Johny Kongerud

• Klepaker, Geir; Svendsen, Martin Veel; Hertel, Jens Kristoffer; Holla, Øystein Lunde; Henneberger, Paul Keefer; Kongerud, Johny & Fell, Anne Kristin Møller (2019). Influence of Obesity on Work ability, Respiratory Symptoms, and Lung Function in Adults with Asthma. Respiration.  ISSN 0025-7931.  98(6), s 473- 481 . doi: 10.1159/000502154 Vis sammendrag

  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 & Søyseth, Vidar (2019). Annual decline in forced expiratory volume and airway inflammatory cells and mediators in a general population-based sample. BMC Pulmonary Medicine.  ISSN 1471-2466.  19 . doi: 10.1186/s12890-018-0765-7
• 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), s 221- 227 . doi: 10.1093/ejcts/ezx274
• Clarhed, Ulrika K E; Svendsen, Martin Veel; Schiöler, Linus; Kongerud, Johny; Torén, Kjell; Hellgren, Johan & Fell, Anne Kristin Møller (2018). Chronic Rhinosinusitis Related to Occupational Exposure: The Telemark Population Study. Journal of Occupational and Environmental Medicine.  ISSN 1076-2752.  60(7), s 656- 660 . doi: 10.1097/JOM.0000000000001312 Fulltekst i vitenarkiv.
• Fell, Anne Kristin Møller; Svendsen, Martin Veel; Kim, J L; Abrahamsen, Regine; Henneberger, Paul K.; Toren, K.; Blanc, Paul D. & Kongerud, Johny (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.  ISSN 1471-2458.  18(1) . doi: 10.1186/s12889-018-5771-4
• Myrdal, Ole Henrik; Kanellopoulos, Adriani; Christiansen, Jon Runar; Ruud, Ellen; Edvardsen, Elisabeth; Kongerud, Johny; Sikkeland, Liv Ingunn Bjoner & Samersaw-Lund, May Brit (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), s 658- 664 . doi: 10.1080/0284186X.2017.1423177 Vis sammendrag

  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.

• Abrahamsen, Regine; Fell, Anne Kristin Møller; Svendsen, Martin Veel; Andersson, E.; Torén, Kjell; Henneberger, Paul K. & Kongerud, Johny (2017). Association of respiratory symptoms and asthma with occupational exposures: findings from a population-based cross-sectional survey in Telemark, Norway. BMJ Open.  ISSN 2044-6055.  7(3) . doi: 10.1136/bmjopen-2016-014018 Fulltekst i vitenarkiv.
• Borander, Anne Katrine; Voie, Øyvind Albert; Longva, Kjetil Sager; Danielsen, Tor ERik; Grahnstedt, Svein; Sandvik, Leiv; Kongerud, Johny & Sikkeland, Liv Ingunn Bjoner (2017). Military small arms fire in association with acute decrements in lung function. Occupational and Environmental Medicine.  ISSN 1351-0711.  74(9), s 639- 644 . doi: 10.1136/oemed-2016-104207
• 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), s 448- 454 . doi: 10.1080/0284186X.2016.1253862
• Abrahamsen, Regine; Svendsen, Martin Veel; Henneberger, Paul K.; Gundersen, Gølin Finkenhagen; Torén, Kjell; Kongerud, Johny & Fell, Anne Kristin Møller (2016). Non-response in a cross-sectional study of respiratory health in Norway. BMJ Open.  ISSN 2044-6055.  6(1) . doi: 10.1136/bmjopen-2015-009912
• 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), s 2125- 2131 . doi: 10.1016/j.athoracsur.2015.12.057 Vis sammendrag

  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.

