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Roio LCD, Stelmach R, Mizutani RF, Terra-Filho M, Santos UDP. 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. Am J Ind Med 2023; 66:529-539. [PMID: 36906884 DOI: 10.1002/ajim.23472] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/22/2023] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
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.
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Affiliation(s)
- Lavinia Clara Del Roio
- Divisao de pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Divisao de pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafael F Mizutani
- Divisao de pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mario Terra-Filho
- Divisao de pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ubiratan D P Santos
- Divisao de pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Barber CM, Cullinan P, Feary J, Fishwick D, Hoyle J, Mainman H, Walters GI. British Thoracic Society Clinical Statement on occupational asthma. Thorax 2022; 77:433-442. [DOI: 10.1136/thoraxjnl-2021-218597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Association Between Depression, Lung Function, and Inflammatory Markers in Patients with Asthma and Occupational Asthma. J Occup Environ Med 2020; 61:453-460. [PMID: 30855523 DOI: 10.1097/jom.0000000000001562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Depression is associated with autonomic and immune dysregulation, yet this remains poorly explored in asthma. We assessed associations between depressive disorder, lung function, and inflammatory markers in patients under investigation for occupational asthma (OA). METHODS One hundred twelve patients under investigation for OA (60% men) underwent a psychiatric interview to assess depressive disorder, and spirometry, a methacholine test, sputum induction, and specific inhalation challenge (SIC) to assess OA. Blood and sputum inflammatory markers were assessed. RESULTS There was a statistically significant association between depressive disorder (P = 0.0195) and forced expiratory volume in 1 second (FEV1) responses, with the drop in FEV1 post-SIC smaller in patients with OA and depression, versus OA with no depression (P < 0.001). CONCLUSION The presence of depressive disorder may influence FEV1 in patients with OA, which may be via autonomic pathways. However, further studies are warranted in order to determine the mechanisms that underlie these effects.
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Comparison of Psychological, Quality of Life, Work-Limitation, and Socioeconomic Status Between Patients With Occupational Asthma and Work-Exacerbated Asthma. J Occup Environ Med 2018; 59:697-702. [PMID: 28692003 DOI: 10.1097/jom.0000000000001066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this study was to compare psychological status, quality of life (QoL), work limitation, and socioeconomic status between patients with occupational asthma (OA) and work-exacerbated asthma (WEA). METHODS The following questionnaires were administered to participants: Beck anxiety and depression (II) inventories, Marks' Asthma Quality of Life Questionnaire, and Work Limitations Questionnaire. Cross-sectional analyses between OA and WEA subgroups were completed. RESULTS There were 77 participants. WEA subjects had a trend to higher anxiety scores (OA = 9.2 ± 8.0, WEA = 12.8 ± 8.3, P = 0.07, Cohen d = 0.4). Depression scores trended higher for those with WEA (OA = 9.6 ± 10.3, WEA = 13.4 ± 13.5, P = 0.2, Cohen d = 0.3). QoL was comparable between groups. WEA subjects had fewer work limitations (N = 50, OA = 25.1 ± 27.3, WEA = 20.6 ± 24.4, P = 0.56, Cohen d = 0.3) and OA subjects were more likely to have reduced income. CONCLUSION In a tertiary clinic, there were some modest differences for specific variables between OA and WEA subjects that may help inform management.
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Prospective Impact of Psychiatric Disorders on Employment Status and Health Care Use in Patients Investigated for Occupational Asthma. J Occup Environ Med 2018; 58:1196-1201. [PMID: 27930478 DOI: 10.1097/jom.0000000000000886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We previously reported high rates (34%) of psychiatric disorders (PSY) in patients evaluated for occupational asthma (OA). We determined the impact of PSY on employment status and health care use 12 to 18 months later. METHODS One hundred ninety-six patients underwent clinical and psychiatric interviews on the day of their OA evaluation. Patients were re-contacted 12to 18 months later to assess employment status and health care use. RESULTS Results indicated that patients with a PSY at baseline were less likely to be employed (adjusted odds ratio = 2.88; 95% confidence interval = 1.29 to 6.44) irrespective of final medical diagnosis (including OA), and had higher rates of emergency visits (35% vs 19%, P = 0.04). CONCLUSION Psychiatric morbidity is common in this population and associated with lower employment rates and greater use of emergency services. Greater efforts should be made to assess and treat PSY in this population.
