ABSTRACT
The role of cleaning and sterilizing agents in work-related asthma (WRA) has been increasingly recognized since early case reports of occupational asthma (OA) over 30 years ago. Cleaning agents have become a more important causative factor in reported series of recognized WRA. The exposures leading to asthma-like symptoms have been reported from among domestic cleaners, and among healthcare workers both among those with primary use of cleaning/disinfecting agents, and among those with likely bystander exposure. In many cases the exposures have included multiple chemical agents in various cleaning products. This is the reason this category of agents is introduced as a new chapter in the current edition of Asthma in the Workplace. Apart from select carefully documented case reports, the causative chemical(s) have often been difficult to determine and in addition, in epidemiologic studies it is often unclear as to whether symptoms have been due to sensitization or an airway irritant response with production of OA, or due to work-exacerbated asthma, or in some cases to another disorder such as a laryngeal syndrome or chronic obstructive pulmonary disease (COPD), mimicking asthma from questionnaire responses. While exposure to these chemicals in the occupational setting is important, additional concern relates to the fact that many of these agents are used in the home and in public buildings including schools. This chapter reports on epidemiological studies, agents involved, and possible mechanisms (immune response to cleaning chemicals, airway epithelial response, toxicity, role of oxidative stress, and neurogenic inflammation). Diagnostic and possible prevention means are also proposed.
