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Type of approach

Type of approach. Clinical-Industrial approach: Workers are classified as OA or WRA by diagnostic criteria and its occurrence compared in diff. exposure categories. Population-based approach:

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Type of approach

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  1. Type of approach • Clinical-Industrial approach: • Workers are classified as OA or WRA by diagnostic criteria and its occurrence compared in diff. exposure categories. • Population-based approach: • Asthma defined according to questionnaire / BHR is compared in exposed and non-exposed workers from general population.

  2. Occupational exposure assessment • Current occupation or, for subjects reporting change of occupation due to respiratory health problems, their occupation at that time. Occupations were coded into 350 distinct jobs. • Occupations were grouped, for this analysis, into 30 occupational sets such as spray painters, bakers, nurses, hairdressers, following UK SWORD classification.

  3. Occupations in the ECRHS with high risk for asthma (bronchial hyperresponsiveness and asthma symptoms or medication) (Kogevinas et al 1999, Lancet)

  4. Cleaners versus office workers. Spanish cleaners, ECRHS-I (SJWE 2001) Asthma risk Office workers 1 (ref) All cleaners 1.7 (1.12.5) Indoor cleaners 1.7 (1.12.7) Home cleaners 3.3 (1.95.8) Other cleaners 1.0 (0.52.0)

  5. Women’s cleaners study, Barcelona (EPIASLI). Odds ratios for asthma symptoms or medication. Thorax 2003. OCCUPATION N OR (95% CI) Total 4251  Never cleaner 2262 1 Ever cleaner 1989 1.73 (1.44 – 2.07) Past cleaners 1371 2.00 (1.63 – 2.43) Homecleaners 1170 2.09 (1.70 – 2.57) Otherplaces 201 1.41 (0.91 – 2.18) Current 888 1.32 (1.04 – 1.69) Homecleaners 593 1.46 (1.10 – 1.92) Otherplaces 295 1.08 (0.72 – 1.61)

  6. Design case-control study • 40 cases persistent chronic respiratory symptoms • (asthma, chronic bronchitis) • 155 controls (no history of respiratory symptoms) • BHR (methacholine) • Face-to-face interview • Detailed information about use of household cleaning products • Total use of cleaning products in own home and other houses

  7. Multivariate analyses Bleach 364-640 times-year Bleach > 640 times-year Non-domestic cleaning (ever) Inhalation accident lifetime

  8. Population based studies • Prevalence and AF: geographical variations • Very high burden in specific populations • New risks likely to be identified

  9. Risk of asthma in cleaners, ECRHS-I

  10. Use of bleach in Europe: ECRHS-II

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