Occupational Asthma Caused by Quaternary Ammonium Compounds: A Multicenter Cohort Study

Area of Science:

• Occupational medicine
• Pulmonology
• Toxicology

Background:

• Quaternary ammonium compounds (QACs) are widely used in cleaning and disinfection.
• Previous reports suggest QACs can cause occupational asthma (OA) identified via bronchoprovocation tests (BPTs).

Purpose of the Study:

• To compare the clinical, functional, and inflammatory characteristics of QAC-induced OA with OA caused by other low-molecular weight (LMW) agents.
• To investigate the sensitizing potential of QACs in the development of OA.

Main Methods:

• Retrospective multicenter cohort study of 871 subjects with OA confirmed by positive BPT.
• Identified 22 subjects with QAC-induced OA and compared them to 289 subjects with OA from other LMW agents.
• Assessed bronchial hyperresponsiveness and sputum eosinophil counts.

Main Results:

• Most subjects with QAC-induced OA worked in healthcare.
• A higher proportion of subjects with QAC-induced OA showed increased bronchial hyperresponsiveness compared to other LMW agents.
• QAC-induced OA demonstrated significantly higher sputum eosinophil increases, indicating an eosinophilic airway response.

Conclusions:

• QAC-induced OA is characterized by a pronounced eosinophilic airway inflammation.
• This study provides strong evidence for the respiratory sensitizing properties of QACs.
• Highlights the diverse biological pathways underlying occupational asthma from LMW agents.