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Cleaning Products and Asthma

Explore the relationship between cleaning products and asthma, ingredients in cleaners, hazards, recommended cleaning practices, and work-related asthma surveillance. Learn about interventions and evidence of cleaning products causing respiratory symptoms.

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Cleaning Products and Asthma

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  1. Cleaning Products and Asthma Elise Pechter MPH, CIH Work-related Asthma Coordinator/Industrial Hygienist Occupational Health Surveillance Program Massachusetts Department of Public Health

  2. Goals—Explore cleaning, cleaning products, and relation to asthma • Benefits and risks of cleaning • Evidence of asthma associated with cleaning • When and how is cleaning dangerous? • Ingredients in cleaning products • Not “Hygiene” hypothesis • Making cleaning safer

  3. How cleaning products work • Dissolve soils, keep soil and bacteria in solution, remove • Nonpolar vs polar soils • Surfactants’ role • Polar (water-loving) end • Nonpolar (water-hating) end • Break up soil, suspend • Lots of ingredients • Separate from disinfection

  4. Cleaning recommended to control asthma • Reduce dust • PM2.5 associated with asthma • Discourage pests • Cockroaches & mice associated with asthma • Remove mold • Molds associated with asthma • Dampness may remain

  5. But cleaning can be hazardous • Cleaning workers, commercial and domestic, have more asthma • Bystanders exposed to cleaning products have asthma • Some cleaning product ingredients can cause asthma • Some evidence that children exposed to cleaning sprays at home have more asthma

  6. State based surveillance of work-related asthma • National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC) • Case based surveillance • Health care providers and hospital records and workers’ compensation • Population based surveillance BRFSS • Massachusetts Occupational Health Surveillance Program (OHSP) and CA, MI, and NJ

  7. Work-related asthma Asthma caused or made worse by work • New-onset asthma • RADS • Work-aggravated asthma • Years to develop; small exposures trigger

  8. Surveillance case definitionWork-related asthma • Health care professional diagnosis consistent with asthma AND • An association between symptoms of asthma and work

  9. Massachusetts Surveillance System for Work-Related Asthma Heath Care Providerreports Emergency Dept Visits (65 per year) Hospitalized persons OHSP Workers’ comp Worker interview Medical records • Employerfollow-up • Worksite investigations • Workerfollow-up • Educational materials • Resources in state Summary data analysis Interventions

  10. Surveillance of Work-Related Asthma (WRA) in Massachusetts • Mandatory reporting of WRA (confirmed and suspected) • 1993 to present, >1300 cases reported, of whom about 677 have been interviewed • Track industries, occupations & exposures that cause or exacerbate WRA • Design interventions to reduce WRA

  11. Cleaning products and WRACA, MA, MI, NJ 1993-1997Rosenman et al 2003 JOEM 45(5):556-63

  12. 305 of 1,879 cases = 16% • Leading exposures • Cleaning products 24% • Latex 20% • Glutaraldehyde 9%

  13. Cleaning-products related asthma • Cleaning products are chemicals • Annually 2nd or 3rd most common exposure in Poison Control Center data (adults) • Studies from US, Europe, Finland, Spain, Brazil, Singapore, Australia, Sweden, South Africa • 2 negative studies, remainder all show cleaners have asthma • 1.5 to 2.5 X background risk; mixing only some • Sensitization—not just irritation • Rosenman KD. Clinical Pulmonary Medicine 2006; 13(4):221-228

  14. Cleaning products associated with respiratory symptoms • Cleaning materials associated with RADs • Henneberger JOEM 2003 4-state data • Short-term respiratory effects of cleaning, with bleach, degreasing chemical sprays, air fresheners in domestic cleaners • Medina-Ramon EuroRespJ 2006 27(6):1196 • “Janitors, housekeepers and cleaners” was the occupational group with highest # of occupational asthma in Sao Paulo, Brazil • Mendonça AJIM 2003 43(6):611

  15. Cleaning products associated with respiratory symptoms • Relative risk of asthma of 1.5 for cleaners compared to administrators in Finland • Karjalainen ERJ 2002 19:90-95 • Asthma prevalence for indoor cleaners in Spain1.7 times rate for office workers • Zock ScandJ WorkEnvHealth 2001 27:76-81 • 26 papers by 2004 (Nazaroff) implicating cleaning as cause of respiratory health impairment • Nazaroff, Weschler 2004 AtmosEnviron 38:2841-2865