• Christensen, Vivi Lycke; Holm, Are Martin; Kongerud, Johny; Bentsen, Signe Berit; Paul, Steven M.; Miaskowski, Christine & Rustøen, Tone (2016). Occurrence, Characteristics, and Predictors of Pain in Patients with Chronic Obstructive Pulmonary Disease.. Pain Management Nursing.  ISSN 1524-9042.  17(2), s 107- 118 . doi: 10.1016/j.pmn.2016.01.002
• Fell, Anne Kristin Møller; Abrahamsen, Regine; Henneberger, Paul K; Svendsen, Martin Veel; Andersson, E.; Toren, K. & Kongerud, Johny (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), s 600- 606 . doi: 10.1136/oemed-2015-103488 Vis sammendrag

  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.

• Nordby, Karl-Christian; Notø, Hilde Pettersen; Wijnand, Eduard; Skogstad, Marit; Fell, Anne Kristin Møller; Thomassen, Yngvar; Skare, Øivind; Bergamaschi, Antonio; Pietroiusti, Antonio; Abderhalden, Rolf; Kongerud, Johny & Kjuus, Helge (2016). Thoracic dust exposure is associated with lung function decline in cement production workers. European Respiratory Journal.  ISSN 0903-1936.  48(2), s 331- 339 . doi: 10.1183/13993003.02061-2015 Vis sammendrag

  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.

• Sikkeland, Liv Ingunn Bjoner; Alexis, Neil E.; Fry, Rebecca C.; Martin, Elizabeth; Danielsen, Tor ERik; Søstrand, Per & Kongerud, Johny (2016). Inflammation in induced sputum after aluminium oxide exposure: An experimental chamber study. Occupational and Environmental Medicine.  ISSN 1351-0711.  73(3), s 199- 205 . doi: 10.1136/oemed-2015-103254
• Sikkeland, Liv Ingunn Bjoner; Johnsen, Helle Laier; Riste, Tonje Bøyum; Alexis, Neil E.; Halvorsen, Bente; Søyseth, Vidar & Kongerud, Johny (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), s 459- 466 . doi: 10.1136/oemed-2015-103083 Vis sammendrag

  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.

• 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), s 322- 329 . doi: 10.1002/ajim.22570 Vis sammendrag

  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.

• 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), s 41- 47 . doi: 10.1097/LBR.0000000000000127
• Nemer, Maysaa Y K Sadeya; Sikkeland, Liv Ingunn Bjoner; Kasem, Mayes; Kristensen, Petter; Nijem, Khaldoun; Bjertness, Espen; Skare, Øivind; Bakke, Berit; Kongerud, Johny & Skogstad, Marit (2015). Airway inflammation and ammonia exposure among female Palestinian hairdressers: A cross-sectional study. Occupational and Environmental Medicine.  ISSN 1351-0711.  72(6), s 428- 434 . doi: 10.1136/oemed-2014-102437 Vis sammendrag

  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.

• Oksholm, Trine; Miaskowsky, Christine; Solberg, Steinar; Lie, Irene; Cooper, Bruce; Paul, Steven M.; Kongerud, Johny & Rustøen, Tone (2015). Changes in symptom occurrence and severity before and after lung cancer surgery. Cancer Nursing.  ISSN 0162-220X.  38(5), s 351- 357 . doi: 10.1097/NCC.0000000000000198
• Oksholm, Trine; Rustøen, Tone; Cooper, Bruce; Paul, Steven M.; Solberg, Steinar; Henriksen, Kari; Kongerud, Johny & Miaskowski, Christine (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), s 995- 1015 . doi: 10.1016/j.jpainsymman.2014.11.297
• 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), s 1106- 1121 . doi: 10.1093/annhyg/mev069 Vis sammendrag

  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), s 1004- 1008 . doi: 10.1097/JOM.0000000000000518 Vis sammendrag

  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.

• Aasen, Tor Olav Brøvig & Kongerud, Johny (2014). Arbeidsrelatert astma : diagnostikk og oppfølging. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  134(20), s 1955- 1959 . doi: 10.4045/tidsskr.13.1225
• 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.  ISSN 0029-2001.  134(9), s 938- 944 . doi: 10.4045/tidsskr.12.1512 Vis sammendrag

  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.

