Characteristics of work related asthma: results from a population based survey

Work-related asthma consequences on socioeconomic, asthma control, quality of life, and psychological status compared with non-work-related asthma: A cross-sectional study in an upper-middle-income country

BACKGROUND

Work-related asthma (WRA) is the most prevalent occupational respiratory disease, and it has negative effects on socioeconomic standing, asthma control, quality of life, and mental health status. Most of the studies on WRA consequences are from high-income countries; there is a lack of information on these effects in Latin America and in middle-income countries.

METHODS

This study compared socioeconomic, asthma control, quality of life, and psychological outcomes among individuals diagnosed with WRA and non-work-related asthma (NWRA) in a middle-income country. Patients with asthma, related and not related to work, were interviewed using a structured questionnaire to assess their occupational history and socioeconomic conditions, and with questionnaires to assess asthma control (Asthma Control Test and Asthma Control Questionnaire-6), quality of life (Juniper's Asthma Quality of Life Questionnaire), and presence of anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Each patient's medical record was reviewed for exams and use of medication, and comparisons were made between individuals with WRA and NWRA.

RESULTS

The study included 132 patients with WRA and 130 with NWRA. Individuals with WRA had worse socioeconomic outcomes, worse asthma control, more quality-of-life impairment, and a higher prevalence of anxiety and depression than individuals with NWRA. Among individuals with WRA, those who had been removed from occupational exposure had a worse socioeconomic impact.

CONCLUSIONS

Consequences on socioeconomic, asthma control, quality of life, and psychological status are worse for WRA individuals when compared with NWRA.

The Role of Immunotherapy and Biologic Treatments in Occupational Allergic Disease

Occupational exposures are estimated to account for 15% to 25% of all adult asthma in the general population. In some cases, workplace allergen exposures can be reduced but not entirely eliminated. Given the potentially significant impact of job change, some workers may choose to continue working in a job in which there is an ongoing occupational allergen exposure. In these cases, a combined approach including personal safety measures, pharmacotherapy, and allergen immunotherapy may result in the best clinical outcomes. This review presents existing evidence for the use of immunotherapy and biologic treatments in occupational allergic disease for various occupational allergens, including wheat flour, mammalian proteins, natural rubber latex, and Hymenoptera venom. There is increasing but modest evidence on beneficial short-term and long-term effects of allergen immunotherapy and safety in worker populations. Available data suggest that allergen immunotherapy can reduce skin and respiratory symptoms and therefore allow workers to continue their current occupation.

Work-related asthma in the USA: nationally representative estimates with extended follow-up

OBJECTIVE

We studied the associations of working in occupations with high asthma trigger exposures with the prevalence and incidence of asthma, and with ever reporting an asthma diagnosis throughout working life.

METHODS

We used the nationally representative Panel Study of Income Dynamics (1968-2015; n=13 957; 205 498 person-years), with annual reports of occupation and asthma diagnoses across 48 years. We compared asthma outcomes in occupations likely to have asthma trigger exposures with those in occupations with limited trigger exposures. We estimated the prevalence ratios and the incidence risk ratios using log-binomial regression adjusted for age, sex, race/ethnicity, education, and current and past atopy and smoking, and accounting for the survey design and sampling weights. We calculated the attributable risk fractions and population attributable risks, and used multinomial logistic Markov models and microsimulation to estimate the percentage of people ever diagnosed with asthma during working life.

RESULTS

The adjusted prevalence ratio comparing high-risk occupations with low-risk was 4.1 (95% CI 3.5 to 4.8); the adjusted risk ratio was 2.6 (CI 1.8 to 3.9). The attributable risk was 16.7% (CI 8.5 to 23.6); the population attributable risk was 11.3% (CI 5.0 to 17.2). In microsimulations, 14.9% (CI 13.4 to 16.3) with low trigger exposure risk reported asthma at least once, ages 18-65, compared with 23.9% (CI 22.3 to 26.0) with high exposure risk.

CONCLUSION

Adults were more than twice as likely to report a new asthma diagnosis if their occupation involved asthma triggers. Work exposures to asthma triggers may cause or aggravate about 11% of all adult asthma and increase the risk of work-life asthma by 60%.

