Airway inflammatory profile among cleaning workers from different workplaces

Edinéia Rosa da Paz, Cynthia Mafra Fonseca de Lima, Soraia Nogueira Felix, Bruna Schaeffer, Clóvis Eduardo Santos Galvão, Aristides Tadeu Correia, Renato Fraga Righetti, Milton de Arruda Martins, Iolanda de Fátima Lopes Calvo Tibério, Beatriz Mangueira Saraiva-Romanholo, Edinéia Rosa da Paz, Cynthia Mafra Fonseca de Lima, Soraia Nogueira Felix, Bruna Schaeffer, Clóvis Eduardo Santos Galvão, Aristides Tadeu Correia, Renato Fraga Righetti, Milton de Arruda Martins, Iolanda de Fátima Lopes Calvo Tibério, Beatriz Mangueira Saraiva-Romanholo

Abstract

Background: Cleaning workers represent a significant proportion of the active population worldwide, with poor remuneration, particularly in developing countries. Despite this, they remain a relatively poorly studied occupational group. They are constantly exposed to agents that can cause symptoms and respiratory problems. This study aimed to evaluate upper airway inflammation in professional cleaning workers in three different occupational settings by comparing nasal cytology inflammation and clinical profiles.

Methods: We performed a cross-sectional study on the prevalence of upper airway inflammation and symptoms of asthma/rhinitis related to cleaning work, according to workplace. A total of 167 participants were divided into four groups: hospital, university, housekeeper and control. A nasal swab was collected for upper airway inflammation evaluation. Clinical profiles and respiratory symptom employee evaluations were performed using specific questionnaires (European Community Respiratory Health Survey-ECRS and the International Study of Asthma and Allergies in Childhood-ISAAC).

Results: Cleaning workers showed increased neutrophils and lymphocytes; the hospital and university groups showed increased macrophages compared to the housekeeper and control groups. The hospital and housekeeper groups showed increased eosinophils when they performed cleaning services for up to one year and reported having more asthma symptoms than the control group. Cleaning workers showed increased rhinitis symptoms. The university group showed increased rhinitis symptoms aggravated by the workplace compared with the hospital and housekeeper groups. Cleaning workers showed an increased affirmative response when directly asked about rhinitis symptoms compared to the control group.

Conclusions: Cleaning workers showed airway inflammation, asthma symptoms and rhinitis, regardless of the occupational environment to which they were exposed, as well as showed increased rhinitis and asthma symptoms. Hospital cleaning workers showed increased macrophages, lymphocytes and eosinophils compared to the others. The length of time spent performing cleaning work was not related to nasal inflammation or respiratory symptoms in this population. However, there were differences in workplaces. Registered on ClinicalTrials.gov.

Trial registration number: NCT03311048. Registration date: 10.16.2017. Retrospectively registered.

Keywords: Cleaning workers; Nasal swab; Respiratory symptoms; Work-related asthma; Work-related rhinitis.

Conflict of interest statement

We have read the journal’s policy, and the authors of this manuscript have declared no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
Nasal swab inflammatory cell percentage as workplace (%). a Eosinophils: no significant difference. b Neutrophils: The hospital and university groups showed differences compared to the control group (*p ≤ 0.001). c Lymphocytes: The control group showed differences compared to the others (**p ≤ 0.001). d Macrophages: The hospital and university groups showed differences compared to the housekeeper and control groups (#, ##p ≤ 0.001)
Fig. 3
Fig. 3
Nasal swab eosinophil percentage as years worked in cleaning services. *p = 0.001 compared to the hospital group; **p = 0.001 compared to 1 year of housekeeping with 2–5 years of housekeeping