• Fell, Anne Kristin Møller; Aasen, Tor Olav Brøvig & Kongerud, Johny (2014). Arbeidsrelatert kols. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  134(22), s 2158- 2163 . doi: 10.4045/tidsskr.14.0255
• Færden, Karl; Lund, May-Brith; Aaløkken, Trond Mogens; Wijnand, Eduard; Søstrand, Per; Langård, Sverre & Kongerud, Johny (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), s 167- 173 . doi: 10.1179/2049396714Y.0000000063 Vis sammendrag

  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.

• Kongerud, Johny & Søyseth, Vidar (2014). Respiratory disorders in aluminum smelter workers. Journal of Occupational and Environmental Medicine.  ISSN 1076-2752.  56(5), s S60- S70 . doi: 10.1097/JOM.0000000000000105
• 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.  ISSN 2225-1219.  1(4), s 183- 189 . doi: 10.7178/jeit.10
• Voie, Øyvind Albert; Borander, Anne Katrine; Sikkeland, Liv Ingunn Bjoner; Grahnstedt, Svein; Johnsen, Arnt Magne; Danielsen, Tor ERik; Longva, Kjetil Sager & Kongerud, Johny (2014). Health effects after firing small arms comparing leaded and unleaded ammunition. Inhalation Toxicology.  ISSN 0895-8378.  26(14), s 873- 879 . doi: 10.3109/08958378.2014.970783
• Auråen, Henrik; Mollnes, Tom Eirik; Bjørtuft, Øystein; Bakkan, Per Arne; Geiran, Odd; Kongerud, Johny; Fiane, Arnt E & Holm, Are Martin (2013). Multiorgan procurement increases systemic inflammation in brain dead donors. Clinical Transplantation.  ISSN 0902-0063.  27(4), s 613- 618 . doi: 10.1111/ctr.12175
• Gabrielsen, Anne Marie; Lund, May-Brith; Kongerud, Johny; Viken, Karl Erik; Røislien, Jo; Hjelmesæth, Jøran & Hofsø, Dag (2013). Pulmonary function and blood gases after gastric bypass and lifestyle intervention: a comparative study. Clinical Obesity.  ISSN 1758-8103.  3, s 117- 123 . doi: 10.1111/cob.12024
• Gregersen, Stina; Holm, Are Martin; Fevang, Børre; Ueland, Thor; Sikkeland, Liv Ingunn Bjoner; Aaløkken, Trond Mogens; Mynarek, Georg; Kongerud, Johny; Aukrust, Pål; Johansen, Bjørn & Frøland, Stig Sophus (2013). Lung disease, T-cells and inflammation in common variable immunodeficiency disorders. Scandinavian Journal of Clinical and Laboratory Investigation.  ISSN 0036-5513.  73(6), s 514- 522 . doi: 10.3109/00365513.2013.819523
• 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), s 803- 809 . doi: 10.1136/oemed-2012-101068 Vis sammendrag

  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.

• 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), s 134- 139 . doi: 10.1097/LBR.0b013e3182917280
• Oksholm, Trine; Miaskowski, Christine; Kongerud, Johny; Cooper, Bruce; Paul, Steven M.; Lærum, Line Pedersen & Rustøen, Tone (2013). Does age influence the symptom experience of lung cancer patients prior to surgery?. Lung Cancer.  ISSN 0169-5002.  82(1), s 156- 161 . doi: 10.1016/j.lungcan.2013.06.016
• 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), s 398- 404 . doi: 10.1111/sji.12035 Vis sammendrag

  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.

• Søyseth, Vidar; Johnsen, Helle Laier & Kongerud, Johny (2013). Respiratory hazards of metal smelting. Current opinion in pulmonary medicine.  ISSN 1070-5287.  19(2), s 158- 162 . doi: 10.1097/MCP.0b013e32835ceeae Vis sammendrag

  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.

