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Original article
Update of an occupational asthma-specific job exposure matrix to assess exposure to 30 specific agents
  1. Nicole Le Moual1,2,
  2. Jan-Paul Zock3,4,5,
  3. Orianne Dumas1,2,
  4. Theodore Lytras3,4,
  5. Eva Andersson6,
  6. Linnéa Lillienberg6,
  7. Vivi Schlünssen7,
  8. Geza Benke8,
  9. Hans Kromhout9
  1. 1 Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France
  2. 2 Inserm, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, Inserm, F-94807, Villejuif, France
  3. 3 Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
  4. 4 University Pompeu Fabra (UPF), Barcelona, Spain
  5. 5 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  6. 6 Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
  7. 7 Department of Public Health, Danish Ramazzini Centre, Aarhus University and National Research Center for the Working Environment, Copenhagen, Denmark
  8. 8 Monash Centre for Occupation and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
  9. 9 Department of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
  1. Correspondence to Dr Nicole Le Moual, Inserm, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, F-94807, Villejuif, France; nicole.lemoual{at}


Objectives We aimed to update an asthmagen job exposure matrix (JEM) developed in the late 1990s. Main reasons were: the number of suspected and recognised asthmagens has since tripled; understanding of the aetiological role of irritants in asthma and methodological insights in application of JEMs have emerged in the period.

Methods For each agent of the new occupational asthma-specific JEM (OAsJEM), a working group of three experts out of eight evaluated exposure for each International Standard Classification of Occupations, 1988 (ISCO-88) job code into three categories: ‘high’ (high probability of exposure and moderate-to-high intensity), ‘medium’ (low-to-moderate probability or low intensity) and ‘unexposed’. Within a working group, experts evaluated exposures independently from each other. If expert assessments were inconsistent the final decision was taken by consensus. Specificity was favoured over sensitivity, that is, jobs were classified with high exposure only if the probability of exposure was high and the intensity moderate-to-high. In the final review, all experts checked assigned exposures and proposed/improved recommendations for expert re-evaluation after default application of the JEM.

Results The OAsJEM covers exposures to 30 sensitisers/irritants, including 12 newly recognised, classified into seven broad groups. Initial agreement between the three experts was mostly fair to moderate (κ values 0.2–0.5). Out of 506 ISCO-88 codes, the majority was classified as unexposed (from 82.6% (organic solvents) to 99.8% (persulfates)) and a minority as ‘high-exposed’ (0.2% (persulfates) to 2.6% (organic solvents)).

Conclusions The OAsJEM developed to improve occupational exposure assessment may improve evaluations of associations with asthma in epidemiological studies and contribute to assessment of the burden of work-related asthma.

  • asthma
  • occupational exposure assessment
  • job-exposure matrix
  • asthmagens

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  • Contributors NLM: study design, acquisition, analysis and interpretation of the data, drafting and revising the manuscript. J-PZ and HK: study design, analysis and interpretation of the data and critical revision of the manuscript. OD, TL, EA, LL, VS, GB: analysis and interpretation of the data and critical revision of the manuscript. All authors approved the final version of the manuscript.

  • Funding PHC Van Gogh programme, EP-Nuffic, Campus France 33653RF (2015-2016); 7th programme-EU (Marie-Curie) (FP7/2007–2013), REA (PCOFUND-GA-2013-609102), PRESTIGE-2015-3-0029 - Campus France. ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya.

  • Competing interests NLM reports grants from the PHC Van Gogh programme, Campus France; OD reports grants from Prestige, Campus France; HK reports grants from the PHC Van Gogh programme, EP-Nuffic, during the conduct of the study

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.