Occupational exposures to irritants, sensitizers associated with adult-onset asthma
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People exposed to sensitizers and irritants on the job faced greater risks for current adult-onset asthma and uncontrolled asthma, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
Occupational clinicians should advise workers with asthma to reduce these exposures, Guillaume Sit, PharmD, PhD student in the Center for Research in Epidemiology and Population Health at the University of Paris-Saclay, and colleagues wrote.
The researchers examined data from 4,469 adults (75.9% women; mean age, 54 years) in the French NutriNet-Santé cohort, including 551 with controlled asthma, 126 with uncontrolled asthma and 3,792 without asthma or respiratory symptoms. Also, 52.8% of patients with asthma had adult-onset asthma, and a greater proportion of these patients had obesity, defined as a BMI of 30 kg/m2 or greater, compared with the reference group (21.5% vs. 8.75%; P < .001).
Exposures at work included irritants (37.5%), disinfectants and cleaning products (DCP; 22.5%), organic solvents (9.9%), sensitizers with high molecular weight (HMW; 20.9%) and sensitizers with low molecular weight (LMW; 21.9%). Also, 68.9% were actively employed.
Although there were no associations between ever, past 5 years or current occupational exposures and childhood-onset asthma, the researchers found positive and significant associations between occupational exposures to HMW and LMW sensitizers, irritants and DCP and adult-onset asthma.
Odds ratios for ever exposures to sensitizers and associations with current adult-onset asthma included 1.53 (95% CI, 1.18-2) for HMW sensitizers, 1.42 (95% CI, 1.09-1.87) for LMW sensitizers, 1.32 (95% CI, 1.03-1.68) for irritants and 1.43 (95% CI, 1.1-1.85) for DCP.
When stratified by levels of exposure, the researchers found significant associations between adult-onset asthma and high exposure to HMW sensitizers and medium exposure to DCP. High exposures and current exposures generally had higher odds ratios for adult-onset asthma.
Participants with BMI of 25 kg/m2 and higher experienced significant associations between adult-onset asthma and HMW and LMW sensitizers and DCP, with no significant differences for participants with BMI of less than 25 kg/m2.
When evaluating the association between occupational exposures and asthma control, researchers observed odds ratios for ever exposures and uncontrolled adult-onset asthma of 2.69 (95% CI, 1.52-4.78) for HMW sensitizers, 2.27 (95% CI, 1.24-4.37) for LMW sensitizers, 2.32 (95% CI, 1.36-3.95) for irritants and 2.59 (95% CI, 1.48-4.54) for DCP.
Additionally, the researchers found significant associations between medium and high levels of ever exposures to irritants, DCP, and HMW and LMW sensitizers and uncontrolled asthma.
Odds ratios for current exposures and uncontrolled adult-onset asthma increased to 3.43 (95% CI, 1.26-9.34) for HMW sensitizers, 2.81 (95% CI, 0.99-8) for LMW sensitizers, 3.62 (95% CI, 1.55-8.45) for irritants and 3.76 (95% CI, 1.54-9.18) for DCP.
Although there were no associations between ever occupational exposures and controlled asthma, current exposures to HMW and LMW sensitizers were significantly associated with controlled asthma, as were current exposures to irritants and DCP when using a physician-confirmed diagnosis definition of asthma.
Overall, the researchers found no significant associations between asthma and organic solvents.
These associations between occupational exposures and current and uncontrolled adult-onset asthma indicate a need for occupational clinicians to consider these exposures and take efforts to reduce them among workers with asthma.
Perspective
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Many articles have looked at occupational asthma and HMW and LMW chemicals for people who work in industry. But this study takes a deeper dive into disinfectants and cleaning products, where there isn’t a lot of data. The researchers found an interesting and new correlation with those products.
Patients who are janitors, for example, will tell us that they have these issues. Other patients will tell us that their asthma flares up when they are cleaning the house. Obviously, we recommend that they should minimize their exposure by wearing a mask or ventilating the room as well as possible while they’re using those agents. These exposures can set off their asthma very significantly.
Also, the authors of this article looked at a variety of chemicals in different industries. We know that people who work in paint booths in car manufacturing facilities and in other industries with a lot of chemicals certainly can have issues.
Whenever we see those patients, we have to address their occupational exposure in practice and make sure we monitor their lung function. Sometimes a decline in lung function may necessitate removing those patients from that occupation.
This article is a good reminder that when we’re going over medical history with our patients, we may talk about allergens, but we also need to talk about their occupational exposures and find out if they’re being exposed to chemicals and cleaning agents.
This article was a retrospective analysis based on a patient questionnaire. A prospective clinical trial that looks at these patients and their exposures to these chemicals would be a better scientific study. But I do think that this article is important because it reiterates the importance of occupational exposures.
Allergists need to be reminded that we need to worry about more than allergen exposures, because other environmental exposures could flare our patients’ asthma, and occupational exposures certainly are important.
Perspective
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Clifford Bassett, MD, FAAAAI, FACAAI
As the authors have noted, hundreds of known occupational agents have the potential to trigger asthma. In fact, the researchers indicated that adult-onset asthma may be associated with occupational exposures in about 15% of patients. The study specifically identified exposure to DCPs and its potential negative impact on airway and/or asthma management.
Although my patients include a varied cross section of urban residents and workers, I do not see a significant number of patients with asthma who work in an industrial setting. But I do agree that the study underscores the importance of a focused and thorough occupational history as an integral component of a patient’s history.
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