• Neyman, Kirill; Sundset, Arve; Naalsund, Anne; Espinoza, Andreas Westenvik; Solberg, Steinar; Kongerud, Johny & Fosse, Erik (2012). Endoscopic Treatment of Bronchial Carcinoids in Comparison to Surgical Resection: A Retrospective Study. Journal of Bronchology & Interventional Pulmonology.  ISSN 1944-6586.  19(1), s 29- 34 . doi: 10.1097/LBR.0b013e3182446b52
• Sikkeland, Liv Ingunn Bjoner; Dahl, Christen Peder; Ueland, Thor; Andreassen, Arne K.; Gude, Einar; Edvardsen, Thor; Holm, Torbjørn; Yndestad, Arne; Gullestad, Lars; Kongerud, Johny; Aukrust, Pål & Øie, Erik (2012). Increased levels of inflammatory cytokines and endothelin-1 in alveolar macrophages from patients with chronic heart failure. PLOS ONE.  ISSN 1932-6203.  7(5:e36815) . doi: 10.1371/journal.pone.0036815
• 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), s 721- 726 . doi: 10.1136/oemed-2011-100632 Vis sammendrag

  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.

• Skogstad, Marit; Sikkeland, Liv Ingunn Bjoner; Øvstebø, Reidun; Foss, Kari Bente; Heldal, Kari Emilie; Skare, Øivind; Kongerud, Johny; Kierulf, Peter & Wijnand, Eduard (2012). Long-term occupational outcomes of endotoxin exposure and the effect of exposure cessation. Occupational and Environmental Medicine.  ISSN 1351-0711.  69(2), s 107- 112 . doi: 10.1136/oem.2010.062414 Vis sammendrag

  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.

• 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), s 245- 252 . doi: 10.1159/000334905
• 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), s 27- 33 . doi: 10.1007/s00420-011-0631-x Vis sammendrag

  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), s 1280- 1285 . doi: 10.1164/rccm.201110-1809OC Vis sammendrag

  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

• Fell, Anne Kristin Møller; Notø, Hilde Pettersen; Skogstad, Marit; Nordby, Karl-Christian; Wijnand, Eduard; Svendsen, Martin Veel; Øvstebø, Reidun; Trøseid, Anne-Marie Siebke & Kongerud, Johny (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), s 799- 805 . doi: 10.1136/oem.2010.057729 Vis sammendrag

  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), s 485- 491 . doi: 10.1007/s11695-010-0306-9
• Nordby, Karl-Christian; Fell, Anne Kristin Møller; Notø, Hilde Pettersen; Wijnand, Eduard; Skogstad, Marit; Thomassen, Yngvar; Bergamaschi, Anna; Kongerud, Johny & Kjuus, Helge (2011). Exposure to thoracic dust, airway symptoms, and lung function in cement production workers. European Respiratory Journal.  ISSN 0903-1936.  38(6), s 1278- 1286 . doi: 10.1183/09031936.00007711 Vis sammendrag

  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; Drevvatne Bugge, Merete; Hetland, Siri & Kongerud, Johny (2011). Incidence of Airflow Limitation Among Employees in Norwegian Smelters. American Journal of Industrial Medicine.  ISSN 0271-3586.  54(9), s 707- 713 . doi: 10.1002/ajim.20946 Vis sammendrag

  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.

• Søyseth, Vidar; Johnsen, Helle Laier; Drevvatne Bugge, Merete; 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), s 24- 29 . doi: 10.1136/oem.2009.049452 Vis sammendrag

  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.

• 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), s 395- 400 . doi: 10.1136/oem.2009.047852
• Gregersen, Stina; Aaløkken, TM; Mynarek, Georg; Fevang, Børre; Holm, Are Martin; Ueland, Thor; Aukrust, Pål; Kongerud, Johny; Johansen, Bjørn & Frøland, Stig Sophus (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), s 503- 510 . doi: 10.1016/j.anai.2010.04.015
• 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), s 1234- 1240 . doi: 10.1164/rccm.200809-1381OC Vis sammendrag

  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.

