Johny Steinar Kongerud

• Søyseth, Vidar; Henneberger, Paul K.; Lindstrøm, Jonas Christoffer; Virji, Mohammed Abbas; Einvik, Gunnar & Bakke, Berit [Show all 7 contributors for this article] (2026). Exposure to Polycyclic Aromatic Hydrocarbons, but Not to Dust or Fluorides, in the Norwegian Aluminum Industry Is Associated With Accelerated Annual Decline in Lung Function. American Journal of Industrial Medicine. ISSN 0271-3586. 69(8), p. 674–682. doi: 10.1002/ajim.70102.
• Zivadinovic, Nikola; Jaioun, Keson; Klepaker, Geir; Wagstaff, Anthony Sverre; Torén, Kjell & Henneberger, Paul K. [Show all 9 contributors for this article] (2025). Occupational risk factors for asthma exacerbation in adults: a five-year follow-up of the Norwegian Telemark study cohort. Journal of Asthma. ISSN 0277-0903. 62(9), p. 1608–1615. doi: 10.1080/02770903.2025.2500077. Full text in Research Archive Show summary

  Objectives Asthma exacerbation due to occupational exposure is highly prevalent among adults with asthma. This study assessed the association between occupational risk factors and asthma exacerbation and estimated the impact of asthma exacerbations on job change, sick leave and work ability. Methods In a prospective study of respiratory health in Telemark, Norway, 1857 adult participants with physician-diagnosed asthma were invited to participate in a follow-up survey. Among those who responded, 740 were found eligible for this study. Participants were categorized into overall, mild, and severe asthma exacerbation groups based on self-reports of hospitalization, doctor or emergency visits for breathing difficulties, or increased or new use of lung medications. Logistic regression, adjusted for age, sex, and smoking, was used to assess associations between self-reported asthma exacerbation and exposure to VGDF, job exposure matrix (N-JEM) data, job change, sick leave, and work ability. Results Asthma exacerbation occurred in 140 (19%) responders; 83 had mild exacerbations and 57 severe exacerbations. Severe exacerbation was associated with daily VGDF exposure (OR 2.57, 95% CI 1.15–5.78) and accidental peak exposure to irritants (OR 4.62, 95% CI 1.13–18.85). Both overall and severe exacerbation were associated with job changes (OR 5.40, 1.26–5.65; OR 3.06, 1.16–8.07), sick leave (OR 1.94, 1.33–2.85; OR 2.78, 1.57–4.92), and reduced work ability (OR 1.61, 1.04–2.49; OR 2.17, 1.18–3.98). Conclusion Asthma exacerbation was associated with VGDF exposure and some N-JEM occupational exposures. Reducing workplace exposure may decrease job-change, sick leave, and improve work ability in individuals with asthma exacerbation.

• Fell, Anne Kristin M.; Zhang, Chi; Klepaker, Geir; Abrahamsen, Regine; Zivadinovic, Nikola & Kongerud, Johny Steinar [Show all 9 contributors for this article] (2025). Occupational exposure and chronic bronchitis in a sample of the general population in Telemark, Norway: a two-phased cross-sectional study. Occupational and Environmental Medicine. ISSN 1351-0711. 82(2), p. 98–104. doi: 10.1136/oemed-2024-109641. Full text in Research Archive Show summary

  Objectives: We aimed to estimate the prevalence of chronic bronchitis (CB), examine its association with occupational exposure to irritants assessed by self-reporting or the Nordic job exposure matrix (N-JEM) stratified by smoking status and estimate the population-attributable fraction (PAF) of CB from occupational exposure. Methods: A two-phased, cross-sectional design was used to analyse a random sample collected in 2013 and 2018 of the population aged 16-55 years in Telemark County, Norway. CB was defined as cough and sputum production for ≥3 months over 2 consecutive years. The participants' occupational histories were categorised using the International Standard Classification of Occupations and linked to the N-JEM. Self-reported occupational exposure was also assessed. Logistic regression was performed with adjustments for age, sex and smoking status and yielded ORs, 95% CIs and associated PAFs. Results: Of the 20 282 participants, 5.3% reported CB symptoms. CB was associated with the frequency of self-reported occupational exposure to vapours, gas, dust and fumes (VGDF), with increasing ORs ranging from 1.6 (95% CI 1.3 to 1.9) for seldom to 3.6 (95% CI 2.9 to 4.5) for daily exposure. Among ever-smokers, the N-JEM 'irritants' category was associated with CB (OR 1.4; 95% CI 1.1 to 1.8) to a similar degree as in the group that reported VGDF exposure (OR 2.1; 95% CI 1.7 to 2.5). The PAFs for CB from VGDF exposure were 41% overall, 49% among ever-smokers and 37% among never-smokers. Conclusions: Occupational exposure to VGDF was associated with CB, when self-reported and for smokers when assessed by the N-JEM. Workplace exposure contributed to more than one third of the overall CB burden.

• Zivadinovic, Nikola; Jaioun, Keson; Klepaker, Geir; Wagstaff, Anthony Sverre; Torén, Kjell & Henneberger, Paul K. [Show all 9 contributors for this article] (2024). Occupational exposure and new-onset asthma in the population-based Telemark study: a 5-year follow-up. BMJ Open. 14(9). doi: 10.1136/bmjopen-2024-090131. Full text in Research Archive Show summary

  Objectives: This study aimed to estimate the incidence of asthma and assess the association between job exposure matrix (N-JEM) assigned occupational exposure, self-reported occupational exposure to vapour, gas, dust and fumes (VGDF), mould, damages from moisture and cold, and new-onset asthma. We also aimed to assess the corresponding population attributable fraction (PAF) for ever exposure to VGDF. Design: Longitudinal population-based respiratory health study. Setting: Responders from the baseline Telemark Study in south-eastern Norway were followed up from 2013 to 2018. Participants: 7120 participants, aged 16-55, were followed during a 5-year period. Main outcome measures: New-onset asthma and its association with self-reported occupational exposure to VGDF, data from the N-JEM and self-reported workplace conditions were assessed using logistic regression adjusted for gender, age, smoking and body mass index. The PAF was calculated using the PUNAF command in STATA. Results: There were 266 (3.7%) cases of new-onset asthma and an incidence density of 7.5 cases per 1000 person-years. A statistically significant association was found for ever exposed to VGDF with an OR of 1.49 (95% CI 1.15 to 1.94), weekly OR 2.00 (95% CI 1.29 to 3.11) and daily OR 2.46 (95% CI 1.39 to 4.35) exposure to VGDF. The corresponding PAF for ever exposed to VGDF was 17% (95% CI 5.4% to 27.8%) and the risk of asthma onset increased with frequent VGDF exposure, indicating a possible exposure-response relationship (p=0.002 for trend). The N-JEM exposure group, accidental peak exposure to irritants had an increased risk of new-onset asthma, OR 2.43 (95% CI 1.21 to 4.90). A significant association was also found for self-reported exposure to visible damages due to moisture 1.51 (95% CI 1.08 to 2.11), visible and smell of mould 1.88 (95% CI 1.32 to 2.68), 1.55 (95% CI 1.12 to 2.16) and cold environment 1.41 (95% CI 1.07 to 1.86). Conclusion: Participants had elevated ORs for asthma associated with self-reported and N-JEM-assigned exposures. A PAF of 17% indicates that work-related asthma is still common. The possible exposure-response relationship suggests that reducing occupational VGDF exposure frequency could prevent the onset of asthma.

• Sarjomaa, Marjut Anneli; Zhang, Chi; Tveten, Yngvar; Kersten, Hege; Reiso, Harald & Eikeland, Randi [Show all 14 contributors for this article] (2024). Risk factors for SARS-CoV-2 infection: A test-negative case-control study with additional population controls in Norway. BMJ Open. 14(1), p. 1–11. doi: 10.1136/bmjopen-2023-073766. Full text in Research Archive Show summary

  Objectives This study aims to assess risk factors for SARS-CoV-2 infection by combined design; first comparing positive cases to negative controls as determined by PCR testing and then comparing these two groups to an additional prepandemic population control group. Design and setting Test-negative design (TND), multicentre case–control study with additional population controls in South-Eastern Norway. Participants Adults who underwent SARS-CoV-2 PCR testing between February and December 2020. PCR-positive cases, PCR-negative controls and additional age-matched population controls. Primary outcome measures The associations between various risk factors based on self- reported questionnaire and SARS-CoV-2 infection comparing PCR-positive cases and PCR-negative controls. Using subgroup analysis, the risk factors for both PCR-positive and PCR-negative participants were compared with a population control group. Results In total, 400 PCR-positive cases, 719 PCR-negative controls and 14 509 population controls were included. Male sex was associated with the risk of SARS-CoV-2 infection only in the TND study (OR 1.9, 95% CI 1.4 to 2.6), but not when PCR-positive cases were compared with population controls (OR 1.2, 95% CI 0.9. to 1.5). Some factors were positively (asthma, wood heating) or negatively (hypertension) associated with SARS-CoV-2 infection when PCR-positive cases were compared with population controls, but lacked convincing association in the TND study. Smoking was negatively associated with the risk of SARS-CoV-2 infection in both analyses (OR 0.5, 95% CI 0.3 to 0.8 and OR 0.6, 95% CI 0.4 to 0.8). Conclusions Male sex was a possible risk factor for SARS-CoV-2 infection only in the TND study, whereas smoking was negatively associated with SARS-CoV-2 infection in both the TND study and when using population controls. Several factors were associated with SARS-CoV-2 infection when PCR-positive cases were compared with population controls, but not in the TND study, highlighting the strength of combining case–control study designs during the pandemic.

• Klepaker, Geir; Torén, Kjell; Henneberger, Paul Keefer; Kongerud, Johny Steinar & Fell, Anne Kristin M. (2024). Occupational exposure to inhalable agents is associated with reduced work ability: A prospective cohort study in Norway. Journal of Occupational and Environmental Medicine. ISSN 1076-2752. doi: 10.1097/JOM.0000000000003292. Full text in Research Archive Show summary

  Background: This study aimed to assess work ability score (WAS) in 2018 based on self-reported data regarding inhalable occupational exposure and data from a northern European job-exposure matrix (N-JEM) recorded in 2013. Methods: During the 5-year follow-up period of this population-based study, 4423 participants completed a postal questionnaire comprising self-reported questions regarding occupational exposure, work history, and WAS. Results: Ever, weekly, and daily exposure to vapors, gas, dust and fumes (VGDF) in the last 5 years in 2013 was associated with reduced WAS in 2018. The N-JEM data showed that exposure to irritants, wood and paper dust, and mixed agricultural agents were associated with reduced WAS. Conclusions: Exposure to several occupational inhalable substances is associated with reduced work ability. We recommend reducing inhalable occupational exposure to prevent reduced work ability.

• Zivadinovic, Nikola; Abrahamsen, Regine; Pesonen, Maiju; Wagstaff, Anthony Sverre; Torén, Kjell & Henneberger, Paul K. [Show all 8 contributors for this article] (2023). Loss to 5-year follow-up in the population-based Telemark Study: risk factors and potential for bias. BMJ Open. 13(3). doi: 10.1136/bmjopen-2022-064311. Full text in Research Archive Show summary

  Objectives: This study aimed to characterise participants lost to follow-up and identify possible factors associated with non-participation in a prospective population-based study of respiratory health in Norway. We also aimed to analyse the impact of potentially biased risk estimates associated with a high proportion of non-responders. Design: Prospective 5-year follow-up study. Setting: Randomly selected inhabitants from the general population of Telemark County in south-eastern Norway were invited to fill in a postal questionnaire in 2013. Responders in 2013 were followed-up in 2018. Participants: 16 099 participants aged 16-50 years completed the baseline study. 7958 responded at the 5-year follow-up, while 7723 did not. Main outcome measures: χ2 test was performed to compare demographic and respiratory health-related characteristics between those who participated in 2018 and those who were lost to follow-up. Adjusted multivariable logistic regression models were used to assess the relationship between loss to follow-up, background variables, respiratory symptoms, occupational exposure and interactions, and to analyse whether loss to follow-up leads to biased risk estimates. Results: 7723 (49%) participants were lost to follow-up. Loss to follow-up was significantly higher for male participants, those in the youngest age group (16-30 years), those in lowest education level category and among current smokers (all p<0.001). In multivariable logistic regression analysis, loss to follow-up was significantly associated with unemployment (OR 1.34, 95% CI 1.22 to 1.46), reduced work ability (1.48, 1.35 to 1.60), asthma (1.22, 1.10 to 1.35), being woken by chest tightness (1.22, 1.11 to 1.34) and chronic obstructive pulmonary disease (1.81, 1.30 to 2.52). Participants with more respiratory symptoms and exposure to vapour, gas, dust and fumes (VGDF) (1.07 to 1.00-1.15), low-molecular weight (LMW) agents (1.19, 1.00 to 1.41) and irritating agents (1.15, 1.05 to 1.26) were more likely to be lost to follow-up. We found no statistically significant association of wheezing and exposure to LMW agents for all participants at baseline (1.11, 0.90 to 1.36), responders in 2018 (1.12, 0.83 to 1.53) and those lost to follow-up (1.07, 0.81 to 1.42). Conclusion: The risk factors for loss to 5-year follow-up were comparable to those reported in other population-based studies and included younger age, male gender, current smoking, lower educational level and higher symptom prevalence and morbidity. We found that exposure to VGDF, irritating and LMW agents can be risk factors associated with loss to follow-up. Results suggest that loss to follow-up did not affect estimates of occupational exposure as a risk factor for respiratory symptoms.

