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Background Water based paint has improved the work environment during occupational as well as domestic painting. Development of water-based paint formulations demanded an addition of anti-fungal/anti-microbial preservatives, and isothiazolinones (ITZ) have been frequently utilized over the last two decades. Isothiazolinones are known to cause skin sensitization and is furthermore suspected to cause problems from the respiratory tract. To assess professional painters’ exposure to air-borne ITZ, there is a need to develop an easy-to-use light-weight portable sampling technique of the three most abundant ITZ. Method Three different designs of SPE-samplers and three different chemistries were evaluated regarding resistance to flow, handling during sampling, analyte break-through and sample elution. The quantification was performed using RP-HPLC-UV. Results SPE-samplers are easy-to-use in a field setting. However, only the novel disc-type designs of SPE worked with the portable pumps because of the relatively low pressure drop over the disc. SPE disks can be obtained either as a syringe-type or as a filter-type. While the syringe-type can be used straight away the filter-type has to be mounted in a sampler. However, the latter design outperformed the former regarding sampling as well as elution procedure. Conclusion The novel design of SPE-discs works well for sampling of ITZ down to 1 nmol/m3 (0.15 µg/m3) when sampling for 8 hours. It is thereby possible to assess workers’ exposure to air concentrations of ITZ previously reported using impinger flasks.

Background Airway obstruction is a key feature of asthma and chronic obstructive pulmonary diseases (COPD). Smoking habits and workplace exposures to vapors, gas, dusts, and fumes (VGDF) could cause or exacerbate airway obstruction. The aim of this study is to evaluate the risk of airway obstruction due to smoking and workplace exposure, and their interaction, in a large population-based study. Methods In this cross-sectional study, a sample (n = 6153) of the Swedish population aged between 24 and 76 years underwent a questionnaire, clinical examination, blood test, and spirometry to gather information on airway obstruction classified by Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria or American Thoracic Society (ATS)/European Respiratory Society (ERS) criteria, risk factors, and confounders. Occupational exposures to VGDF were rated according to a specific job-exposure matrix. Adjusted logistic regression models were used to evaluate risk factors for airway obstruction in smokers and nonsmokers. Results In total, 9.8% had airway obstruction by GOLD criteria and 10.3% by ATS/ERS. Smokers with a high likelihood of exposure to VGDF had a higher risk of airway obstruction than those not exposed (odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.15-2.65 by GOLD; OR: 1.58, 95% CI: 1.06-2.37 by ATS/ERS) especially those >50 years of age. In smokers highly exposed to VGDF, risk estimates were higher than in the whole population, and the interaction between high exposure to VGDF and smoking further increased the risk of airway obstruction. Conclusions This study suggests a possible role for interaction between cigarette smoking and VGDF exposure on the risk of airway obstruction.

Introduction: Solar radiation exposure is a relevant risk factor in many occupational activities and a widespread occupational carcinogen. A proper quantitative assessment of ultra violet (UV) exposure levels in different occupations is among the main issues for an adequate risk evaluation and prevention. Material and Methods: Within the “Exposome Project for Health and Occupational Research” (EPHOR), three expert groups, i.e. for Northern, Central and Southern Europe, including 10 individual assessors, independently evaluated the probability and duration of daytime outdoor work between April and September for all occupations of the International Standard Classification of Occupations 88 (ISCO-88). The assessment is a multi-step process, in order to reach final European expert scores for the three regions. All 390 ISCO-88 occupations have been rated by the assessors, within four categories of a) 0 ; >0 to 0 to 2 ; >2 to 4 ; >4 hours respectively for probability and duration of current outdoor work. Results: The results of the first round of assessment of the three groups have shown good agreement between assessors for the low and high categories and ranged between 0.48 and 0.64 both with respect to probability and duration. The overall interrater agreements ranged between 0.43 and 0.48 across the three European regions. Conclusion: This effort will finally aim at building a quantitative job exposure matrix (JEM) for a detailed evaluation of occupational solar UV radiation exposure in different occupations, that will also include personal UV measurements.