• 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), s 226- 234 . doi: 10.1016/j.hrtlng.2009.08.002
• Søyseth, Vidar; Johnsen, Helle Laier; Bugge, M; Hetland, SM & Kongerud, Johny (2009). The association between symptoms and dust exposure among employees in the Norwegian smelting industry. American Journal of Respiratory and Critical Care Medicine.  ISSN 1073-449X.  34, s 1845
• Fell, Anne Kristin Møller; Sikkeland, Liv Ingunn Bjoner; Svendsen, MV & Kongerud, Johny (2009). Airway Inflammation in Cement Production Workers. Occupational and Environmental Medicine.  ISSN 1351-0711. . doi: 10.1136/oem.2009.047852
• Gregersen, Stina; Aaløkken, Trond Mogens; Mynarek, Georg; Kongerud, Johny; Aukrust, Pål; Frøland, Stig Sophus & Johansen, Bjørn (2009). High resolution computed tomography and pulmonary function in common variable immunodeficiency. Respiratory Medicine.  ISSN 0954-6111.  103, s 873- 880 . doi: 10.1016/j.rmed.2008.12.015
• Kongerud, Johny; Laier Johnsen, H & Søyseth, V (2009). Obstruktiv lungesykdom i norsk aluminiums- og smelteverksindustri. Fagbladet Allergi i praksis.  ISSN 0806-5462.  1, s 34- 39
• Kongerud, Johny & Sikkeland, Liv Ingunn Bjoner (2009). Indusert sputum: metode for diagnostikk av lungesykdom. Fagbladet Allergi i praksis.  ISSN 0806-5462.  4, s 20- 29
• Lund, May Brit; Sikkeland, Liv Ingunn Bjoner & Kongerud, Johny (2009). Utredning av yrkesastma på ulike nivåer i helsevesenet. Fagbladet Allergi i praksis.  ISSN 0806-5462.  1, s 16- 23
• Sikkeland, Liv Ingunn Bjoner; Eduard, W; Larsen, Astrid Marie; Thorgersen, Ebbe Billmann; Haug, T.; Aukrust, Pål; Halvorsen, Bente; Mollnes, Tom Eirik & Kongerud, Johny (2009). Occupational exposure to bacterial single cell protein induces inflammation in lung and blood. Inhalation Toxicology.  ISSN 0895-8378.  21(8-11), s 674- 681 . doi: 10.1080/08958370802491425
• Skogstad, M; Sikkeland, Liv Ingunn Bjoner; Øvstebø, Reidun; Foss Haug, Kari Bente; Kierulf, Peter; Heldal, KK; Kongerud, Johny & Wijnand, Eduard (2009). Does endotoxin exposure affect lung function and induce systemic inflammation in workers handling bacterial single cell protein?. Scandinavian Journal of Work, Environment and Health.  ISSN 0355-3140.  7, s 36- 40
• Johnsen, Helle Laier; Hetland, SM; Saltyte-Benth, Jurate; Kongerud, Johny & Søyseth, Vidar (2008). Quantitative and Qualitative Assessment of Exposure among Employees in Norwegian Smelters. Annals of Occupational Hygiene.  ISSN 0003-4878.  52(7), s 623- 633 . doi: 10.1093/annhyg/men046
• Johnsen, Helle Laier; Kongerud, Johny; Hetland, SM; Saltyte-Benth, Jurate & Søyseth, Vidar (2008). Decreased lung function among employees at Norwegian smelters. American Journal of Industrial Medicine.  ISSN 0271-3586.  51(4), s 296- 306 . doi: 10.1002/ajim.20557
• Johnsen, Helle Laier; Søyseth, Vidar; Hetland, SM; Saltyte-Benth, Jurate & Kongerud, Johny (2008). Production of silicon alloys is associated with respiratory symptoms among employees in Norwegian smelters. International Archives of Occupational and Environmental Health.  ISSN 0340-0131.  81, s 451- 459 . doi: 10.1007/s00420-007-0237-5 Vis sammendrag