Work-related asthma surveillance in Washington State: time trends, industry rates, and workers' compensation costs, 2002-2016

Objective: Washington State's work-related asthma (WRA) surveillance program utilizes workers' compensation (WC) data as its primary data source and has spanned a 15-year time period. This study analyses trends for WRA claim incidence rates compared to all WC claim incidence rates. WRA claim incidence rates and WC costs are analyzed by industry. Methods: Potential WRA cases were identified through the WC system and through direct provider report and classified by industry, age, and year of illness onset. WRA claim rates by industry and year were calculated using total work hours reported by employers covered by the WC system. Claim costs for accepted claims were compared by industry and year. Results: WRA claim incidence rates decreased 8.9% (95% CI: -10.6, -7.2) annually for the time period 2002-2016. The decline in WRA claim incidence rate is slightly faster than the incidence rate for all WC claims which had its steepest decrease from 2007 to 2010 at an estimated annual 8.4% decrease (95% CI: -11.8, -5.0). WRA claim rates were highest for workers in Public Administration, Manufacturing, and the Agricultural, Forestry, Fishing and Hunting industries. Median claim costs for WRA did not change significantly by year (p = 0.2, range $595-$1442) and the distribution of WRA WC claim costs by industry were highest in Manufacturing (21.3%) and Construction (16.4%) industries. Conclusion: WRA claim incidence rates are declining in Washington State. The cause for the decline is unclear. Workers across all industries in Washington remain at risk for WRA.

Long-term socioprofessional and psychological status in workers investigated for occupational asthma in quebec

OBJECTIVE

To compare the long-term status of workers with occupational asthma (OA) with those of subjects with work-exacerbated asthma (WEA) and nonasthmatic (NA) workers.

METHODS

We contacted 179 subjects investigated for suspected OA at Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada, from 1997 to 2007. Participants completed questionnaires on psychological and functional status, followed by a telephone interview about socioprofessional outcomes and health care utilization.

RESULTS

The OA workers are more likely to have been removed from the workplace than the WEA workers. The health-related quality of life of all workers was still impaired. A high prevalence of psychiatric disorders was found among OA and WEA workers. Compared with WEA and OA workers, the NA group showed a higher rate of physician consultations for all causes.

CONCLUSIONS

Regardless of the diagnosis they received, these workers need to benefit from psychosocial support in the period after investigation for suspicion of OA.

A case of occupational asthma in a plastic injection process worker

OBJECTIVES

We report a case of death due to asthma attack in a plastic injection process worker with a history of asthma.

METHODS

To assess task relevance, personal history including occupational history and medical records were reviewed. Samples of the substances utilized in the injection process were collected by visiting the patient's workplace. The work environment with the actual process was reproduced in the laboratory, and the released substances were evaluated.

RESULTS

The medical records confirmed that the patient's conventional asthma was in remission. The analysis of the resins discharged from the injection process simulation revealed styrene, which causes occupational asthma, and benzenepropanoic acid, 3,5-bis(1,1-dimethylethyl)-4-hydroxy-, and octadecyl ester. Even though it was not the case in the present study, various harmful substances capable of inducing asthma such as formaldehyde, acrolein, and acetic acid are released during resin processing.

CONCLUSION

A worker was likely to occur occupational asthma as a result of the exposure to the harmful substances generated during the plastic injection process.

Asthma symptoms among adults with work-related asthma

Objective. To examine the number of days with asthma symptoms among individuals with work-related asthma (WRA) and non-WRA. Methods. We calculated adjusted prevalence ratios and compared mean number of days with asthma symptoms using 2006-2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data for ever-employed adults with current asthma from 38 states and District of Columbia. Results. Compared with persons with non-WRA, those with WRA had higher mean number of days with asthma symptoms. Regardless of WRA status, individuals with higher number of days with asthma symptoms were more likely to be unable to work or carry out their usual activities due to asthma. Associations between frequency of asthma symptoms and activity limitation due to asthma were weaker among currently employed adults and stronger among adults not currently employed than the observed associations for all ever-employed adults. Conclusions. These results suggest higher frequency of asthma symptoms among adults with WRA and underscore the need for optimal asthma management in individuals with WRA.

Work-exacerbated asthma and occupational asthma: do they really differ?

BACKGROUND

Although work-exacerbated asthma (WEA) is a prevalent condition likely to have an important societal burden, there are limited data on this condition.

OBJECTIVES

The aims of this study were (1) to compare the clinical, functional, and inflammatory characteristics of workers with WEA and occupational asthma (OA) and (2) compare health care use and related costs between workers with WEA and OA, as well as between workers with work-related asthma (WRA; ie, WEA plus OA) and those with non-work-related asthma (NWRA) in a prospective study.

