Assessing the Impact of Asthma: A Cross-Sectional Study in Workers Undergoing Therapy
Main Article Content
Keywords
Asthma, work productivity, activity impairment, employment
Abstract
Background: This study aimed to investigate the impact of asthma on work productivity among adults receiving asthma therapy. Methods: A cross-sectional study involving 101 asthmatic patients treated at the Pulmonology Department of University Hospital in Mahdia (Tunisia) who had been employed for at least six months was conducted over the course of a year. Recruited patients were asked to complete a self-administered questionnaire that consisted of the Simplified Medication Adherence Questionnaire (SMAQ), the Work Productivity and Activity Impairment (WPAI), and the Pichot questionnaire. Results: The study's participants had a sex ratio of 0.51 and a mean age of 44.1±13.2 years. Exposure to aerocontaminants was high among 64.4% of patients. The majority of the patients were treated with inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) (54.4%), and nearly half were classified as having moderate asthma. Our findings revealed significant challenges faced by these patients, with 62.4% experiencing poorly controlled or uncontrolled asthma. Additionally, 69.3% were non-adherent to treatment, and 71.3% reported worsening symptoms while at work. They worked an average of 38.3±16.4 hours per week. The impact of general health status on work productivity was measured at 3.3±2.5. Absenteeism and presenteeism rates were 4.2% and 33.1%, respectively, resulting in a productivity loss of 30.4%. Activity impairment was associated with factors such as gender, alcohol consumption, and uncontrolled asthma. Conclusion: Addressing asthma control, working conditions, and mental health emerges as essential strategies to enhance workplace productivity. When evaluating the effectiveness of interventions among active asthmatic patients, presenteeism, absenteeism, and productivity loss should be considered.
References
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30. Provost D, Delmas MC, Chastang JF, et al. Asthme et itinéraire professionnel à partir des données de l’enquête SIP, 2006 et 2010. Archives des Maladies Professionnelles et de l’Environnement. 2019;80(4):241 249. Doi : https://doi.org/10.1016/j.admp.2019.01.008
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40. Bloom CI, Nissen F, Douglas IJ, Smeeth L, Cullinan P, Quint JK. Exacerbation risk and characterisation of the UK's asthma population from infants to old age. Thorax. 2018;73(4):313-320. Doi: 10.1136/thoraxjnl-2017-210650
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42. Knoeller GE, Mazurek JM, Moorman JE. Health-related quality of life among adults with work-related asthma in the United States. Qual Life Res. 2013;22(4):771-780. Doi: 10.1007/s11136-012-0206-7
43. Chapman KR, Boulet LP, Rea RM, Franssen E. Suboptimal asthma control: prevalence, detection and conse-quences in general practice. Eur Respir J. 2008;31(2):320-325. Doi: 10.1183/09031936.00039707
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49. Vietri J, Burslem K, Su J. Poor Asthma control among US workers: health-related quality of life, work im-pairment, and health care use. J Occup Environ Med. 2014;56(4):425-430.Doi: 10.1097/JOM.0000000000000123
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2. Reddel HK, Bacharier LB, Bateman ED, et al. Global initiative for asthma strategy 2021. Executive summary and rationale for key changes. Arch Bronconeumol. 2022;58(1):35-51. Doi: 10.1016/j.arbres.2021.10.003
3. Masoli M, Fabian D, Holt S, Beasley R. Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004;59(5):469-478. Doi: 10.1111/j.1398-9995.2004.00526.x
4. Ebmeier S, Thayabaran D, Braithwaite I, Bénamara C, Weatherall M, Beasley R. Trends in international asth-ma mortality: analysis of data from the WHO Mortality Database from 46 countries (1993-2012). Lancet. 2017;390(10098):935-945. Doi: 10.1016/S0140-6736(17)31448-4
5. Kwas H, Guermazi E, Zendah I, Khattab A, Khouaja I, Ghédira H. L’asthme allergique en Tunisie. Rev Mal Respir. 2016(Suppl);33:A77. Doi: https://doi.org/10.1016/j.rmr.2015.10.082
6. Price D, Fletcher M, van der Molen T. Asthma control and management in 8,000 European patients: the REc-ognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014;24:14009. Doi: 10.1038/npjpcrm.2014.9
7. Global Initiative for Asthma. Global strategy for asthma management and prevention, 2018. Available online : https://ginasthma.org/wp-content/uploads/2019/01/2018-GINA.pdf (Accessed on 28 Dec 2023).