• Mangseth, Henrik; Sikkeland, Liv Ingunn Bjoner; Durheim, Michael Thomas; Ulvestad, Mariann; Myrdal, Ole Henrik & Kongerud, Johny Steinar [Show all 7 contributors for this article] (2023). Comparison of different reference values for lung function: implications of inconsistent use among centers. BMC Pulmonary Medicine. 23. doi: 10.1186/s12890-023-02430-7. Full text in Research Archive Show summary

  Background For interpretation of pulmonary function tests (PFTs), reference values based on sex, age, height and ethnicity are needed. In Norway, the European Coal and Steel Community (ECSC) reference values remain widely used, in spite of recommendations to implement the more recent Global Lung Function Initiative (GLI) reference values. Objective To assess the effects of changing from ECSC to GLI reference values for spirometry, DLCO and static lung volumes, using a clinical cohort of adults with a broad range in age and lung function. Methods PFTs from 577 adults (18–85 years, 45% females) included in recent clinical studies were used to compare ECSC and GLI reference values for FVC, FEV1, DLCO, TLC and RV. Percent predicted and lower limit of normal (LLN) were calculated. Bland-Altman plots were used to assess agreement between GLI and ECSC % predicted values. Results In both sexes, GLI % predicted values were lower for FVC and FEV1, and higher for DLCO and RV, compared to ECSC. The disagreement was most pronounced in females, with mean (SD) difference 15 (5) percent points (pp) for DLCO and 17 (9) pp for RV (p < 0.001). With GLI, DLCO was below LLN in 23% of the females, with ECSC in 49% of the females. Conclusions The observed differences between GLI and ECSC reference values are likely to entail significant consequences with respect to criteria for diagnostics and treatment, health care benefits and inclusion in clinical trials. To ensure equity of care, the same reference values should be consistently implemented across centers nationwide.

• Klepaker, Geir; Henneberger, Paul Keefer; Torén, Kjell; Brunborg, Cathrine; Kongerud, Johny & Fell, Anne Kristin M. (2022). Association of respiratory symptoms with body mass index and occupational exposure comparing sexes and subjects with and without asthma: follow-up of a Norwegian population study (the Telemark study). BMJ Open Respiratory Research. 9(1), p. 1–10. doi: 10.1136/bmjresp-2021-001186. Full text in Research Archive Show summary

  Background: Occupational exposure and increased body mass index (BMI) are associated with respiratory symptoms. This study investigated whether the association of a respiratory burden score with changes in BMI as well as changes in occupational exposure to vapours, gas, dust and fumes (VGDF) varied in subjects with and without asthma and in both sexes over a 5-year period. Methods: In a 5-year follow-up of a population-based study, 6350 subjects completed a postal questionnaire in 2013 and 2018. A respiratory burden score based on self-reported respiratory symptoms, BMI and frequency of occupational exposure to VGDF were calculated at both times. The association between change in respiratory burden score and change in BMI or VGDF exposure was assessed using stratified regression models. Results: Changes in respiratory burden score and BMI were associated with a β-coefficient of 0.05 (95% CI 0.04 to 0.07). This association did not vary significantly by sex, with 0.05 (0.03 to 0.07) for women and 0.06 (0.04 to 0.09) for men. The association was stronger among those with asthma (0.12; 0.06 to 0.18) compared with those without asthma (0.05; 0.03 to 0.06) (p=0.011). The association of change in respiratory burden score with change in VGDF exposure gave a β-coefficient of 0.15 (0.05 to 0.19). This association was somewhat greater for men versus women, with coefficients of 0.18 (0.12 to 0.24) and 0.13 (0.07 to 0.19), respectively (p=0.064). The estimate was similar among subjects with asthma (0.18; -0.02 to 0.38) and those without asthma (0.15; 0.11 to 0.19). Conclusions: Increased BMI and exposure to VGDF were associated with increased respiratory burden scores. The change due to increased BMI was not affected by sex, but subjects with asthma had a significantly larger change than those without. Increased frequency of VGDF exposure was associated with increased respiratory burden score but without statistically significant differences with respect to sex or asthma status.

• Sikkeland, Liv Ingunn Bjoner; Durheim, Michael; Riste, Tonje Bøyum; Kongerud, Johny; Alexis, Neil E. & Holm, Are Martin (2021). Relation of sputum neutrophilia to the development of chronic lung allograft dysfunction after lung transplantation. Clinical Transplantation. ISSN 0902-0063. 35(3), p. 1–5. doi: 10.1111/ctr.14188. Full text in Research Archive
• Klepaker, Geir; Henneberger, Paul Keefer; Hertel, Jens Kristoffer; Holla, Øystein Lunde; Kongerud, Johny & Fell, Anne Kristin Møller (2021). Influence of asthma and obesity on respiratory symptoms, work ability and lung function: findings from a cross-sectional Norwegian population study. BMJ Open Respiratory Research. doi: 10.1136/bmjresp-2021-000932. Full text in Research Archive Show summary

  Background: Although asthma and obesity are each associated with adverse respiratory outcomes, a possible interaction between them is less studied. This study assessed the extent to which asthma and overweight/obese status were independently associated with respiratory symptoms, lung function, Work Ability Score (WAS) and sick leave; and whether there was an interaction between asthma and body mass index (BMI) ≥25 kg/m2 regarding these outcomes. Methods: In a cross-sectional study, 626 participants with physician-diagnosed asthma and 691 without asthma were examined. All participants completed a questionnaire and performed spirometry. The association of outcome variables with asthma and BMI category were assessed using regression models adjusted for age, sex, smoking status and education. Results: Asthma was associated with reduced WAS (OR=1.9 (95% CI 1.4 to 2.5)), increased sick leave in the last 12 months (OR=1.4 (95% CI 1.1 to 1.8)) and increased symptom score (OR=7.3 (95% CI 5.5 to 9.7)). Obesity was associated with an increased symptom score (OR=1.7 (95% CI 1.2 to 2.4)). Asthma was associated with reduced prebronchodilator and postbronchodilator forced expiratory volume in 1 s (FEV1) (β=-6.6 (95% CI -8.2 to -5.1) and -5.2 (95% CI -6.7 to -3.4), respectively) and prebronchodilator forced vital capacity (FVC) (β=-2.3 (95% CI -3.6 to -0.96)). Obesity was associated with reduced prebronchodilator and postbronchodilator FEV1 (β=-2.9 (95% CI -5.1 to -0.7) and -2.8 (95% CI -4.9 to -0.7), respectively) and FVC (-5.2 (95% CI -7.0 to -3.4) and -4.2 (95% CI -6.1 to -2.3), respectively). The only significant interaction was between asthma and overweight status for prebronchodilator FVC (β=-3.6 (95% CI -6.6 to -0.6)). Conclusions: Asthma and obesity had independent associations with increased symptom scores, reduced prebronchodilator and postbronchodilator FEV1 and reduced prebronchodilator FVC. Reduced WAS and higher odds of sick leave in the last 12 months were associated with asthma, but not with increased BMI. Besides a possible association with reduced FVC, we found no interactions between asthma and increased BMI.

• Ulvestad, Mariann; Godang, Kristin; Durheim, Michael; Kongerud, Johny S.; Lund, May-Brith & Bollerslev, Jens [Show all 7 contributors for this article] (2021). Effect of high-intensity training on bone health and body composition in lung transplant recipients: A secondary analysis of a randomized controlled trial. Clinical Transplantation. ISSN 0902-0063. p. 1–9. doi: 10.1111/ctr.14375. Full text in Research Archive Show summary

  Background: Loss of bone mineral and skeletal muscle mass is common after lung transplantation (LTx), and physical activity (PA) may prevent further deterioration. We aimed to assess the effects of 20-week high-intensity training (HIT) on body composition, bone health, and PA in LTx recipients, 6–60 months after surgery. Methods: In a randomized controlled trial, 51 LTx recipients underwent Dual-energy X-ray absorptiometry (DXA), and PA level and sedentary time were objectively recorded by accelerometers for seven consecutive days. Of these, 39 participants completed the study, including 19 participants in the HIT group and 20 participants in the standard care group. Results: Following the intervention, ANCOVA models revealed a nonsignificant between-group difference for change in lean body mass (LBM) and bone mineral density (BMD) of the lumbar spine of 0.4% (95% CI = −3.2, 1.5) (p = .464) and 1.0% (95% CI=−1.3, 3.4) (p = .373), respectively. Trabecular bone score (TBS) of the lumbar spine (L1-L4), however, increased by 2.2 ± 5.0% in the exercise group and decreased by −1.6 ± 5.9% in the control group, giving a between-group difference of 3.8% (95% CI=0.1, 7.5) (p = .043). There were no between-group differences in PA or sedentary time. Conclusion: High-intensity training after LTx improved TBS significantly, but not PA, LBM or BMD.

• Myrdal, Ole Henrik; Aaløkken, Trond Mogens; Diep, Phoi Phoi; Ruud, Ellen; Brinch, Lorentz & Fosså, Kristian [Show all 10 contributors for this article] (2021). Late-Onset, Noninfectious Pulmonary Complications following Allogeneic Hematopoietic Stem Cell Transplantation: A Nationwide Cohort Study of Long-Term Survivors. Respiration. ISSN 0025-7931. p. 1–9. doi: 10.1159/000520824. Full text in Research Archive Show summary

  Background: Survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at risk for pulmonary adverse events. Data on late-onset noninfectious pulmonary complications in long-term adult survivors of allo-HSCT are limited and incomplete. Objectives: This study aimed (1) to determine occurrence and degree of pulmonary sequelae in adult survivors of allo-HSCT and (2) to identify associations between pulmonary function, high-resolution CT (HRCT), and clinical characteristics. Method: In a nationwide, single-center cross-sectional study, 103 survivors (aged median [range] 35 [17–58] years, 53% females) were examined 17 (6–32) years after allo-HSCT and compared with healthy controls (n = 105). Methods included pulmonary function tests and HRCT. Results: Chronic graft-versus-host disease was diagnosed in 33% of survivors, including 12% with bronchiolitis obliterans syndrome (BOS). Mean lung volumes (TLC, FVC, and FEV1) and gas diffusing capacity were &gt;80% of predicted for the survivors as a group, but significantly lower than in healthy controls. Pathological HRCT findings were detected in 48% of the survivors (71% airways disease, 35% interstitial lung disease, and 24% apical subpleural interstitial thickening). Air trapping (%) on HRCT correlated with % predicted FEV1, p &lt; 0.001. In a multiple logistic regression model, both BOS and pathological findings on HRCT were associated with chemotherapy prior to allo-HSCT, p &lt; 0.05. Conclusions: Long-term allo-HSCT survivors had significantly lower pulmonary function than age- and gender-matched healthy controls and nearly half had pathological findings on HRCT. Longitudinal data will determine if pulmonary sequelae will remain stable or progress. We recommend lifelong monitoring of pulmonary function in allo-HSCT survivors. HRCT provides additional information, but is not suited for surveillance.

• Ulvestad, Mariann; Durheim, Michael; Kongerud, Johny; Hansen, Bjørge Herman; Samersaw-Lund, May Brit & Edvardsen, Elisabeth (2020). Cardiorespiratory Fitness and Physical Activity following Lung Transplantation: A National Cohort Study. Respiration. ISSN 0025-7931. 99(4), p. 316–324. doi: 10.1159/000506883. Full text in Research Archive Show summary

  Background: Low cardiorespiratory fitness and inactivity are common after lung transplantation (LTx). The causes of exercise intolerance are incompletely understood. Objectives: The aim of this study was to objectively assess cardiorespiratory fitness and physical activity, evaluate causes of exercise intolerance, and explore clinical factors associated with cardiorespiratory fitness after bilateral LTx (BLTx). Materials and Methods: Peak oxygen uptake (V∙O2peak) and exercise-limiting factors were evaluated by a treadmill cardiopulmonary exercise test (CPET) 6–60 months after BLTx. Physical activity was measured with accelerometers, and results were compared with Norwegian normative data and the World Health Organization’s (WHO) recommendations for physical activity. Results: In 54 included BLTx recipients (mean age 50 ± 15 years, 50% females), V∙O2peak (mL × kg–1 × min–1) was 21.8 ± 7.7 for men and 22.4 ± 6.2 for women, corresponding to 57 ± 17 and 70 ± 12% of predicted, respectively. Three patients (6%) met criteria for normal V∙O2peak. Deconditioning limited V∙O2peak in 22 patients (41%), while ventilatory limitation and abnormal gas exchange were observed in 14 (26%) and 20 (37%) patients, respectively (some had more than 1 finding). Forty-three patients (86%) did not meet the WHO physical activity recommendations. There was a moderate correlation between V∙O2peak and physical activity (r = 0.642, p < 0.01). Body mass index, physical activity, forced expiratory volume after 1 second, sex, and hemoglobin together accounted for 73% of the variability in V∙O2peak. Conclusions: Low cardiorespiratory fitness was observed in the majority of BLTx recipients. Both deconditioning and cardiopulmonary limitations were common findings. Nearly 90% were classified as being inactive according to physical activity recommendations. CPET appears to identify a deconditioned subgroup of BLTx recipients for whom exercise training may be especially beneficial.

• Ulvestad, Mariann; Durheim, Michael; Kongerud, Johny; Samersaw-Lund, May Brit & Edvardsen, Elisabeth (2020). Effect of high-intensity training on peak oxygen uptake and muscular strength after lung transplantation: A randomized controlled trial. The Journal of Heart and Lung Transplantation. ISSN 1053-2498. 39(9), p. 1–9. doi: 10.1016/j.healun.2020.06.006. Full text in Research Archive Show summary

  BACKGROUND: Peak oxygen uptake (VO2peak) remains low after lung transplantation (LTx). We evaluated the effect of high-intensity interval training (HIIT) on VO2peak, muscular strength, health-related quality of life (HRQOL), pulmonary function, and physical function after LTx. METHODS: In this randomized controlled trial, 54 participants were enrolled from 6 to 60 months after LTx. The HIIT group (n = 25) followed a supervised HIIT program, consisting of endurance and strength trainings 3 times a week for 20 weeks. The control group (n = 29) received usual care. The primary outcome was a change in VO2peak measured by cardiopulmonary exercise testing. The secondary outcomes were changes in 1-repetition maximum (1RM) for arm press and leg press, HRQOL (36-Item Short-Form Health Survey [SF-36]), pulmonary function (forced expiratory volume in 1 sec, diffusing capacity of the lungs for carbon monoxide), and physical function (1RM in handgrip, 15-sec stair run, and 30-sec chair stand). RESULTS: A total of 46 participants completed the study, including 23 of 25 in the intervention group. For the primary outcome, the intention-to-treat analysis revealed a non-significant between-group difference for change in VO2peak of 0.7 ml/(kg.min) (95% CI = ‒0.3, 1.8) (p = 0.17). The between-group differences for 1RM arm press and leg press and mental aspect of SF-36 were 4.9 kg (95% CI = ‒0.1, 9.9) (p = 0.05), 11.6 kg (95% CI = 0.1, 23.0) (p < 0.05), and 5.7 kg (95% CI = 0.9, 10.4) (p = 0.02), respectively. There were no between-group differences in pulmonary function or physical function. When excluding participants with an attendance of <70% (n = 16), the between-group difference for VO2peak was 1.2 ml/(kg.min) (95% CI = 0.1, 2.4) (p = 0.032). CONCLUSIONS: HIIT improved muscular strength and HRQOL but did not improve VO2peak more than usual care after LTx. However, with acceptable adherence, HIIT appears to have beneficial effects on VO2peak.