METHODS

We performed a prospective observational study of workers with and without WRA with a 2-year follow-up. The diagnosis of OA and WEA was based on the positivity and negativity of results on specific inhalation challenges, respectively.

RESULTS

One hundred fifty-four subjects were enrolled: 53 with WEA, 68 with OA, and 33 control asthmatic subjects (NWRA). WEA was associated with more frequent prescriptions of inhaled corticosteroids (odds ratio [OR], 4.4; 95% CI, 1.4-13.6; P = .009), a noneosinophilic phenotype (OR, 0.3; 95% CI, 0.1-0.9; P = .04), a trend toward a lower FEV1 (OR, 0.9; 95% CI, 0.9-1.0; P = .06), and a higher proportion of smokers (OR, 2.5; 95% CI, 0.96-9.7; P = .06) than the diagnosis of OA. The health care use of WRA and related costs were 10-fold higher than those of NWRA.

CONCLUSION

Workers with WEA appeared to have features of greater asthma severity than workers with OA. In contrast with OA, WEA was associated with a noneosinophilic phenotype. Both OA and WEA were associated with greater health care use and 10-fold higher direct costs than NWRA.

Socioeconomic impact of work-related asthma

Work-related asthma (WRA) accounts for 10-15% of adult asthma. This review will summarize the available information related to the socioeconomic outcomes inherent to WRA. A substantial proportion of subjects suffering from WRA experience prolonged work disruption and subsequent loss of income. Moreover, recent studies have established that WRA is associated with a higher use of healthcare resources and a lower quality of life than asthma unrelated to work. The negative socioeconomic consequences are mostly influenced by professional and demographic factors, including reduced possibilities for relocation to an unexposed job within the same company, lack of effective retraining programs and low level of education. These socioeconomic considerations should be regarded as a central component in the implementation of rational management and prevention policies.

Characteristics associated with health care professional diagnosis of work-related asthma among individuals who describe their asthma as being caused or made worse by workplace exposures

OBJECTIVE

To identify factors associated with health care professional-diagnosed work-related asthma (WRA) among adults who describe their asthma as being caused or made worse by workplace exposures (possible WRA).

METHODS

We calculated prevalence ratios adjusted for age and sex using data from the 2006 to 2008 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey from 37 states and the District of Columbia for ever-employed adults with current asthma and possible WRA.

RESULTS

An estimated 17.6% of ever-employed adults with current asthma and possible WRA had health care professional-diagnosed WRA. Health care professional-diagnosed WRA was associated with age, income, employment status, asthma control level, asthma attack, emergency department visit, hospitalization, urgent treatment, and changing/quitting a job due to asthma.

CONCLUSIONS

Among ever-employed adults with possible WRA, health care professional-diagnosed WRA is associated with poorer asthma control and frequent unscheduled health care visits.

Health-related quality of life among adults with work-related asthma in the United States

PURPOSE

The objective of this study was to examine health-related quality of life among adults with work-related asthma.

METHODS

We analyzed 2006-2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data for ever-employed adults with current asthma from 38 states and District of Columbia. Individuals with work-related asthma had been told by a doctor or other health professional that their asthma was related to any job they ever had. Health-related quality of life indicators included poor self-rated health, impaired physical health, impaired mental health, and activity limitation. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, employment, and health insurance.

RESULTS

Of ever-employed adults with current asthma, an estimated 9.0% had work-related asthma, 26.9 % had poor self-rated health, 20.6% had impaired physical health, 18.2% had impaired mental health, and 10.2% had activity limitation. Individuals with work-related asthma were significantly more likely than those with non-work-related asthma to have poor self-rated health [PR, 1.45; 95% confidence interval (CI), 1.31-1.60], impaired physical health (PR, 1.60; 95% CI, 1.42-1.80), impaired mental health (PR, 1.55; 95% CI, 1.34-1.80), and activity limitation (PR, 2.16; 95% CI, 1.81-2.56).

CONCLUSIONS

Future research should examine opportunities to improve health-related quality of life among individuals with work-related asthma.