8. Global Initiative for Asthma. Global strategy for asthma management and prevention, 2014. Available online: https://ginasthma.org/wp-content/uploads/2019/01/2014-GINA.pdf (Accessed on 28 Dec 2023).
9. Chapman KR, Ernst P, Grenville A, Dewland P, Zimmerman S. Control of asthma in Canada: failure to achieve guideline targets. Can Respir J. 2001;8 Suppl A:35A-40A. Doi: 10.1155/2001/245261
10. Carlton BG, Lucas DO, Ellis EF, Conboy-Ellis K, Shoheiber O, Stempel DA. The status of asthma control and asthma prescribing practices in the United States: results of a large prospective asthma control survey of primary care practices. J Asthma. 2005;42(7):529-535. Doi: 10.1081/JAS-67000
11. Partridge MR, van der Molen T, Myrseth SE, Busse WW. Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study. BMC Pulm Med. 2006;6:13. Doi: 10.1186/1471-2466-6-13
12. Demoly P, Annunziata K, Gubba E, Adamek L. Repeated cross-sectional survey of patient-reported asthma control in Europe in the past 5 years. Eur Respir Rev. 2012;21(123):66-74. Doi: 10.1183/09059180.00008111
13. Cisternas MG, Blanc PD, Yen IH, et al. A comprehensive study of the direct and indirect costs of adult asthma. J Allergy Clin Immunol. 2003;111(6):1212-1218. Doi: 10.1067/mai.2003.1449
14. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med. 1992;326(13):862-866. Doi: 10.1056/NEJM199203263261304
15. Prasad M, Wahlqvist P, Shikiar R, Shih YC. A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective. Pharmacoeconomics. 2004;22(4):225-244. Doi: 10.2165/00019053-200422040-00002
16. Global Initiative for Asthma. Global strategy for asthma management and prevention, 2019. Available online: https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf
17. Reinaud F. Test de provocation bronchique. Available online: https://www.concilio.com/pneumologie-examens-test-de-provocation-bronchique (Accessed on 28 Dec 2023).
18. Ortega Suárez FJ, Sánchez Plumed J, Pérez Valentín MA, et al. Validation on the simplified medication adhe-rence questionnaire (SMAQ) in renal transplant patients on tacrolimus. Nefrologia. 2011;31(6):690-696. Doi: 10.3265/Nefrologia.pre2011.Aug.10973
19. Knobel H, Alonso J, Casado JL, et al. Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS. 2002;16(4):605-613. Doi: 10.1097/00002030-200203080-00012
20. Juniper EF, Guyatt GH, Epstein RS, Ferrie PJ, Jaeschke R, Hiller TK. Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax. 1992;47(2):76-83. Doi: 10.1136/thx.47.2.76
21. Chen H, Blanc PD, Hayden ML, et al. Assessing productivity loss and activity impairment in severe or diffi-cult-to-treat asthma. Value Health. 2008;11(2):231-239. Doi: 10.1111/j.1524-4733.2007.00229.x
22. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity im-pairment instrument. Pharmacoeconomics. 1993;4(5):353-365. Doi: 10.2165/00019053-199304050-00006
