Airway diseases related to the use of cleaning agents in occupational settings.

Exposure to disinfectants and cleaning products (DCP) is now a well-established risk factor for work-related asthma (WRA). However, questions remain on the specific causal agents and pathophysiological mechanisms. Few studies have also reported an association between DCP and rhinitis or chronic obstructive pulmonary disease. This review discusses the recent evidence pertaining to airway diseases attributable to occupational exposure to DCP. In contrast to other agents, the incidence of WRA due to DCP has increased over time. The use of DCP in spray form has clearly been identified as an added risk factor. The mechanisms for WRA associated with DCP remain poorly studied, however, both allergic and nonallergic responses have been described, with irritant mechanisms thought to play a major role. An early diagnostic work-up based on clinical assessment accompanied by evaluation of lung function, immunological and airway inflammatory markers is important to guide optimal care and exposure avoidance to the implicated agent. Future research should focus on the effects of "green" products, pathophysiological mechanisms and quantitative exposure assessment including the use of barcode-based methods to identify specific agents. There is an urgent need to strengthen preventive measures and interventions to reduce the burden of airway diseases associated with DCP.