The epidemiology of work-related asthma

Much has been learned from epidemiologic studies conducted in the past 4 decades that can be directly applied to the management of workers affected with occupational asthma. Studies have provided information about host factors, environmental exposure, and occupational agents posing the highest risks for development of severe irreversible airway obstruction and asthma disability. Investigators have developed methods for screening workers at risk and novel interventions that may prevent new cases among exposed worker populations. Less is known about the natural history and chronic morbidity associated with work-aggravated asthma and irritant-induced asthma syndromes; more studies are needed in at-risk worker populations.

Work-related asthma, financial barriers to asthma care, and adverse asthma outcomes: asthma call-back survey, 37 states and District of Columbia, 2006 to 2008

BACKGROUND

Proper asthma management and control depend on patients having affordable access to healthcare yet financial barriers to asthma care are common.

OBJECTIVE

To examine associations of work-related asthma (WRA) with financial barriers to asthma care and adverse asthma outcomes.

RESEARCH DESIGN

Cross-sectional, random-digit-dial survey conducted in 37 states and District of Columbia.

SUBJECTS

A total of 27,927 ever-employed adults aged ≥18 years with current asthma.

MEASURES

Prevalence ratios (PR) for the associations of WRA with financial barriers to asthma care and of WRA with adverse asthma outcomes stratified by financial barriers.

RESULTS

Persons with WRA were significantly more likely than those with non-WRA to have at least 1 financial barrier to asthma care [PR, 1.66; 95% confidence interval (CI), 1.43-1.92]. Individuals with WRA were more likely to experience adverse asthma outcomes such as asthma attack (PR, 1.31; 95% CI, 1.22-1.40), urgent treatment for worsening asthma (PR, 1.57; 95% CI, 1.39-1.78), asthma-related emergency room visit (PR, 1.69; 95% CI, 1.41-2.03), and very poorly controlled asthma (PR, 1.54; 95% CI: 1.36-1.75). After stratifying for financial barriers to asthma care, the associations did not change.

CONCLUSIONS

Financial barriers to asthma care should be considered in asthma management, and individuals with WRA are more likely to experience financial barriers. However, individuals with WRA are more likely to experience adverse asthma outcomes than individuals with non-WRA, regardless of financial barriers. Additional studies are needed to identify medical, behavioral, occupational, or environmental factors associated with adverse asthma outcomes among individuals with WRA.

Complementary and alternative medicine use among adults with work-related and non-work-related asthma

BACKGROUND

The prevalence of complementary and alternative medicine (CAM) use among adults with current asthma has been estimated to be 40%. To our knowledge, there is no information on the prevalence of CAM use among individuals with work-related asthma (WRA).

OBJECTIVES

To examine the associations between WRA, CAM use, and adverse asthma events.

METHODS

We analyzed data from the 2006-2008 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey from 37 states and the District of Columbia for ever-employed adults with current asthma. We defined WRA as health-professional-diagnosed WRA. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, health insurance, and geographic region of residence.

RESULTS

Of ever-employed adults with current asthma, an estimated 38.1% used CAM and 8.6% had WRA. An estimated 56.6% of individuals with WRA reported using CAM compared with 27.9% of those with non-WRA (PR = 2.0). People with WRA were more likely than those with non-WRA to have adverse asthma events including an asthma attack in the past month (PR = 1.43), urgent treatment for worsening asthma (PR = 1.74), emergency room visit (PR = 1.95), overnight hospital stay (PR = 2.49), and poorly controlled asthma (PR = 1.27). The associations of WRA with adverse asthma events remained after stratifying for CAM use.

CONCLUSIONS

Compared with non-WRA, individuals with WRA were more likely to use CAM to control their asthma. However, there was no evidence that the use of CAM modified the association of WRA with adverse asthma events.

An official american thoracic society statement: work-exacerbated asthma

RATIONALE

Occupational exposures can contribute to the exacerbation as well as the onset of asthma. However, work-exacerbated asthma (WEA) has received less attention than occupational asthma (OA) that is caused by work.

OBJECTIVES

The purpose of this Statement is to summarize current knowledge about the descriptive epidemiology, clinical characteristics, and management and treatment of WEA; propose a case definition for WEA; and discuss needs for prevention and research.

METHODS

Information about WEA was identified primarily by systematic searches of the medical literature. Statements about prevention and research needs were reached by consensus.