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Ouellette DR, Lavoie KL. Recognition, diagnosis, and treatment of cognitive and psychiatric disorders in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:639-650. [PMID: 28243081 PMCID: PMC5317263 DOI: 10.2147/copd.s123994] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
COPD is highly prevalent and associated with substantial morbidity and mortality. Clinicians have long been aware that patients with COPD have problems with cognition and are susceptible to mood (depression) and anxiety disorders. With the increasing awareness of COPD as a multisystem disorder, many studies have evaluated the prevalence of neuropsychiatric conditions in patients with COPD. This review presents evidence regarding the prevalence of neuropsychiatric conditions (cognitive disorders/impairment, depression/anxiety) in COPD, their risk factors, and their impact on relevant outcomes. It also discusses both assessment and treatment of neuropsychiatric conditions and makes recommendations for improved screening and treatment. The findings suggest that clinicians caring for patients with COPD must become familiar with diagnosing these comorbid conditions and that future treatment has the potential to impact these patients and thereby improve COPD outcomes.
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Affiliation(s)
- Daniel R Ouellette
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Kim L Lavoie
- Montreal Behavioral Medicine Center (MBMC), Research Center, Integrated University Health and Social Services Center - Sacred Heart Hospital of Montreal, Montreal, QC, Canada
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Kroll DS, Nieva HR, Barsky AJ, Linder JA. Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care. J Gen Intern Med 2016; 31:1027-34. [PMID: 27177914 PMCID: PMC4978684 DOI: 10.1007/s11606-016-3740-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/31/2016] [Accepted: 05/02/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Benzodiazepine use is associated with adverse drug events and higher mortality. Known risk factors for benzodiazepine-related adverse events include lung disease, substance use, and vulnerability to fracture. OBJECTIVE To determine whether benzodiazepine prescribing is associated with risk factors for adverse outcomes. DESIGN Longitudinal cohort study between July 1, 2011, and June 30, 2012. PARTICIPANTS Patients who visited hospital- and community-based practices in a primary care practice-based research network. MAIN MEASURES Odds ratio of having a target medical diagnosis for patients who received standard and high-dose benzodiazepine prescriptions; rates per 100 patients for outpatient and emergency department visits and hospitalizations. KEY RESULTS Among 65,912 patients, clinicians prescribed at least one benzodiazepine to 15 % (9821). Of benzodiazepine recipients, 5 % received high doses. Compared to non-recipients, benzodiazepine recipients were more likely to have diagnoses of depression (OR, 2.7; 95 % CI, 2.6-2.9), substance abuse (OR, 2.2; 95 % CI, 1.9-2.5), tobacco use (OR, 1.7; 95 % CI, 1.5-1.8), osteoporosis (OR, 1.6; 95 % CI, 1.5-1.7), chronic obstructive pulmonary disease (OR, 1.6; 95 % CI, 1.5-1.7), alcohol abuse (OR, 1.5; 95 % CI, 1.3-1.7), sleep apnea (OR, 1.5; 95 % CI, 1.3-1.6), and asthma (OR, 1.5; 95 % CI, 1.4-1.5). Compared to low-dose benzodiazepine recipients, high-dose benzodiazepine recipients were even more likely to have certain medical diagnoses: substance abuse (OR, 7.5; 95 % CI, 5.5-10.1), alcohol abuse (OR, 3.2; 95 % CI, 2.2-4.5), tobacco use (OR, 2.7; 95 % CI, 2.1-3.5), and chronic obstructive pulmonary disease (OR, 1.5; 95 % CI, 1.2-1.9). Benzodiazepine recipients had more primary care visits per 100 patients (408 vs. 323), specialist outpatient visits (815 vs. 578), emergency department visits (47 vs. 29), and hospitalizations (26 vs. 15; p < .001 for all comparisons). CONCLUSIONS Clinicians prescribed benzodiazepines and high-dose benzodiazepines more frequently to patients at higher risk for benzodiazepine-related adverse events. Benzodiazepine prescribing was associated with increased healthcare utilization.
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Affiliation(s)
- David S Kroll
- Harvard Medical School, Boston, MA, USA.
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02120, USA.
