Effect of exposure to detergents and other chemicals on biomarkers of pulmonary response in exhaled breath from hospital cleaners: a pilot study

Purpose

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).

Materials and 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_ENO) was measured online, and pH, ammonium (NH₄ ⁺), H₂O₂ 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_ENO 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). H₂O₂-EBC (0.26 0.09–0.53] μM vs. 0.07 0.04–0.15] μM; p < 0.01), NH₄ ⁺-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 NH₄ ⁺-EBC (r = 0.33, p < 0.05) and a weak correlation between 4-HNE-EBC and H₂O₂-EBC (r = 0.37, p < 0.05).

Conclusion

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 H₂O₂-EBC levels correlated with 4-HNE-EBC levels) in workers with no signs of airway diseases.