MEASUREMENTS AND MAIN RESULTS

WEA is defined as the worsening of asthma due to conditions at work. WEA is common, with a median prevalence of 21.5% among adults with asthma. Different types of agents or conditions at work may exacerbate asthma. WEA cases with persistent work-related symptoms can have clinical characteristics (level of severity, medication needs) and adverse socioeconomic outcomes (unemployment, reduction in income) similar to those of OA cases. Compared with adults with asthma unrelated to work, WEA cases report more days with symptoms, seek more medical care, and have a lower quality of life. WEA should be considered in any patient with asthma that is getting worse or who has work-related symptoms. Management of WEA should focus on reducing work exposures and optimizing standard medical management, with a change in jobs only if these measures are not successful.

CONCLUSIONS

WEA is a common and underrecognized adverse outcome resulting from conditions at work. Additional research is needed to improve the understanding of the risk factors for, and mechanisms and outcomes of, WEA, and to inform and evaluate preventive interventions.

Prevalence of work-related asthma in Michigan, Minnesota, and Oregon

INTRODUCTION

Adults who have asthma that is caused or aggravated by triggers at work experience a reduced quality of life. In this study, the authors sought to estimate the proportion of asthma that is associated with work using a state-based survey of adults with asthma.

METHODS

In 2005, Michigan, Minnesota, and Oregon piloted the Behavioral Risk Factor Surveillance System Adult Asthma Call-Back Survey, with sample sizes of 867, 469, and 1072, respectively. Six questions addressing work-related asthma (WRA) were analyzed to generate estimates of the proportion of adult asthma that is work-related and compare those with and without WRA.

RESULTS

Over half of all adults with asthma (53%) reported that their asthma was caused or made worse by any job they ever had, and among these respondents reporting WRA, only 21.5% to 25.1% reported ever telling or being told by a health professional that their asthma was work-related. Additionally, adults with WRA consistently reported poorer asthma control and higher health care utilization than adults with non-WRA.

CONCLUSIONS

WRA is a common but frequently unrecognized health problem, and this lack of recognition might contribute to poorer asthma control among adults with WRA. Because early recognition, treatment, and management of WRA are crucial for improving long-term prognosis, clinicians need to include assessment of workplace triggers in both their diagnostic and treatment plans for adult patients with asthma.

Psychological distress and occupational asthma

PURPOSE OF REVIEW

To summarize recent findings on the psychological impact of occupational asthma, on the basis of a review of medical and psychological literature published between 1998 and 2008. For the purposes of this review, 'psychological impacts' are defined as the experience of psychological stress or distress, which refers to the experience of negative emotions (e.g., anxiety and sadness/depression). When severe and chronic, psychological distress may reach clinical levels and is referred to as a 'psychiatric disorder', which is a clinical diagnosis based on established diagnostic criteria.

RECENT FINDINGS

Only one original article assessing psychological impacts has been published in the past 10 years (in 2007). Levels of psychological distress (i.e., depression, anxiety, and cognitive dysfunction) were all in the clinical range, and rates of anxiety disorders and dysthymia (a chronic form of depression) affected approximately 35 and 23% of patients, respectively.

SUMMARY

The paucity of available literature indicates that the study of psychological factors associated with occupational asthma is still in its infancy. Though preliminary and in need of replication, the only published study to date suggests that patients with occupational asthma may be highly anxious and many are chronically depressed, a finding that is consistent with previous studies with nonoccupational asthmatics. The established link between psychological factors (e.g., depression and anxiety) and nonoccupational asthma suggests that future studies are desperately needed to more comprehensively assess the scope and severity of the psychological burden of this disease.

Management of work-related asthma

The physician managing work-related asthma (WRA) assumes many roles. The first is to confirm an accurate diagnosis, recognizing that WRA has multiple phenotypes, including sensitizer-induced occupational asthma (OA) caused by high-molecular-weight (HMW) proteins or low-molecular-weight (LMW) chemicals; irritant-induced asthma; and work-exacerbated asthma. Pharmacotherapy for WRA is identical to nonwork-related asthma and should be guided by current asthma guidelines emphasizing control of both asthma impairment and risk domains. It is well established that the majority of workers diagnosed with OA caused by sensitizers experience persistent asthma after leaving the workplace. However, the long-term risk of persistent unremitting asthma can be prevented in a minority of cases, particularly with OA caused by LMW sensitizers, by establishing an early diagnosis of OA and reducing or eliminating exposure. The physician consultant may advise employers on workplace interventions needed to minimize effectively an affected employee's exposure to a causative agent or condition, and what measures are required to prevent new cases of WRA (ie, primary prevention). Although allergen immunotherapy has a putative role in treating and preventing WRA caused by HMW sensitizers, further study is needed.