Aim The aim of this study was to investigate occupational, environmental, early life and other risk factors associated with respiratory infections and antibiotics use in a general population and among asthmatic individuals. Method This study included 15 842 participants of the Respiratory Health in Northern Europe (RHINE) study aged 25–54 years from five Nordic countries, who answered a questionnaire covering respiratory outcomes, exposures, demographic characteristics and numbers of infections and courses of antibiotics in the last 12 months. Multiple logistic regression with and without adjustment for age, sex, smoking status, body mass index and centre were used to study the risk of infection and antibiotics in relation to asthma, and also the association between infection and antibiotics and occupations. Results In the whole population, 11.6% reported having three or more respiratory infections, and 14.7% had used antibiotics because of respiratory tract infections within the last year. Asthmatic participants reported tripled odds for such infections (adjusted OR 2.98, 95% CI 2.53–3.52) and antibiotics use (adjusted OR 3.67, 95% CI 3.18–4.24) as compared to non-asthmatic participants. Both in the general and the asthmatic population, female sex, obesity and exposure to building dampness were associated with respiratory infections. Female sex and current smoking and living in Tartu were associated with antibiotic use. The use of antibiotics was doubled in people hospitalised for severe respiratory infection in childhood. Conclusion In this study we identified several factors associated with increased respiratory infections and use of antibiotics in a general population and among asthmatic individuals. The frequency of respiratory infections and subsequent antibiotic treatment were increased among those with asthma., The main findings of this study are that asthmatics reported three times higher odds for respiratory tract infections and more than three times higher odds for subsequent antibiotics than subjects without asthma https://bit.ly/3hwsH67

After observing several clinical patients with respiratory symptoms, we initiated a questionnaire survey to assess prevalence of and predictors for asthma and work-related symptoms among workers in fish processing plants. A questionnaire with items on work conditions, work-related symptoms, and respiratory symptoms/diseases was sent to 916 fish processing workers, the 1836 licenced fishermen in Sweden, and 1965 controls; of those, 43%, 57%, and 53%, respectively, responded. Risks, hazard ratios (HRs), and prevalence ratios (PRs) were calculated with Cox regression, and 95% confidence intervals (CIs) were computed. The risk of asthma among fish filleting workers was increased during the years working in the fish processing industry when compared to the other fish processing workers and controls (HR 3.6, 95% CI 1.6-8.1, adjusted for atopy, gender, and ever smoking). The filleters had an increased PR for most of the work-related respiratory symptoms investigated. All fish processing workers had a higher PR for flu-like symptoms. Use of a pressure sprayer was identified as a risk for asthma and respiratory symptoms among both fish processing workers and controls. Filleters had changed work tasks because of respiratory symptoms more often (Fisher's exact test, p = 0.02) than other fish processing workers. In conclusion the fish filleters and pressure sprayer users reported more adult asthma and cough with phlegm compared to the other fish processing workers and controls. The use of pressure sprayers must be reduced and machinery should be completely encased to reduce workers' exposure to bioaerosols and its effects on the respiratory tract.

Objectives The aim of this study was to characterize personal occupational exposure to endotoxin in size-separated airborne particles of MWF aerosol, using a Sioutas cascade impactor (SCI). Methods Exposure to inhalable fractions of MWF aerosol and endotoxin was measured by personal sampling of 52 individuals over an 8-h work shift using a PAS-6 sampler in parallel with a SCI ( Results A total of 117 measurements of inhalable MWF aerosols were made among 52 workers. The geometric mean of inhalable MWF aerosol was 0.16 mg m−3 air. The geometric mean of endotoxin concentration on the inhalable sampler was 0.15 EU m−3. Airborne endotoxin was found on all size fractions from the impactor, with the major part seen in the fraction (2.5–10 µm). There was a correlation between the inhalable fraction of endotoxin measured by the PAS-6 sampler and on the SCI sampler (2.5–10 µm), estimated to be 0.51 for all samples (P < 0.0001). The concentration of endotoxin varied between the MWFs, as did the proportion of Gram-negative bacteria among the culturable bacteria (>80% in one MWF and Conclusions The personal exposure to inhalable fractions of endotoxin contained in the MWF aerosol were low, where most of the endotoxin were found in fraction (2.5–10 µm), measured by SCI. There are differences between factories and MWF systems regarding the distribution of endotoxin and so results from one context should not be generalized to other plants and systems. Compressed air was used for less than 10 min shift−1. The mixed-effect model showed that working with open machines and grinding as cutting task were important determinants of exposure to inhalable aerosol. It is important to keep occupational exposure to aerosols low with the help of good ventilation systems, enclosed machines, and organization of work.