• Bortoli, Marit Müller De; Fell, Anne Kristin Møller; Svendsen, Martin Veel; Henneberger, Paul K; Kongerud, Johny & Oellingrath, Inger Margaret (2020). Lifestyle, sick leave and work ability among Norwegian employees with asthma?A population-based cross-sectional survey conducted in Telemark County, Norway. PLOS ONE. 15(4). doi: 10.1371/journal.pone.0231710. Full text in Research Archive Show summary

  Objective To investigate whether physician-diagnosed asthma modifies the associations between multiple lifestyle factors, sick leave and work ability in a general working population. Methods A cross-sectional study was conducted in Telemark County, Norway, in 2013. A sample of 16 099 respondents completed a self-administered questionnaire. We obtained complete data on lifestyle, work ability and sick leave for 10 355 employed persons aged 18–50 years. We modelled sick leave and work ability using multiple logistic regression, and introduced interaction terms to investigate whether associations with lifestyle factors were modified by asthma status. Results Several lifestyle risk factors and a multiple lifestyle risk index were associated with sick leave and reduced work ability score among persons both with and without physician-diagnosed asthma. A stronger association between lifestyle and sick leave among persons with asthma was confirmed by including interaction terms in the analysis: moderate lifestyle risk score * asthma OR = 1.4 (95% CI 1.02–2.1); high lifestyle risk score * asthma OR = 1.6 (95% CI 1.1–2.3); very high lifestyle risk score * asthma OR = 1.6 (95% CI 0.97–2.7); obesity * asthma OR = 1.5 (95% CI 1.02–2.1); past smoking * asthma OR = 1.4 (95% CI 1.01–1.9); and current smoking * asthma OR = 1.4 (95% CI 1.03–2.0). There was no significant difference in the association between lifestyle and work ability score among respondents with and without asthma. Conclusions In the present study, we found that physician-diagnosed asthma modified the association between lifestyle risk factors and sick leave. Asthma status did not significantly modify these associations with reduced work ability score. The results indicate that lifestyle changes could be of particular importance for employees with asthma.

• Sikkeland, Liv Ingunn Bjoner; Durheim, Michael Thomas; Riste, Tonje Bøyum; Kongerud, Johny; Alexis, Neil E. & Holm, Are Martin (2020). Relation of sputum neutrophilia to the development of chronic lung allograft dysfunction after lung transplantation. Clinical Transplantation. ISSN 0902-0063. doi: 10.1111/ctr.14188. Full text in Research Archive
• Myrdal, Ole Henrik; Diep, Phoi Phoi; Ruud, Ellen; Brinch, Lorentz; Massey, Richard J & Edvardsen, Elisabeth [Show all 9 contributors for this article] (2020). Determinants of cardiorespiratory fitness in very long-term survivors of allogeneic hematopoietic stem cell transplantation: a national cohort study. Supportive Care in Cancer. ISSN 0941-4355. 29(4). doi: 10.1007/s00520-020-05644-1. Full text in Research Archive Show summary

  Purpose: Survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at risk for cardiopulmonary adverse events. Data on long-term effects on cardiorespiratory fitness are limited. To address the gap in knowledge, we aimed to determine peak oxygen uptake (V̇O2peak) and identify associations between cardiorespiratory fitness and clinical characteristics, self-reported physical activity, cardiac, and pulmonary function. Methods: In a nationwide, single-center cross-sectional study, 90 survivors [aged median (range) 35 (17–54) years, 56% females] were examined, 17 (6–26) years after allo-HSCT. Myeloablative conditioning comprised busulfan/cyclophosphamide or cyclophosphamide only. Methods included pulmonary function tests, echocardiography, and cardiopulmonary exercise test. Results: Chronic graft-versus-host disease (cGVHD) was found in 31% of the subjects, of whom 40% had bronchiolitis obliterans syndrome (BOS). Seventy-one percent of the survivors did not meet WHO recommendations for physical activity and 42% were overweight. Reduced gas diffusion (DLCO) and systolic ventricular dysfunction (LVEF) were found in 44% and 31%, respectively. For the group, mean (95% CI), V̇O2peak was 36.4 (34.7–38.0) mL/min/kg [89 (85–93)% of predicted]. V̇O2peak was low at 43%. Cardiopulmonary factors and deconditioning were equally common limitations for exercise. In a multiple linear regression model, low V̇O2peak was associated with low DLCO, low LVEF, BOS, overweight, and inactivity. Conclusion: Half of the survivors had reduced cardiorespiratory fitness median 17 years after allo-HSCT. Cardiopulmonary factors and deconditioning were equally common limitations to exercise. We encourage long-term cardiopulmonary monitoring of allo-HSCT survivors and targeted advice on modifiable lifestyle factors.

• Holm, Are Martin; Andreassen, Siw Lillevik; Christensen, Vivi Lycke; Kongerud, Johny; Almås, Øystein & Auråen, Henrik [Show all 10 contributors for this article] (2020). Hypogammaglobulinemia and risk of exacerbation and mortality in patients with COPD. The International Journal of Chronic Obstructive Pulmonary Disease. ISSN 1176-9106. 15, p. 799–807. doi: 10.2147/COPD.S236656. Full text in Research Archive Show summary

  Introduction: Chronic obstructive pulmonary disease (COPD) may, in some patients, be characterized by recurring acute exacerbations. Often these exacerbations are associated with airway infections. As immunoglobulins (Ig) are important parts of the immune defence against airway infections, the aim of this study was to relate the levels of circulating immunoglobulins to clinical features in unselected patients with COPD included in a Norwegian multicenter study. Methods: Clinical and biological data, including circulating levels of immunoglobulins, were assessed in 262 prospectively included patients with COPD GOLD stage II–IV at five hospitals in south-eastern Norway. A revisit was done after one year, and survival was assessed after five years. Clinical features and survival of those with immunoglobulin levels below reference values were compared to those with normal levels. Results: In total, 11.5% of all COPD patients and 18.5% of those with GOLD stage IV had IgG concentrations below reference values. These patients were more likely to use inhaled or oral steroids, had lower BMI, and lower FEV1%. Moreover, they had significantly more COPD-related hospital admissions (2.8 vs 0.6), number of prednisolone courses (3.9 vs 1.2), and antibiotic treatments (3.7 vs 1.5) in the preceding year. Importantly, hypogammaglobulinemia was significantly associated with reduced survival in a log-rank analysis. In multivariate regression analysis, we found that the higher risk for acute exacerbations in these patients was independent of other risk factors and was associated with impaired survival. Conclusion: In conclusion, our study suggests that hypogammaglobulinemia may be involved in poor outcome in COPD and may thus be a feasible therapeutic target for interventional studies in COPD.

• Sikkeland, Liv Ingunn Bjoner; Qiao, Shuo Wang; Ueland, Thor; Myrdal, Ole Henrik; Wyrozemski, Lukasz Adam & Aukrust, Pål [Show all 12 contributors for this article] (2020). Lung CD4+ T cells in patients with lung fibrosis produce pro-fibrotic IL-13 together with IFNγ. European Respiratory Journal. ISSN 0903-1936. 57:2000983(3), p. 1–4. doi: 10.1183/13993003.00983-2020. Full text in Research Archive Show summary

  Progressive fibrosing interstitial lung diseases (PF-ILD) have poor prognosis and survival, and their pathogenesis is not well understood[1]. Mechanistically, lung fibrosis is thought to result from distorted wound-healing following tissue insults and inflammation, leading to scar formation by excess deposition of extracellular matrix proteins and destruction of lung architecture[2]. The fibrotic process is complex, and CD4+ T cells are likely involved by their production of a wide range of cytokines and growth factors that promote fibroblast proliferation and differentiation, collagen production, and stimulate production of pro-fibrotic mediators by tissue macrophages[3]. However, CD4+ T cells in PF-ILD are poorly characterized. To this end, we performed a detailed analysis of phenotype, cytokine production and clonality of T cells from the lungs [bronchoalveolar lavage (BAL)] of PF-ILD patients. We found that BAL from PF-ILD lungs contained high numbers of clonally expanded CD4+ T cells that produced an unusual combination of interferon (IFN)  and pro-fibrotic interleukin (IL)-13. Such cells were not found in patient blood or in control BAL samples.

• Abrahamsen, Regine; Gundersen, Gølin Finkenhagen; Svendsen, Martin Veel; Klepaker, Geir; Kongerud, Johny & Fell, Anne Kristin Møller (2020). Possible Risk Factors for Poor Asthma Control Assessed in a Cross-Sectional Population-Based Study From Telemark, Norway. PLOS ONE. 15(5). doi: 10.1371/journal.pone.0232621. Full text in Research Archive Show summary

  This cross-sectional study of the general population of Telemark County, Norway, aimed to identify risk factors associated with poor asthma control as defined by the Asthma Control Test (ACT), and to determine the proportions of patients with poorly controlled asthma who had undergone spirometry, used asthma medication, or been examined by a pulmonary physician. In 2014-2015, the study recruited 326 subjects aged 16-50 years who had self-reported physician-diagnosed asthma and presence of respiratory symptoms during the previous 12 months. The clinical outcome measures were body mass index (BMI), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), fractional exhaled nitric oxide (FeNO), immunoglobulin E (IgE) in serum and serum C-reactive protein (CRP). An ACT score ≤ 19 was defined as poorly controlled asthma. Overall, 113 subjects (35%) reported poor asthma control. The odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with poorly controlled asthma were: self-reported occupational exposure to vapor, gas, dust, or fumes during the previous 12 months (OR 2.0; 95% CI 1.1-3.6), body mass index ≥ 30 kg/m2 (OR 2.2; 95% CI 1.2-4.1), female sex (OR 2.6; 95% CI 1.5-4.7), current smoking (OR 2.8; 95% CI 1.5-5.3), and past smoking (OR 2.3; 95% CI 1.3-4.0). Poor asthma control was also associated with reduced FEV1 after bronchodilation (β -3.6; 95% CI -7.0 to -0.2). Moreover, 13% of the participants with poor asthma control reported no use of asthma medication, 51% had not been assessed by a pulmonary physician, and 20% had never undergone spirometry. Because these data are cross-sectional, further studies assessing possible risk factors in general and objectively measured occupational exposure in particular are needed. However, our results suggest that there is room for improvement with regards to use of spirometry and pulmonary physician referrals when a patient's asthma is inadequately controlled.

• Klepaker, Geir; Svendsen, Martin Veel; Hertel, Jens Kristoffer; Holla, Øystein Lunde; Henneberger, Paul Keefer & Kongerud, Johny [Show all 7 contributors for this article] (2019). Influence of Obesity on Work ability, Respiratory Symptoms, and Lung Function in Adults with Asthma. Respiration. ISSN 0025-7931. 98(6), p. 473–481. doi: 10.1159/000502154. Full text in Research Archive Show summary

  BACKGROUND:Asthma is defined by variable respiratory symptoms and lung function, and may influence work ability. Similarly, obesity may contribute to respiratory symptoms, affect lung function, and reduce work ability. Thus, assessment of the influence of obesity on work ability, respiratory symptoms, and lung function in adults with asthma is needed. OBJECTIVES:We hypothesized that patients with obesity and asthma have more respiratory symptoms and reduced work ability and lung function compared with normal-weight patients with asthma. METHODS:We examined 626 participants with physician-diagnosed asthma, aged 18-52 years, recruited from a cross-sectional general population study using a comprehensive questionnaire including work ability score, the asthma control test (ACT), height and weight, and spirometry with reversibility testing. RESULTS:Participants with a body mass index (BMI) ≥30 kg/m2 (i.e., obese) had a higher symptom score (OR 1.78, 95% CI 1.14-2.80), current use of asthma medication (1.60, 1.05-2.46), and incidence of ACT scores ≤19 (poor asthma control) (1.81, 1.03-3.18) than participants with BMI ≤24.9 kg/m2 (i.e., normal weight). Post-bronchodilator forced vital capacity (FVC) as a percentage of predicted (β coefficient -4.5) and pre-bronchodilator forced expiratory volume in 1 s as a percentage of predicted (FEV1) (β coefficient -4.6) were negatively associated with BMI ≥30 kg/m2. We found no statistically significant association of BMI >30 kg/m2 (compared to BMI <24.9 kg/m2) with sick leave (1.21, 0.75-1.70) or reduced work ability (1.23, 0.74-2.04). CONCLUSIONS:There were indications that patients with obesity had a higher symptom burden, poorer asthma control, higher consumption of asthma medication, and reduced lung function, in particular for FVC, compared with normal-weight patients.

• Kononova, Natalia; Sikkeland, Liv Ingunn Bjoner; Mahmood, Faiza; Vistnes, Maria; Kongerud, Johny & Einvik, Gunnar [Show all 7 contributors for this article] (2019). Annual decline in forced expiratory volume and airway inflammatory cells and mediators in a general population-based sample. BMC Pulmonary Medicine. 19. doi: 10.1186/s12890-018-0765-7. Full text in Research Archive Show summary

  Background Few studies have examined the relationships between sputum inflammatory markers and subsequent annual decline in forced expiratory volume in 1 s (dFEV1). This study investigated whether indices of airway inflammation are predictors of dFEV1 in a general population-based sample. Methods The study, conducted from 2003 to 2005, included 120 healthy Norwegian subjects aged 40 to 70 years old. At baseline, the participants completed a self-administered respiratory questionnaire and underwent a clinical examination that included spirometry, venous blood sampling, and induced sputum examination. From 2015 to 2016, 62 (52%) participants agreed to a follow-up examination that did not include induced sputum examination. Those with a FEV1/forced vital capacity (FVC) ratio <  0.70 underwent a bronchial reversibility test. The levels of cytokines, pro-inflammatory M1 macrophage phenotypes were measured in induced sputum using bead-based multiplex analysis. The associations between cytokine levels and dFEV1 were then analysed. Results The mean dFEV1 was 32.9 ml/year (standard deviation 26.3). We found no associations between dFEV1 and the baseline indices of sputum inflammation. Seven participants had irreversible airflow limitation at follow-up. They had lower FEV1 and gas diffusion at baseline compared with the remaining subjects. Moreover, two of these individuals had a positive reversibility test and sputum eosinophilia at baseline. Conclusions In this cohort of presumably healthy subjects, we found no associations between sputum inflammatory cells or mediators and dFEV1 during 10 years of follow-up.