| | - Harry Reyes Nieva
- Harvard Medical School, Boston, MA, USA
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Arthur J Barsky
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02120, USA
| | - Jeffrey A Linder
- Harvard Medical School, Boston, MA, USA
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
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Li J, Brackbill RM, Jordan HT, Cone JE, Farfel MR, Stellman SD. Effect of asthma and PTSD on persistence and onset of gastroesophageal reflux symptoms among adults exposed to the September 11, 2001, terrorist attacks. Am J Ind Med 2016; 59:805-14. [PMID: 27582483 DOI: 10.1002/ajim.22644] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Little is known about the direction of causality among asthma, posttraumatic stress disorder (PTSD), and onset of gastroesophageal reflux symptoms (GERS) after exposure to the 9/11/2001 World Trade Center (WTC) disaster. METHODS Using data from the WTC Health Registry, we investigated the effects of early diagnosed post-9/11 asthma and PTSD on the late onset and persistence of GERS using log-binomial regression, and examined whether PTSD mediated the asthma-GERS association using structural equation modeling. RESULTS Of 29,406 enrollees, 23% reported GERS at follow-up in 2011-2012. Early post-9/11 asthma and PTSD were each independently associated with both the persistence of GERS that was present at baseline and the development of GERS in persons without a prior history. PTSD mediated the association between early post-9/11 asthma and late-onset GERS. CONCLUSIONS Clinicians should assess patients with post-9/11 GERS for comorbid asthma and PTSD, and plan medical care for these conditions in an integrated fashion. Am. J. Ind. Med. 59:805-814, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene; New York New York
| | | | - Hannah T. Jordan
- New York City Department of Health and Mental Hygiene; New York New York
| | - James E. Cone
- New York City Department of Health and Mental Hygiene; New York New York
| | - Mark R. Farfel
- New York City Department of Health and Mental Hygiene; New York New York
| | - Steven D. Stellman
- New York City Department of Health and Mental Hygiene; New York New York
- Department of Epidemiology; Mailman School of Public Health; Columbia University; New York New York
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Jordan HT, Stellman SD, Reibman J, Farfel MR, Brackbill RM, Friedman SM, Li J, Cone JE. Factors associated with poor control of 9/11-related asthma 10-11 years after the 2001 World Trade Center terrorist attacks. J Asthma 2015; 52:630-7. [PMID: 25539137 PMCID: PMC4776729 DOI: 10.3109/02770903.2014.999083] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective: To identify key factors associated with poor asthma control among adults in the World Trade Center (WTC) Health Registry, a longitudinal study of rescue/recovery workers and community members who were directly exposed to the 2001 WTC terrorist attacks and their aftermath. Methods: We studied incident asthma diagnosed by a physician from 12 September 2001 through 31 December 2003 among participants aged ≥18 on 11 September 2001, as reported on an enrollment (2003–2004) or follow-up questionnaire. Based on modified National Asthma Education and Prevention Program criteria, asthma was considered controlled, poorly-controlled, or very poorly-controlled at the time of a 2011–2012 follow-up questionnaire. Probable post-traumatic stress disorder, depression, and generalized anxiety disorder were defined using validated scales. Self-reported gastroesophageal reflux symptoms (GERS) and obstructive sleep apnea (OSA) were obtained from questionnaire responses. Multinomial logistic regression was used to examine factors associated with poor or very poor asthma control. Results: Among 2445 participants, 33.7% had poorly-controlled symptoms and 34.6% had very poorly-controlled symptoms in 2011–2012. Accounting for factors including age, education, body mass index, and smoking, there was a dose–response relationship between the number of mental health conditions and poorer asthma control. Participants with three mental health conditions had five times the odds of poor control and 13 times the odds of very poor control compared to participants without mental health comorbidities. GERS and OSA were significantly associated with poor or very poor control. Conclusions: Rates of poor asthma control were very high in this group with post-9/11 diagnosed asthma. Comprehensive care of 9/11-related asthma should include management of mental and physical health comorbidities.
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Affiliation(s)
- Hannah T Jordan
- a World Trade Center Health Registry , New York City Department of Health and Mental Hygiene , Queens , NY , USA
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Amore M, Antonucci C, Bettini E, Boracchia L, Innamorati M, Montali A, Parisoli C, Pisi R, Ramponi S, Chetta A. Disease control in patients with asthma is associated with alexithymia but not with depression or anxiety. Behav Med 2014; 39:138-45. [PMID: 24236811 DOI: 10.1080/08964289.2013.818931] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This observational cohort study investigated the relationship between alexithymia, coping strategies, anxiety, depression, pulmonary function, and disease control in bronchial asthma (BA) patients who attended a tertiary care center between December 2010 and November 2011. Participants (N = 117) were administered self-report scales measuring anxiety, depression, alexithymia, and coping strategies. Pulmonary function expressed as forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), forced expiratory flow rate over the middle 50% of the FVC (FEF25-75) as% predicted and FEV1/FVC as%, fractional exhaled nitric oxide (FeNO) in ppb and the Asthma Control Test (ACT) were recorded. A hierarchical cluster analysis revealed two clusters of patients with different FEV1 values (p < .001) and alexithymia scores (p < .001). The cluster with lower FEV1 and higher alexithymia used more maladaptive coping strategies (p < .05), and had lower ACT scores (p < .05). Alexithymia was significantly associated with the severity of depression and anxiety symptoms (p < .001 for each comparison). In BA patients, alexithymia was associated with worse pulmonary function and disease control and a more frequent use of maladaptive coping strategies. These results support a multidimensional approach to asthmatic patients, including psychoeducational and behavioral interventions aimed at reducing maladaptive coping strategies.
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Affiliation(s)
- Lauren Cohn
- 1 Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and
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