title: Effect of exposure to detergents and other chemicals on biomarkers of pulmonary response in exhaled breath from hospital cleaners: a pilot study.
abstract: OBJECTIVE
  The main aim of the study was to provide evidence whether professional cleaning was associated with biomarkers of lung damage in non-invasively collected biological fluids (exhaled air and exhaled breath condensate--EBC).
  
  
  METHODS
  This cross-sectional study involved 40 cleaners regularly exposed to cleaning detergents and 40 controls. The subjects completed a standard questionnaire from European Community Respiratory Health Survey (ECRHS II) and underwent a spirometry. Fractional exhaled nitric oxide (F(E)NO) was measured online, and pH, ammonium (NH(4) (+)), H(2)O(2) and 4-hydroxynonenal (4-HNE) were assayed in EBC.
  
  
  RESULTS
  Among the cleaners, the frequency of asthma and rhinitis was, respectively, 2.5 and 20%. The most frequently reported symptoms were sneezing (27.5%), nasal and/or pharyngeal pruritus (25%), ocular pruritus (22.5%) and cough (22.5%). There were no significant differences in comparison with the control group. Median F(E)NO levels were higher in African than in Caucasian cleaners (21.5 [16.5-30.0] ppb and 18.0 [13.5-20.5] ppb; p < 0.05). H(2)O(2)-EBC (0.26 [0.09-0.53] μM vs. 0.07 [0.04-0.15] μM; p < 0.01), NH(4) (+)-EBC (857 [493-1,305] μM vs. 541 [306-907] μM; p < 0.01) and pH-EBC (8.17 [8.09-8.24] vs. 8.06 [7.81-8.10]; p < 0.01) were higher in the cleaners than in the controls. Finally, the cleaners showed significant correlations between pH-EBC and NH(4) (+)-EBC (r = 0.33, p < 0.05) and a weak correlation between 4-HNE-EBC and H(2)O(2)-EBC (r = 0.37, p < 0.05).
  
  
  CONCLUSIONS
  The promising role of EBC analysis in biomonitoring of exposed workers was confirmed. It was also possible to identify the potential biomarkers of exposure to alkaline products (increased ammonium-EBC and pH-EBC levels) and potential biomarkers of oxidative stress (increased H(2)O(2)-EBC levels correlated with 4-HNE-EBC levels) in workers with no signs of airway diseases.
authors.affiliation: Laboratory of Industrial Toxicology, Department of Clinical Medicine, Nephrology and Health Sciences, University of Parma, Via Gramsci 14, 431 00, Parma, Italy. massimo.corradi@unipr.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Corradi
authors.forename: Petra
authors.initials: P
authors.lastname: Gergelova
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Di Pilato
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Folesani
authors.forename: Matteo
authors.initials: M
authors.lastname: Goldoni
authors.forename: Roberta
authors.initials: R
authors.lastname: Andreoli
authors.forename: Luisella
authors.initials: L
authors.lastname: Selis
authors.forename: Antonio
authors.initials: A
authors.lastname: Mutti
mesh_terms: D000447:Aldehydes / Q000032:analysis*; D001249:Asthma / Q000453:epidemiology; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests; D003430:Cross-Sectional Studies; D003902:Detergents / Q000009:adverse effects*; D045853:Exhalation; D005260:Female; D006801:Humans; D006861:Hydrogen Peroxide / Q000032:analysis*; D006863:Hydrogen-Ion Concentration; D008168:Lung / Q000473:pathology*; D008297:Male; D009569:Nitric Oxide / Q000032:analysis*; D009784:Occupational Diseases / Q000453:epidemiology; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D010865:Pilot Projects; D012140:Respiratory Tract Diseases / Q000139:chemically induced* / Q000453:epidemiology; D012220:Rhinitis / Q000139:chemically induced / Q000453:epidemiology; D013147:Spirometry; D011795:Surveys and Questionnaires
chemical_list: D000447:Aldehydes; D015415:Biomarkers; D003902:Detergents; D009569:Nitric Oxide; D006861:Hydrogen Peroxide; C027576:4-hydroxy-2-nonenal