Impact of Occupational Exposure to Disinfectant or Cleaning Agents on Asthma

描述（由申请人提供）：最近预防医疗保健相关感染的努力导致消毒剂和清洁剂的使用增加。研究表明，经常接触这些物质的职业群体（如卫生保健工作者）患哮喘的风险增加。然而，这些常见药物在哮喘的发展和临床过程中的实际作用，以及所涉及的具体药物和任务，在很大程度上是未知的。拟议项目的总体目标是解决护士健康研究II中的这一信息差距，这是一项正在进行的前瞻性队列研究，对1989年24-44岁基线年龄的116,678名注册护士进行了研究。在最初的22年里，我们预计在10000名有哮喘病史的护士中，有6500例医生诊断的哮喘病例。在2009年和2011年，我们询问了所有护士的工作类型和自我报告的消毒剂或清洁剂暴露情况（约35%的护士每周暴露）。我们建议通过补充问卷来加强对暴露和结果的评估。所有患有哮喘的护士都将收到关于职业暴露和哮喘控制（根据2007年NIH指南的定义）的问卷。补充职业问卷也将随机发给无哮喘的护士（~1万名）；来自非哮喘组的暴露数据将用于创建工作暴露矩阵（JEM）和任务暴露矩阵（TEM），可应用于整个队列，以更好地估计对特定物质的暴露。增强的数据将提高统计能力，并允许识别与哮喘风险最密切相关的特定药物。拟议的项目有三个具体目标。首先，我们将使用1989-2011年的队列数据来确定职业暴露与哮喘事件之间的关系。我们将通过考虑与哮喘状态相关的工作变化来评估潜在的“健康工人效应”。其次，我们将进行一项横断面研究（2013），以确定职业暴露与哮喘严重程度/控制之间的关系。第三，我们将进行一项前瞻性研究，以确定职业暴露与哮喘事件之间的关系（2007-2013，n~ 1800例）。总之，该项目将首次确定护士中常见的职业暴露与成人发作哮喘风险和哮喘控制不良之间的关系。该项目提供了一个独特的机会，在一个大的职业队列中，测试几个关于职业暴露于消毒剂或清洁剂及其对哮喘影响的新假设。研究结果可能对卫生保健工作者、清洁工和其他经常接触消毒剂或清洁剂的人的福祉产生重大的公共卫生影响。

DESCRIPTION (provided by applicant): Recent efforts to prevent healthcare-associated infections have led to increased use of disinfectants and cleaning agents. Studies suggest that occupational groups with regular exposure to these agents (e.g., health care workers) are at increased risk of asthma. However, the actual role of these common agents on the development and clinical course of asthma, and the specific agents and tasks involved, is largely unknown. The overall aim of the proposed project is to address this information gap in the Nurses' Health Study II, an ongoing prospective cohort study of 116,678 registered nurses, aged 24-44 years at baseline in 1989. Over the first 22 years, we anticipate ~6,500 incident cases of doctor-diagnosed asthma among ~10,000 nurses with a lifetime history of asthma. In 2009 and 2011, we asked all nurses about their job types and self-reported exposure to disinfectant or cleaning agents (~35% of nurses were exposed weekly). We propose to enhance assessment of both the exposure and outcome through supplementary questionnaires. All nurses with asthma will be sent questionnaires with validated questions on occupational exposures and asthma control (as defined by the 2007 NIH guidelines). The supplementary occupational questionnaire also will be also sent to a random sample of nurses without asthma (~10,000); exposure data from this non-asthmatic group will be used to create job exposure matrices (JEM) and task exposure matrices (TEM) that can be applied to the entire cohort to better estimate exposure to specific agents. The enhanced data will improve statistical power and permit identification of the specific agents that are most closely linked with asthma risk. The proposed project has three specific aims. First, we will use cohort data from 1989-2011 to determine the association between occupational exposure and incident asthma. We will evaluate a potential "healthy worker effect" by taking into account job changes in relation to asthma status. Second, we will perform a cross-sectional study (2013) to determine the association between occupational exposure and asthma severity/control. Third, we will conduct a prospective study to determine the association between occupational exposure and incident asthma (2007-2013, n~1,800 cases). In summary, this project will, for the first time, determine the relation of a common occupational exposure among nurses to risk of adult-onset asthma and poor asthma control. The project provides a unique opportunity, in a large occupational cohort, to test several novel hypotheses about occupational exposures to disinfectant or cleaning agents and their impact on asthma. The study results could have a major public health impact on the well-being of health care workers, cleaners, and others who are regularly exposed to disinfectant or cleaning agents.