• Clarhed, Ulrika K E; Svendsen, Martin Veel; Schiöler, Linus; Kongerud, Johny; Torén, Kjell & Hellgren, Johan [Show all 7 contributors for this article] (2018). Chronic Rhinosinusitis Related to Occupational Exposure: The Telemark Population Study. Journal of Occupational and Environmental Medicine. ISSN 1076-2752. 60(7), p. 656–660. doi: 10.1097/JOM.0000000000001312. Full text in Research Archive Show summary

  Objective: The aim of this study was to investigate the association between occupational exposure and chronic rhinosinusitis. Methods: A random population from the region of Telemark, aged 16 to 50 years, answered a respiratory questionnaire including questions on chronic rhinosinusitis and exposure in the occupational environment. Results: A total of 16,099/48,142 subjects responded. The prevalence of chronic rhinosinusitis was 9%. Exposure associated with chronic rhinosinusitis comprised paper dust [odds ratio (OR) 1.3, 95% confidence interval (95% CI) 1.1 to 1.5], cleaning agents (OR 1.2, 95% CI 1.0 to 1.3), metal dust (OR 1.3, 95% CI 1.1 to 1.6), animals (OR 1.2, 95% CI 1.0 to 1.5), moisture/mould/mildew (OR 1.3, 95% CI 1.1 to 1.5), and physically strenuous work (OR 1.4, 95% CI 1.2 to 1.7). Conclusion: Occupational exposure to paper dust, cleaning agents, metal dust, animals, moisture/mould/mildew, and physically strenuous work was independently related to having chronic rhinosinusitis. An occupational history should be reviewed when assessing patients with chronic rhinosinusitis.

• Myrdal, Ole Henrik; Kanellopoulos, Adriani; Christiansen, Jon Runar; Ruud, Ellen; Edvardsen, Elisabeth & Kongerud, Johny [Show all 8 contributors for this article] (2018). Risk factors for impaired pulmonary function and cardiorespiratory fitness in very long-term adult survivors of childhood acute lymphoblastic leukemia after treatment with chemotherapy only*. Acta Oncologica. ISSN 0284-186X. 57(5), p. 658–664. doi: 10.1080/0284186X.2017.1423177. Full text in Research Archive Show summary

  Background: Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk of late treatment-related side-effects. Data regarding prevalence and risk factors for impairments in pulmonary function and cardiorespiratory fitness are limited, and reported findings are inconsistent and inconclusive. Material and methods: In a cross-sectional study, 116 ALL survivors (median 5 years at diagnosis, 29 years at follow-up, 53% females) were examined, median 23 years after treatment with chemotherapy only. Individual cumulative doses of cytostatic agents were calculated. Methods included blood tests, echocardiography, pulmonary function tests and cardiorespiratory exercise test. Results: Females had lower % predicted gas diffusing capacity (DLCO) than males (mean [SD] 84 [13] versus 97 [14], p < .001). Impairment in DLCO was found in 34% females versus 7% males, p < .001. In a multiple linear regression model, female gender, body mass index (BMI) and smoking were risk factors for reduced % predicted DLCO, with a borderline significant effect of left ventricular ejection fraction (LVEF). Impaired cardiorespiratory fitness was found in 42% of the survivors, with a borderline increased risk in females, p = .06. Smoking and BMI were risk factors for reduced % predicted VO2peak. Subjects exposed to anthracyclines had lower LVEF% and % predicted VO2peak than those not exposed, (mean [SD] 56.2 [4.3] versus 59.2 [5.2], p = .01 and 86.9 [18.4] versus 92.8 [18.4], p = .03, respectively). Conclusions: Impairments in pulmonary function and cardiorespiratory fitness are common in very long-term survivors of childhood ALL. Risk factors are female gender, BMI and smoking. In order to preserve pulmonary function and cardiorespiratory fitness, we suggest increased attention and targeted advice on modifiable lifestyle factors such as smoking, inactivity and overweight.

• Bugge, Anders; Lund, May-Brith; Valberg, Morten; Brustugun, Odd Terje; Solberg, Steinar & Kongerud, Johny (2018). Cause-specific death after surgical resection for early-stage non-small-cell lung cancer. European Journal of Cardio-Thoracic Surgery. ISSN 1010-7940. 53(1), p. 221–227. doi: 10.1093/ejcts/ezx274. Full text in Research Archive
• Fell, Anne Kristin Møller; Svendsen, Martin Veel; Kim, J L; Abrahamsen, Regine; Henneberger, Paul K. & Toren, K. [Show all 8 contributors for this article] (2018). Exposure to second-hand tobacco smoke and respiratory symptoms in non-smoking adults: cross-sectional data from the general population of Telemark, Norway. BMC Public Health. 18(1). doi: 10.1186/s12889-018-5771-4. Full text in Research Archive Show summary

  Background In Norway, data on the association between second-hand tobacco smoke (SHS) exposure at home and respiratory symptoms in adults are limited. Methods We assessed the association between self-reported exposure to SHS and the prevalence of respiratory symptoms among never-smokers aged 16 to 50 years from the general population who were included in a cross-sectional population-based study in Telemark County, Norway. Logistic regression analysis was used to estimate the odds ratios of symptoms among 8850 never-smokers who provided an affirmative response to questions regarding SHS; 504 (5.7%) of these reported that they lived in a home with daily or occasional indoor smoking. Results Productive cough and nocturnal dyspnoea were statistically associated with daily SHS exposure (ORs 1.5 [95% CI 1.04–2.0] and 1.8 [1.2–2.7], respectively). In analyses stratified by gender, nocturnal dyspnoea was associated with SHS among women (OR 1.8 [1.1–3.1]), but not among men (OR 0.93 [0.49–1.8]). Symptoms were not associated with occasional SHS exposure in the entire group, but infrequent exposure among men only was associated with increased prevalence of chronic cough; (OR 1.6; [1.04–2.6]) and was negatively associated with wheeze; (OR 0.44 [0.21–0.92)]. Conclusions Daily SHS exposure in private homes was associated with productive cough and nocturnal dyspnoea. Our results suggest that preventive measures may be needed to reduce the respiratory effects of SHS at home. Trial registration ClinicalTrials.gov Identifier: NCT02073708 Registered February 27. 2014.

• Bugge, Anders; Kongerud, Johny; Brunborg, Cathrine; Solberg, Steinar & Lund, May-Brith (2017). Gender-specific survival after surgical resection for early stage non-small cell lung cancer. Acta Oncologica. ISSN 0284-186X. 56(3), p. 448–454. doi: 10.1080/0284186X.2016.1253862. Full text in Research Archive
• Abrahamsen, Regine; Fell, Anne Kristin Møller; Svendsen, Martin Veel; Andersson, E.; Torén, Kjell & Henneberger, Paul K. [Show all 7 contributors for this article] (2017). Association of respiratory symptoms and asthma with occupational exposures: findings from a population-based cross-sectional survey in Telemark, Norway. BMJ Open. 7(3). doi: 10.1136/bmjopen-2016-014018. Full text in Research Archive Show summary

  Objectives The aim of this study was to estimate the prevalence of respiratory symptoms and physician-diagnosed asthma and assess the impact of current occupational exposure. Design Cross-sectional analyses of the prevalence of self-reported respiratory health and association with current occupational exposure in a random sample of the general population in Telemark County, Norway. Settings In 2013, a self-administered questionnaire was mailed to a random sample of the general population, aged 16–50, in Telemark, Norway. The overall response rate was 33%, comprising 16 099 responders. Outcome measures The prevalence for respiratory symptoms and asthma, and OR of respiratory symptoms and asthma for occupational groups and exposures were calculated. Occupational exposures were assessed using self-reported exposure and an asthma-specific job-exposure matrix (JEM). Results The prevalence of physician-diagnosed asthma was 11.5%. For the occupational groups, the category with agriculture/fishery workers and craft/related trade workers was associated with wheezing and asthma attack in the past 12 months, showing OR 1.3 (1.1 to 1.6) and 1.9 (1.2 to 2.8), respectively. The group including technicians and associated professionals was also associated with wheezing OR 1.2 (1.0 to 1.3) and asthma attack OR 1.4 (1.1 to 1.9). The JEM data show that exposure to flour was associated with wheezing OR 3.2 (1.4 to 7.3) and woken with dyspnoea OR 3.5 (1.3 to 9.5), whereas exposures to diisocyanates, welding/soldering fumes and exposure to vehicle/motor exhaust were associated with dyspnoea OR 2.9 (1.5 to 5.7), 3.2 (1.6 to 6.4) and 1.4 (1.0 to 1.8), respectively. Conclusions The observed prevalence of physician-diagnosed asthma was 11.5%. The ‘manual’ occupations were associated with respiratory symptoms. Occupational exposure to flour, diisocyanates, welding/soldering fumes and vehicle/motor exhaust was associated with respiratory symptoms in the past 12 months and use of asthma medication. However, prospective data are needed to confirm the observed associations.

• Borander, Anne Katrine; Voie, Øyvind Albert; Longva, Kjetil Sager; Danielsen, Tor ERik; Grahnstedt, Svein & Sandvik, Leiv [Show all 8 contributors for this article] (2017). Military small arms fire in association with acute decrements in lung function. Occupational and Environmental Medicine. ISSN 1351-0711. doi: 10.1136/oemed-2016-104207. Full text in Research Archive Show summary

  Objective After introduction of unleaded ammunition, Norwegian Armed Forces received reports of acute respiratory symptoms in soldiers after exposure to fumes from firing the standard weapon, HK416. The aim of the present study was to examine lung function before and after exposure to fumes from HK416 in a double-blinded standardised study design using three different types of ammunition. Methods Fifty-four healthy, non-smoking male volunteers (19–62 years) fired the weapons for 60 min with either leaded, unleaded or ‘modified’ unleaded ammunition. Gaseous and particulate emissions were monitored. Spirometry and exhaled nitric oxide (eNO) were performed within 14 days before (T0), shortly after (T1) and 24 hours after (T2) shooting. Methacholine provocation and diffusing capacity of carbon monoxide (DLCO) were carried out at T0 and T2. Results The mean forced expiratory volume in 1 s on a group level was significantly reduced both at T1 and T2 compared with T0, with means and 95% CI of 226 mL (158 to 294 mL) and 285 mL (218 to 351 mL), respectively. The same significant pattern was seen for DLCO, forced vital capacity and eNO. The methacholine test indicated a slight increase in bronchial hyper-reactivity. However, there were no significant differences between types of ammunition used. Conclusion Exposure to fumes from military weapons might be a respiratory hazard for soldiers who do live-fire training regularly or are in a closed combat environment.

• Sikkeland, Liv Ingunn Bjoner; Borander, Anne Katrine; Voie, Øyvind Albert; Aass, Hans Christian Dalsbotten; Øvstebø, Reidun & Aukrust, Pål [Show all 10 contributors for this article] (2017). Systemic and Airway Inflammation After Exposure to Fumes from Military Small Arms. American Journal of Respiratory and Critical Care Medicine. ISSN 1073-449X. doi: 10.1164/rccm.201709-1857LE. Full text in Research Archive
• Nordby, Karl-Christian; Notø, Hilde Pettersen; Wijnand, Eduard; Skogstad, Marit; Fell, Anne Kristin Møller & Thomassen, Yngvar [Show all 12 contributors for this article] (2016). Thoracic dust exposure is associated with lung function decline in cement production workers. European Respiratory Journal. ISSN 0903-1936. 48(2), p. 331–339. doi: 10.1183/13993003.02061-2015. Full text in Research Archive Show summary

  We hypothesised that exposure to workplace aerosols may lead to lung function impairment among cement production workers. Our study included 4966 workers in 24 cement production plants. Based on 6111 thoracic aerosol samples and information from questionnaires we estimated arithmetic mean exposure levels by plant and job type. Dynamic lung volumes were assessed by repeated spirometry testing during a mean follow-up time of 3.5 years (range 0.7–4.6 years). The outcomes considered were yearly change of dynamic lung volumes divided by the standing height squared or percentage of predicted values. Statistical modelling was performed using mixed model regression. Individual exposure was classified into quintile levels limited at 0.09, 0.89, 1.56, 2.25, 3.36, and 14.6 mg·m−3, using the lowest quintile as the reference. Employees that worked in administration were included as a second comparison group. Exposure was associated with a reduction in forced expiratory volume in 1 s (FEV1), forced expiratory volume in 6 s and forced vital capacity. For FEV1 % predicted a yearly excess decline of 0.84 percentage points was found in the highest exposure quintile compared with the lowest. Exposure at the higher levels found in this study may lead to a decline in dynamic lung volumes. Exposure reduction is therefore warranted.

• Christensen, Vivi Lycke; Holm, Are Martin; Kongerud, Johny; Bentsen, Signe Berit; Paul, Steven M. & Miaskowski, Christine [Show all 7 contributors for this article] (2016). Occurrence, Characteristics, and Predictors of Pain in Patients with Chronic Obstructive Pulmonary Disease. Pain Management Nursing. ISSN 1524-9042. 17(2), p. 107–118. doi: 10.1016/j.pmn.2016.01.002. Full text in Research Archive
• Abrahamsen, Regine; Svendsen, Martin Veel; Henneberger, Paul K.; Gundersen, Gølin Finkenhagen; Torén, Kjell & Kongerud, Johny [Show all 7 contributors for this article] (2016). Non-response in a cross-sectional study of respiratory health in Norway. BMJ Open. 6(1). doi: 10.1136/bmjopen-2015-009912. Full text in Research Archive
• Søyseth, Vidar; Henneberger, Paul K; Einvik, Gunnar; Virji, Mohammed Abbas; Bakke, Berit & Kongerud, Johny (2016). Annual decline in forced expiratory volume is steeper in aluminum potroom workers than in workers without exposure to potroom fumes. American Journal of Industrial Medicine. ISSN 0271-3586. 59(4), p. 322–329. doi: 10.1002/ajim.22570. Full text in Research Archive Show summary

  Background: Aluminum potroom exposure is associated with increased mortality of COPD but the association between potroom exposure and annual decline in lung function is unknown. We have measured lung volumes annually using spirometry from 1986 to 1996. The objective was to compare annual decline in forced expiratory volume in 1 s (dFEV1) and forced vital capacity (dFVC). Methods: The number of aluminum potroom workers was 4,546 (81% males) and the number of workers in the reference group was 651 (76% males). The number of spirometries in the index group and the references were 24,060 and 2,243, respectively. Results: After adjustment for confounders, the difference in dFEV1 and dFVC between the index and reference groups were 13.5 (P < 0.001) and −8.0 (P = 0.060) ml/year. Conclusion: Aluminum potroom operators have increased annual decline in FEV1 relative to a comparable group with non‐exposure to potroom fumes and gases.