References

    1. Francis HC, Prys-Picard CO, Fishwick D, Stenton C, Burge PS, Bradshaw LM, et al. Defining and investigating occupational asthma: a consensus approach. Occup Environ Med. 2007;64(6):361–365. doi: 10.1136/oem.2006.028902.
    1. Nicholson PJ, Cullinan P, Taylor AJN, Burge PS, Boyle C. Evidence based guidelines for the prevention, identification, and management of occupational asthma. Occup Environ Med. 2005;62(5):290–299. doi: 10.1136/oem.2004.016287.
    1. Le Moual N, Zock J-P, Dumas O, Lytras T, Andersson E, Lillienberg L, et al. Update of an occupational asthma-specific job exposure matrix to assess exposure to 30 specific agents. Occup Environ Med. 2018;75(7):507–514. doi: 10.1136/oemed-2017-104866.
    1. Vandenplas O, D’Alpaos V, Evrard G, Jamart J, Thimpont J, Huaux F, et al. Asthma related to cleaning agents: a clinical insight. BMJ Open. 2013;3(9):e003568. doi: 10.1136/bmjopen-2013-003568.
    1. Mendonça EMC, Algranti E, de Freitas JBP, Rosa EA, dos Santos-Freire JA, de Paula-Santos UdU, et al. Occupational asthma in the city of São Paulo, 1995–2000, with special reference to gender analysis. Am J Ind Med. 2003;43(6):611–7. doi: 10.1002/ajim.10210.
    1. Baur X, Sigsgaard T, Aasen TB, Burge PS, Heederik D, Henneberger P, et al. Guidelines for the management of work-related asthma. Eur Respir J. 2012;39(3):529–545. doi: 10.1183/09031936.00096111.
    1. Folletti I, Siracusa A, Paolocci G. Update on asthma and cleaning agents. Curr Opin Allergy Clin Immunol. 2017;17(2):90–95. doi: 10.1097/ACI.0000000000000349.
    1. Pralong JA, Cartier A, Vandenplas O, Labrecque M. Occupational asthma: new low-molecular-weight causal agents, 2000–2010. J Allergy. 2012;2012:597306. doi: 10.1155/2012/597306.
    1. Galli SJ, Tsai M. IgE and mast cells in allergic disease. Nat Med. 2012;18(5):693–704. doi: 10.1038/nm.2755.
    1. Castano R, Yucesoy B, Johnson VJ, Castellanos L, Cartier A. Inflammatory proteins in nasal lavage of workers exposed to occupational agents. Clin Exp Allergy. 2017;47(12):1566–1573. doi: 10.1111/cea.13039.
    1. Kotz S, Pechtold L, Jörres RA, Nowak D, Chaker AM. Occupational rhinitis. Allergol Sel. 2021;5:51–56. doi: 10.5414/ALX02165E.
    1. Crivellaro MA, Ottaviano G, Maculan P, Pendolino AL, Vianello L, Mason P, et al. Upper and lower respiratory signs and symptoms in workers occupationally exposed to flour dust. Int J Environ Res Public Health. 2020;17(19):1–14. doi: 10.3390/ijerph17197075.
    1. GINA. Global strategy for asthma management and prevention (main report). 2021.
    1. GINA. Global strategy for asthma management and prevention. Online Appendix. 2020.
    1. Rocha MRA, Marin MJS, Macias-Seda J. Living, working conditions and mental health: a study with Brazilian and Spanish workers who work in hospital cleaning services. Cienc e Saude Coletiva. 2020;25(10):3821–3832. doi: 10.1590/1413-812320202510.35912018.
    1. Eurofound and International Labour Organization. Working conditions in a global perspective. 2019.
    1. Dumas O. Cleaners and airway diseases. Curr Opin Allergy Clin Immunol. 2021;21(2):101–9. doi: 10.1097/ACI.0000000000000710.
    1. Burney PGJ, Luczynska C, Chinn S, Jarvis D. The European community respiratory health survey. Eur Respir J. 1994;7(5):954–60. doi: 10.1183/09031936.94.07050954.
    1. Ribeiro M, Angelini L, Robles-Ribeiro PG, Stelmach R, de Paula-Santos U, Terra-Filho M. Validation of the Brazilian-Portuguese version of the European Community Respiratory Health Survey in asthma patients. J Asthma. 2007;44(5):371–375. doi: 10.1080/02770900701364015.
    1. Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8(3):483–491. doi: 10.1183/09031936.95.08030483.
    1. de Fátima-Maçãira E, Algranti E, Medina-Coeli-Mendonça E, Antônio-Bussacos M. Rhinitis and asthma symptoms in non-domestic cleaners from the Sao Paulo metropolitan area Brazil. Occup Environ Med. 2007;64(7):446–53. doi: 10.1136/oem.2006.032094.
    1. Ronchetti R, Villa MP, Martella S, La Grutta S, Ronchetti F, Biscione GL, et al. Nasal cellularity in 183 unselected schoolchildren aged 9 to 11 years. Pediatrics. 2002;110(6):1137–1142. doi: 10.1542/peds.110.6.1137.
