Regular use of chemical disinfectants and cleaning products may be a risk factor for developing chronic obstructive pulmonary disease (COPD) in nurses, according to research results published in JAMA Network Open

The study included women from the Nurses’ Health Study II who were working as nurses and had no history of COPD prior to 2009. Information on the types of nursing job, general disinfection tasks, and the use of disinfectant sprays was obtained via biennial questionnaires. Disinfectants and cleaning products were broken down into 7 categories: formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide, alcohol, quaternary ammonium compounds, and enzymatic cleaners. The frequency of cleaning or spray use was also examined.

A total of 73,262 women were eligible for analysis (mean age, 54.7±4.6 years; 96% white) of whom 5.7% were current smokers. Participants were asked to report any diagnosed condition(s) that had occurred since the previous questionnaire cycle, including emphysema or chronic bronchitis. This information was used to identify incident cases of physician-diagnosed COPD from 2009 to 2015.

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“Occupational exposure to cleaning products and disinfectants was significantly associated with a 25% to 38% increased risk of developing chronic obstructive pulmonary disease independent of asthma and smoking,” wrote the researchers. 

Based on 368,145 person-years of follow-up, 582 nurses reported physician-diagnosed COPD. A total of 16,786 of the nurses (22.9%) reported weekly use of disinfectants to clean surfaces only, and 13,899 (19.0%) reported weekly use to clean medical instruments; both were associated with an increased risk for  COPD (hazard ratios [HR] 1.38 and 1.31, respectively).

High-level exposure to 5 specific disinfectants (glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quaternary ammonium compounds) was significantly associated with COPD incidence (HRs 1.25 to 1.36). Associations with COPD were not modified by smoking or asthma status.

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“Further research is needed to better establish a causal link between exposure to cleaning products and disinfectants and COPD development,” the investigators concluded. “Nonetheless, clinicians should be aware of this new risk factor and systematically look for sources of exposure to cleaning products and disinfectants in addition to other occupational exposures in patients with COPD.”


Dumas O, Varraso R, Boggs KM, et al. Association of occupational exposure to disinfectants with incidence of chronic obstructive pulmonary disease among US female nurses. JAMA Netw Open. 2019;2(10):e1913563.