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Introduction: Occupational and regular cleaning at home is associated with excess risk of asthma and respiratory symptoms, but little is known about long term effects on lung function decline. Aim: To study whether occupational cleaning and/or cleaning at home causes accelerated lung function decline. Methods: Lung function (FVC and FEV 1 ) was measured in the ECRHS multicentre population-based study in 1992-94 and at two follow-ups in 1998-02 and 2010-12. In ECRHS II 3462 women responded to the questions “since the last survey, have you been the person doing the cleaning and/or washing in your home?” and “since the last survey, have you worked as a cleaner?” respectively. Decline in FVC and FEV 1 between ECRHS I and III was analysed by mixed effect models adjusted for FEV 1 , age and height at baseline, number of years between each follow-up, BMI at each survey, pack years at last survey, age at completed education, social class and centre. Results: Between the first and last survey, women not working as cleaners or doing the cleaning at home had an adjusted mean decline in FVC and FEV 1 of 19.5 (95% CI [15.4-23.6]) and 29.6 [26.8-32.3] ml/yr, respectively. Women cleaning at home had an adjusted mean decline in FVC and FEV 1 of 24.6 [23.4-25.5] and 33.6 [32.9-34.3] ml/yr, whereas the decline in occupational cleaners was 27.6 [24.2-31.0] and 34.6 [32.2-36.7] ml/yr, respectively. Lung function decline was significantly more rapid in both groups of cleaners as compared to the reference group (p Conclusion: Women who work as cleaners and/or regularly clean their home had accelerated lung function decline and are thus at increased risk for the development of obstructive and/or restrictive lung disease.

Background: Nicotine receptors are present in many organs including the lungs. It is therefore plausible that nicotine exposure (without cigarette smoke) has a negative impact on lung health. Aim: To assess the association between use of nasal and oral moist tobacco (snus) and asthma symptoms. Methods: We used data collected 2013-15 on lung health and tobacco habits from 7826 adult participants (mean age: 30.4 yrs; 42% men) from the RHINESSA study with populations from Northern Europe. Logistic regression models adjusted for age, sex, occupational status, parental smoking during childhood, and clustered by centre were used to assess association between use of snus (with or without cigarette smoking) and having 3 or more of the following symptoms: Wheezing, breathless when wheezing, wheezing when not having a cold, woken by tightness in chest, woken by shortness of breath, night cough, asthma attack, and current asthma medication. Results: Current use of snus was most common in Norway (21%) and Sweden (17%), followed by Iceland (included oral and nasal tobacco: 7%), Estonia (4%) and Denmark (1%). In Norway and Sweden 40% of the snus users were women. The overall prevalence of ever-smoking was 31% (11% current smokers). The risk of ≥3 asthma symptoms was similar for the current smokers aOR: 1.54 (95% CI: 1.26, 1.87) and snus users aOR: 1.53 (95% CI: 1.26, 1.87), but highest for combined use of current snus and cigarette smoking aOR: 2.55 (95% CI: 1.72, 3.76) as compared to those never having used snus nor smoked (59%). Conclusion: The use of snus is frequent in the Nordic countries and being a current snus-user as well combined use of snus and cigarette smoking is associated with having multiple asthma symptoms.