  16. Evidence about hazards of cleaning products—asthma and children • Sherriff 2005. Frequent use of chemical household products is associated with persistent wheezing in pre-school children. Thorax 2005;60:45. • Mendell 2007. Indoor residential chemical emissions as risk factors for respiratory and allergic effects in children: a review. Indoor Air 17:259. • Henderson 2008. Household chemicals, persistent wheezing and lung function: effect modification by atopy? Eur Resp J 31:547

  17. Hazards in cleaning products • Disinfectants • Bleach • “Quats” (quaternary ammonium compounds) • Overuse • Sprays, aerosols • Other ingredients: solvents, 2-BE ethanolamines • Irritants • Acids, bases • Fragrances and colors

  18. Challenges in cleaning • Messages for health • Fear • Infection • Asthma • Moral

  19. Challenges in Cleaning: Healthcare • Requirements for disinfection • Single product—disinfectant combined with cleaning • Thousands of products • Multiple ingredients in each product • Hospital acquired infections • C. dif and MRSA • Round-the-clock occupancy • Patients with health problems

  20. Challenges of Cleaning Schools • School always occupied • Kids, food, arts materials • Understaffing • Poor ventilation • MRSA—superbug • Thousands of cleaning products, marketing • MSDSs—difficult to use • Pressure from parents • Staff brings cleaners from home

  21. Children more vulnerable • Higher rate of asthma • Faster breathing rate • Incomplete immunologic system—more responsive? • Smaller body volume • Hand to mouth • Time on the ground in contact with cleaning chemicals

  22. Hygiene hypothesis • Lack of exposure to infectious agents in children leads to increased susceptibility to allergic disease, including asthma • 1989 Strachan • Th1 and Th2, endotoxin, some evidence • Opposed by Soap and Detergent Association • Hypothesis • Making cleaning products safer—different!

  23. Narrowing the problem: Using what we know • Selection of products • Specific ingredients • Inappropriate mixing • Volatility/aerosolization • Methods of use • Work practices • Training • Outsourcing

  24. Prevention opportunity • Primary prevention—make cleaning safer • Using data—occupational and children • Asthma planning linked with intervention • Potential for broad based improvement • Addresses challenges • Review of dozens of MSDS to pick the best • Go beyond individual approaches (schools, long term care, residences, etc) • Address the limits of “green chemicals”

  25. Existing methods to evaluate cleaning productsThird party certification • Criteria for environment and performance, and now health • Corporate funding by companies who want to get their product certified • Greenguard, Design for Environment (EPA)

  26. GS37 Standard for Industrial and Institutional Cleaners This product meets Green Seal’s environmental standard for industrial and institutional cleaners based on its reduced human and aquatic toxicity and reduced smog production potential.

  27. GS37 Criteria • Performance, using cold water • Oral and inhalation toxicity • No carcinogens, mutagens, repro toxins • Not corrosive to skin and eyes • Not skin sensitizer • No ozone depletion • No toxicity to aquatic life • Packaging • Concentrated-reduce transportation costs • Consensus standard

  28. GS37 Green Seal cleaners to protect against asthma • Chemicals defined as asthma-causing agents by AOEC • Criteria based on peer-reviewed articles about workers • Absence of consensus • Purpose—protect workers and bystanders, including children in schools and residents in long term care

  29. Can GS37 protect against asthma? • Chemical ingredients • MEA, DEA, TEA, sulfuric acid, terpene, glacial acetic acid • Only ~5 out of 500 GS approved products have one of these ingredients • Skin sensitizers excluded • Strong corporate opposition

  30. Suggestions: Disinfectants • Use disinfectants only when needed • Promote cleaning • Decide when and where disinfection needed • Use disinfectants correctly • Correct concentration, not more • 10 minute requirements? • Purchase safer disinfectants • Be aware of health effects

  31. Suggestions: Fragrances • Avoid air fresheners • Suggest policies that discourage perfumes and colognes • Buy products without scents

  32. Suggestions: Cleaning • Select products carefully • Reduce total # of cleaning products • Read MSDS • Use Green Seal or other 3rd party certification • Clean—don’t disinfect • Provide training, labeling and directions • No sprays or aerosols • Good ventilation • Pick timing to reduce exposure

  33. Cleaning products and asthma • Provides an opportunity for primary prevention • Will help adults and children • Applicability on the job, in schools, health care and at home • Opportunity for collaboration between work-related asthma and asthma planning

  34. Elise Pechter MPH, CIH Industrial Hygienist/Intervention Coordinator Occupational Health Surveillance Program 250 Washington Street Boston, MA 02108 617 624-5681 Occupational.Asthma@state.ma.us www.mass.gov/dph/ohsp/

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