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Psycho-socio-economic impact of occupational asthma

Psycho-socio-economic impact of occupational asthma. Olivier Vandenplas Department of Chest Medicine Mont-Godinne Hospital Catholic University of Louvain Yvoir - Belgium. Focus on impairment & disability. Age, sex Work conditions Socio-economic status Emotional factors

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Psycho-socio-economic impact of occupational asthma

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  1. Psycho-socio-economic impact of occupational asthma Olivier Vandenplas Department of Chest Medicine Mont-Godinne Hospital Catholic University of Louvain Yvoir - Belgium

  2. Focus on impairment & disability • Age, sex • Work conditions • Socio-economic status • Emotional factors • Co-morbidities, …

  3. Evaluation of impairment in asthma ATS guidelines From: ATS Guidelines Am Rev Respir Dis 1993;147:1056

  4. Airway inflammation & evaluation of impairment 50 patients with red cedar OA r = 0.52, p<0.001 Sputum eosinophils correlate with ATS class of impairment (Chan-Yeung M, Am J Respir Crit Care Med 1999;159:1434-8) Persistence of airway inflammation after removal from exposure:  sputum eosinophils in 20% of subjects  sputum neutrophils in 30% of subjects  eosinophils and/or neutrophils in 17% of subjects with normal FEV1 and PC20 (Yacoub MR, Eur Respir J 2007;29:889)  Increased risk of exacerbation? Chan-Yeung M, Am J Respir Crit Care Med 1999;159:1434-8

  5. Rating of impairment: requirements Stable asthma Asthma Control Questionnaire (ACQ): 7 items (www.qoltech.co.uk)  Score <0.75 = well controlled; score >1.50 = inadequately controlled Asthma control Test (ACT): 5 items (www.qualitymetric.com)  Score >19 = inadequately controlled GINA classification of severity/control (www.ginasthma.com) Optimal treatment Minimum medication required to maintain control Timing of assessment 2 to 5 yrs after removal from causal exposure (Malo JL, Am J Respir Crit Care Med 2004;169:1304)

  6. Disability – Quality of life Q 61 & 66. What is the impact of work-related asthma on Quality of Life (QoL) assessed using validated instruments in various populations? Q 61 & 62. What are the factors that determine QoL in subjects with OA: income loss, compensation, severity of asthma? Tarlo SM & Malo JL. An ATS/ERS report: 100 key questions and needs in occupational asthma. Eur Respir J 2006;27:607-14

  7. Quality of life in occupational asthma Comparison with other types of asthma Non-occupational asthma QoL is lower in subjects with OA (mean D AQLQ score: -0.6) than in those with non-OA matched for the severity of asthma (Malo JL, J Allergy Clin Immunol 1993) Work-exacerbated asthma QoL is similar in OA and WEA (Lemière C, J Occup Environ Med 2006) Determinants of QoL “Satisfaction with life” is associated with: - current employment - less severe asthma (use of medication, PEF variability) (Piirila P, J Occup Health 2005;47:112-18)

  8. Q 65. Are psychological factors involved in the aetiology of work-related asthma and how psychological factors affect treatment and outcome of OA? Tarlo SM & Malo JL. An ATS/ERS report: 100 key questions and needs in occupational asthma. Eur Respir J 2006;27:607-14

  9. Psychological factors in occupational asthma Significant level of psychological distress,including anxiety, and depression in ~50% of subjects with OA after cessation of exposure (Psychiatric Symptom Index,PSI) Anxiety disorders in 35% of subjects with OA (Millon Clinical Multiaxial Inventory, MCMI-III) (Yacoub MR, Eur Respir J 2007;29:889)  Prospective investigation of the influence of psychological factors on asthma control, QoL, and socioeconomic impact of OA by comparison with non-occupational asthma, and the effect of interventions (e.g. rehabilitation) on psychological disorders

  10. Disability – Work productivity Q 62. What is the cost of OA in different countries? Q 62. What should be done to reduce socio-economic losses due to work-related asthma? Tarlo SM & Malo JL. An ATS/ERS report: 100 key questions and needs in occupational asthma. Eur Respir J 2006;27:607-14

  11. Cost of occupational asthma Direct costs Healthcare expenses Indirect cost Impaired work productivity: Job changes/Unemployment Absenteeism Reduced work effectiveness Compensation, rehabilitation Intangible costs QoL

  12. Socio-economic consequences of OA Updated from: Vandenplas O, Toren K & Blanc PD, Eur Respir J 2003;22:689

  13. Socio-economic consequences of WEA * Work-related asthma; ¥ New-onset occupational asthma Adapted from: Vandenplas O & Henneberger PK, Curr Opin Allergy Clin Immunol 2007

  14. Determinants of adverse economic outcomes(1)

  15. Determinants of adverse economic outcomes(2) Avoidance of exposure to the causal agent Change of employer  15-21% of workers with OA are relocated within the same company vs. 31% in Quebec Age, low education level, small-size company Absence of retraining program?  Information on rehabilitation unavailable for most countries (<5% in Belgium)  Rehabilitation: 31% in Quebec and 34% in Finland Severity of asthma  Minimal effect in available studies  Exception of Finland: Unemployment is associated with nocturnal symptoms, PEF variability, and use of SABA (Piirila P, J Occup Health 2005;47:112-18) Compensation should aim at reducing non-medical factors that determine work-disability

  16. Q 63. What are the consequences of initiating a claim for work-related asthma? Q 64. What weight should be given to impairment and disability in compensating subjects with OA? Tarlo SM & Malo JL. An ATS/ERS report: 100 key questions and needs in occupational asthma. Eur Respir J 2006;27:607-14

  17. Compensation of OA Initiating a claim for compensation? Higher rate of unemployment (Ameille J, Eur Respir J 1997): cause or consequence? Loss of income offset by compensation 22% of compensated workers (Larbanois A, Eur Respir J 2003) ~30% of affected workers remain exposed to causal agent Compensation of OA based on physiological impairment is highly inefficient, at least in countries where work-disability remains the major determinant of the impact on socio-economic status and QoL

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