Prsentation PowerPoint

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
19931471056
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Airway inflammation evaluation of impairment
50 patients with red cedar OA r 0.52, plt0.001

• Sputum eosinophils correlate with
• ATS class of impairment
• (Chan-Yeung M, Am J Respir Crit Care Med
• 19991591434-8)
• 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 200729889)
• ? Increased risk of exacerbation?

Chan-Yeung M, Am J Respir Crit Care Med
19991591434-8
5
Rating of impairment requirements

• Stable asthma
• Asthma Control Questionnaire (ACQ) 7 items
  (www.qoltech.co.uk)
• ? Score lt0.75 well controlled score gt1.50
  inadequately controlled
• Asthma control Test (ACT) 5 items
  (www.qualitymetric.com)
• ? Score gt19 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 20041691304)

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 200627607-14
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 200547112-18)

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 200627607-14
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 200729889)
• ? 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 200627607-14
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 200322689
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
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Determinants of adverse economic outcomes (1)
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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 (lt5 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 200547112-18)
• 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 200627607-14
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