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Resume But de l’etude L’exposition aux produits de nettoyage est frequente, tant dans le cadre professionnel que domestique. L’objectif de cet article est de faire un etat de la question sur la relation entre l’asthme et les expositions aux produits de nettoyage. Methodes Une revue de la litterature a ete effectuee. Apres une breve presentation des produits de nettoyage ayant potentiellement un effet sur la sante respiratoire, les resultats d’etudes de cas, d’etudes de surveillance et d’etudes epidemiologiques sont synthetises. Resultats Les produits de nettoyage et de desinfection sont composes de nombreux agents chimiques, pouvant etre classes en irritants ou en sensibilisants. Les etudes de surveillance ont mis en avant la place importante de l’exposition aux produits de nettoyage dans l’asthme professionnel ou l’asthme exacerbe par le travail, en particulier dans le secteur de la sante. Dans des etudes epidemiologiques principalement transversales et dans une etude longitudinale prospective, des associations avec l’asthme ont ete mises en evidence pour les professions de sante ou de menage, ou l’exposition aux produits de nettoyage. Des associations avec l’asthme ont le plus souvent ete observees pour l’utilisation d’ammoniac, d’eau de javel et de produits sous forme de spray, lorsque ces informations etaient disponibles. Peu d’etudes ont evalue le role des produits de nettoyage sur des phenotypes d’asthme specifiques. Des associations avec l’asthme non IgE-dependant et l’asthme IgE-dependant ont ete observees. Des travaux methodologiques seraient necessaires pour ameliorer les estimations des expositions aux produits de nettoyage. Les estimations des expositions aux produits de nettoyage specifiques sont le plus souvent basees sur la declaration des sujets, ce qui peut engendrer des biais de declaration differentiels. Discussion et conclusion Il est maintenant etabli que l’exposition aux produits de nettoyage est liee a la fois a l’apparition de l’asthme et a des exacerbations d’asthmes preexistants. Il reste cependant de nombreuses questions sur les produits specifiques impliques et leurs mecanismes d’action. Des methodes d’estimation des expositions plus objectives et applicables a de grandes populations, comme les matrices tâche-exposition, pourraient etre developpees. Des mesures quantitatives seraient utiles pour ameliorer l’estimation des expositions.

Occupational exposure to disinfectants is associated with work-related asthma, especially in healthcare workers. However, little is known about the specific products involved. To evaluate disinfectant exposures, we designed job-exposure (JEM) and job-task-exposure (JTEM) matrices, which are thought to be less prone to differential misclassification bias than self-reported exposure. We then compared the three assessment methods: self-reported exposure, JEM and JTEM.Disinfectant use was assessed by an occupational questionnaire in 9073 US female registered nurses without asthma, aged 49-68 years, drawn from the Nurses' Health Study II. A JEM was created based on self-reported frequency of use (1-3, 4-7 days/week) of 7 disinfectants and sprays in 8 nursing jobs. We then created a JTEM combining jobs and disinfection tasks to further reduce misclassification. Exposure was evaluated in 3 classes (low, medium, high) using product-specific cut-offs (eg,30%, 30-49.9%, ≥50%, respectively, for alcohol); the cut-offs were defined from the distribution of self-reported exposure per job/task.The most frequently reported disinfectants were alcohol (weekly use: 39%), bleach (22%) and sprays (20%). More nurses were classified as highly exposed by JTEM (alcohol 41%, sprays 41%, bleach 34%) than by JEM (21%, 30%, 26%, respectively). Agreement between JEM and JTEM was fair-to-moderate (κ 0.3-0.5) for most disinfectants. JEM and JTEM exposure estimates were heterogeneous in most nursing jobs, except in emergency room and education/administration.The JTEM may provide more accurate estimates than the JEM, especially for nursing jobs with heterogeneous tasks. Use of the JTEM is likely to reduce exposure misclassification.

