title: Respiratory Health in Cleaners in Northern Europe: Is Susceptibility Established in Early Life?
abstract: BACKGROUND
  There is some evidence that maternal smoking increases susceptibility to personal smoking's detrimental effects. One might question whether early life disadvantage might influence susceptibility to occupational exposure.
  
  
  OBJECTIVE
  In this cross-sectional study we investigated respiratory symptoms, asthma and self-reported chronic obstructive pulmonary disease (COPD) as related to working as a cleaner in Northern European populations, and whether early life factors influenced susceptibility to occupational cleaning's unhealthy effects.
  
  
  METHODS
  The RHINE III questionnaire study assessed occupational cleaning in 13,499 participants. Associations with respiratory symptoms, asthma and self-reported COPD were analysed with multiple logistic regressions, adjusting for sex, age, smoking, educational level, parent´s educational level, BMI and participating centre. Interaction of occupational cleaning with early life disadvantage (maternal smoking, severe respiratory infection <5 years, born during winter months, maternal age at birth >35 years) was investigated.
  
  
  RESULTS
  Among 2138 ever-cleaners the risks of wheeze (OR 1.4, 95% CI 1.3-1.6), adult-onset asthma (1.5 [1.2-1.8]) and self-reported COPD (1.7 [1.3-2.2]) were increased. The risk increased with years in occupational cleaning (adult-onset asthma: ≤1 year 0.9 [0.7-1.3]; 1-4 years 1.5 [1.1-2.0]; ≥4 years 1.6 [1.2-2.1]). The association of wheeze with cleaning activity ≥4 years was significantly stronger for those with early life disadvantage than in those without (1.8 [1.5-2.3] vs. 1.3 [0.96-1.8]; pinteraction 0.035).
  
  
  CONCLUSIONS
  Occupational cleaners had increased risk of asthma and self-reported COPD. Respiratory symptom risk was particularly increased in persons with factors suggestive of early life disadvantage. We hypothesize that early life disadvantage may increase airway vulnerability to harmful exposure from cleaning agents later in life.
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Øistein
authors.initials: Ø
authors.lastname: Svanes
authors.affiliation: Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Trude Duelien
authors.initials: TD
authors.lastname: Skorge
authors.affiliation: Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
authors.forename: Ane
authors.initials: A
authors.lastname: Johannessen
authors.affiliation: Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Randi Jacobsen
authors.initials: RJ
authors.lastname: Bertelsen
authors.affiliation: Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
authors.forename: Magne
authors.initials: M
authors.lastname: Bråtveit
authors.affiliation: Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Forsberg
authors.affiliation: Department of Respiratory Medicine and Sleep, National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: Thorarin
authors.initials: T
authors.lastname: Gislason
authors.affiliation: Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Mathias
authors.initials: M
authors.lastname: Holm
authors.affiliation: Department of Medical Sciences, Occupational and Environmental Medicine, University of Uppsala, Uppsala, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Janson
authors.affiliation: Lung Clinic, Tartu University Hospital, Tartu, Estonia.
authors.forename: Rain
authors.initials: R
authors.lastname: Jögi
authors.affiliation: Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Macsali
authors.affiliation: Department of Medical Sciences, Occupational and Environmental Medicine, University of Uppsala, Uppsala, Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Norbäck
authors.affiliation: Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
authors.forename: Ernst Reidar
authors.initials: ER
authors.lastname: Omenaas
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway.
authors.forename: Francisco Gómez
authors.initials: FG
authors.lastname: Real
authors.affiliation: Department of Public Health, Section for Environment, Occupation and Health, Aarhus University, Aarhus, Denmark.
authors.forename: Vivi
authors.initials: V
authors.lastname: Schlünssen
authors.affiliation: Department of Public Health, Section for Environment, Occupation and Health, Aarhus University, Aarhus, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Sigsgaard
authors.affiliation: Department of Medical Sciences, Occupational and Environmental Medicine, University of Uppsala, Uppsala, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Wieslander
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
authors.forename: Jan-Paul
authors.initials: JP
authors.lastname: Zock
authors.affiliation: Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Tor
authors.initials: T
authors.lastname: Aasen
authors.affiliation: Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Basel, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Dratva
authors.affiliation: Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Centre for International Health, University of Bergen, Bergen, Norway.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Svanes
mesh_terms: D004198:Disease Susceptibility; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012140:Respiratory Tract Diseases / Q000453:epidemiology*