• Bugge, Anders Standal; Lund, May-Brith; Brunborg, Cathrine; Solberg, Steinar & Kongerud, Johny (2016). Survival after surgical resection for lung cancer in patients with chronic obstructive pulmonary disease. Annals of Thoracic Surgery. ISSN 0003-4975. 101(6), p. 2125–2131. doi: 10.1016/j.athoracsur.2015.12.057. Full text in Research Archive Show summary

  Background The best curable therapy for lung cancer is surgical resection. Chronic obstructive pulmonary disease (COPD) may influence survival, and lung function is crucial in the preoperative assessment. We hypothesized that COPD would influence survival after lung cancer resection. Methods During the period 2003 to 2013, 688 patients were operated on for stage I and II non-small cell lung cancer and prospectively registered. Spirometry was performed, and COPD categorized according to the definition by the Global Initiative for Chronic Obstructive Lung Disease. An explanatory strategy was used to investigate the relationship between severe COPD and survival. Results COPD was present in 455 patients (66.1%) and was severe in 51 (7.4%) and mild to moderate in 404 (58.7%), whereas 233 patients (33.9%) had normal lung function. Cumulative survival was similar in patients with normal lung function and patients with mild to moderate COPD. Patients with severe COPD had significantly reduced cumulative survival after 2 and 5 years of 63.5% (95% confidence interval [CI], 48.4% to 75.2%) and 41.8% (95% CI, 26.5% to 56.3%), respectively, compared with nonsevere COPD at 81.7% (95% CI, 77.4% to 85.2%) and 61.3% (95% CI, 55.3% to 66.6%), respectively. Severe COPD was associated with a 69% increased risk of mortality (adjusted hazard ratio, 1.69; 95% CI, 1.12 to 2.55). Conclusions With careful preoperative selection, surgical resection may safely be offered to lung cancer patients with severe COPD. However, these patients have decreased long-term overall survival. Similar survival between patients with normal lung function and mild to moderate COPD suggests that similar indications for lung cancer operations may be applied.

• Sikkeland, Liv Ingunn Bjoner; Alexis, Neil E.; Fry, Rebecca C.; Martin, Elizabeth; Danielsen, Tor ERik & Søstrand, Per [Show all 7 contributors for this article] (2016). Inflammation in induced sputum after aluminium oxide exposure: An experimental chamber study. Occupational and Environmental Medicine. ISSN 1351-0711. 73(3), p. 199–205. doi: 10.1136/oemed-2015-103254. Full text in Research Archive
• Fell, Anne Kristin Møller; Abrahamsen, Regine; Henneberger, Paul K; Svendsen, Martin Veel; Andersson, E. & Toren, K. [Show all 7 contributors for this article] (2016). Breath-taking jobs: a case-control study of respiratory work disability by occupation in Norway. Occupational and Environmental Medicine. ISSN 1351-0711. 73(9), p. 600–606. doi: 10.1136/oemed-2015-103488. Full text in Research Archive Show summary

  Background The current knowledge on respiratory work disability is based on studies that used crude categories of exposure. This may lead to a loss of power, and does not provide sufficient information to allow targeted workplace interventions and follow-up of patients with respiratory symptoms. Objectives The aim of this study was to identify occupations and specific exposures associated with respiratory work disability. Methods In 2013, a self-administered questionnaire was mailed to a random sample of the general population, aged 16–50, in Telemark County, Norway. We defined respiratory work disability as a positive response to the survey question: ‘Have you ever had to change or leave your job because it affected your breathing?’ Occupational exposures were assessed using an asthma-specific job-exposure matrix, and comparison of risks was made for cases and a median of 50 controls per case. Results 247 workers had changed their work because of respiratory symptoms, accounting for 1.7% of the respondents ever employed. The ‘breath-taking jobs’ were cooks/chefs: adjusted OR 3.6 (95% CI 1.6 to 8.0); welders: 5.2 (2.0 to 14); gardeners: 4.5 (1.3 to 15); sheet metal workers: 5.4 (2.0 to 14); cleaners: 5.0 (2.2 to 11); hairdressers: 6.4 (2.5 to 17); and agricultural labourers: 7.4 (2.5 to 22). Job changes were also associated with a variety of occupational exposures, with some differences between men and women. Conclusions Self-report and job-exposure matrix data showed similar findings. For the occupations and exposures associated with job change, preventive measures should be implemented.

• Sikkeland, Liv Ingunn Bjoner; Johnsen, Helle Laier; Riste, Tonje Bøyum; Alexis, Neil E.; Halvorsen, Bente & Søyseth, Vidar [Show all 7 contributors for this article] (2016). Sputum neutrophils are elevated in smelter workers, and systemic neutrophils are associated with rapid decline in FEV1. Occupational and Environmental Medicine. ISSN 1351-0711. 73(7), p. 459–466. doi: 10.1136/oemed-2015-103083. Full text in Research Archive Show summary

  Abstract: Objectives In a previous study on smelter workers we, found significant relationship between exposure to dust and accelerated annual decline in forced expiratory volume in 1 s (FEV1). In this cross-sectional study at the end of a follow-up, we aimed to investigate the possible association between annual decline in FEV1 and markers of airways, and systemic inflammation in smelter workers. Methods: Employees (n=76 (27 current smokers)) who had been part of a longitudinal study (9–13 years) that included spirometry (>6 measurements) and respiratory questionnaires, performed induced sputum, exhaled NO and had blood drawn. Participants with annual decline in FEV1≥45 mL were compared with participants with annual decline <45 mL; also 26 non-exposed controls were included. Results: Compared with non-exposed controls, smelter workers demonstrated a significantly increased percentage of neutrophils (mean (SD)) (57% (17) vs 31% (15)) and matrix metalloproteinases 8 (MMP-8) levels in sputum, and MMP-9, surfactant protein D (SpD) and transforming growth factor β (TGFb) levels in blood. A significant association in FEV1≥45 mL was found for blood neutrophils when controlling for smoking habits (OR=1.7 (95% CI 1.0 to 2.8), p=0.045). Airway and blood protein markers were not associated with annual decline in FEV1. Conclusions: All workers displayed airway and systemic inflammation characterised by increased levels of neutrophils and MMP-8 in sputum, and MMP-9, SpD and TGFβ in blood compared with non-exposed controls. Blood neutrophils in particular were significantly elevated in those workers with the most rapid decline in lung function. A similar observation was not seen with airway neutrophils. In the present study, we were able to identify systemic but not airway inflammatory markers that can predict increased decline in FEV1 in smelter workers.

• Nemer, Maysaa Y K Sadeya; Sikkeland, Liv Ingunn Bjoner; Kasem, Mayes; Kristensen, Petter; Nijem, Khaldoun & Bjertness, Espen [Show all 10 contributors for this article] (2015). Airway inflammation and ammonia exposure among female Palestinian hairdressers: A cross-sectional study. Occupational and Environmental Medicine. ISSN 1351-0711. 72(6), p. 428–434. doi: 10.1136/oemed-2014-102437. Full text in Research Archive Show summary

  Objectives: Little is known about the working conditions and airway inflammation in hairdressers in Palestine. We aimed to investigate if hairdressers in Palestine have a higher level of airway inflammation as compared to a control group. We also assessed the hairdressers’ physical working conditions and exposure to ammonia gases at the hair salons. Lastly, we investigated the association between ammonia levels and inflammation markers in the airways and the blood. Methods: Our study participants were 33 non-smoking hairdressers (aged 19–50 years) and 35 non-smoking control subjects (aged 18–49 years). Both groups answered a questionnaire on respiratory symptoms, and performed lung function and exhaled nitric oxide (eNO) tests. Blood and sputum samples were collected from all participants and air concentration levels of ammonia were measured in 13 salons. Results: Hairdressers had a higher level of sputum neutrophil count (absolute numbers/mg sputum (median (25th–75th centiles)) compared to controls, 376 (183–980) and 182 (96–358), respectively. Hairdressers also had significantly elevated eNO and blood C reactive protein (CRP) levels compared to the control subjects, controlled for age and body mass index. Exposure measurements showed that the hairdressers in salons with scarce ventilation were exposed to ammonia concentration, ranging from 3 to 61 mg/m3. Conclusions: Compared to unexposed controls, the hairdressers had signs of neutrophilic airway inflammation, higher eNO levels and higher CRP. The hairdressers were exposed to high concentrations of ammonia from hairdressing chemicals and their working conditions were unsatisfactory.

• Espinoza, Andreas Westenvik; Neumann, Kirill; Halvorsen, Per Steinar; Sundset, Arve; Kongerud, Johny & Fosse, Erik (2015). Critical airway obstruction: Challenges in airway management and ventilation during therapeutic bronchoscopy. Journal of Bronchology & Interventional Pulmonology. ISSN 1944-6586. 22(1), p. 41–47. doi: 10.1097/LBR.0000000000000127. Full text in Research Archive
• Søyseth, Vidar; Henneberger, Paul; Virji, Mohammed Abbas; Bakke, Berit & Kongerud, Johny (2015). Construction of a job exposure matrix to dust, fluoride, and polycyclic aromatic hydrocarbons in the Norwegian aluminum industry using prediction models. Annals of Occupational Hygiene. ISSN 0003-4878. 59(9), p. 1106–1121. doi: 10.1093/annhyg/mev069. Full text in Research Archive Show summary

  Background: The Norwegian aluminum industry developed and implemented a protocol for prospective monitoring of employees’ exposure using personal samplers. We analyzed these data to develop prediction lines to construct a job exposure matrix (JEM) for the period 1986–1995. Methods: The protocol for personal monitoring of exposure was implemented in all seven Norwegian aluminum plants in 1986 and continued until 1995. Personal samplers were used to collect total dust, fluorides, and total polycyclic aromatic hydrocarbons (PAH). In addition, exposure could be categorized according to process, i.e. prebake, Søderberg, and ‘other’. We constructed four-dimensional JEMs characterized by: Plant, Job descriptor, Process, and Year. Totally 8074, 6734, and 3524 measurements were available for dust, fluorides, and PAH, respectively. The data were analyzed using linear mixed models with two-way interactions. The models were assessed using the Akaike criterion (AIC) and unadjusted R2. The significance level was set to 10% (two-sided) for retaining variables in the model. Results: In 1986, the geometric mean (95% confidence interval in parentheses) for total dust, total fluorides, and PAH were 3.18 (0.46–22.2) mg m−3, 0.58 (0.085–4.00) mg m−3, and 33.9 (2.3–504) µg m−3, respectively. During 10 years of follow-up, the exposure to total dust, fluorides, and PAH decreased by 9.2, 11.7, and 14.9% per year, respectively. Each model encompassed from 49 to 72 significant components of the interaction terms. The interaction components were at least as important as the main effects, and 65 to 91% of the significant components of the interaction terms were time-dependent. Conclusion: Our prediction models indicated that exposures were highly time-dependent. We expect that the time-dependent changes in exposure are of major importance for longitudinal studies of health effects in the aluminum industry.

• Søyseth, Vidar; Johnsen, Helle Laier; Henneberger, Paul K. & Kongerud, Johny (2015). Increased decline in pulmonary function among employees in Norwegian smelters reporting work-related asthma-like symptoms. Journal of Occupational and Environmental Medicine. ISSN 1076-2752. 57(9), p. 1004–1008. doi: 10.1097/JOM.0000000000000518. Full text in Research Archive Show summary

  Objective: To investigate associations between work-related asthma-like symptoms (WASTH) and annual pulmonary function decline among employees of 18 Norwegian smelters. Methods: A 5-year longitudinal study in which WASTH was defined as a combination of dyspnea and wheezing that improved on rest days and vacation. Results: A total of 12,966 spirometry examinations were performed in 3084 employees. Crude annual decline in forced expiratory volume in 1 second (FEV1) (dFEV1) was 32.9 mL/yr (95% confidence interval, 30.5 to 35.3), and crude annual decline in forced vital capacity (FVC) (dFVC) was 40.9 mL/yr (37.8 to 43.9). After adjustment for relevant covariates, employees reporting WASTH showed higher dFEV1 by 16.0 m:/yr (3.4 to 28.6) and higher dFVC by 20.5 mL/yr (6.0 to 35.0) compared with employees not reporting WASTH. Conclusion: Work-related asthma-like symptom was associated with greater annual declines in FEV1 and FVC, indicating a restrictive pattern.

