Original Article
Household Cleaning and Poor Asthma Control Among Elderly Women

https://doi.org/10.1016/j.jaip.2021.02.022Get rights and content

Background

Asthma control is suboptimal in nearly half of adults with asthma. Household exposure to disinfectants and cleaning products (DCP) has been associated with adverse respiratory effects, but data on their association with asthma control are scant.

Objectives

To investigate the association between household use of DCP and asthma control in a large cohort of French elderly women.

Methods

We used data from a case-control study on asthma (2011-2013) nested in the E3N cohort. Among 3023 women with current asthma, asthma control was defined by the Asthma Control Test (ACT). We used a standardized questionnaire to assess the frequency of cleaning tasks and DCP use. We also identified household cleaning patterns using a clustering approach. Associations between DCP and ACT were adjusted for age, smoking status, body mass index, and education.

Results

Data on ACT and DCP use were available for 2223 women (70 ± 6 years old). Asthma was controlled (ACT = 25), partly controlled (ACT = 20-24), and poorly controlled (ACT ≤ 19) in 29%, 46%, and 25% of the participants, respectively. Weekly use of sprays and chemicals was associated with poorly controlled asthma (odds ratio [95% confidence interval]: 1 spray: 1.31 [0.94-1.84], ≥2 sprays: 1.65 [1.07-2.53], P trend: .01; 1 chemical: 1.24 [0.94-1.64], ≥2 chemicals: 1.47 [1.03-2.09], P trend: .02). Risk for poor asthma control increased with the patterns “very frequent use of products” (1.74 [1.13-2.70]) and “infrequent cleaning tasks and intermediate use of products” (1.62 [1.05-2.51]).

Conclusion

Regular use of DCP may contribute to poor asthma control in elderly women. Limiting their use may help improve asthma management.

Section snippets

Population

The E3N study, initiated in 1990, is a prospective cohort among women affiliated to the Mutuelle Générale de l'Education Nationale, a French national health insurance plan covering mostly teachers.28 A total of 98,997 women aged 40 to 65 years were included at baseline and have been followed up approximately every 2 years since. The current analysis uses data from a nested case-control study on asthma (Asthma-E3N) conducted in 2011 to 2013.23,29,30 A total of 7100 women with asthma (positive

Results

Among the 7100 women with ever asthma invited to participate, 6274 (88%) returned the questionnaire, of whom 3023 had current asthma (Figure 1). Women with missing data for all questions on household cleaning (n = 18), smoking status (n = 25), or asthma control (n = 747) were excluded. This yielded a population of 2233 women eligible for analyses. Participants were 69.7 years old on average, 46% were ex-smokers and 4% were current smokers, 13% had a BMI ≥30 kg/m2, and 37% had a high education

Discussion

In this study of 2223 elderly women with asthma, self-reported weekly use of at least 2 types of sprays or at least 2 types of chemicals for home cleaning was associated with poor asthma control. In addition, a household cleaning pattern with very frequent use of multiple DCP was associated with poor asthma control.

Our results are consistent and extend results from the only other study that examined the association between use of cleaning sprays at home and asthma control. In this previous

Acknowledgments

The authors would like to thank the E3N team and especially M. Fangon, M. Niravong, L. A. Hoang, M. Valdenaire, S. Eltaief, R. Gomes, F. Wilm, C. Kernaleguen, W. Tello, C. Laplanche, P. Gerbouin-Rérolle, R. Chaït, G. Esselma, and F. Clavel-Chapelon (Inserm U1018 CESP, Villejuif, France) for the implementation and management of the E3N study. They are indebted to all participants, without whom the study would not have been possible, for their high involvement in the E3N study.

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    This work was supported by the Institut pour la Recherche en Santé Publique (IRESP), and the joint help of Direction Générale de la Santé (DGS), the Mission recherche de la Direction de la Recherche, des Etudes, de l’Evaluation et des Statistiques (Mire-DREES), the Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), Régime Social des Indépendants (RSI), and Caisse nationale de solidarité pour l'autonomie (CNSA). The E3N-E4N cohort is supported by the Mutuelle Générale de l'Education Nationale (MGEN), the French League against Cancer (LNCC), Gustave Roussy, and the French Research Agency (ANR grant, ANR-10-COHO-0006). ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program.

    Conflicts of interest: The authors declare that they have no relevant conflicts of interest.

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