Etat de la question L’asthme touche 300 millions de personnes dans le monde et la pollution atmospherique est l’un des facteurs environnementaux associes a son apparition. Parmi les mecanismes biologiques qui pourraient expliquer cette association, le stress oxydant est fortement suggere. Les 8-isoprostanes (8-iso) sont des marqueurs de dommages tissulaires lies au stress oxydant, pouvant etre doses dans le condensat de l’air expire (CAE). L’objectif de cette etude est double : – confirmer l’association entre la pollution atmospherique et l’asthme actuel ; – etudier l’association entre la pollution atmospherique et les 8-iso et l’association entre les 8-iso et l’asthme actuel, chez l’adulte dans l’etude EGEA. Methodes Les analyses ont concerne 663 participants adultes vus au premier suivi de l’etude epidemiologique des facteurs genetiques et environnementaux de l’asthme (EGEA, http://egeaintranet.vjf.inserm.fr/ ), etude cas-temoin, familiale et multicentrique. La pollution atmospherique (NO 2 , NOx, PM 10 , PM 2,5 et trafic routier) a ete estimee dans le cadre du programme FP7 ESCAPE ( http://www.escapeproject.eu/ ). Les 8-iso ont ete mesures dans le CAE, fluide proche du poumon et recueilli de maniere non invasive. Des modeles lineaires generalises avec prise en compte de la dependance familiale et des modeles mixtes sur la ville ont ete utilises. Resultats L’âge moyen des participants etait de 41,9 ans, 49 % etaient des hommes et 36,2 % avaient un asthme actuel. Les niveaux de pollution etaient disponibles a Paris, Lyon, Grenoble et Marseille et etaient plus eleves a Paris ( p 8-iso ) et des 25 e et 75 e percentiles de 3,25 pg/mL (1,43;7,76). A Paris, la MG 8-iso etait 7 fois plus elevee que dans les trois autres villes ( p n = 368), la MG 8-iso etait de 2,69 pg/mL (1,12;6,78) et elle etait plus elevee chez la femme ( p 95 % ] = 1,10 [1,00;1,19]). Seules les PM 2,5 etaient associees positivement et significativement aux 8-iso (β [IC95 %] = 0,29 [0,06;0,51] ; p = 0,01). Enfin, les 8-iso etaient associes positivement a l’asthme actuel qu’ils soient exprimes en continu (OR [IC95 %] = 1,50 [1,06;2,12]) ou en classes, definies selon la mediane (OR [IC95 %] = 1,57 [1,03;2,40]). Conclusions Cette etude montre pour la premiere fois chez l’adulte une association entre la pollution atmospherique et la [8-iso]. Elle souligne l’interet du CAE en epidemiologie respiratoire, et l’utilite des 8-iso comme marqueurs potentiels de dommages lies a la pollution dans l’asthme.

The aim of the present study was to determine dietary patterns and investigate their association with asthma incidence, current asthma and frequent asthma exacerbations. Dietary habits and asthma data were collected from the large E3N study (of French females, mostly teachers). Of the 54,672 females followed-up in 2003, 2,634 reported ever-adulthood asthma, 1,063 reported current asthma, 206 reported frequent asthma attacks (one or more a week), and 628 reported asthma onset between 1993 and 2003. Using principal component analysis, three dietary patterns were identified: the "prudent" pattern (fruits and vegetables); the "Western" pattern (pizza/salty pies, dessert and cured meats); and the "nuts and wine" pattern. Pattern scores were categorised into tertiles, and the incidence and prevalence of asthma was compared between tertiles. After adjustment for confounders, no association of dietary patterns was observed with asthma incidence, ever-asthma or current asthma. The Western pattern was associated with an increased risk of reporting frequent asthma attacks (highest versus lowest tertile odds ratio (OR) 1.79, 95% confidence interval (CI) 1.11-3.73). Increasing scores of the nuts and wine pattern were associated with a decreased risk of reporting frequent asthma attacks (highest versus lowest tertile OR 0.65, 95% CI 0.31-0.96). The results of the present study suggest that overall diet could be involved in frequent asthma exacerbations, one aspect of asthma severity.