ObjectivesOccupational exposures to metal fumes have been associated with increased pneumonia risk, but the risk of invasive pneumococcal disease (IPD) has not been characterised previously.MethodsWe studied 4438 cases aged 20–65 from a Swedish registry of invasive infection caused by Streptococcus pneumoniae. The case index date was the date the infection was diagnosed. Six controls for each case, matched for gender, age and region of residency, were selected from the Swedish population registry. Each control was assigned the index date of their corresponding case to define the study observation period. We linked cases and controls to the Swedish registries for socioeconomic status (SES), occupational history and hospital discharge. We applied a job–exposure matrix to characterise occupational exposures. We used conditional logistic analyses, adjusted for comorbidities and SES, to estimate the OR of IPD and the subgroup pneumonia–IPD, associated with selected occupations and exposures in the year preceding the index date.ResultsWelders manifested increased risk of IPD (OR 2.99, 95% CI 2.09 to 4.30). Occupational exposures to fumes and silica dust were associated with elevated odds of IPD (OR 1.11, 95% CI 1.01 to 1.21 and OR 1.33, 95% CI 1.11 to 1.58, respectively). Risk associated with IPD with pneumonia followed a similar pattern with the highest occupational odds observed among welders and among silica dust exposed.ConclusionWork specifically as a welder, but also occupational exposures more broadly, increase the odds for IPD. Welders, and potentially others with relevant exposures, should be offered pneumococcal vaccination.

Occupational hazards exist in the processing of seafood both in land-based facilities as well as on board vessels. Recent findings on occupational injury and respiratory health risks among seafood processing workers were presented and discussed at the IFISH5 conference. Particular emphasis was put on the challenges that im/migrant workers encounter, the greater risks onboard factory vessels, especially where processing machinery are retrofitted to older vessels not primarily designed for this purpose, and the difficulties in assessing and preventing bioaerosol exposures and associated respiratory health risks despite recent advances in characterising agents responsible for allergic and non-allergic reactions. Based on appraisal of existing knowledge in the published literature and new findings presented at the conference, recommendations for immediate actions as well as for future research have been proposed. Among these include the importance of improving extraction ventilation systems, optimising machinery performance, enclosure of bioaerosol sources, improved work organization, and making special efforts to identify and support the needs of im/migrant workers to ensure they also benefit from such improvements. There is a need for studies that incorporate longitudinal study designs, have improved exposure and diagnostic methods, and that address seafood processing in countries with high seafood processing activities such as Asia and those that involve im/migrant workers worldwide. The medical and scientific community has an important role to play in prevention but cannot do this in isolation and should cooperate closely with hygienists, engineers, and national and international agencies to obtain better health outcomes for workers in the seafood industry.

Background: Occupational exposures to metal fumes and inorganic dust have been associated with increased pneumonia risk, but the risk of invasive pneumococcal disease (IPD) has not been characterized previously. Methods: We studied 4 438 cases 20 to 65 years of age from a Swedish national registry of invasive infection caused by Streptococcus pneumoniae. The case index date was the day the infection was diagnosed. Six controls for each case, matched for gender and age, were selected from the Swedish population registry. Each control was assigned the index date of their corresponding case to define the study observation period. We linked cases and controls to the Swedish registries for socioeconomic status (SES), occupational history, hospital discharge and mortality. We applied a job-exposure matrix (JEM) to characterize occupational exposures. We used conditional logistic analyses, adjusted for co-morbidities and SES, to estimate the odds ratio (OR) of IPD and the subgroup with pneumonia, associated with selected occupations and exposures the year before index date. Results: Welders manifested increased risk of IPD (OR 2.99, 95% confidence interval (CI) 2.09 - 4.30). Occupations likely to have exposure to fumes based on a JEM-assignment were also associated with elevated odds of IPD (OR 2.40, 95% CI 1.72-3.36). Risk associated with IPD with pneumonia followed a similar pattern with the highest occupational odds observed among welders (OR 3.28, 95% CI 2.22-4.84). Conclusions: Work as welder and occupational exposure to fumes increase the odds for IPD. Welders and potentially others with relevant exposures should be offered pneumococcal vaccination. Funding Statement: Swedish Heart and Lung Foundation, Swedish Council for Working Life, Health, and Welfare (FORTE) and by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement, 74570. Declaration of Interests: All authors have completed the Unified Competing Interest form at www.icmje/coi_disclosure.pdf (available in request from the corresponding author): KT, IQ, OA, NM, RN, ADH, PDB and LS do not have any conflict of interest to report. Ethical Approval Statement: The Gothenburg Committee of Ethics approved the study (Dnr 729-16).