  Objectives: To develop a qualitative exposure classification of employees in Norwegian smelters and to investigate the relationship between respiratory symptoms and occupational exposure using this classification. Methods: The 3,924 participants completed a standardised questionnaire including questions of respiratory symptoms, familial asthma, allergy, doctor-diagnosed asthma, smoking habits, previous exposure and occupation. The employees were classified according to their current job function: (1) line operators were employed full time on the production line, (2) non-exposed employees did not work in production, (3) the remaining employees were classified as non-line operators. The association between the prevalence of respiratory symptoms and job category was examined using multivariate logistic regression. Results: The mean age of the participants was 38.6 years (standard deviation 9.2 years), 88.5% were males. The odds ratios (OR) (95% confidence intervals in parenthesis) for dyspnoea, cough and phlegm regarding previous exposure compared with no previous exposure were 1.4 (1.1–1.7), 1.4 (1.2–1.8) and 1.3 (1.0–1.7), respectively. The OR in line operators compared with non-exposed employees was 1.2 (0.9–1.7) for dyspnoea, 1.3 (1.0–1.8) for cough and 1.9 (1.4–2.7) for phlegm. The OR for respiratory symptoms was higher in relation to previous exposure than current job function except for phlegm. Conclusion: In Norwegian smelters respiratory symptoms appear to be positively related to both current job function and previous exposure. Previous exposure appears to be more important than current job function.

• Eduard, W; Kruse, K; Skogstad, A; Nilsen, T; Synnes, O; Kongerud, Johny & Heldal, KK (2008). Generation and homogeneity of aerosols in a human whole-body inhalation chamber. Annals of Occupational Hygiene.  ISSN 0003-4878.  52, s 545- 554 . doi: 10.1093/annhyg/men039

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• Sikkeland, Liv Ingunn Bjoner; Borander, Anne Katrine; Voie, Øyvind Albert; Aass, Hans Christian Dalsbotten; Øvstebø, Reidun; Aukrust, Pål; Longva, Kjetil Sager; Alexis, Neil E.; Kongerud, Johny & Ueland, Thor (2018). Systemic and Airway Inflammation After Exposure to Fumes from Military Small Arms. American Journal of Respiratory and Critical Care Medicine.  ISSN 1073-449X.  197(10), s 1349- 1353 . doi: 10.1164/rccm.201709-1857LE
• Christensen, Vivi Lycke; Holm, Are Martin; Kongerud, Johny; Bentsen, Signe Berit; Paul, Steven M; Miaskowski, Christine; Aouizerat, Bradley E & Rustøen, Tone (2017). Smerter hos pasienter med kronisk obstruktiv lungesykdom (KOLS).
• Abrahamsen, Regine; Fell, Anne Kristin Møller; Svendsen, Martin Veel; Andersson, Eva; Torén, Kjell; Henneberger, Paul K & Kongerud, Johny (2016). Occupational groups associated with asthma related respiratory symptoms in a cross-sectional study from Norway..
• Abrahamsen, Regine; Fell, Anne Kristin Møller; Svendsen, Martin Veel; Andersson, Eva; Torén, Kjell; Henneberger, Paul K & Kongerud, Johny (2016). Occupational groups associated with asthma related respiratory symptoms in a cross-sectional study from Norway.. European Respiratory Journal.  ISSN 0903-1936.
• 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..
• 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.
• Fell, Anne Kristin Møller; Kim, Jeong-Lim; Abrahamsen, Regine; Svendsen, Martin Veel; Torén, Kjell; Henneberger, Paul K & Kongerud, Johny (2016). Household smoking and respiratory health in Telemark, Norway - 10 years after the introduction of a smoking ban..
• Fell, Anne Kristin Møller; Kim, Jeong-Lim; Abrahamsen, Regine; Svendsen, Martin Veel; Torén, Kjell; Henneberger, Paul K & Kongerud, Johny (2016). Household smoking and respiratory health in Telemark, Norway - 10 years after the introduction of a smoking ban.. European Respiratory Journal.  ISSN 0903-1936.
• Oksholm, Trine; Rustøen, Tone & Kongerud, Johny (2016). Patients' symptom experiences before and after lung cancer surgery. Predictors of patients’ symptom burden. Vis sammendrag