• Oksholm, Trine; Miaskowsky, Christine; Solberg, Steinar; Lie, Irene; Cooper, Bruce & Paul, Steven M. [Show all 8 contributors for this article] (2015). Changes in symptom occurrence and severity before and after lung cancer surgery. Cancer Nursing. ISSN 0162-220X. 38(5), p. 351–357. doi: 10.1097/NCC.0000000000000198. Full text in Research Archive
• Oksholm, Trine; Rustøen, Tone; Cooper, Bruce; Paul, Steven M.; Solberg, Steinar & Henriksen, Kari [Show all 8 contributors for this article] (2015). Trajectories of symptom occurrence and severity from before through five months after lung cancer surgery. Journal of Pain and Symptom Management. ISSN 0885-3924. 49(6), p. 995–1015. doi: 10.1016/j.jpainsymman.2014.11.297. Full text in Research Archive
• Aasen, Tor Olav Brøvig & Kongerud, Johny (2014). Arbeidsrelatert astma : diagnostikk og oppfølging. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(20), p. 1955–1959. doi: 10.4045/tidsskr.13.1225. Full text in Research Archive
• Fell, Anne Kristin Møller; Aasen, Tor Olav Brøvig & Kongerud, Johny (2014). Arbeidsrelatert kols. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(22), p. 2158–2163. doi: 10.4045/tidsskr.14.0255. Full text in Research Archive
• Bugge, Anders Standal; Naalsund, Anne; Johnsrud, Kjersti; Berstad, Audun Elnæs; Samersaw-Lund, May Brit & Kongerud, Johny (2014). PET-CT i utredningen av lungekreft ved Rikshospitalet 2007 - 11. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(9), p. 938–944. doi: 10.4045/tidsskr.12.1512. Full text in Research Archive Show summary

  BAKGRUNN PET-CT er et hjelpemiddel ved utredning av lungekreft for å finne operable pasienter. Undersøkelsen anbefales hos de fleste pasienter med ikke-småcellet lungekreft som etter primærutredning antas å ha kurativ sykdom. Vi ønsket å beregne nytteverdien av PET-CT hos antatt operable pasienter som har fått utført undersøkelsen ved Rikshospitalet. MATERIALE OG METODE Pasienter innlagt til lungekreftutredning registreres fortløpende i avdelingens kvalitetsdatabase. Vi har analysert data for perioden 2007 – 11 for pasienter som etter primærutredning hadde en antatt operabel tumor. Av kapasitetshensyn ble noen operert uten forutgående PET-CT. RESULTATER Av 651 antatt operable pasienter ble PET-CT utført hos 533, hvorav 403 (76 %)ble operert. Vi beregnet at undersøkelsen hadde sensitivitet 78 % (95 % KI 70 – 86) og spesifisitet 88 % (95 % KI 85 – 91), positiv prediktiv verdi 64 % (95 % KI 55 – 72) og negativ prediktiv verdi 94 % (95 % KI 91 – 96) for spredning til mediastinale lymfeknuter. Diagnostisk nøyaktighet var 86 % (95 % KI 83 – 89) med kappaoverensstemmelse 0,61 (95 % KI 0,53 – 0,69) mellom PET-CT og faktiske funn av maligne eller benigne mediastinale lymfeknuter. FORTOLKNING PET-CT var et nyttig verktøy for utvelgelse av potensielt operable lungekreftpasienter ved Rikshospitalet 2007 – 11. Forutsatt at populasjonen vi undersøker med PET-CT ikke endrer seg, kan pasienter med negativ PET-CT med få unntak henvises direkte til operasjon uten ytterligere invasiv utredning.

• Færden, Karl; Lund, May-Brith; Aaløkken, Trond Mogens; Wijnand, Eduard; Søstrand, Per & Langård, Sverre [Show all 7 contributors for this article] (2014). Hypersensitivity pneumonitis in a cluster of sawmill workers: A 10-year follow-up of exposure, symptoms, and lung function. International journal of occupational and environmental health. ISSN 1077-3525. 20(2), p. 167–173. doi: 10.1179/2049396714Y.0000000063. Full text in Research Archive Show summary

  Background: The long-term prognosis of repeated acute episodes of hypersensitivity pneumonitis (HP) is not well described. We report on a 10-year follow-up of a 10-person cluster from a Norwegian sawmill who had all experienced relapsing episodes of HP. Objectives: To evaluate the health symptoms, work-related sick-leave, and lung function of 10 workers exposed to mold in a Norwegian sawmill. Methods: Participants were evaluated at baseline and 10 years later at follow-up. A structured interview, measurement of serum IgG antibodies to Rhizopus microsporus (R. microsporus) antigens, lung function tests, high resolution computed tomography (HRCT) of the chest, and personal measurements of exposure to mold spores and dust were completed for each participant. Results: At baseline, nearly all workers reported acute episodes of HP more than twice a month. At follow-up, both the frequency and intensity of symptoms had declined. Sick-leave was reduced and gas diffusing capacity improved – paralleling the gradually reduced air levels of mold spores. Conclusions: In spite of an initially high occurrence of symptoms, long-term clinical and physiological outcome was good. With reduced exposure to mold spores, symptoms declined and lung function was restored.

• Sikkeland, Liv Ingunn Bjoner; Samersaw-Lund, May Brit & Kongerud, Johny (2014). Immunological Analysis of Induced Sputum in Work Exposures. Journal of Environmental Immunology and Toxicology. 1(4), p. 183–189. doi: 10.7178/jeit.10. Full text in Research Archive
• Kongerud, Johny & Søyseth, Vidar (2014). Respiratory disorders in aluminum smelter workers. Journal of Occupational and Environmental Medicine. ISSN 1076-2752. 56(5), p. S60–S70. doi: 10.1097/JOM.0000000000000105. Full text in Research Archive
• Voie, Øyvind Albert; Borander, Anne Katrine; Sikkeland, Liv Ingunn Bjoner; Grahnstedt, Svein; Johnsen, Arnt Magne & Danielsen, Tor ERik [Show all 8 contributors for this article] (2014). Health effects after firing small arms comparing leaded and unleaded ammunition. Inhalation Toxicology. ISSN 0895-8378. doi: 10.3109/08958378.2014.970783. Full text in Research Archive Show summary

  A number of Norwegian soldiers have reported health problems after live-fire training using the HK416 rifle. The objective of this study was to characterize gaseous and particulate emissions from three different types of ammunition, and record the health effects after exposure to emissions from live-firing. Fifty-five healthy, non-smoking men (mean age 40 years) were recruited and divided randomly into three groups, one for each type of ammunition. All subjects fired the HK416 rifle in a semi-airtight tent for 60 min using leaded ammunition, unleaded ammunition and modified unleaded ammunition. Gaseous and particulate emissions were monitored within the tent. The symptoms experienced by the subjects were recorded immediately after and the day after firing using a standardized questionnaire. The concentrations of particulate matter and copper exceeded their respective occupational exposure limits (eight hours per day, five days a week) by a factor of 3 and 27, respectively. Of the 55 subjects, 54 reported general and respiratory symptoms. The total number of symptoms reported was significantly higher among shooters using unleaded ammunition as compared with the use of leaded and modified unleaded ammunition. Copper was the substance that had the highest concentration relative to its toxicity. Although the general symptoms were found to be consistent with the development of metal fume fever, the respiratory symptoms indicated an irritant effect of the airways different from that seen in metal fume fever. More symptoms were reported when unleaded ammunition was used compared with leaded and modified unleaded ammunition.

• Sjåheim, Tone Bjørg; Bjørtuft, Øystein; Drabløs, P.-A.; Kongerud, Johny & Halstensen, Trond Sundby (2013). Increased Bronchial Density of CD25+Foxp3+ Regulatory T Cells in Occupational Asthma: Relationship to Current Smoking. Scandinavian Journal of Immunology. ISSN 0300-9475. 77(5), p. 398–404. doi: 10.1111/sji.12035. Full text in Research Archive Show summary

  To identify activated T cell subset in the asthmatic bronchia, we developed a triple-colour immunohistofluorescence labelling technique on cryo-section to discriminate activated CD4+CD25+ T cells, (effector T cells) from Foxp3+ regulatory T cells (Treg). Additional coexpression of activation and proliferation markers was also examined in situ. Bronchial biopsies were taken from 20 aluminium potroom workers (12 smokers) with asthma (>12% reversibility), 15 non-asthmatic potroom workers (7 smokers) and 10 non-smoking, non-exposed controls. Non-smoking asthmatics had significantly higher subepithelial density of both Tregs, effector T cells, activated (HLA-DR+) CD8+ and activated CD4+ T cells. Moreover, both Tregs, effector T cells and CD8+ T cells proliferated in the non-smoking asthmatics, only. Although smoking asthmatics had no asthma-associated increase in bronchial T cell, both had a significantly increase in effector T cell to Treg ratios. The significantly increased bronchial density of Tregs, effector T cells, proliferative T cells and activated CD8+ T cells in non-smoking asthmatics clearly showed that both the effector T cells and the inhibitory Treg system were activated in asthma.

• Neumann, Kirill; Sundset, Arve; Espinoza, Andreas Westenvik; Kongerud, Johny & Fosse, Erik (2013). Changes in Quality of Life, Dyspnea Scores, and Lung Function in Lung Cancer Patients With Airway Obstruction After a Therapeutic Bronchoscopy. Journal of Bronchology & Interventional Pulmonology. ISSN 1944-6586. 20(2), p. 134–139. doi: 10.1097/LBR.0b013e3182917280. Full text in Research Archive
• Oksholm, Trine; Miaskowski, Christine; Kongerud, Johny; Cooper, Bruce; Paul, Steven M. & Lærum, Line Pedersen [Show all 7 contributors for this article] (2013). Does age influence the symptom experience of lung cancer patients prior to surgery? Lung Cancer. ISSN 0169-5002. 82(1), p. 156–161. doi: 10.1016/j.lungcan.2013.06.016. Full text in Research Archive
• Gabrielsen, Anne Marie; Lund, May-Brith; Kongerud, Johny; Viken, Karl Erik; Røislien, Jo & Hjelmesæth, Jøran [Show all 7 contributors for this article] (2013). Pulmonary function and blood gases after gastric bypass and lifestyle intervention: a comparative study. Clinical Obesity. ISSN 1758-8103. 3, p. 117–123. doi: 10.1111/cob.12024. Full text in Research Archive
• Søyseth, Vidar; Johnsen, Helle Laier & Kongerud, Johny (2013). Respiratory hazards of metal smelting. Current opinion in pulmonary medicine. ISSN 1070-5287. 19(2), p. 158–162. doi: 10.1097/MCP.0b013e32835ceeae. Full text in Research Archive Show summary

  Purpose of review: The metal smelting industry is an important industry in the majority of countries in the world and employs millions of workers. In most of the production types, a variety of pollutants are emitted into the workplace atmosphere. Some of these pollutants have sensitizing properties, whereas other act as irritants in the respiratory tract. This review will explore the recent studies (2010–2012) which address the impact of exposure to pollutants in the smelting industry on nonmalignant respiratory disorders. Recent findings: The association between different respiratory symptoms as well as pulmonary function and the level of exposure to different agents has been investigated. Likewise, the effect of primary prevention (exposure reduction) and secondary prevention (relocation) has been studied. Finally, the association between the incidence of community-acquired pneumonia and exposure to pollutants encountered at work in the smelting industry and the results from mortality studies are reported. Summary: It appears that exposure to emissions of pollutants in the smelting industry is associated with respiratory symptoms, including asthma, lung function decline and chronic obstructive pulmonary disease, depending on the type of production. Moreover, it is possible that these exposures may enhance the risk of infectious pneumonia.

• Gregersen, Stina; Holm, Are Martin; Fevang, Børre; Ueland, Thor; Sikkeland, Liv Ingunn Bjoner & Aaløkken, Trond Mogens [Show all 11 contributors for this article] (2013). Lung disease, T-cells and inflammation in common variable immunodeficiency disorders. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 73(6), p. 514–522. doi: 10.3109/00365513.2013.819523. Full text in Research Archive
• Auråen, Henrik; Mollnes, Tom Eirik; Bjørtuft, Øystein; Bakkan, Per Arne; Geiran, Odd & Kongerud, Johny [Show all 8 contributors for this article] (2013). Multiorgan procurement increases systemic inflammation in brain dead donors. Clinical Transplantation. ISSN 0902-0063. 27(4), p. 613–618. doi: 10.1111/ctr.12175. Full text in Research Archive
• Johnsen, Helle Laier; Bugge, Merete Drevvatne; Føreland, Solveig; Kjuus, Helge; Kongerud, Johny & Søyseth, Vidar (2013). Dust exposure is associated with increased lung function loss among workers in the Norwegian silicon carbide industry. Occupational and Environmental Medicine. ISSN 1351-0711. 70(11), p. 803–809. doi: 10.1136/oemed-2012-101068. Full text in Research Archive Show summary

  Objectives: To investigate the relationship between dust exposure and annual change in lung function among employees in Norwegian silicon carbide (SiC) plants using a quantitative job exposure matrix (JEM) regarding total dust. Methods: All employees, 20–55 years of age by inclusion (n=456), were examined annually for up to 5 years (1499 examinations). Spirometry was performed at each examination, and a questionnaire encompassing questions of respiratory symptoms, smoking status, job and smoking history, and present job held was completed. A JEM was constructed based on 1970 personal total dust exposure measurements collected during the study period. The association between lung function and total dust exposure was investigated using linear mixed models. Results: The annual change in forced expiratory volume (FEV) in one second per squared height, FEV1/height2, per mg/m3 increase in dust exposure was −2.3 (95% CI −3.8 to −0.79) (mL/m2)×year−1. In an employee of average height (1.79 m) and exposure (1.4 mg/m3) the estimated contribution to the annual change in FEV1 associated with dust was 10.4 mL/year. The annual change in FEV1/height2 in current, compared with non-smokers was −1.9 (−7.2 to 3.4) (mL/m2)×year−1. The estimated overall annual decline in FEV1 among current and non-smokers in the highest exposed group was −91.2 (−124.3 to −58.1) (mL/m2)×year−1 and −49.0 (−80.2 to −17.8) (mL/m2)×year−1, respectively. Conclusions: Dust exposure, expressed by a quantitative JEM, was found to be associated with an increased yearly decline in FEV1 in employees of Norwegian SiC plants.