23. Gardenas J. Échelles et outils d’évaluation en médecine générale. Le Généraliste. 2002;2187(Suppl):1-54.
24. Pichot P, Brun JP. Brief self-evaluation questionnaire for depressive, asthenic and anxious dimensions. Ann Med Psychol (Paris). 1984;142(6):862-865. PMID: 6524792
25. Abramson MJ, Kutin JJ, Rosier MJ, Bowes G. Morbidity, medication and trigger factors in a community sample of adults with asthma. Med J Aust. 1995;162(2):78-81. Doi: 10.5694/j.1326-5377.1995.tb138438.x
26. Blanc PD, Trupin L, Eisner M, et al. The work impact of asthma and rhinitis: findings from a population-based survey. J Clin Epidemiol. 2001;54(6):610-618. Doi: 10.1016/s0895-4356(00)00349-8
27. Kauppi P, Salo P, Hakola R, et al. Allergic rhinitis alone or with asthma is associated with an increased risk of sickness absences. Respir Med. 2010;104(11):1654-1658. Doi: 10.1016/j.rmed.2010.05.006
28. Hakola R, Kauppi P, Leino T, et al. Persistent asthma, comorbid conditions and the risk of work disability: a prospective cohort study. Allergy. 2011;66(12):1598-1603. Doi: 10.1111/j.1398-9995.2011.02729.x
29. Yelin E, Katz P, Balmes J, et al. Work life of persons with asthma, rhinitis, and COPD: a study using a national, population-based sample. J Occup Med Toxicol. 2006;1:2. Doi: 10.1186/1745-6673-1-2
30. Provost D, Delmas MC, Chastang JF, et al. Asthme et itinéraire professionnel à partir des données de l’enquête SIP, 2006 et 2010. Archives des Maladies Professionnelles et de l’Environnement. 2019;80(4):241 249. Doi : https://doi.org/10.1016/j.admp.2019.01.008
31. Torén K, Zock JP, Kogevinas M, et al. An international prospective general population-based study of respir-atory work disability. Thorax. 2009;64(4):339-344. Doi: 10.1136/thx.2008.105007
32. Chen W, Mempel M, Schober W, Behrendt H, Ring J. Gender difference, sex hormones, and immediate type hypersensitivity reactions. Allergy. 2008;63(11):1418-1427. Doi: 10.1111/j.1398-9995.2008.01880.x
33. Siroux V, Curt F, Oryszczyn MP, Maccario J, Kauffmann F. Role of gender and hormone-related events on IgE, atopy, and eosinophils in the Epidemiological Study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy. J Allergy Clin Immunol. 2004;114(3):491-498. Doi: 10.1016/j.jaci.2004.05.027
34. Almqvist C, Worm M, Leynaert B; working group of GA2LEN WP 2.5 Gender. Impact of gender on asthma in childhood and adolescence: a GA2LEN review. Allergy. 2008;63(1):47-57. Doi: 10.1111/j.1398-9995.2007.01524.x
35. Demoly P, Annunziata K, Gubba E, Adamek L. Repeated cross-sectional survey of patient-reported asthma control in Europe in the past 5 years. Eur Respir Rev. 2012;21(123):66-74. Doi: 10.1183/09059180.00008111
36. Arif AA, Delclos GL, Serra C. Occupational exposures and asthma among nursing professionals. Occup Envi-ron Med. 2009;66(4):274-278. Doi: 10.1136/oem.2008.042382
37. Dumas O, Donnay C, Heederik DJ, et al. Occupational exposure to cleaning products and asthma in hospital workers. Occup Environ Med. 2012;69(12):883-889. Doi: 10.1136/oemed-2012-100826
38. Le Moual N, Carsin AE, Siroux V, et al. Occupational exposures and uncontrolled adult-onset asthma in the European Community Respiratory Health Survey II. Eur Respir J. 2014;43(2):374-386. Doi: 10.1183/09031936.00034913
39. Patel M, Pilcher J, Reddel HK, et al. Predictors of severe exacerbations, poor asthma control, and β-agonist overuse for patients with asthma. J Allergy Clin Immunol Pract. 2014;2(6):751-758. Doi: 10.1016/j.jaip.2014.06.001
40. Bloom CI, Nissen F, Douglas IJ, Smeeth L, Cullinan P, Quint JK. Exacerbation risk and characterisation of the UK's asthma population from infants to old age. Thorax. 2018;73(4):313-320. Doi: 10.1136/thoraxjnl-2017-210650
