Occupational exposure to disinfectants may raise COPD risk

New data published in JAMA Network Open showed that the risk for COPD incidence was higher among nurses who regularly performed cleaning and disinfectant tasks.

The researchers evaluated data from 73,262 women (mean age, 54.7 years; 96% white) who participated in the Nurses’ Health Study II from 2009 to 2015. Participants were still working in a nursing job and did not have COPD in 2009. Of these women, 22.9% reported weekly use of disinfectants to clean surfaces only and 19% reported weekly use of disinfectants to clean medical instruments.

Based on 368,145 person-years of follow-up, 582 nurses reported being diagnosed with COPD. After adjustment for age, smoking, race, ethnicity and BMI, analyses linked weekly use of disinfectants to clean surfaces only (adjusted HR = 1.38; 95% CI, 1.13-1.68) and weekly use of disinfectants to clean medical instruments (aHR = 1.31; 95% CI, 1.07-1.61) with incidence of COPD.

Notably, nurses who used disinfectants more often — 4 to 7 days per week — had a higher risk for COPD incidence, with an aHR of 1.43 (95% CI, 1.13-1.8; P for trend < .001) for use of any disinfectants and an aHR of 1.37 (95% CI, 1.09-1.72; P for trend = .003) for use of disinfectants to clean surfaces only.

Results also indicated that high-level exposure, as determined by a job-task-exposure matrix, to glutaraldehyde, bleach, hydrogen peroxide, alcohol and quaternary ammonium compounds was associated with increased COPD incidence, with aHRs ranging from 1.25 (95% CI, 1.04-1.51) to 1.36 (95% CI, 1.13-1.64).

Smoking or asthma status did not appear to significantly affect the association between weekly disinfectant use and COPD incidence, according to the data.

“A large body of evidence already supports an association between these exposures and asthma; our additional findings of an association with COPD incidence urges the need for the development of exposure-reduction strategies that remain compatible with infection control in health care settings,” the researchers wrote.

“Further research is needed to better establish a causal link between exposure to cleaning products and disinfectants and COPD development. Nonetheless, clinicians should be aware of this new risk factor and systematically look for sources of exposure to cleaning products and disinfectants in addition to other occupational exposures in patients with COPD.” – by Melissa Foster

Disclosures: Several of the authors report they received grants from the National Institute for Occupational Safety and Health (NIOSH) of the CDC. Another author reports he received personal fees from Partners HealthCare System and he is a paid consultant on a NIOSH R01 grant.