• Skogstad, Marit; Sikkeland, Liv Ingunn Bjoner; Øvstebø, Reidun; Foss, Kari Bente; Heldal, Kari Emilie & Skare, Øivind [Show all 9 contributors for this article] (2012). Long-term occupational outcomes of endotoxin exposure and the effect of exposure cessation. Occupational and Environmental Medicine. ISSN 1351-0711. 69(2), p. 107–112. doi: 10.1136/oem.2010.062414. Full text in Research Archive Show summary

  Objective: To study the possible respiratory and haematological effects of endotoxin exposure to bacterial single-cell protein (BSCP) in workers during a follow-up period of 5 years including 4 years of exposure and 1 year without exposure. Methods: The study included 28 workers examined in 2002–2005 and 1 year after exposure termination in 2007. The arithmetic mean endotoxin exposure was 5800–11 000 EU/m3 among the high exposure group and 390 EU/m3 in the low exposure group. Assessment of lung function included spirometry and gas diffusion in 2003, 2004 and 2007. Rhinometry was performed in 2004 and 2007. Blood analysis included leukocyte cell count and measurement of the acute phase proteins: C-reactive protein, interleukin-6, eosinophilic cationic protein, macrophage inflammatory protein-1α, monocyte chemoattractant protein-1, chemoattractant protein RANTES, platelet-derived growth factor BB, fibrinogen and D-dimer. Results: In the low exposure group, but not in the high exposure group, there were significant improvements in both forced vital capacity (FVC) (290 ml) and forced expiratory volume in 1 s (FEV1) (180–210 ml) (p=0.004–0.03) 1 year after the end of exposure. The number of leukocytes and eosinophilic cationic protein and D-dimer levels increased significantly with increasing endotoxin exposures and decreased significantly 1 year after exposure termination. Changes in acute phase proteins suggested exposure-related tolerance. Conclusions: An inflammatory tendency during an exposure period of 4 years seems to reverse 1 year after cessation of exposure to endotoxins from a single species. Lung function improved significantly among workers exposed to low levels of endotoxin but not among the highly exposed workers.

• Sikkeland, Liv Ingunn Bjoner; Wijnand, Eduard; Skogstad, Marit; Alexis, Neil E. & Kongerud, Johny (2012). Recovery from workplace-induced airway inflammation 1 year after cessation of exposure. Occupational and Environmental Medicine. ISSN 1351-0711. 69(10), p. 721–726. doi: 10.1136/oemed-2011-100632. Full text in Research Archive Show summary

  Background Bacterial single-cell protein (BSCP) constitutes of dried bacterial mass which is used as protein enrichment in animal and fish feed. In the production of BSCP, workers are exposed to organic dust containing high levels of endotoxins (arithmetic mean 390 EU/m3 in the moderate exposure and 5800–11 000 EU/m3 in the high exposure groups) and have elevated levels of sputum neutrophils and cytokines associated with exposure. Objective The aim of the present study was to investigate if airway inflammation among the workers had declined 1 year after cessation of exposure. Methods Twenty-four non-smoking production workers (age 28–52) with a work history of 2–7 years were included in the study. Measurements Markers of airways inflammation and innate immune function (using flow cytometry) were assessed in an exposure period and 1 year after cessation of exposure. Results Sputum neutrophil proportion and numbers were significantly decreased 1 year after cessation of exposure to BSCP (43% vs 71%, 186 vs 598 neutrophils/mg sputum; p<0.001) as were eNO (17 ppb vs 21 ppb (p=0.01) and interleukin-1β (p<0.05) and interleukin-8 (p<0.05). Neutrophils had enhanced expression of CD11b/CR3 (p<0.01) and CD16/FcγRIII (p<0.001) and macrophages had lower expression of CD86 (p<0.01) 1 year after cessation of exposure. Conclusions One year after closure of the plant airway neutrophils and exhaled NO levels resolved to lower levels and cell surface phenotypes associated with innate immune function recovered to higher levels, indicating that these changes were partly reversible among workers who were no longer exposed to endotoxins in a BSCP plant.

• Sikkeland, Liv Ingunn Bjoner; Dahl, Christen Peder; Ueland, Thor; Andreassen, Arne K.; Gude, Einar & Edvardsen, Thor [Show all 12 contributors for this article] (2012). Increased levels of inflammatory cytokines and endothelin-1 in alveolar macrophages from patients with chronic heart failure. PLOS ONE. 7(5:e36815). doi: 10.1371/journal.pone.0036815. Full text in Research Archive
• Sundset, Arve; Lund, May-Brith; Hansen, Gunnar; Bjørtuft, Øystein; Kongerud, Johny & Geiran, Odd (2012). Airway Complications after Lung Transplantation: Long-Term Outcome of Silicone Stenting. Respiration. ISSN 0025-7931. 83(3), p. 245–252. doi: 10.1159/000334905. Full text in Research Archive
• Søyseth, Vidar; Johnsen, Helle Laier; Bugge, Merete Drevvatne & Kongerud, Johny (2012). The association between symptoms and exposure is stronger in dropouts than in non-dropouts among employees in Norwegian smelters: a five-year follow-up study. International Archives of Occupational and Environmental Health. ISSN 0340-0131. 85(1), p. 27–33. doi: 10.1007/s00420-011-0631-x. Full text in Research Archive Show summary

  Purpose: We have investigated the association between respiratory symptoms and dust exposure among employees in 18 Norwegian smelters using a longitudinal design. Methods: All employees (N = 3,084) were examined annually for 5 years (12,996 health examinations). At each examination, the subjects reported if they had respiratory symptoms, coded as 1 (yes) or 0 (no), on a respiratory questionnaire. Symptom score was constructed as the sum of symptoms (0–5). Full-time workers in the production line were classified as line operators; subjects never exposed in the production line were regarded as non-exposed. The remaining individuals were classified as non-line operators. A job-exposure matrix regarding dust exposure was also available. Analyses of repeated measurements were performed using generalised linear mixed model with log-link (Poisson regression). Adjustments were made for overdispersion. Results: The mean age at inclusion was 39.0 years, and 89% were men. The median dust exposure in tertiles 1–3 was 0.19, 1.76 and 3.47 mg/m3. The longitudinal analyses showed that the association between symptoms-score ratio (SSR) and job category was significantly stronger in dropouts compared with non-dropouts (p = 0.01). Among the dropouts, SSR was 1.61 (95% confidence interval: 1.27–2.05) and 1.39 (1.09–1.77) in line operators and non-line operators compared with non-exposed employees, respectively. The corresponding SSR for subjects who completed the study was 1.13 (1.01–1.27) and 1.12 (1.00–1.26), respectively. Similarly, among the dropouts, the SSR between the second and the first tertile was 1.28 (1.05–1.55) and 1.37 (1.13–1.66) between the third tertile and the first tertile. Conclusions: Line operators had more respiratory symptoms than non-exposed employees. This effect was significantly stronger in dropouts than in those who continued their jobs, indicating that there is a selection of subjects without respiratory symptoms in this industry.

• Søyseth, Vidar; Johnsen, Helle Laier; Henneberger, Paul K. & Kongerud, Johny (2012). The incidence of work-related asthma-like symptoms and dust exposure in Norwegian smelters. American Journal of Respiratory and Critical Care Medicine. ISSN 1073-449X. 185(12), p. 1280–1285. doi: 10.1164/rccm.201110-1809OC. Full text in Research Archive Show summary

  Rationale: The prevalence of respiratory symptoms amongemployees in smelters is positively associated with dust exposure. Objectives: To investigate the association between the incidence of work-related asthma-like symptoms (WASTH) and dust exposure. Methods: All the employees were invited to participate in a 5-year longitudinal study. The outcome of WASTH was defined as the combination of dyspnea and wheezing improving on rest days or vacation in an individual who had no asthma previously. Information about smoking and occupational status was obtained from a questionnaire. A job exposure matrix of total dust was developed. Multivariate data analyses were performed using Cox regression. Measurements and Main Results: The total follow-up time of the employees (n ¼ 2,476) was 8,469 years, and the median follow-up time for participantswas 4.0 years.During the follow-up, 91employees developed WASTH, and the corresponding incidence rate for WASTH per 1,000 person-years was 8.9 (7.3–10.9) (95% confidence interval in parentheses). The risk ratio ofWASTH increased significantly (P ¼ 0.0001)with dust exposure in the middle andhighcategories (1.0–2.9 and>3.0mg/m3). Stratifiedanalyses showedthat theeffect ofcurrent dust exposure varied with both previous exposure (PE) to dust and fumes (P ¼ 0.006) and airflow limitation (AFL) (P ¼ 0.033). The final analyses showedthat the risk ratios forWASTHper 1mg/m3 increase in current dust exposure were 1.1 (0.93–1.2), 1.4 (1.1–1.8), 1.6 (1.1–2.3), and 1.9 (1.2–3.0) for the categories (PE1/AFL2), (PE2/AFL2), (PE1/ AFL1, and (PE2/AFL1). Conclusions: In conclusion, dust exposure was associated with an increased incidence of WASTH. Keywords: work-related asthma-like symptoms; incidence; dust exposure

• Neyman, Kirill; Sundset, Arve; Naalsund, Anne; Espinoza, Andreas Westenvik; Solberg, Steinar & Kongerud, Johny [Show all 7 contributors for this article] (2012). Endoscopic Treatment of Bronchial Carcinoids in Comparison to Surgical Resection: A Retrospective Study. Journal of Bronchology & Interventional Pulmonology. ISSN 1944-6586. 19(1), p. 29–34. doi: 10.1097/LBR.0b013e3182446b52. Full text in Research Archive
• Nordby, Karl-Christian; Fell, Anne Kristin Møller; Notø, Hilde Pettersen; Wijnand, Eduard; Skogstad, Marit & Thomassen, Yngvar [Show all 9 contributors for this article] (2011). Exposure to thoracic dust, airway symptoms, and lung function in cement production workers. European Respiratory Journal. ISSN 0903-1936. 38(6), p. 1278–1286. doi: 10.1183/09031936.00007711. Full text in Research Archive Show summary

  Cement dust exposure has previously been associated with airway symptoms and ventilatory impairment. The aim of the present study was to examine lung function and airway symptoms among employees in different jobs and at different levels of exposure to thoracic dust in the cement production industry. At the start of a 4-yr prospective cohort study in 2007, exposure to cement dust, symptoms and lung function were recorded cross-sectionally in 4,265 employees in 24 European cement plants. Bronchial exposure was assessed by 2,670 full-shift dust samples with cyclones collecting the thoracic aerosol fraction. A job exposure matrix was constructed by grouping dust concentrations according to job type and plant. Elevated odds ratios for symptoms and airflow limitation (range 1.2–2.6 in the highest quartile), but not for chronic bronchitis, were found in the higher quartiles of exposure compared with the lowest quartile. Forced expiratory volume in 1 s (FEV1) showed an exposure–response relationship with a 270-mL deficit of FEV1 (95% CI 190–300 mL) in the highest compared with the lowest exposure level. The results support the hypothesis that exposure to dust in cement production may lead to respiratory symptoms and airway obstruction.

• Søyseth, Vidar; Johnsen, Helle Laier; Bugge, Merete Drevvatne; Hetland, Siri & Kongerud, Johny (2011). Incidence of Airflow Limitation Among Employees in Norwegian Smelters. American Journal of Industrial Medicine. ISSN 0271-3586. 54(9), p. 707–713. doi: 10.1002/ajim.20946. Full text in Research Archive Show summary

  We have investigated the association between the incidence of airflow limitation and occupational exposure. The employees (n = 3,924) were investigated annually during five years (n = 16,570) using spirometry. Exposure was classified using job category and a job exposure matrix. Airflow limitation was expressed using two indices: (i) as forced expiratory volume in one second/force vital capacity (FEV1/FVC) <0.7 and (ii) lower limit of normal (LLN). The incidence of airflow limitation was 21.2/1000 years−1 and 15.1/1000 years−1 using the fixed limit (0.7) and the LLN criterion, respectively. We found a dose–response relationship between the incidence of airflow limitation and tobacco consumption and with job‐category in non‐smokers. The associations between airflow limitation and covariates were independent of how airflow limitation was defined. The incidence of airflow limitation defined as FEVl/FVC <0.7 yielded higher incidence rates of airflow limitation than LLN. We found a significant association between the incidence of airflow limitation and occupational exposure in non‐smokers.

• Fell, Anne Kristin Møller; Notø, Hilde Pettersen; Skogstad, Marit; Nordby, Karl-Christian; Wijnand, Eduard & Svendsen, Martin Veel [Show all 9 contributors for this article] (2011). A cross-shift study of lung function, exhaled nitric oxide and inflammatory markers in blood in Norwegian cement production workers. Occupational and Environmental Medicine. ISSN 1351-0711. 68(11), p. 799–805. doi: 10.1136/oem.2010.057729. Full text in Research Archive Show summary

  Objectives To study possible effects of aerosol exposure on lung function, fractional exhaled nitric oxide (FeNO) and inflammatory markers in blood from Norwegian cement production workers across one work shift (0 to 8 h) and again 32 h after the non-exposed baseline registration. Methods 95 workers from two cement plants in Norway were included. Assessment of lung function included spirometry and gas diffusion pre- and post-shift (0 and 8 h). FeNO concentrations were measured and blood samples collected at 0, 8 and 32 h. Blood analysis included cell counts of leucocytes and mediators of inflammation. Results The median respirable aerosol level was 0.3 mg/m3 (range 0.02–6.2 mg/m3). FEV1, FEF25–75% and DLCO decreased by 37 ml (p=0.04), 170 ml/s (p<0.001) and 0.17 mmol/min/kPa (p=0.02), respectively, across the shift. A 2 ppm reduction in FeNO between 0 and 32 h was detected (p=0.01). The number of leucocytes increased by 0.6×109 cells/l (p<0.001) across the shift, while fibrinogen levels increased by 0.02 g/l (p<0.001) from 0 to 32 h. TNF-α level increased and IL-10 decreased across the shift. Baseline levels of fibrinogen were associated with the highest level of respirable dust, and increased by 0.39 g/l (95% CI 0.06 to 0.72). Conclusions We observed small cross-shift changes in lung function and inflammatory markers among cement production workers, indicating that inflammatory effects may occur at exposure levels well below 1 mg/m3. However, because the associations between these acute changes and personal exposure measurements were weak and as the long-term consequences are unknown, these findings should be tested in a follow-up study.

