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

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Presentation transcript:

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.

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.

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

Cleaners versus office workers. Spanish cleaners, ECRHS-I (SJWE 2001) Asthma risk Office workers1(ref) All cleaners1.7(1.1  2.5) Indoor cleaners1.7(1.1  2.7) Home cleaners3.3(1.9  5.8) Other cleaners1.0(0.5  2.0)

Women’s cleaners study, Barcelona (EPIASLI). Odds ratios for asthma symptoms or medication. Thorax OCCUPATIONNOR (95% CI) Total4251  Never cleaner Ever cleaner (1.44 – 2.07) Past cleaners (1.63 – 2.43) Home cleaners (1.70 – 2.57) Other places (0.91 – 2.18) Current (1.04 – 1.69) Home cleaners (1.10 – 1.92) Other places (0.72 – 1.61)

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

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

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

Risk of asthma in cleaners, ECRHS-I

Use of bleach in Europe: ECRHS-II