41. Ehteshami-Afshar S, FitzGerald JM, Carlsten C, et al. The impact of comorbidities on productivity loss in asthma patients. Respir Res. 2016;17(1):106. Doi: 10.1186/s12931-016-0421-9
42. Knoeller GE, Mazurek JM, Moorman JE. Health-related quality of life among adults with work-related asthma in the United States. Qual Life Res. 2013;22(4):771-780. Doi: 10.1007/s11136-012-0206-7
43. Chapman KR, Boulet LP, Rea RM, Franssen E. Suboptimal asthma control: prevalence, detection and conse-quences in general practice. Eur Respir J. 2008;31(2):320-325. Doi: 10.1183/09031936.00039707
44. Gershon AS, Wang C, Guan J, To T. Burden of comorbidity in individuals with asthma. Thorax. 2010;65(7):612-618. Doi: 10.1136/thx.2009.131078
45. Hanania NA, Chapman KR, Sturtridge WC, Szalai JP, Kesten S. Dose-related decrease in bone density among asthmatic patients treated with inhaled corticosteroids. J Allergy Clin Immunol. 1995;96(5 Pt 1):571-579. Doi: 10.1016/s0091-6749(95)70254-7
46. Hubbard RB, Smith CJ, Smeeth L, Harrison TW, Tattersfield AE. Inhaled corticosteroids and hip fracture: a population-based case-control study. Am J Respir Crit Care Med. 2002;166(12 Pt 1):1563-1566. Doi: 10.1164/rccm.200206-606OC
47. Fletcher M, Jha A, Dunlop W, et al. Patient reported burden of asthma on resource use and productivity across 11 countries in Europe. Adv Ther. 2015;32(4):370-380. Doi: 10.1007/s12325-015-0204-6
48. Ojeda P, Sanz de Burgoa V; Coste Asma Study. Costs associated with workdays lost and utilization of health care resources because of asthma in daily clinical practice in Spain. J Investig Allergol Clin Immunol. 2013;23(4):234-241. PMID: 23964552
49. Vietri J, Burslem K, Su J. Poor Asthma control among US workers: health-related quality of life, work im-pairment, and health care use. J Occup Environ Med. 2014;56(4):425-430.Doi: 10.1097/JOM.0000000000000123
50. Blanc PD, Cisternas M, Smith S, Yelin EH. Asthma, employment status, and disability among adults treated by pulmonary and allergy specialists. Chest. 1996;109(3):688-696. Doi: 10.1378/chest.109.3.688
51. Ameille J, Pairon JC, Bayeux MC, et al. Consequences of occupational asthma on employment and financial status: a follow-up study. Eur Respir J. 1997;10(1):55-58. Doi: 10.1183/09031936.97.10010055
52. Martínez-Moragón E, Serra-Batllés J, De Diego A, et al. Economic cost of treating the patient with asthma in Spain: the AsmaCost study. Arch Bronconeumol. 2009;45(10):481-486. Doi: 10.1016/j.arbres.2009.04.006
53. Alexopoulos EC, Burdorf A. Prognostic factors for respiratory sickness absence and return to work among blue-collar workers & office personnel. Occup Environ Med. 2001;58(4):246-252. Doi: 10.1136/oem.58.4.246
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17-04-2025
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Omrane A, Krayem L, Touil I, Romdhani R, Brahem Y, Boussoffara L, et al. Assessing the Impact of Asthma: A Cross-Sectional Study in Workers Undergoing Therapy. Med Lav [Internet]. 2025 Apr. 17 [cited 2025 May 12];116(2):15786. Available from: https://mattioli1885journals.com/index.php/lamedicinadellavoro/article/view/15786
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This work is licensed under a CC BY-NC 4.0 Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Omrane A, Krayem L, Touil I, Romdhani R, Brahem Y, Boussoffara L, et al. Assessing the Impact of Asthma: A Cross-Sectional Study in Workers Undergoing Therapy. Med Lav [Internet]. 2025 Apr. 17 [cited 2025 May 12];116(2):15786. Available from: https://mattioli1885journals.com/index.php/lamedicinadellavoro/article/view/15786
