A bottle of cleaning solution looks the same whether it’s protecting a hospital floor or slowly wearing down the lungs of the person applying it. Every day, millions of workers rely on cleaning and disinfecting products to keep our buildings safe. But what do those products do to the people using them?

A growing body of peer-reviewed research spanning seven major studies and nearly 200,000 workers offers a clear, if incomplete, answer: Occupational exposure to cleaning products is consistently linked to elevated risk of asthma, chronic lung disease, and declining lung function.

The Center for Evidence-Based Cleaning (CEBC) and the Making Safer Choices program reviewed the science on cleaning products; workers’ respiratory health; and how the facility, distributor, and manufacturer communities can help close the remaining gaps.

A higher asthma risk

A research team led by Olia Archangelidi set out to answer a deceptively simple question: How much does working as a cleaner affect your respiratory health? They combed through 1,124 studies to find an answer. The result, published in Occupational and Environmental Medicine in 2021, is one of the most comprehensive syntheses of the field to date: a systematic review of 39 studies, with 21 combined into a formal meta-analysis of asthma outcomes.

Working as a cleaner was found to be associated with a 50% increased risk of asthma (meta-relative risk RR 1.50) and a 43% increased risk of chronic obstructive pulmonary disease (COPD) (meta-RR 1.43).

The most likely culprits

If the Archangelidi review left us wanting agent-level detail, a parallel 2021 review from Karla Romero Starke and colleagues, published in the International Journal of Environmental Research and Public Health, starts to fill that gap, at least for healthcare workers. This systematic review and meta-analysis pulled together 14 studies focused specifically on nurses and healthcare professionals who clean and disinfect as part of their jobs.

In healthcare settings, bleach and glutaraldehyde stand out as specific culprits.

Nurses exposed to bleach had more than double the asthma risk (RR 2.44); glutaraldehyde exposure nearly doubled it as well (RR 1.91). Overall, nurses had a 67% higher risk of new-onset asthma compared to other occupations.

A broader look at hospital workers confirmed the pattern—and the blind spots.

A third systematic review, led by Kelly Dang and published in Health Science Reports in 2022, widened the lens beyond nurses to hospital workers more broadly, including respiratory therapists, physiotherapists, and general hospital staff who perform cleaning and disinfecting tasks.

Screening 2,549 articles down to 34 eligible studies, with 10 pooled into a formal meta-analysis, the review found a 35% increased risk of asthma and asthma-like symptoms among cleaning-exposed hospital workers (meta-RR 1.35). A finding consistent with, if somewhat more moderate than, the Romero Starke results.

The exposure here remained broadly defined: general use of occupational cleaning and disinfecting products in a hospital setting, without the agent-level specificity of the Romero Starke review.

COPD risk—independent of smoking

Not every strong study in this field is a review of other studies. Some of the most compelling evidence comes from large original cohort research. And none is larger or more rigorous than the Nurses’ Health Study II analysis published by Orianne Dumas and colleagues in JAMA Network Open in 2019. It was the largest study yet of over 73,000 nurses showing that disinfectants raise COPD risk—independent of smoking.

This wasn’t a meta-analysis pooling old data; it was a fresh, prospective look at 73,262 U.S. female nurses tracked over six years and 368,145 person-years of follow-up. The researchers used a validated job-task-exposure matrix to assign real exposure levels to seven common disinfectants. Not job titles.

Nurses who used disinfectants weekly had a 35% increased risk of developing COPD (Adjusted Hazard Ratio 1.35) independent of asthma and smoking, with a clear dose-response relationship between frequency of use and risk.

Specific agents—glutaraldehyde, bleach, hydrogen peroxide, alcohol, and quaternary ammonium compounds—were each independently associated with increased COPD risk. Critically, this association held up even after adjusting for smoking and pre-existing asthma, meaning disinfectant exposure appears to be an independent risk factor for COPD, not simply a marker for something else.

Cleaning—a high-risk occupation

Sometimes the clearest evidence comes from stepping back and comparing cleaning work against dozens of other occupations at once.

That’s what Linnéa Lillienberg and colleagues did with the RHINE study (Respiratory Health in Northern Europe), tracking 13,284 adults across five countries—Denmark, Estonia, Iceland, Norway, and Sweden—from the early 1990s through 2001, then reconstructing occupational exposure history back to 1980. This European study found that cleaners are among the highest-risk occupations.

Men in cleaning occupations had more than 2.6 times the asthma risk of workers in reference occupations; among men without a personal history of allergies, that risk climbed to over four times higher.