  I 2013 ble 601 pasienter operert for lungekreft i Norge. De fleste av disse var over 70 år. Trine Oksholm har i sitt doktorgradsarbeid undersøkt symptombelastning og livskvalitet hos pasienter med lungekreft før og etter operasjon. Dette ble kartlagt ved hjelp av spørreskjema hos 270 pasienter. Pasientene fylte først ut spørreskjema før operasjon, deretter etter en og fem måneder etter operasjonen. Avhandlingen består av tre delarbeider. I det første ble det undersøkt forskjeller i symptombelastning hos yngre og eldre pasienter før lungekreftoperasjon. Pasientene hadde i gjennomsnitt 9 symptomer før operasjon. Symptombelastningen var relativt lik for yngre og eldre pasienter. I det andre delarbeidet ble det sett på hvordan symptomene endret seg fra før operasjon til en måned etter operasjon. Gjennomsnittlig antall symptomer var da steget til 13. Hele 4 av 5 pasienter opplevde kortpustethet, å ha lite energi, smerte og søvnighet en måned etter operasjon. Det tredje delarbeidet viste at antall symptomer ble redusert fra en til 5 måneder, men det var fortsatt høyere enn før operasjon. Hele 79 % av pasientene var kortpustet 5 måneder etter operasjonen, mens 71 % hadde lite energi og 56 % hadde smerter. Studien viser at pasienter med lungekreft har mange symptomer både før og etter operasjon. Antall symptomer før operasjon samt antall tilleggs-sykdommer påvirket hvor mange symptomer pasientene hadde etter operasjon. Det viste seg videre at 5-10 % av pasientene hadde så mange alvorlige og kraftige symptomer at de trengte spesiell oppfølging. På tross av anbefaling gjennom internasjonale retningslinjer hadde kun 32 % av pasientene fått fysioterapi og kun 16 % hadde vært på rehabiliteringsopphold. Studien viser også at mens 30 % av pasientene var i arbeid før operasjon var kun 9 % i arbeid 5 måneder etter operasjonen. Konklusjonen er at helsepersonell bør informere pasientene om vanlig symptomforløp etter en lungekreftoperasjon. Det bør også utvikles tiltak for å hjelpe pasientene til symptomlindring eller eventuelt til å mestre symptomene etter lungekreftoperasjon