Asthma often remains uncontrolled, despite the fact that the pharmacological treatment has undergone large changes. We studied changes in the treatment of asthma over a 20-year period and identified factors associated with the regular use of inhaled corticosteroid (ICS) treatment. Changes in the use of medication were determined in 4617 randomly selected subjects, while changes in adults with persistent asthma were analysed in 369 participants. The study compares data from three surveys in 24 centres in 11 countries. The use of ICSs increased from 1.7% to 5.9% in the general population and the regular use of ICSs increased from 19% to 34% among persistent asthmatic subjects. The proportion of asthmatic subjects reporting asthma attacks in the last 12 months decreased, while the proportion that had seen a doctor in the last 12 months remained unchanged (42%). Subjects with asthma who had experienced attacks or had seen a doctor were more likely to use ICSs on a regular basis. Although ICS use has increased, only one-third of subjects with persistent asthma take ICSs on a regular basis. Less than half had seen a doctor during the last year. This indicates that underuse of ICSs and lack of regular healthcare contacts remains a problem in the management of asthma., Despite increased ICS use, only 34% of subjects with persistent asthma take ICSs on a regular basis

Objective: Hairdressers have an increased risk for airway symptoms especially when using hair-bleaching powder containing persulfate. To minimize exposure, dust-free bleaching powder (DFP) has been made available. We studied the effects of regular powder (RP) or DFP on the airway symptoms of hairdressers with hair-bleaching associated rhinitis. Methods: Twelve hairdressers each performed three hair-bleachings on a wig in an exposure chamber. Half of the subjects used RP and half used DFP. Exposure to persulfate and ammonia was measured. Before and after each bleaching, the participants stated their degree of airway symptoms on a visual analogue scale. Nasal lavage and blood were sampled before exposure, after the last bleaching, and in the morning after exposure to measure inflammatory markers. Results: Exposure to persulfate was higher when using RP compared to DFP, 22 (11-55) vs. 12 (8-13) μg/m3; median (min-max). Exposure to ammonia did not differ between the groups. Both groups reported an increase in asthma-like symptoms and this increase was significant. Neutrophils, lymphocytes, and monocytes increased after exposure in both groups; monocytes decreased the day after. In nasal lavage, IL-8 was increased the morning after for both types of powder, and the increase was significant in the total group. IL-6 increased immediately after exposure and the day after only in the group using RP. Conclusions: Although DFP powder emits lower levels of persulfate, effects are still elicited in symptomatic hairdressers.

Patients with airway symptoms working in metal working industries are increasing, despite efforts to improve the environmental air surrounding the machines. Our aim was to analyse the amount of endotoxin in size-separated airborne particles of metal working fluid (MWF) aerosol, by using the personal sampler Sioutas cascade impactor, to compare filter types, and to compare the concentration of airborne endotoxin to that of the corresponding MWFs. In a pilot field study, aerosols were collected in two separate machine halls on totally 10 occasions, using glass fibre and polytetrafluoroethylene (PTFE) filters in parallel at each station. Airborne endotoxin was distributed over all size fractions. While a major part was found in the largest size fraction (72%, 2.5-10 µm), up to 8% of the airborne endotoxin was detected in the smallest size fraction (

