title: Impact of occupational exposures on exacerbation of asthma: a population-based asthma cohort study.
abstract: Asthma is a prevalent chronic disease and occupation contributes to approximately 15 % of cases among adults. However, there are still few studies on risk factors for work-exacerbated asthma. The current study investigated the association between asthma exacerbations and occupational exposures.
  
  
  
  The study comprised all currently working adults (n = 1356) who reported ever asthma in prior population-based cohorts. All subjects completed a questionnaire about exposures, occupations and exacerbations of asthma. Exposure to high and low molecular weight agents, irritating agents and asthmagens were classified using the asthma-specific job exposure matrix for northern Europe (N-JEM). Severe exacerbation of asthma was defined as sought emergency care at a hospital, admitted to a hospital overnight, or made an urgent visit to a primary care physician or district medical office due to breathing problems during the last 12 months. Moderate exacerbation was defined as both being not severe exacerbation and an additional visit to a primary care physician or district medical office, or had extra treatments with corticosteroid tablets. Mild exacerbation was defined as being neither severe nor moderate exacerbation, and increasing usage of inhaled corticosteroids. Multiple logistic regression was applied to investigate the association between exacerbation of asthma and occupational exposures while adjusting for potential confounders.
  
  
  
  Approximately 26 % of the working asthmatics reported exacerbation, and more than two-thirds of them had moderate or severe exacerbation. From 23 to 49 % of the asthmatics reported occupational exposure to a variety of different types of agents. Exposure to any gas, smoke or dust (OR 1.7[95 % CI 1.2-2.6]) was associated with severe exacerbation of asthma, as were organic dust (OR 1.7[1.2-2.5]), dampness and mold (OR 1.8[1.2-2.7]), cold conditions (OR 1.7[1.1-2.7]), and a physically strenuous job (OR 1.6[1.03-2.3]). Asthmagens and low molecular weight agents classified by the N-JEM were associated with mild exacerbation, with OR 1.6[1.1-2.5] and OR 2.2[1.1-4.4], respectively.
  
  
  
  Self-reported exposure to any gas, smoke or dust, organic dust, dampness and mold, cold conditions and physically strenuous work, and jobs handling low molecular weight agents were associated with exacerbation of asthma. Reduction of these occupational exposures may help to reduce exacerbation of asthma.
authors.affiliation: Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden. jeong-lim.kim@amm.gu.se.
authors.forename: Jeong-Lim
authors.initials: JL
authors.lastname: Kim
authors.affiliation: National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Henneberger
authors.affiliation: Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden.
authors.forename: Susanna
authors.initials: S
authors.lastname: Lohman
authors.affiliation: Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden.
authors.forename: Anna-Carin
authors.initials: AC
authors.lastname: Olin
authors.affiliation: Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Dahlman-Höglund
authors.affiliation: Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Andersson
authors.affiliation: Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden.
authors.forename: Kjell
authors.initials: K
authors.lastname: Torén
authors.affiliation: Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden.
authors.forename: Mathias
authors.initials: M
authors.lastname: Holm
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001249:Asthma / Q000453:epidemiology*; D015331:Cohort Studies; D018450:Disease Progression; D004391:Dust / Q000276:immunology; D005260:Female; D005658:Fungi / Q000276:immunology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D012307:Risk Factors; D057566:Self Report; D013548:Sweden; D017132:Workplace
chemical_list: D000305:Adrenal Cortex Hormones; D004391:Dust
keywords: Asthma; Exacerbation; Job exposure matrix; Occupational exposure; Work exacerbated asthma; Workplace