Nurses who regularly use disinfectants to clean surfaces could be at increased risk of developing chronic obstructive pulmonary disease, researchers announced on Monday.

The findings come from a study of more than 55,000 registered nurses in the United States, conducted by researchers with the French National Institute of Health and Medical Research. The study followed nurses with no history of COPD from 2009 to 2017, to determine if there was a link between disinfectant use and the disease.

The researchers found that nurses who used disinfectants to clean surfaces and medical instruments at least once a week had around a 22% increased risk of COPD. That risk increased as much as 32% for certain disinfectants.

The study’s authors noted their findings are preliminary and only point to an association — not a direct cause — between use of the chemicals and developing COPD. But the research still raises important questions about disinfectant use by healthcare workers, lead researcher Orianne Dumas, Ph.D., said in a statement.

“To the best of our knowledge, we are the first to report a link between disinfectants and COPD among healthcare workers, and to investigate specific chemicals that may underlie this association,” Dumas said. “Our findings provide further evidence of the effects of exposure to disinfectants on respiratory problems, and highlight the urgency of integrating occupational health considerations into guidelines for cleaning and disinfection in healthcare settings.”

The study’s full findings were presented Monday at the European Respiratory Society International Congress.