• Gabrielsen, Anne Marie; Lund, May Brit; Kongerud, Johny; Viken, Karl Erik; Røislien, Jo & Hjelmesæth, Jøran (2011). The Relationship Between Anthropometric Measures, Blood Gases, and Lung Function in Morbidly Obese White Subjects. Obesity Surgery. ISSN 0960-8923. 21(4), p. 485–491. doi: 10.1007/s11695-010-0306-9. Full text in Research Archive
• Søyseth, Vidar; Johnsen, Helle Laier; Bugge, Merete Drevvatne; Hetland, Siri & Kongerud, Johny (2011). Prevalence of airflow limitation among employees in Norwegian smelters: a longitudinal study. Occupational and Environmental Medicine. ISSN 1351-0711. 68(1), p. 24–29. doi: 10.1136/oem.2009.049452. Full text in Research Archive Show summary

  Aims To investigate the association between airflow limitation and occupational exposure and to compare a fixed limit with an age adjusted limit for airflow limitation. Methods 3924 employees in 24 Norwegian smelters and related workplaces were investigated annually over 5 years (n=16 570) using spirometry and a respiratory questionnaire on smoking habits and job category. Employees working full time on the production line were classified as line operators; subjects who never worked on the production line were regarded as non-exposed. A job exposure matrix (JEM) was available in most smelters. Airflow limitation was expressed as (i) forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC ratio) <0.7 and (ii) FEV1/FVC ratio less than the lower limit of normal (LLN). Longitudinal analyses on the prevalence of airflow limitation were performed using a generalised linear mixed model. Results The prevalence of airflow limitation was stable during follow-up. The OR of airflow limitation during follow-up was 1.24 (95% CI 1.03 to 1.50) in line operators compared with unexposed subjects for FEV1/FVC ratio <0.7 and 1.44 (1.14 to 1.81) for FEV1/FVC ratio <LLN. A dose–response relationship was also found between prevalence of airflow limitation and dust exposure. The annual decline in FEV1 was −77.5 (SD 99.9) ml/year in subjects with FEV1/FVC ratio <0.7 and −83.8 (114.2) ml/year in subjects with FEV1/FVC ratio <LLN. Conclusion Prevalence of airflow limitation was higher in exposed than non-exposed employees. Both the FEV1/FVC ratio <0.7 and FEV1/FVC ratio <LLN identify subjects with accelerated annual decline in FEV1.

• Lohne, Vibeke; Drangsholt, Hanne Camilla Heer; Andersen, Marit Helen; Miaskowsky, Christine; Kongerud, Johny & Rustøen, Tone (2010). Qualitative study of pain of patients with chronic obstructive pulmonary disease. Heart & Lung. ISSN 0147-9563. 39(3), p. 226–234. doi: 10.1016/j.hrtlng.2009.08.002. Full text in Research Archive
• Gregersen, Stina; Aaløkken, TM; Mynarek, Georg; Fevang, Børre; Holm, Are Martin & Ueland, Thor [Show all 10 contributors for this article] (2010). Development of pulmonary abnormalities in patients with common variable immunodeficiency: associations with clinical and immunologic factors. Annals of Allergy, Asthma & Immunology. ISSN 1081-1206. 104(6), p. 503–510. doi: 10.1016/j.anai.2010.04.015. Full text in Research Archive
• Fell, Anne Kristin Møller; Sikkeland, Liv Ingunn Bjoner; Svendsen, Martin Veel & Kongerud, Johny (2010). Airway inflammation in cement production workers. Occupational and Environmental Medicine. ISSN 1351-0711. 67(6), p. 395–400. doi: 10.1136/oem.2009.047852. Full text in Research Archive
• Johnsen, Helle Laier; Hetland, Siri M.; Saltyte-Benth, Jurate; Kongerud, Johny & Søyseth, Vidar (2010). Dust Exposure Assessed by a Job Exposure Matrix Is Associated with Increased Annual Decline in FEV1 A 5-year Prospective Study of Employees in Norwegian Smelters. American Journal of Respiratory and Critical Care Medicine. ISSN 1073-449X. 181(11), p. 1234–1240. doi: 10.1164/rccm.200809-1381OC. Full text in Research Archive Show summary

  Rationale: The relationship between dust exposure and annual decline in lung function among employees in the smelting industry is unknown. Objectives: The aim of the study was to investigate the relationship between annual change in lung function and occupational dust exposure among workers in 15 Norwegian smelters. Methods: All employees (n = 2,620) were examined annually for 5 years (11,335 health examinations). At each examination spirometry was performed and a respiratory questionnaire was completed. The smelters were grouped as follows: (1) ferrosilicon alloys (FeSi) and silicon metal (Si-metal); and (2) silicon manganese (SiMn), ferromanganese (FeMn), and ferrochromium (FeCr). A job exposure matrix was available on the basis of 2,619 personal dust exposure measurements. The association between lung function expressed as FEV1 and FVC per squared height (height2) and dust exposure was investigated using multivariate linear mixed model analyses. Measurements and Main Results: The annual change in FEV1/height2 (δFEV1) related to dust exposure in the FeSi/Si-metal and SiMn/FeMn/FeCr smelters was –0.42 (95% confidence interval, −0.95 to 0.11) and −1.1 (−2.1 to −0.12) (ml/m2) × (mg/m3)−1 × year−1, respectively. The annual decline in FEV1/height2 was 1.6 ml/m2 (0.15 to 3.1) steeper in smokers than in nonsmokers. The median geometric mean of the time-weighted dust exposure concentration levels of the employees was 2.3 mg/m3 in the FeSi/Si-metal smelters and 1.6 mg/m3 in the SiMn/FeMn/FeCr smelters. Among nonsmokers, δFEV1 was −0.86 (−1.6 to −0.10) and –1.1 (−2.5 to 0.25) (ml/m2) × (mg/m3)−1 × year−1 in the FeSi/Si-metal and SiMn/FeMn/FeCr smelters, respectively. Thus, for a 1.80 m tall employee the annual decline in FEV1 associated with average dust exposure was 5.7 ml/year in the SiMn/FeMn/FeCr smelters, and 6.4 ml/year for a nonsmoker in the FeSi/Si-metal smelters. Conclusions: In all smelters combined, the annual change in FEV1 was negatively associated with increasing dust exposure. This association was also significant among workers in SiMn/FeMn/FeCr smelters and among nonsmokers in the FeSi/Si-metal smelters.

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• Christensen, Vivi Lycke; Holm, Are Martin; Kongerud, Johny; Bentsen, Signe Berit; Paul, Steven M & Miaskowski, Christine [Show all 8 contributors for this article] (2017). Smerter hos pasienter med kronisk obstruktiv lungesykdom (KOLS). Full text in Research Archive
• Fell, Anne Kristin Møller; Kim, Jeong-Lim; Abrahamsen, Regine; Svendsen, Martin Veel; Torén, Kjell & Henneberger, Paul K [Show all 7 contributors for this article] (2016). Household smoking and respiratory health in Telemark, Norway - 10 years after the introduction of a smoking ban. European Respiratory Journal. ISSN 0903-1936. Full text in Research Archive
• Abrahamsen, Regine; Fell, Anne Kristin Møller; Svendsen, Martin Veel; Andersson, Eva; Torén, Kjell & Henneberger, Paul K [Show all 7 contributors for this article] (2016). Occupational groups associated with asthma related respiratory symptoms in a cross-sectional study from Norway. Full text in Research Archive
• Fell, Anne Kristin Møller; Kim, Jeong-Lim; Abrahamsen, Regine; Svendsen, Martin Veel; Torén, Kjell & Henneberger, Paul K [Show all 7 contributors for this article] (2016). Household smoking and respiratory health in Telemark, Norway - 10 years after the introduction of a smoking ban. Full text in Research Archive
• Abrahamsen, Regine; Svendsen, Martin Veel; Henneberger, Paul K; Torén, Kjell; Kongerud, Johny & Fell, Anne Kristin Møller (2016). Exposure to damp and mould at home in relation to respiratory symptoms in the Telemark study, Norway. European Respiratory Journal. ISSN 0903-1936. Full text in Research Archive
• Abrahamsen, Regine; Svendsen, Martin Veel; Henneberger, Paul K; Torén, Kjell; Kongerud, Johny & Fell, Anne Kristin Møller (2016). Exposure to damp and mould at home in relation to respiratory symptoms in the Telemark study, Norway. Full text in Research Archive
• Abrahamsen, Regine; Fell, Anne Kristin Møller; Svendsen, Martin Veel; Andersson, Eva; Torén, Kjell & Henneberger, Paul K [Show all 7 contributors for this article] (2016). Occupational groups associated with asthma related respiratory symptoms in a cross-sectional study from Norway. European Respiratory Journal. ISSN 0903-1936. Full text in Research Archive
• Abrahamsen, Regine; Svendsen, Martin Veel; Henneberger, Paul K; Gundersen, Gølin Finkenhagen; Torén, Kjell & Kongerud, Johny [Show all 7 contributors for this article] (2015). Non-response in a population-based study of respiratory health in Norway. Full text in Research Archive
• Abrahamsen, Regine; Svendsen, Martin Veel; Henneberger, Paul K; Gundersen, Gølin Finkenhagen; Torén, Kjell & Kongerud, Johny [Show all 7 contributors for this article] (2015). Non-response in a population-based study of respiratory health in Norway. European Respiratory Journal. ISSN 0903-1936. Full text in Research Archive
• Fell, Anne Kristin Møller; Abrahamsen, Regine; Henneberger, Paul K; Svendsen, Martin Veel; Torén, Kjell & Kongerud, Johny (2015). Late braking abstract: Breath-taking jobs: Respiratory work disability by occupation. ERS Poster discussion. European Respiratory Journal. ISSN 0903-1936. Full text in Research Archive
• Fell, Anne Kristin Møller; Abrahamsen, Regine; Henneberger, Paul K; Svendsen, Martin Veel; Torén, Kjell & Kongerud, Johny (2015). Late braking abstract: Breath-taking jobs: Respiratory work disability by occupation. ERS Poster discussion. Full text in Research Archive
• Aasen, Tor Olav Brøvig & Kongerud, Johny (2015). T.O.B. Aasen &amp; J. Kongerud svarer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(1), p. 11–11. doi: 10.4045/tidsskr.14.1488. Full text in Research Archive
• Aasen, Tor Olav Brøvig & Kongerud, Johny (2015). T.O.B. Aasen & J. Kongerud svarer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(1), p. 11–12. doi: 10.4045/tidsskr.14.1487. Full text in Research Archive
• Oksholm, Trine; Rustøen, Tone; Miaskowski, Christine; Paul, Steven; Solberg, Steinar & Cooper, Bruce A. [Show all 7 contributors for this article] (2014). Changes in symptoms from before to five months after lung cancer surgery. Full text in Research Archive
• Fell, Anne Kristin Møller; Abrahamsen, Regine; Svendsen, Martin Veel; Torén, Kjell; Henneberger, Paul K & Kongerud, Johny (2014). Respiratory symptoms and change of workplace in the general population of Telemark. Full text in Research Archive
• Aasen, Tor Olav Brøvig & Kongerud, Johny (2014). Arbeidsmiljøet gir fremdeles sykdom. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(20), p. 1916–1916. doi: 10.4045/tidsskr.14.1220. Full text in Research Archive
• Oksholm, Trine; Rustøen, Tone; Kongerud, Johny & Ekstedt, Mirjam (2014). Postsurgical transfer between hospitals is a risk situation for lung cancer patients. Full text in Research Archive
• Oksholm, Trine; Rustøen, Tone; Cooper, Bruce; Miaskowski, Christine & Kongerud, Johny (2013). Changes in symptom occurrence rating before and following lung cancer surgery. Full text in Research Archive
• Oksholm, Trine; Rustøen, Tone; Miaskowski, Christine; Paul, Steven; Cataldo, Janine & Kongerud, Johny (2013). Reliability of and correlates with a measure of lung cancer stigma in Norwegian patients who underwent lung cancer surgery. Full text in Research Archive
• Nemer, Maysaa Yousef Khaled; Kasem, Mayes; Sikkeland, Liv Ingunn Bjoner; Kristensen, Petter; Nijem, Khaldoun Issa & Kongerud, Johny [Show all 8 contributors for this article] (2013). Airways inflammation among female Palestinian hairdressers. A cross-sectional study. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 23, p. 20–20. Full text in Research Archive
• Nemer, Maysaa Yousef Khaled; Kasem, Mayes; Sikkeland, Liv Ingunn Bjoner; Kristensen, Petter; Nijem, Khaldoun Issa & Kongerud, Johny [Show all 8 contributors for this article] (2013). Airways inflammation among female Palestinian hairdressers. A cross-sectional study. Full text in Research Archive
• Søyseth, Vidar; Johnsen, Helle Laier & Kongerud, Johny (2012). Merchant seafaring: a changing and hazardous occupation Response. Occupational and Environmental Medicine. ISSN 1351-0711. 69(9), p. 690–690. doi: 10.1136/oemed-2012-100695. Full text in Research Archive
• Auråen, Henrik; Mollnes, Tom Eirik; Kongerud, Johny; Bjørtuft, Øystein; Geiran, Odd & Fiane, Arnt E [Show all 7 contributors for this article] (2012). Procedure for solid organ recovery leads to systemic inflammatory response. The Journal of Heart and Lung Transplantation. ISSN 1053-2498. 31(4), p. S220–S220. doi: 10.1016/j.healun.2012.01.651. Full text in Research Archive
• Oksholm, Trine; Rustøen, Tone & Kongerud, Johny (2016). Patients’ symptom experiences before and after lung cancer surgery - predictors of patients’ symptom burden. Universitetet i Oslo. Full text in Research Archive Show summary

  The purpose of this study was to explore multiple symptoms in lung cancer patients before and after surgery and to identify predictors of patients’ symptom burden (including age). In total, 264 lung cancer patients were recruited from 3 university hospitals. They completed questionnaires preoperatively, and 1 and 5 months after surgery. The study revealed that patients’ experienced a mean of 10 symptoms before surgery, with only small differences in the older patients compared to the younger ones (>65 years). When comparing the occurrence of symptoms before and after surgery, there was a significant increase in the mean number of symptoms at 1 month. However, the only characteristic that was associated with a higher number of symptoms 1 month after surgery was the number of symptoms reported before surgery. At 5 months, the number of symptoms was reduced compared to the 1 month assessment, but it was still significantly higher compared to the preoperative assessment. A total of 79% of the patients experienced shortness of breath (SOB) 5 months after surgery, while 71% experienced lack of energy, and 56% reported pain. Some of the symptoms were intense. Our findings show that patients with more comorbidities and a higher number of preoperative symptoms need special attention, as they tend to experience a higher number of postoperative symptoms. Even though it is recommended in guidelines, only 32% of the patients had physical therapy after surgery and 16% had inpatient rehabilitation. While 30% of the patients were working preoperatively, only 9% worked at 5 months. This study provides important information about the symptom burden of patients that underwent lung cancer surgery, and about the most vulnerable patients. The results can be used to educate patients about the normal course of postoperative recovery. Clinicians need to perform a comprehensive symptom assessment prior to surgery and at regular intervals after surgery.

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