WORK-RELATED ASTHMA comprises occupational asthma (OA) that is caused by conditions at work and work-exacerbated asthma (WEA), in which existing asthma is made worse by workplace conditions.1 Work-related asthma is common, with work accounting for an average 16.9% of all new adult-onset asthma cases,2 and with WEA detected in an estimated 21.5% of working adults with asthma.3 While substantial costs and lost work time are associated with both WEA and OA,4,5 WEA has received less attention in terms of research and prevention efforts.1 WEA is potentially preventable by minimizing harmful workplace exposures,3 but a better understanding of which agents pose a risk is needed to guide prevention efforts. While surveillance in the United States indicates that WEA is frequently caused by irritants, low molecular weight (e.g., acids, bases, aldehydes) and high molecular weight (e.g., latex) agents are also implicated.6 The absence of denominators (i.e., the number of workers exposed) prohibits using surveillance data to estimate agent-specific risk. We used data from a previous study to identify occupational risk factors for exacerbation of asthma.7 In previous analyses of data from this study, we determined WEA status on a case-by-case basis. However, for the current investigation, we modeled severe exacerbation of asthma and determined which occupational exposures were associated with it, while simultaneously controlling for potential confounders. We assessed occupational exposures using a new asthma-specific job-exposure matrix (JEM).8

Background 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. Methods 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. Results 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. Conclusions 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.

Background Exposure to allergen may induce a modified T H 2 response characterized by high IgG 4 levels, absence of IgE sensitization, and a decreased risk of allergic respiratory symptoms. Objective To assess the association of IgG 4 level with allergic respiratory symptoms in a community-based sample of adults. Methods Information on exposure to cats, respiratory symptoms, and mattress allergen levels was obtained from 2780 adults. Levels of cat and house dust mite (HDM) specific IgE, IgG, and IgG 4 were measured. The association of exposure to allergen with IgG 4 and of IgG 4 with symptoms was assessed. Results Geometric mean (GM) cat specific IgG and IgG 4 was higher in subjects who had a cat that was allowed in the bedroom than in subjects without a cat (adjusted ratio of GM IgG 4 , 1.41; 95% CI, 1.25-1.57). Levels of HDM specific IgG and IgG 4 were similar in subjects with undetectable and high (>20.22 μg/g) mattress Der 1 levels (adjusted ratio of GM IgG 4 , 1.02; 95% CI, 0.89-1.17). There was no evidence that high cat or HDM specific IgG 4 levels were associated with less IgE sensitization or with fewer symptoms. Conclusion In this community-based sample of adults, high IgG 4 levels to cat or HDM were not associated with a lower risk of allergic respiratory symptoms. Clinical implications In adults, high cat allergen exposure does not protect against respiratory symptoms.

An association between indoor dampness and respiratory symptoms has been reported, but dampness as a risk factor for the onset or remission of respiratory symptoms and asthma is not well documented.This follow up study included 16 190 subjects from Iceland, Norway, Sweden, Denmark, and Estonia who had participated in the European Community Respiratory Health Survey (ECRHS I). Eight years later the same subjects answered a postal questionnaire that included questions on respiratory symptoms and indicators of indoor dampness.Subjects living in damp housing (18%) had a significantly (p0.001) higher prevalence of wheeze (19.1% v 26.0%), nocturnal breathlessness (4.4% v 8.4%), nocturnal cough (27.2% v 36.5%), productive cough (16.6% v 22.3%) and asthma (6.0% v 7.7%). These associations remained significant after adjusting for possible confounders. Indoor dampness was a risk factor for onset of respiratory symptoms but not for asthma onset in the longitudinal analysis (OR 1.13, 95% CI 0.92 to 1.40). Remission of nocturnal symptoms was less common in damp homes (OR 0.84, 95% CI 0.73 to 0.97).Subjects living in damp housing had a higher prevalence of respiratory symptoms and asthma. Onset of respiratory symptoms was more common and remission of nocturnal respiratory symptoms was less common in subjects living in damp housing.

Background Airway diseases in hairdressers are a concern. The objective of this investigation is to evaluate the risk for three respiratory symptoms, wheeze, dry cough, and nasal blockage, in hairdressers. Methods A questionnaire on respiratory symptoms, atopy, smoking, and work history was answered by 3,957 female hairdressers and 4,905 women from the general population as referents. Incidence rates (IR) and incidence rate ratios (IRRs)for the three symptoms were estimated. Results The IRs of all three studied symptoms were higher in the hairdressers compared with the referents. Smoking modified the effects of cohort affiliationfor all threesymptoms; the combined effect from hairdressing work and smoking was less than expected. In addition, the effect of cohort affiliation for wheeze was also modified by atopy, and the effect of cohort affiliation for nasal blockage was also modified by calendar year. Conclusions Hairdressing work was associated with increased incidences of respiratory symptoms. Smoking had a negative modifying effect.