Among all the occupations studied, cleaners and building caretakers ranked among the highest-risk groups for new-onset asthma. Women showed a similarly elevated, if somewhat less dramatic, pattern.

An important study

Most of the studies in this review are asking, in one form or another, “Is cleaning-related asthma risk real?” A 2024 study from Jenil Patel and a University of Texas research team asks a different, more actionable question: Has anything changed?

The team resurveyed the Texas healthcare workforce—physicians, nurses, respiratory and occupational therapists, and nurse aides—14 years after an original 2003 study by many of the same investigators. Nearly 10,000 workers were sampled, with 2,421 completing the survey.

The headline finding: Not much had changed. The risk had not gone away.

Building surface cleaning (odds ratio OR 1.91), bleach/quaternary compounds (OR 1.91), spray products (OR 1.97), and disinfectants like ortho-phthalaldehyde (OR 1.77) were significantly associated with new-onset asthma (prevalence rate 6.7%) and bronchial hyperresponsiveness symptoms (prevalence rate 31.1%) in 2016 and statistically similar to 2003 levels.

Cleaning’s toll on lung function after 20 years

Øistein Svanes and an international team drew on the European Community Respiratory Health Survey (ECRHS), a population followed at three points over two decades, to ask a fundamental question: Does cleaning work actually change how well your lungs function over time, not just whether you develop asthma?

Among 6,235 participants with repeated lung function measurements, the answer was yes—but only for women. The exposure again centered on cleaning sprays and general cleaning agents, assessed by questionnaire rather than direct measurement, spanning both home and occupational settings.

Women who cleaned at home or worked as occupational cleaners saw their lung function (FEV1) decline roughly 22 mL per year, notably faster than the 18.5 mL per year decline seen in women who didn’t clean; an effect comparable to smoking 10 to 20 cigarettes daily.

Twenty years of data on cleaning showed that the lung function of women was as if they smoked a pack a day.

What do these studies add up to?

Across every study design—systematic reviews, meta-analyses, and large prospective cohorts alike—occupational exposure to cleaning and disinfecting products is consistently associated with an elevated risk of asthma, COPD, and accelerated lung function decline.

Of these studies and nearly 200,000 workers, three themes cut across nearly all seven:

1. Exposure measurement remains the field’s biggest weakness. Most of these studies define “exposure” by job title or occupation rather than by what a worker actually breathed.
2. Certain products and chemical classes recur again and again as likely culprits. Bleach, glutaraldehyde, ortho-phthalaldehyde, quaternary ammonium compounds. Spray application appears repeatedly as an independent risk factor distinct from the underlying chemical itself, suggesting that how a product is applied matters as much as what’s in it—a detail with real, practical implications for training and protocol design.
3. Whole populations of cleaning workers are essentially missing from this literature. Nurses and healthcare workers are comparatively well studied; commercial and institutional cleaning staff, hospitality and janitorial workers, and school custodial staff are not. And almost none of these studies can put a dollar figure on the resulting burden of missed work, turnover, and healthcare costs, even though the health signal is strong enough to suggest that burden is real.

Where the CEBC comes in

The Center for Evidence-Based Cleaning was established to be the translation layer between the kind of research reviewed in this article and the daily decisions made on the floor of the buildings where cleaning happens. The CEBC’s model creates value for everyone at the table.

• Studying real products and real practices—not just occupational categories—inside working facilities, in partnership with building service contractors (BSCs), distributors, and facility management teams.
• Measuring actual exposures—air sampling, task-level monitoring, and product-use data—to finally answer the “what exactly caused this” question that nearly every study in this review left open.
• Expanding the populations studied, particularly in commercial and institutional cleaning sectors that remain underrepresented relative to healthcare settings.
• Tracking outcomes over time, in partnership with the same facilities and workforces, to build the kind of longitudinal evidence base that currently barely exists outside a handful of nursing cohorts.
• Translating findings into practice. Helping manufacturers evaluate formulation choices, helping BSCs and facility managers make informed product and protocol decisions, and helping workers and their employers understand real, evidence-based risk rather than anecdote or marketing claims.

The science reviewed here spans nearly two decades and close to 200,000 workers. What’s needed now isn’t more proof that the problem exists. It’s the applied, industry-embedded research that turns “we know this happens” into “here’s exactly what to change.”

What the studies haven’t told us yet is which specific interventions—product reformulation, application method changes, ventilation improvements, training, personal protective equipment (PPE)—actually move the needle. That’s the next chapter, and it’s one CEBC intends to help write, with direct input from the industry.