753247

https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2753247/dumas_2019_oi_190517.pdf

http://web.archive.org/web/20191216104839/https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2753247/dumas_2019_oi_190517.pdf

Question Is exposure to disinfectants and cleaning products associated with incidence of chronic obstructive pulmonary disease among health care workers?

Findings In a cohort study of 73 262 US female nurses participating in the Nurses’ Health Study II who were followed up from 2009 to 2015, occupational exposure to cleaning products and disinfectants was significantly associated with a 25% to 38% increased risk of developing chronic obstructive pulmonary disease independent of asthma and smoking.

Meaning This study’s findings suggest that regular use of chemical disinfectants among nurses may be a risk factor for developing chronic obstructive pulmonary disease.

…

Results Among the 73 262 women included in the analyses, mean (SD) age at baseline was 54.7 (4.6) years and 70 311 (96.0%) were white, 1235 (1.7%) black, and 1716 (2.3%) other; and 1345 (1.8%) Hispanic, and 71 917 (98.2%) non-Hispanic. Based on 368 145 person-years of follow-up, 582 nurses reported incident physician-diagnosed COPD. Weekly use of disinfectants to clean surfaces only (16 786 [22.9%] of participants exposed) and to clean medical instruments (13 899 [19.0%] exposed) was associated with COPD incidence, with adjusted hazard ratios of 1.38 (95% CI, 1.13-1.68) for cleaning surfaces only and 1.31 (95% CI, 1.07-1.61) for cleaning medical instruments after adjustment for age, smoking (pack-years), race, ethnicity, and body mass index. High-level exposure, evaluated by the JTEM, to several specific disinfectants (ie, glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quaternary ammonium compounds) was significantly associated with COPD incidence, with adjusted hazard ratios ranging from 1.25 (95% CI, 1.04-1.51) to 1.36 (95% CI, 1.13-1.64). Associations were not modified by smoking or asthma status (P for interaction > .15).

Conclusions and Relevance These longitudinal results suggest that regular use of chemical disinfectants among nurses may be a risk factor for developing COPD. If future studies confirm these results, exposure-reduction strategies that are compatible with infection control in health care settings should be developed.