Household disinfectants, cleaning products associated with uncontrolled asthma
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Key takeaways:
- Weekly use of household disinfectants and cleaning products was associated with current asthma.
- Risks for uncontrolled asthma increased by a factor of two to three with almost daily use.
Uncontrolled asthma was associated with weekly use of household disinfectants and cleaning products in a study published in The Journal of Allergy and Clinical Immunology: In Practice.
Health practitioners should consider how their patients use these products in their plans for achieving asthma control, Emilie Pacheco Da Silva, MS, doctoral student at Université Paris-Saclay and the French National Institute of Health and Medical Research, and colleagues wrote.
The study used 2018 data from NutriNet-Santé, an ongoing web-based prospective cohort of adults. First, the researchers analyzed data from 37,043 participants including 2,609 with current asthma. Next, they analyzed data from 36,623 participants, including 1,669 who had controlled asthma and 490 with uncontrolled asthma.
In the overall study population, participants had a mean age of 47.5 years, 75.4% were women, 12.5% were current smokers, 32.2% were classified as having overweight (BMI 25 kg/m2) and 63.8% had 2 years or more of university education.
The participants with current asthma and uncontrolled asthma tended to be younger, women, current smokers and classified as having overweight. Education levels were higher for those with current asthma and lower for those with uncontrolled asthma.
Participants with current asthma and uncontrolled asthma reported greater weekly use of household disinfectants and cleaning products (HDCPs), defined as irritants such as bleach, ammonia, acids and solvents, and “green” products, in both sprays and wipes.
Researchers used multinomial logistic regressions to determine cross-sectional associations of HDCP home use frequency and asthma control adjusted for sex, age, smoking status, BMI and educational level.
Odds ratios for current asthma and a respective cleaning product used 1 to 3 days a week and 4 to 7 days a week included:
- irritants: 1.25 (95% CI, 1.12-1.4) and 1.69 (95% CI, 1.42-2.01);
- sprays: 1.18 (95% CI, 1.05-1.33) and 1.52 (95% CI, 1.31-1.77);
- disinfectant wipes: 1.46 (95% CI, 1.26-1.68) and 1.89 (95% CI, 1.51-2.37); and
- green products: 1.25 (95% CI, 1.12-1.41) and 1.48 (95% CI, 1.25-1.75).
All the dose-response trends in frequency of use were statistically significant, the researchers said, with a dose-response trend observed for the number of irritants and sprays used as well.
Participants classified as having overweight experienced stronger associations between current asthma and use of irritants, sprays and green products than participants who did not have overweight.
Similarly, participants who did not have household help experienced stronger associations between asthma and use of irritants, sprays and green products than participants who did have household help.
Positive associations with current asthma persisted for disinfectant wipes (OR = 1.42; 95% CI, 1.14-1.78) and green products (OR = 1.19; 95% CI, 1.02-1.38) when irritants and sprays were not used.
Odds ratios for controlled asthma and a respective cleaning product used 1 to 3 days a week and 4 to 7 days a week included:
- irritants: 1.18 (95% CI, 1.03-1.34) and 1.44 (95% CI, 1.16-1.8);
- sprays: 1.11 (95% CI, 0.96-1.28) and 1.29 (95% CI, 1.06-1.57);
- wipes: 1.24 (95% CI, 1.04-1.48) and 1.49 (95% CI, 1.12-2); and
- green products: 1.25 (95% CI, 1.09-1.43) and 1.3 (95% CI, 1.05-1.6).
For uncontrolled asthma and a respective cleaning product used 1 to 3 days a week and 4 to 7 days a week, odds ratios included:
- irritants: 1.65 (95% CI, 1.27-2.14) and 2.81 (95% CI, 1.97-4);
- sprays: 1.49 (95% CI, 1.13-1.97) and 2.69 (95% CI, 1.97-3.68);
- disinfecting wipes: 2.2 (95% CI, 1.61-3.01) and 3.51 (95% CI, 2.31-5.33); and
- green products: 1.49 (95% CI, 1.13-1.96) and 2.4 (95% CI, 1.7-3.39).
Overall, the researchers noted dose-response trends between controlled and uncontrolled asthma and the frequency and number of products used.
The researchers also classified the associations between frequencies of 4 to 7 times a week and uncontrolled asthma as strong and between these frequencies and controlled asthma as modest, compared with participants who did not have asthma.
Additionally, the associations between uncontrolled asthma and disinfecting wipes (OR = 1.99; 95% CI, 1.24-3.22) and green products (OR = 1.59; 95% CI, 1.12-2.23) remained statistically significant when they were not used with irritants or sprays.
Based on these findings, the researchers concluded that there were strong associations between the use of HDCPs and uncontrolled asthma, with risks increasing by factors of two to three with almost daily use.
The researchers called for additional research to determine which compounds in green products patients with asthma should avoid, along with longitudinal studies of the effects that HDCPs have on asthma control.
Also, the researchers advised physicians to consider how their patients use HDCPs and potentially recommend changes in their cleaning habits to improve and maintain asthma control.
Perspective
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Asthma is a chronic inflammatory condition with multiple triggers. When we think of triggers of asthma, we often think of upper respiratory infections, environmental allergies, or exposure to secondhand smoke. Our approach to the treatment of asthma is often related to the management of these triggers. However, it is important to also recognize that there may be other triggers inherent in our activities of daily living, such as common household cleaning items.
This study finds that frequent use of household disinfectant cleaning products was associated with uncontrolled asthma, with a greater risk in women and patients with overweight. These findings parallel what I commonly see in my clinical practice. Particularly in the wake of the COVID-19 pandemic, which saw a general increase in the frequency of use of cleaning products in the home environment, I have had several patients report needing to use their rescue inhalers more often. Anecdotally, I noticed this correlation and have therefore started to recommend that my asthma patients attempt to minimize exposure to strong cleaning agents such as disinfectant wipes and aerosol cleaning sprays.
What is significant about this study is not only the fact that this association is now supported by clinical evidence, but also that the authors identified specific amounts of exposure at which the risk for asthma exacerbations can be reduced. In clinical practice, it is more often helpful to offer specific recommendations, rather than vague generalizations, and so following the authors’ recommendations of using these products less than once a week is much more impactful compared with asking patients to decrease the frequency of use in general. Not only does this allow us to better manage our patients’ symptoms as providers, but it also empowers patients to take better control of their disease.
Studies like these are important, as they allow us to broaden our discussions with patients on what may be triggering their asthma. Not all triggers are preventable, but these are examples of some that patients can control with the right guidance. However, we all know that asthma control varies over time. Therefore, longitudinal studies are needed to determine the long-term impact of cleaning products on this disease state.
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Pacheco Da Silva E, et al. J Allergy Clin Immunol Pract. 2023;doi:10.1016/j.jaip.2023.12.029.
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