Occupational and work-related respiratory disease attributed to cleaning products
Occupational and work-related respiratory disease attributed to cleaning products
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DOI：
10.1136/oemed-2018-105646
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发表时间：
2019-08-01
影响因子：
4.9
通讯作者：
van Tongeren, Martie
中科院分区：
文献类型：
--
作者：
Carder, Melanie;Seed, Martin J.;van Tongeren, Martie
目的接触清洁产品与不良呼吸结果相关。本研究旨在调查由清洁剂引起的与工作有关的呼吸系统疾病的医学报告发病率、发病率趋势和职业决定因素，并探讨“定量构效关系”（QSAR）在确证化学呼吸系统致敏物识别中的作用。方法从1989-2017年健康与职业研究（THOR）监测网络中提取归因于清洁剂的呼吸道诊断。调查了按职业分列的发病率、发病趋势和发病率比率。制剂按化学类型分类，并确定特定有机化学品的QSAR危险指数。结果779例（6%）的非石棉类THOR呼吸道感染可归因于清洁剂。诊断主要是哮喘（58%）和吸入性事故（27%），经常报告的化学类别是醛类（30%）和氯/其释放物（26%）。未观察到哮喘发病率的显著趋势（1999-2017年）（年平均变化为-1.1%（95%CI-4.4至2.4））。这与非清洁剂的哮喘发病率统计学显著性年度下降（-6.8%（95%CI-8.0至-5.6））形成对比。职业之间的风险差异很大。特别确定的15种有机化学品中有7种具有与呼吸道致敏物一致的QSAR生成的危害指数。结论特定职业的清洁剂引起的不良呼吸结果的风险增加。虽然暴露于戊二醛等试剂已得到解决，但其他暴露，如氯，仍然很重要。清洁剂的化学特征有助于区分致敏剂和刺激剂。
Objectives Exposure to cleaning products has been associated with adverse respiratory outcomes. This study aimed to investigate the medically reported incidence, trends in incidence and occupational determinants of work-related respiratory disorders attributed to cleaning agents and to explore the role of 'Quantitative Structure Activity Relationships' (QSAR) in corroborating the identification of chemical respiratory sensitisers. Methods Respiratory diagnoses attributed to cleaning agents were extracted from The Health and Occupation Research (THOR) surveillance network, 1989-2017. Incidence, trends in incidence and incidence rate ratios by occupation were investigated. Agents were classified by chemical type and QSAR hazard indices were determined for specific organic chemicals. Results Approximately 6% (779 cases) of the (non-asbestos) THOR respiratory cases were attributed to cleaning agents. Diagnoses were predominantly asthma (58%) and inhalation accidents (27%) with frequently reported chemical categories being aldehydes (30%) and chlorine/its releasers (26%). No significant trend in asthma incidence (1999-2017) was observed (annual average change of -1.1% (95% CI -4.4 to 2.4)). This contrasted with a statistically significant annual decline in asthma incidence (-6.8% (95% CI -8.0 to -5.6)) for non-cleaning agents. There was a large variation in risk between occupations. 7 of the 15 organic chemicals specifically identified had a QSAR generated hazard index consistent with being a respiratory sensitiser. Conclusion Specific occupations appear to be at increased risk of adverse respiratory outcomes attributed to cleaning agents. While exposure to agents such as glutaraldehyde have been addressed, other exposures, such as to chlorine, remain important. Chemical features of the cleaning agents helped distinguish between sensitising and irritant agents.