Resume Introduction L’etude EGEA (Etude epidemiologique des facteurs Genetiques et Environnementaux de l’Asthme, l’atopie et l’hyperreactivite bronchique), une etude cas-temoins et familiale regroupant 2 048 individus, a ete initiee afin de rechercher les facteurs environnementaux et genetiques de l’asthme. Nous presentons les resultats portant sur les aspects phenotypiques et environnementaux de l’asthme severe et de l’allergie obtenus depuis 2002 dans l’etude EGEA. Methodes et Resultats Les resultats etayent le role de facteurs hormonaux dans la severite de l’asthme et certains marqueurs allergiques associes a l’asthme. Un indice de masse corporelle eleve etait associe a la severite de l’asthme chez les femmes ayant eu des regles precoces. Des associations sont apparues entre des marqueurs d’allergie (eosinophiles, IgE, atopie) et des evenements hormono-dependants chez les femmes (asthme premenstruel, menopause et contraceptifs oraux). Chez les asthmatiques, l’exposition professionnelle aux nuisances asthmogenes, le tabagisme actif et passif etaient associes a un score clinique de severite plus eleve. L’etude a mis en evidence le role protecteur de la vie a la campagne et de l’exposition aux animaux domestiques dans la petite enfance vis-a-vis de l’allergie chez l’adulte, etayant ainsi l’hypothese hygieniste. Conclusions De nouvelles hypotheses seront prochainement testees grâce a la seconde phase de l’etude actuellement en cours.

Occupational exposure to disinfectants is associated with work-related asthma, especially in healthcare workers. However, little is known about the specific products involved. In epidemiologic studies, assessment of exposure by job-exposure matrices (JEM) is less prone to differential misclassification bias than self-report. We designed JEM and job-task-exposure matrices (JTEM) to better evaluate disinfectant exposures using data from the Nurses9 Health Study II, a prospective study of U.S. female registered nurses. Disinfectant use was assessed by an occupational questionnaire in a random sample of 8,580 nurses (49-68 years) without asthma. A JEM was created based on the frequency (1-3, >4 days/week) of reported use of 8 disinfectants in 8 nursing jobs. Nurses reported weekly disinfection tasks to clean instruments (21%) and surfaces (54%). A JTEM combining job types and disinfection tasks was created to further reduce misclassification. Exposure was evaluated in 3 classes: no, medium, high. Alcohol (weekly use: 39%), bleach (22%) and sprays (19%) were the most frequently used; more nurses were classified exposed (medium/high) by JEM (84% for alcohol, bleach and sprays) and JTEM (75%, 64%, 59%, respectively). Agreement between JEM and JTEM were fair (kappa: 0.2 to 0.4). For Emergency Room and administration nursing jobs, JEM and JTEM estimates were similar; more variations were observed for other jobs. The JTEM may provide more accurate estimates than the JEM especially for nursing jobs with heterogeneous tasks, which will reduce exposure misclassification. These methods and others based on exposure intensity/frequency will be applied to study associations with asthma. Grant: R01 OH-10359.

The role of smoking as potential risk factor, selection factor ("healthy smoker" effect) and modifying factor (severity) of asthma was studied in the Epidemiological study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy (EGEA). The analysis involved 200 adult asthmatic cases recruited in chest clinics, 265 nonasthmatic controls and 586 relatives of asthmatics (147 with asthma). Asthma in childhood was not associated with a reduced take-up of smoking (odds ratio (OR)=1.06 in males and 0.98 in females), but smoker asthmatic cases quit more often than controls (OR = 2.20 (95% confidence interval (95% CI) 1.11-4.34) in males and 2.76 (1.19-6.42) in females). Adult onset asthma was unrelated to ever smoking (OR 1.07 in males and 1.02 in females). In asthmatic cases, active smoking was associated with asthma severity. Current smokers, compared to never and exsmokers, had more asthma symptoms, more frequent (> or =1 attack x day(-1)) asthma attacks (OR 2.39 (95% CI 1.06-5.36)) and higher asthma severity scores. No clear pattern regarding the relationships of smoking habits with asthma was observed in first degree relatives. It is concluded that active smoking is not a risk factor for asthma in adulthood, but that smoking increases asthma severity.