An interdisciplinary analysis of sex and gender in relation to the pathogenesis of bronchial asthma

BACKGROUND

An increasing number of studies confirm that pathogenesis and prevalence of bronchial asthma are age and sex dependent. Detailed physiological mechanisms of the changing sex ratios with age are not fully known, however, the gender (socio-cultural) factors are also imperative. Although multiple factors definitely influence the pathogenesis of asthma, only individual or few combinations of these have been investigated.

METHODS

The terms 'sex', 'gender' and plausible combinations of both were systematically researched in selected databases (Medline, Scopus) or other sources, including publications from January 2000 to June 2007. Generated articles were categorized, either as endogenous or exogenous factors influencing the pathogenesis of asthma, and divided into the following subgroups: genetic, immunological, hormonal, gynaecological, nutritional, and environmental parameters.

RESULTS

An increasing number of studies investigate the influence of sex and gender in the aetiology, therapy and prevention of asthma. While their results are still debatable, others regarding its initiation, perpetuation and cessation have been clarified. Recent insights into interactions at biomolecular and immunological levels greatly contribute to clarifying sex-specific influences. Despite occasional oversimplifications, a trend for explanations considering the complex interplay of different factors can be observed. This work is in line with this trend and offers explanation models from our point of view.

CONCLUSIONS

Some disagreements regarding the patho-physiology, diagnosis, treatment and prevention of asthma still prevail. Nevertheless, in order to better appreciate its complexity, openness to and persistent consideration for interdisciplinary as well as sex- and gender-related factors is required of the medical-research community in future investigations.

Characteristics and medical resource use of asthmatic subjects with and without work-related asthma

BACKGROUND

Asthma is work related when there is an association between symptoms and work. Occupational asthma (OA) is induced by the workplace, whereas work-exacerbated asthma (WEA) is triggered by the workplace but not induced by it.

OBJECTIVE

We sought to compare the clinical characteristics and the use of medical resources between subjects with work-related asthma (WRA) and asthmatic control subjects without WRA, as well as between subjects with OA and subjects with WEA.

METHODS

We performed a retrospective cohort study of the charts of subjects with WRA who were investigated between 2001 and 2004 in our centers. These subjects were matched according to sex, age, and FEV(1) to subjects with non-WRA investigated during the same period. All charts were linked to the information provided by the Régie de l'assurance maladie du Québec, including outpatient clinic visits and visits to the emergency department and hospitalizations during the year before and after the initial assessment in our centers.

RESULTS

Three hundred fifty-one subjects had WRA (WEA, 145; OA, 206), whereas 384 subjects were asthmatic control subjects without WRA. Subjects with WRA had more asthma exacerbations than subjects with non-WRA. The risk factor of experiencing a severe asthma exacerbation was no greater for OA than for WEA (odds ratio, 1.15; 95% CI, 0.75-1.75).

CONCLUSION

WRA is associated with a larger use of medical resources than non-WRA.

CLINICAL IMPLICATIONS

Improving the diagnosis and management of WRA is crucial for limiting the use of medical resources associated with this condition.

Socioeconomic outcomes in work-exacerbated asthma

PURPOSE OF REVIEW

Work-exacerbated asthma has received little attention until recent years, although it is likely that the condition has a considerable societal impact because of its high prevalence. The purpose of this review is to provide a critical analysis of recently published data pertaining to the socioeconomic outcomes of work-exacerbated asthma.

RECENT FINDINGS

Recent data have confirmed that work-exacerbated asthma is associated with a similar impact on work productivity and earning capacity as immunologically mediated occupational asthma. The specific impact of work-exacerbated asthma on these outcomes should be further distinguished from the consequences of asthma unrelated to work. There is some suggestion that work-exacerbated asthma might be associated with higher rates of symptoms and exacerbations when compared with asthma unrelated to work. The impact of work-exacerbated asthma in terms of disease severity and healthcare utilization should therefore be further characterized.

SUMMARY

The socioeconomic impact of work-exacerbated asthma should be taken into account in the management of this common, although often underestimated, condition. In addition, evaluating the economic burden of work-exacerbated asthma and its various components is a key step in implementing cost-effective prevention policies.