Background: The pathophysiologic interactions of inflammatory reactions between the mucosa of the respiratory tract and that of the gastrointestinal tract in individuals with allergy are poorly studied, despite the fact that allergic symptoms in the airways and the gastrointestinal tract might arise in the same patient. Objective: The objective of this study was to examine the inflammatory response histologically by enumerating eosinophils, IgE+ cells, and T cells in duodenal biopsy specimens in adult patients with IgE-mediated birch pollen allergy during the birch pollen season and off-season. Methods: Nine patients with birch pollen allergy verified by skin prick test and serum IgE antibodies were investigated toward the end of the birch pollen season and again 6 months later (off-season). Duodenal biopsy specimens were obtained and studied by immunostaining for the eosinophil major basic protein (MBP), IgE, and CD3+ T cells. Results: Oral allergy syndrome to birch-associated foods was present in all patients as indicated by questionnaire. Duodenal increases of MBP+ eosinophils and IgE-bearing cells were found in the patients during the birch pollen season as compared with off-season. No seasonal differences in the T-cell numbers in these patients were seen. Off-season, there was no significant difference between the patients and the control subjects regarding the intestinal frequencies of MBP+ eosinophils, mucosal IgE+ cells, and T cells. Conclusion: Birch pollen exposure triggered a local inflammation with an increase in duodenal eosinophils and IgE-carrying mast cells in patients with allergy. Our study gives evidence for the interplay between immunologically active cells in the airways and the gut. (J Allergy Clin Immunol 2003;112:45-51.)

OBJECTIVE We have recently published a study on new-onset asthma in a large population in northern Europe using a modified job exposure matrix (N-JEM) to better reflect exposure assignment in these countries. The aim of this paper was to investigate how the N-JEM differs in exposure assignment and asthma risks from an already established JEM. METHOD The study comprised 6253 men and 7031 women from northern Europe, born 1945-1973, who had answered both a screening (1989-1992) and a follow-up questionnaire (1999-2001). During the study period (1980-2000), there were 136 men and 293 women with new-onset asthma. Hazard ratios of new-onset asthma were calculated for both JEMs using Cox regression models. The analyses were made separately for men and women and were also stratified for atopy. Cohen's kappa (κ) was used to show agreements in exposure assignment (yes/no) between the JEMs. Population attributable risks (PARs) were calculated as well. RESULTS The agreement in exposure assignment between the JEMs was substantial for the group 'any exposure' to asthma agents (κ = 0.78). The agreement between comparable exposure groups in the JEMs varied from κ = 1.00 (pharmaceutical product antigens, textile dust, cleaning agents) to κ = 0.27 (low molecular weight agents). Significant increased asthma risks were seen for men exposed to isocyanates and accidental peak exposure with both JEMs. With the N-JEM, increased asthma risks were seen for men exposed to plant-associated antigens (all and non-atopic), epoxy compounds (all and non-atopic), and acrylates (non-atopic). With the other JEM, increased asthma risks were seen in men and women exposed to 'possible exposure to irritant gases or fumes' (all and non-atopic), a group classified as having low asthma risk. Men and women exposed to cleaning agents also showed significant asthma risks with both JEMs. PAR with the N-JEM was 14.3% for men and 6.6% for women, compared with 12.9% and 8.3% with the other JEM. CONCLUSIONS Acrylates, epoxy compounds, and isocyanates are three exposure groups in the modified asthma JEM that might better reflect exposure situations in northern Europe than the already established JEM. Exposure to 'possible exposure to irritant gases or fumes', a low asthma risk group in the established JEM, seems to be a group with high asthma risk in northern Europe. It is important to continuously update JEMs, which are based only on occupational titles, in order to find new risk groups and to better reflect changes in work exposures when old risks disappear and new emerge.