Introduction Un risque eleve d’asthme a ete observe chez les infirmieres et pourrait etre lie a l’exposition aux desinfectants. Nous avons etudie l’influence de l’asthme sur le type et les changements de metier chez les infirmieres chez 98 048 femmes participant a la Nurses’ Health Study II, une etude prospective americaine d’infirmieres suivies depuis 1989 (âge : 24-44 ans). Methodes Les informations sur les types de metier, l’asthme et la date de diagnostic etaient recueillies par questionnaires a l’inclusion en 1989 puis tous les 2 ans entre 1993 en 2011. Les associations entre l’asthme diagnostique avant l’inclusion et le type de metier et les changements de metiers entre 1989 et 2011, ont ete evaluees (regressions logistiques et modeles de Cox, ajustes sur l’âge et l’ethnicite). Resultats A l’inclusion, 44 % des femmes exercaient des metiers impliquant une exposition potentiellement elevee aux desinfectants (notamment bloc operatoire et urgences), et 12 % exercaient des metiers avec une probabilite faible d’exposition (formation/administration). Les femmes avec un asthme diagnostique avant l’inclusion ( n = 5311) etaient moins souvent employees en bloc operatoire ( odds ratio : 0,73 [IC 95 %, 0,63–0,86]) et aux urgences ou autres service exposes (0,89 [0,82–0,97]) qu’en formation/administration. Pendant le suivi, les femmes avec de l’asthme changeaient plus souvent de metier pour des metiers avec une faible probabilite d’exposition aux desinfectants ( hazard ratio : 1,13 [1,07–1,18]), en particulier celles avec un asthme plus severe (hazard ratio pour l’asthme leger persistant : 1,13, modere persistant : 1,26 ; severe persistant : 1,50, en comparaison avec l’asthme intermittent, p tendance : 0,004). Conclusion L’asthme etait associe au type de metier a l’inclusion et aux changements de metier chez les infirmieres. Cela pourrait en partie refleter l’evitement de tâches impliquant l’usage de desinfectants. Financements : R01 OH-10359 ; FRM SPE20130326585 ; FRSR.

OBJECTIVES--The aim of this analysis of the French Cooperative PAARC (Pollution Atmosphérique et Affections Respiratoires Chroniques) survey, was to test whether occupational exposures to dusts, gases, or chemical fumes or to specific hazards, estimated by job exposure matrices, were related to a decrease in forced expiratory volume in one second (FEV1). METHODS--The most recent occupation was recorded in adults, aged 25-59, from non-manual worker households. Analysis was restricted to 10,046 subjects whose occupation was encountered at least 10 times in the study and who performed good FEV1 tracings. From occupational title, exposures to dusts, gases, and chemical fumes, and to specific hazards were classified in three categories (no, low, and high) with a British, a French, and an Italian job exposure matrix. Specific hazards were analysed for the British and French job exposure matrices for the same 42 specific dusts, gases, and chemical fumes. To limit spurious associations, a selection of seven hazard groups and 12 specific hazards was set before the start of the analysis. Based on the consistency of the relations according to sex and the British and French job exposure matrices, associations of age, height, city, and smoking adjusted FEV1 score with occupational exposures were classified as very likely, possible, or unlikely. RESULTS--For the three job exposure matrices and both sexes clear exposure-response relations between the level of exposure to dusts, gases, and chemical fumes, and a decrease in FEV1 were found. Associations with FEV1 were classified as very likely for known hazards such as organic dusts and textile dusts, and not previously recognised hazards such as polycyclic aromatic hydrocarbons (PAHs) and detergents, and as possible for solvents, waxes and polishes, and diesel fumes. Associations found for PAHs and solvents were confirmed by the Italian job exposure matrix. Associations remained significant in women, but not in men, after adjustment for educational level. CONCLUSIONS--Hypotheses have been generated for exposure to detergents, PAHs, and solvents, but they need to be interpreted with caution before replication. Significant associations found for known risk factors with a decrease in FEV1 are arguments for the validity of the matrices. Despite the expected limitations of job exposure matrices, these results encourage further work to improve exposure assessment by job exposure matrices.

The aims were to assess longitudinally 1) the role of asthma as a potential selection factor for smoking initiation and 2) the role of smoking as a potential risk factor for asthma incidence in relatives of asthmatics. The analyses were conducted in the EGEA study, a 12−year follow−up of asthmatic cases, their first degree relatives and controls (n=1848). The first question was addressed in 511 non smoker children at inclusion (258 asthmatics, 253 non asthmatics). The second question was addressed in 496 adult relatives of cases, non asthmatic at inclusion. Survival analyses (Cox model) were conducted with adjustment on confounders (age, sex, ETS, father educational level, centre for question 1, and sex, age, educational level, atopy, rhinitis for question 2) and stratification for age. Children with asthma at inclusion started smoking as often as non asthmatic children (45.4% vs 48.6% respectively, RR[IC 95%] = 1.0 [0.7;1.3]). Among adult relatives of cases, 37 had incident asthma at follow−up (7.5%). Both smoking at inclusion (non smoker n=242, ex−smoker n=124, smoker n=130) and a time dependant smoking variable were used (never (n=341), beginner (n=22), persistent (n=74), former (n=55)). Smoking at inclusion did not affect asthma incidence (RR for smokers and ex−smokers compared to non smokers were 1.8 [0.8;3.9] and 0.7 [0.3;2.1] respectively). However, compared to never smokers, the risk for asthma incidence was increased in beginner and persistent smokers (RR=3.2 [1.0;10.1] and 2.5 [1.0;5.9]). Asthmatics started smoking as often as non asthmatics. This analysis indicates that smoking may be a risk factor for asthma incidence in first degree relatives of asthmatics, a potentially more sensitive population.

Introduction Un risque eleve d’asthme a ete observe chez les infirmieres et pourrait etre lie a l’exposition aux desinfectants. Nous avons etudie l’influence de l’asthme sur le type et les changements de metier chez les infirmieres chez 114 778 femmes participant a la « Nurses’ Health Study II », une etude prospective americaine d’infirmieres suivies depuis 1989 (âge : 24–44 ans). Methodes Les informations sur les types de metier, l’asthme et la date de diagnostic etaient recueillies par questionnaires a l’inclusion en 1989 puis tous les deux ans entre 1993 en 2011. Les associations entre l’asthme diagnostique avant l’inclusion et le type de metier et les changements de metiers entre 1989 et 2011, ont ete evaluees (regressions logistiques et modeles de Cox, ajustes sur l’âge et l’ethnicite). Resultats A l’inclusion, 44 % des femmes exercaient des metiers impliquant une exposition potentiellement elevee aux desinfectants (notamment bloc operatoire et urgences), et 12 % exercaient des metiers avec une probabilite faible d’exposition (formation/administration). Les femmes avec un asthme diagnostique avant l’inclusion ( n = 5739 ; 5 %) etaient moins souvent employees en bloc operatoire ( odds ratio : 0,71–2 [IC95 %, 0,61–0,82]) et aux urgences ou autres service exposes (0,88 [0,81–0,96]) qu’en formation/administration. Pendant le suivi, les femmes avec de l’asthme changeaient plus souvent de metier pour des metiers avec une faible probabilite d’exposition aux desinfectants ( hazard ratio : 1,14 [1,09–1,20]). Conclusion L’asthme etait associe au type de metier a l’inclusion et aux changements de metier chez les infirmieres. Cela pourrait en partie refleter l’evitement de tâches impliquant l’usage de desinfectants.

Workplace and home exposures to cleaning products constitute an emerging health issue. The aim is to address the potential adverse role of exposure to cleaning agents on asthma in private homes and healthcare workers. Regarding healthcare workers, recent publications showed that they may be exposed to high level of cleaning products. As a cause of concern, they underestimated their exposures and appeared as a high risk group for asthma. Regarding home cleaning, two studies have published on this topic and suggested a deleterious role of the frequent use of cleaning sprays on asthma activity and incidence. One of them suggested a possible avoidance of spray use by women with asthma. More recently, in a nested case-control survey on asthma of French women from the ‘Etude Epidemiologique aupres des femmes de la MGEN’ (E3N study), we investigated the association between self-reported weekly use of cleaning products (evaluated as previously) and current asthma among 570 women (235 with current asthma and 335 without asthma; 68 years, 59% never smokers). A positive association was suggested between weekly use of at least one spray and current asthma (odds ratio [95% confidence interval] adjusted for age, diploma, body mass index and smoking status: 1.45 [0.94–2.24], p = 0.09), with a significant association in women without cleaning help (1.86 [1.04–3.33]). Avoidance of polluted places was significantly more frequent in women with current asthma who had at least two symptoms. Domestic exposure to cleaning sprays may represent an important public health issue especially in women and it may be important to limit their use. Female hospital workers are exposed to numerous cleaning products at high risk for asthma. Selection bias may be important for both domestic and workplace exposures. More work is needed to identify the underlying mechanism (allergic or non-allergic) and to have accurate estimates of cleaning agents.

Objective This epidemiologic study was undertaken after a cluster of five cases of rare forms of cancer (bone sarcoma, non-Hodgkin's lymphoma) had been observed among biomedical research workers at the Pasteur Institute in Paris to ascertain whether their disease was connected with exposure during this research. Methods A mortality study included 3765 people who worked at the Pasteur Institute between 1971 and 1986 and were followed until the end of 1987. Within this cohort a nested case-referent study included 23 cases of cancer [non-Hodgkin's lymphoma (6), multiple myeloma (1), leukemia (3), pancreatic cancer (7), bone cancer (3), brain tumor (3)], and four referents per case, matched for gender and year of birth. Results Total mortality from cancer was less than expected, the standardized mortality ratio (SMR) being 72 for the men and 82 for the women. Among the women the proportion of pancreatic cancer cases was larger than expected [SMR 490, 95% confidence interval (95%CI) 158--1144], as was the number of brain cancer cases (SMR 239, 95% CI 48--696). Among the men, mortality from bone cancer was greater than expected (SMR 553, 95% CI 62--2006). In the nested case-referent study, more cases than referents had worked in the areas of molecular biology [odds ratio (OR) 7.1, 95% CI 1.5--33] and microbial genetics (OR 6.7, 95% CI 1.3--35). These cases especially included non-Hodgkin's lymphoma and bone cancer. Associated with this finding was the fact that more cases had used certain chemicals, including ethidium bromide, acrylamide, methylnitronitrosoguanidine and ethylmethanesulfonate, and radioactive compounds (essentially 32phosphorus). Conclusion As the products used are potent genotoxicants, the present findings suggest that work in biomedical research might well involve an increased risk of certain types of cancer; this conclusion should be balanced by the fact that two of the five index cases were included in the mortality study and four in the nested case-referent study.

The relationships between occupational risk factors in France and bladder cancer were assessed from a hospital-based case-control study conducted between 1984 and 1987 in five regions representing various industries, including mining, textile manufacture, metallurgy and the production of rubber and chemicals. The study concerned 765 cases (658 men and 107 women) and the same number of controls. Odds ratios (OR) adjusted for matching variables (age, place of residence and hospital), and tobacco smoking were estimated by unconditional logistic regression. A significantly increased risk of bladder cancer was observed among men employed in coal mining (OR = 2.42; 95% confidence interval (Cl) : 1.25-4.67) and the chemicals industry (OR = 2.36; 95% Cl : 1.23-4.53). Aircraft and ship's officers (OR = 11.8; 95% Cl : 1.46-95.7), managers (OR = 1.64; 95% Cl : 1.11-2.43) and street vendors (OR = 3.60; 95% Cl : 1.15-11.3) also had an increased risk. Among women, employment in the clothing industry was associated with a high OR (= 3.21; 95% Cl : 1.34-7.71). Assessment of individual exposures by a panel of industrial hygiene experts showed that significantly more cases than controls had been exposed to the following substances: chlorinated solvents (OR = 1.86; 95% Cl : 1.19-2.90), industrial oils and greases (OR = 1.44; 95% Cl : 1.10-1.89), welding fumes (OR = 1.40; 95% Cl : 0.98-2.01), coal dust (OR = 1.71; 95% Cl : 1.02-2.89) and metallic oxide dust (OR = 2.99; 95% Cl : 1.12-8.01).(ABSTRACT TRUNCATED AT 250 WORDS)