Cleaning’s Hidden Threat: The Link Between Common Products and Occupational Asthma

Exploring the connection between widely used cleaning agents and the surge in respiratory issues among cleaning and maintenance workers, and why safer practices and greater awareness in workplace settings are needed.

• By Christine Robinson
• Oct 11, 2023

Asthma is a non-communicable, chronic respiratory disease characterized by inflammation and narrowing of the airways. Affecting approximately 360 million people worldwide, asthma is often developed in childhood and can be caused by environmental factors (allergens), viral infections and/or family history, according to the National Heart, Lung and Blood Institute (www.nhlbi.nih.gov/health/asthma). 

The Centers for Disease Control and Prevention estimates that 17 percent of all adult-onset asthma cases in the United States are related to occupational exposures. A variation of asthma, “occupational asthma,” has become a public health issue. More than 400 agents are associated with occupational asthma. While a number of factors contribute to the development of occupational asthma, the use of cleaning and disinfecting products in the workplace has emerged as a significant source of exposure. 

Asthma and Cleaning Products

Several studies have suggested a higher prevalence of asthma among cleaning and maintenance workers compared to other occupational groups. A study published in the American Journal of Respiratory and Critical Care Medicine found that professional cleaning work was associated with an increased risk of adult-onset asthma (Mapp, Boschetto, Maestrelli, & Fabri, 2005).  

Another study published in the Scandinavian Journal of Work, Environment & Health reported a higher risk of asthma among cleaning professionals, particularly among those exposed to specific cleaning agents such as bleach and ammonia (Sejbaek et. al., 2022). Cleaning and maintenance workers often have direct and prolonged exposure to cleaning products, thus increasing their exposure and risk of developing respiratory diseases like asthma. 

Cleaning products play an important role in maintaining cleanliness and hygiene in the workplace. The use of such products was never more prevalent than during the recent pandemic; however, it’s troubling to learn that many of the chemicals found in cleaning products used to protect us from other diseases can induce asthma. This emphasizes the importance of understanding exposure risks to workers. Low-moderate exposures to inhalation irritants repeatedly can cause workers to develop asthma over time.

Volatile organic compounds (VOCs), or chemicals that can vaporize into the air, are prevalent in most cleaning products, from air fresheners to disinfectant sprays and wipes to window and glass cleaners, and even carpet cleaners. Commonly found chemical compounds in these products include formaldehyde, benzene, toluene, ammonia, sodium hypochlorite, and chlorine. Additionally, fragrances and perfumes may contain a mixture of chemicals, including phthalates, alcohols, and synthetic musks, that can also irritate the respiratory tract. 

VOCs can irritate the respiratory system, leading to asthma symptoms. Prolonged exposure to VOCs can also contribute to the development of asthma in individuals previously unaffected by the condition. For example, ammonia is a highly effective cleaning agent found in many household and industrial cleaners, especially glass and window cleaners. Although ammonia evaporates quickly, it can irritate the respiratory system when inhaled, leading to coughing, wheezing, and shortness of breath. Prolonged exposure to ammonia can cause chemical-induced asthma, particularly in individuals with pre-existing respiratory conditions. 

Sodium hypochlorite, commonly known as bleach, is a powerful disinfectant found in many cleaning products. While bleach is effective at killing bacteria and viruses, inhaling its fumes can irritate the airways and trigger asthma symptoms. Individuals with asthma are particularly sensitive to the effects of bleach, and prolonged exposure can worsen their condition or induce asthma in previously unaffected individuals.

Many cleaning products contain fragrances and perfumes to impart a pleasant scent; however, these fragrances often consist of a complex mixture of chemicals, including phthalates and synthetic musks, which can cause respiratory irritation and trigger asthma attacks. Individuals with asthma or other respiratory conditions should be cautious when using scented cleaning products.

Formaldehyde is a commonly used disinfectant found in cleaning products such as dishwashing liquids and furniture polishes. Prolonged exposure to formaldehyde can also lead to the development of asthma and other respiratory disorders.

Chlorine is a strong disinfectant commonly found in household bleach and toilet bowl cleaners. Inhalation of chlorine fumes can irritate the respiratory system, leading to coughing, wheezing, and chest tightness. Individuals with asthma are particularly susceptible to the effects of chlorine, and exposure to high concentrations can cause severe asthma attacks.

What Can Be Done?

To mitigate the risk for cleaning and maintenance workers, it’s important to bring awareness to respiratory risks and implement a program that reduces exposure. When selecting products for cleaning, choose fragrance-free alternatives, select low-VOC products, and consider natural alternatives. Companies also can: 

• Provide workers with personal protective equipment while paying close attention to respiratory protection. 
• Ensure that properly ventilated workspaces are available.  
• Provide workers with training and awareness for safe handling and use of cleaning products.  
• Make safety data sheets available for all cleaning products.  
• Consider implementing regular respiratory screening and medical monitoring for all cleaning and maintenance workers.  

Companies and workers should always remember early detection and management are important for improved health outcomes.

Implications for Public Health

Asthma is one of the greatest contributors to the global burden of respiratory diseases. Nearly 4 million people die prematurely from respiratory diseases each year, while hundreds of millions more suffer from respiratory diseases (Ferkol & Schraufnagel, 2014). Reducing exposure risks is one way to avoid the development of respiratory illness and relieve the burden.

The economic impact of asthma is astounding as the costs of medical care, absenteeism, and deaths figure at nearly $82 million a year for businesses in the United States. (Tiotui et al, 2020). Globally, 180,000 deaths are attributed to asthma each year (Ferkol & Schraufnagel, 2014), but the greatest problem is morbidity and quality of life. It is estimated that about 40 million people in the United States suffer from asthma (Nunes, Pereira, & Marais-Almeida, 2017). The average cost of treating one patient annually is $3,266. Approximately 8.7 million workdays are missed annually due to asthma (Toitui et al., 2020). 

From an economic standpoint, public health policies can have a significant impact on adult-onset occupational asthma by addressing preventable risk factors such as exposure to indoor environmental air pollutants.

In Conclusion

Maintaining cleanliness in offices is essential, but it’s not without its risks to cleaning and maintenance workers. The increased risk of asthma in the workplace is a significant concern for workers across various industries. 

It is important to be aware of the potential risks associated with common cleaning products. Aerosol sprays, disinfectant wipes, window and glass cleaners, carpet cleaners, and fragranced cleaning products are among the common products that can increase the risk of occupational asthma. Implementing a program of choosing safer alternatives, improving ventilation, ensuring proper use of respiratory projection, providing training on the proper use of cleaning products, and instituting medical monitoring can help minimize the risk and create a healthier work environment for all workers. 

Employers, regulatory bodies, and workers should collaborate in implementing preventative measures. By prioritizing respiratory health and raising awareness, the risk of workers developing occupational asthma can be mitigated.

This article originally appeared in the October 2023 issue of Occupational Health & Safety.