    1. Davis KU, Sheats MK. The role of neutrophils in the pathophysiology of asthma in humans and horses. Inflammation. 2021;44(2):450–465. doi: 10.1007/s10753-020-01362-2.
    1. Rank MA, Ochkur SI, Lewis JC, Teaford HG, Wesselius LJ, Helmers RA, et al. Nasal and pharyngeal eosinophil peroxidase levels in adults with poorly controlled asthma correlate with sputum eosinophilia. Allergy. 2016;71(4):567–70. doi: 10.1111/all.12817.
    1. De Matteis S, Heederik D, Burdorf A, Colosio C, Cullinan P, Henneberger PK, et al. Current and new challenges in occupational lung diseases. Eur Respir Rev. 2017;26(146):170080. doi: 10.1183/16000617.0080-2017.
    1. Svanes Ø, Bertelsen RJ, Lygre SHL, Carsin AE, Antó JM, Forsberg B, et al. Cleaning at home and at work in relation to lung function decline and airway obstruction. Am J Respir Crit Care Med. 2018;197(9):1157–1163. doi: 10.1164/rccm.201706-1311OC.
    1. Zock J-P, Vizcaya D, Le Moual N. Update on asthma and cleaners. Curr Opin Allergy Clin Immunol. 2010;10(2):114–120. doi: 10.1097/ACI.0b013e32833733fe.
    1. Quirce S, Barranco P. Cleaning agents and asthma. J Investig Allergol Clin Immunol. 2010;20(7):542–50.
    1. Karjalainen A, Martikainen R, Klaukka T, Saarinen K, Uitti J. Risk of asthma among Finnish patients with occupational rhinitis. Chest. 2003;123(1):283–288. doi: 10.1378/chest.123.1.283.
    1. Jaakkola JJK, Piipari R, Jaakkola MS. Occupation and asthma: a population-based incident case-control study. Am J Epidemiol. 2003;158(10):981–987. doi: 10.1093/aje/kwg238.
    1. Jang A-S, Choi I-S, Lee S, Nam H-S, Kweon S-S, Son M-H, et al. The effect of passive smoking on asthma symptoms, atopy, and airway hyperresponsiveness in schoolchildren. J Korean Med Sci. 2004;19(2):214–217. doi: 10.3346/jkms.2004.19.2.214.
    1. van Aalderen WM. Childhood asthma: diagnosis and treatment. Scientifica (Cairo) 2012;2012:674204.
    1. Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004;24(5):758–764. doi: 10.1183/09031936.04.00013904.
    1. Folletti I, Zock J-P, Moscato G, Siracusa A. Asthma and rhinitis in cleaning workers: a systematic review of epidemiological studies. J Asthma. 2014;51(1):18–28. doi: 10.3109/02770903.2013.833217.
    1. Slavin RG. Occupational rhinitis. Ann Allergy Asthma Immunol. 2003;90(5 Suppl 2):2–6. doi: 10.1016/S1081-1206(10)61640-7.
    1. Ciprandi G, Vizzaccaro A, Cirillo I, Tosca M, Massolo A, Passalacqua G. Nasal eosinophils display the best correlation with symptoms, pulmonary function and inflammation in allergic rhinitis. Int Arch Allergy Immunol. 2005;136(3):266–272. doi: 10.1159/000083953.
    1. Marseglia GL, Cirillo I, Vizzaccaro A, Klersy C, Tosca MA, La Rosa M, et al. Role of forced expiratory flow at 25–75% as an early marker of small airways impairment in subjects with allergic rhinitis. Allergy Asthma Proc. 2007;28(1):74–78. doi: 10.2500/aap.2007.28.2920.
    1. Pal I, Sinha Babu A, Halder I, Kumar S. Nasal smear eosinophils and allergic rhinitis. Ear Nose Throat J. 2017;96(10–11):E17–22. doi: 10.1177/0145561317096010-1105.
    1. Castano R, Maghni K, Castellanos L, Trudeau C, Malo J-L, Gautrin D. Proinflammatory mediators in nasal lavage of subjects with occupational rhinitis. Otolaryngol Neck Surg. 2010;143(2):301–3.e1. doi: 10.1016/j.otohns.2010.04.272.
    1. Hox V, Steelant B, Fokkens W, Nemery B, Hellings PW. Occupational upper airway disease: how work affects the nose. Allergy. 2014;69(3):282–291. doi: 10.1111/all.12347.
    1. Clarhed UKE, Svendsen M, Schiöler L, Kongerud J, Torén K, Hellgren J, et al. Chronic rhinosinusitis related to occupational exposure: the Telemark population study. J Occup Environ Med. 2018;60(7):656–660. doi: 10.1097/JOM.0000000000001312.
    1. Lovato A, Staffieri C, Ottaviano G, Cappellesso R, Giacomelli L, Bartolucci GB, et al. Woodworkers and the inflammatory effects of softwood/hardwood dust: evidence from nasal cytology. Eur Arch Oto-Rhino-Laryngol. 2016;273(10):3195–3200. doi: 10.1007/s00405-016-3989-2.
    1. Gelardi M, Iannuzzi L, Quaranta N, Landi M, Passalacqua G. NASAL cytology: practical aspects and clinical relevance. Clin Exp Allergy. 2016;46(6):785–792. doi: 10.1111/cea.12730.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere