Nicole Le Moual has strong expertise in epidemiology of occupational respiratory diseases and has developed a research program on both the etiological role of occupational exposures and methodological aspects. She has extensive expertise in the development of various methods to assess occupational exposures, both in the occupational setting and in population surveys. Regarding job-exposure matrix (JEM) research, she has developed strong international collaborations with specialists in exposure assessment in Canada (Asthma-specific JEM), the Netherlands (ECOJEM and Van Gogh projects; a new Occupational Asthma-specific JEM (OAsJEM)) and USA (R01 OH-10359, PI Camargo, on exposure to disinfectants or cleaning products and asthma in the NHSII, for which she served as co-PI). Her research projects strongly contributed to the recently recognized deleterious role of occupational exposures especially to cleaning agents in asthma. She obtained, as PI, many grants to improve the assessment of occupational exposures to disinfectants and cleaning agents and to study their associations with asthma among adults and young children. She has 25-years experience working in epidemiology of occupational and environmental respiratory diseases with two complementary topics on methodological and etiological aspects, with an extensive contribution to four specific research questions described above.
A first methodological topic is to improve evaluation of occupational and domestic exposures especially to disinfectants and cleaning agents. The team has strongly contributed to the creation of innovative exposure assessment tools at international level. In the context of a European project, she has created a population-based JEM for COPD. In addition, she was strongly involved in the development of the first asthma-specific JEM (http://asthmajem.vjf.inserm.fr/), an international reference in the field and she has leaded its update (OAsJEM; PHC Van Gogh grant; PI), through international collaboration (http://oasjem.vjf.inserm.fr). She has leaded an expert assessment of occupational exposures, for healthcare workers in France, which shown an under estimation of self-reported exposures by hospital workers compared to expert evaluation. Assessment of exposure is generally based on self-report, which may generate a differential misclassification bias. Therefore, the development of accurate tools of assessment is an important and timely issue. She has leaded the creation of a Job-Task-Exposure Matrix, a new tool to evaluate occupational exposure to disinfectants and cleaning agents among NHSII nurses (http://nursesjem.vjf.inserm.fr/). She has also developed an innovative tool through a barcode-based exposure assessment method to evaluate occupational exposure to cleaning products and disinfectants. These two last projects were performed by a PhD student she has supervised.
A second topic is to evaluate the impact of healthy worker effect in the associations between exposures and diseases. The team has extensively contributed to recent international publication on this topic. They have underlined that the healthy worker effect may be important in asthma. They have shown that selection bias both at hire and during life were important and may underestimate associations between exposures and the disease. Some of these projects were performed by Orianne Dumas during her thesis she has co-supervised.
Regarding etiological aspects, her epidemiological projects have contributed to a better understanding of the complex mechanisms of occupational asthma, especially for irritant-induced asthma. The team evidenced a deleterious role of occupational exposure on asthma, especially for cleaning agents. She showed for the first time in the literature that occupational exposures to asthmagens relate not only to adult-onset asthma, but also to asthma severity (in the French Epidemiological study on the Genetics and Environment of Asthma (EGEA)), and to asthma control (in the European Community Respiratory Health Study (ECRHS)). In a large Estonian study, the team showed a significant increased risk of current asthma among workers with lifetime exposure to low to moderate level of irritants. These results, which are consistent with those from the French EGEA study, strengthened the evidence of a role of long-term low to moderate exposures to irritants in work-related asthma. In addition, her early publications suggested the deleterious effect of occupational exposures to detergents on lung function in both men and women from a large French study.
She is in charge of another important topic on the role of household exposure to disinfectants and cleaning agents in asthma and related phenotypes (severity, control, inflammatory and allergic characteristics). The team are one of the most recognized epidemiological team at international level working on this topic. Cleaning agents and disinfectants are used commonly at particularly high-level among healthcare workers and cleaners and contain various chemicals, which may be irritants (e.g. bleach, ammonia) or sensitizers (e.g. perfumes). The team evidenced their adverse role in asthma at workplace with consistent findings for household exposure among both young adults and elderly women. She supervised the work of PhD students on these projects.