Exposure Profiles for the Long-Term Use of Disinfectants and Cleaning Products and Asthma

Abstract

Background: Using disinfectants and cleaning products (DCPs) at home and work is known to influence both the onset and course of asthma, but most epidemiological studies did not consider the multiplicity and correlations of exposures to DCPs. We aimed to identify exposure profiles for the long-term weekly use of DCPs by latent class analysis (LCA) and assess their associations with asthma.

Methods: LCA was conducted on data from 1143 young adults initially recruited in the German centers of Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC) and followed up three times. In our LCA model, we included the use of cleaning sprays, disinfectant sprays, and nonspray disinfection methods, measured at ages 19-24 (first assessment) and 29-34 years (second assessment). Associations between identified exposure profiles and current as well as incident asthma/wheeze were evaluated by logistic regression.

Results: We identified five long-term exposure profiles to DCPs (latent classes): no weekly use of DCPs (55% of participants), use in first assessment (7%), use in second assessment (18%), persistent use (8%), and persistent cleaning sprays use (12%). Compared to "no weekly use," being in the "persistent use" profile was associated with both current asthma (OR = 1.68, 95% CI = [0.48-5.88]) and current wheeze (OR = 1.71, 95% CI = [0.75-3.90]). For incident asthma/wheeze, interval estimates were very wide.

Conclusions: Our study identified five distinct long-term exposure profiles to DCPs. Among those, only a persistent weekly use of multiple DCPs over time seemed to have an adverse effect on asthma. However, large confidence intervals indicate considerable uncertainty.

Keywords: asthma; disinfectants and cleaning products; exposure profiles; latent class analysis; sprays.

FIGURE 1

For each of the four study phases, a box describes the time period of data collection, the age range, and the number of participants at data collection.

FIGURE 2

Probabilities of weekly use of DCPs at SOLAR 2 and 3 according to exposure profiles. Each subplot shows the probabilities of weekly use of cleaning sprays, disinfectant sprays, and nonspray disinfection methods with their respective 95% confidence interval at SOLAR 2 and 3 for one latent class. Prevalence of each exposure profile (latent class), with their respective 95% confidence interval, is shown under their label. Numerical values are displayed in Table S3. poLCA calculated an entropy between 2.40 and 2.50 for the models based on the 20 imputed datasets.

FIGURE 3

Associations of the identified exposure profiles with current asthma/wheeze and incident asthma/wheeze. LC 1: No weekly use; LC 2: Persistent cleaning sprays use; LC 3: Decreased use; LC 4: Increased use; LC 5: Persistent use. Adjusted odds ratios (ORs) for sex, age, smoking status, study center, and socioeconomic status, presented with their 95% confidence interval [95% CI] were estimated by logistic regression models. Models for current asthma/wheeze at SOLAR 3 were further adjusted for current asthma/wheeze at SOLAR 2, respectively. The arrow on the upper CI means that the value is larger than 10, that is, the x‐axis upper limit. Associations with current asthma were performed on 1003 to 1008 participants (from the 20 imputed datasets) with the remaining ones being excluded due to remittent asthma. Associations with current wheeze were performed on 1143 participants. Associations with incident asthma were performed on 911 to 920 participants (from the 20 imputed datasets), and those with incident wheeze were performed on 860 to 870 participants (from the 20 imputed datasets) with the remaining ones being excluded due to remittent asthma/wheeze, respectively. Participants with current asthma/wheeze were compared to those with no current asthma/wheeze at SOLAR 3. Participants with incident asthma/wheeze were compared to those with no asthma/wheeze from ISAAC Phase 2 to SOLAR 3.