• Aasen, Tor Olav Brøvig & Kongerud, Johny (2015). T.O.B. Aasen & J. Kongerud svarer. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  135(1), s 11- 12 . doi: 10.4045/tidsskr.14.1487
• Aasen, Tor Olav Brøvig & Kongerud, Johny (2015). T.O.B. Aasen &amp; J. Kongerud svarer. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  135(1), s 11- 11 . doi: 10.4045/tidsskr.14.1488
• Abrahamsen, Regine; Svendsen, Martin Veel; Henneberger, Paul K; Gundersen, Gølin Finkenhagen; Torén, Kjell; Kongerud, Johny & Fell, Anne Kristin Møller (2015). Non-response in a population-based study of respiratory health in Norway..
• Abrahamsen, Regine; Svendsen, Martin Veel; Henneberger, Paul K; Gundersen, Gølin Finkenhagen; Torén, Kjell; Kongerud, Johny & Fell, Anne Kristin Møller (2015). Non-response in a population-based study of respiratory health in Norway.. European Respiratory Journal.  ISSN 0903-1936.
• 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..
• 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.
• Aasen, Tor Olav Brøvig & Kongerud, Johny (2014). Arbeidsmiljøet gir fremdeles sykdom. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  134(20), s 1916- 1916 . doi: 10.4045/tidsskr.14.1220
• 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..
• Oksholm, Trine; Rustøen, Tone; Kongerud, Johny & Ekstedt, Mirjam (2014). Postsurgical transfer between hospitals is a risk situation for lung cancer patients.
• Oksholm, Trine; Rustøen, Tone; Miaskowski, Christine; Paul, Steven; Solberg, Steinar; Cooper, Bruce A. & Kongerud, Johny (2014). Changes in symptoms from before to five months after lung cancer surgery.
• Nemer, Maysaa Yousef Khaled; Kasem, Mayes; Sikkeland, Liv Ingunn Bjoner; Kristensen, Petter; Nijem, Khaldoun Issa; Kongerud, Johny; Bjertness, Espen & Skogstad, Marit (2013). Airways inflammation among female Palestinian hairdressers. A cross-sectional study.
• Nemer, Maysaa Yousef Khaled; Kasem, Mayes; Sikkeland, Liv Ingunn Bjoner; Kristensen, Petter; Nijem, Khaldoun Issa; Kongerud, Johny; Bjertness, Espen & Skogstad, Marit (2013). Airways inflammation among female Palestinian hairdressers. A cross-sectional study. Norsk Epidemiologi, Supplement.  ISSN 0803-4206.  23, s 20- 20
• Oksholm, Trine; Rustøen, Tone; Cooper, Bruce; Miaskowski, Christine & Kongerud, Johny (2013). Changes in symptom occurrence rating before and following lung cancer surgery..
• 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.
• Auråen, Henrik; Mollnes, Tom Eirik; Kongerud, Johny; Bjørtuft, Øystein; Geiran, Odd; Fiane, Arnt E & Holm, Are Martin (2012). Procedure for solid organ recovery leads to systemic inflammatory response. The Journal of Heart and Lung Transplantation.  ISSN 1053-2498.  31(4), s S220- S220 . doi: 10.1016/j.healun.2012.01.651
• 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), s 690- 690 . doi: 10.1136/oemed-2012-100695
• Dahl, Christen Peder; Sikkeland, Liv Ingunn Bjoner; Andreassen, Arne K.; Gude, Einar; Gullestad, Lars; Kongerud, Johny; Aukrust, Pål & Øie, Erik (2009). Increased levels of cytokines, vasoactive peptides, and growth factors in alveolar macrophages in heart failure.
• Kongerud, Johny (2009). Occupational asthma--not only for occupational health physicians!. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  129, s 647- 648 . doi: 10.4045/tidsskr.09.0145
• Rustøen, Tone; Lohne, Vibeke; Kongerud, Johny; Andersen, M; Drangsholt Heer, H.C & Miaskowski, Christine (2009). A qualitative study of the pain experiences of patients with chronic obstructive pulmonary disease.
• Søyseth, Vidar; Johnsen, Helle Laier; Bugge, M & Kongerud, Johny (2009). Prevalence and incidence of airflow limitation among employees in Norwegian smelters.
• Øie, Erik; Sikkeland, Liv Ingunn Bjoner; Dahl, Christen Peder; Andreassen, Arne K.; Gude, Einar; Gullestad, Lars; Kongerud, Johny & Aukrust, Pål (2009). Increased levels of cytokines, vasoactive peptides, and growth factors in alveolar macrophages in heart failure.
• Johnsen, HL; Kongerud, Johny; Hetland, SM; Benth, JS & Søyseth, Ingvild Dønnem (2008). Occupational Exposure to Dust in Norwegian Smelters Is Associated with Increased Annual Decline of FEV1.
• Fell, Anne Kristin Møller; Sikkeland, Liv Ingunn Bjoner & Kongerud, Johny (2008). Airway Inflammation among Portland Cement Workers.
• Gabrielsen, Anne-Marie; Hjelmesæth, K; Viken, KE; Kongerud, Johny & Lund, May Brit (2008). The relationship between measures of obesity and arterial blood gases.
• Kongerud, Johny (2008). Astma og allergi - mer enn en organsykdom. Fagbladet Allergi i praksis.  ISSN 0806-5462.  3, s 5

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