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Asthma Affects Work Productivity

While for some asthma is no more than a minor inconvenience, for others it can be quite problematic, interfering with normal living and sometimes even leading to a life-threatening situation. Find out how asthma drains your work productivity and what you can do about this.


By definition, asthma is a condition characterized by a narrowing of your breathing airways. This narrowing is caused by a combination of swelling as well as the production of excess mucus. The results can include coughing, difficulty in breathing, wheezing or shortness of breath (Mayo Clinic, 2011).


Symptoms of Asthma


The symptoms and frequency of asthma can vary greatly from person to person.  While some people may have very infrequent episodes that are no more than annoying, others have debilitating and sometimes life-threatening asthma attacks with alarming frequency. While some patients experience triggered episodes, such as exercise-induced asthma, others may have ongoing, constant symptoms. The signs that your asthma is getting worse include an increased use of asthma inhalers and an increase in asthma symptoms.


The signs and symptoms of asthma include:


• Shortness of breath, or difficulty breathing, which can make sleep difficult
• Chest tightness or pain
• Coughing
• Wheezing (wheezing is often observed in children with asthma)(Mayo Clinic, 2011)


Asthma Triggers


Asthma “triggers” are things that make the condition come about and situations that cause you to have symptoms. Asthma may be triggered by multiple occupational or environmental factors. These include:


• Exercise (often exercise-induced asthma may be exacerbated by cold, dry air)
• Occupational irritants and hazards (chemicals, fumes, gases or dust)
• Allergies to pet dander, cockroaches or pollen(Mayo Clinic, 2011)


Asthma Science


While the condition of asthma is very complex from a clinical perspective, the disease process is fairly straight forward. There are two simultaneous processes occurring, working together to make breathing difficult. The airways are blocked by plugs of materials secreted from the bloodstream, mucus and various cell types. The tissue that makes up the airway becomes fragile and thickens. Further to that, the blood vessels surrounding the airway become larger, congested and begin retaining excess fluid. The muscles surrounding the airways become inflamed and enlarged. These simultaneous events work together resulting in a constriction of the airways and asthma symptoms (Jeffrey, 1992).


The Burden of Asthma on America


According to a 2011 report from the US Centers for Disease Control (CDC), the incidence of asthma is increasing significantly, with 4.3 million new cases diagnosed between 2001 and 2009. The asthma rates were shown to be increasing most rapidly among African American children, rising nearly 50% in this timeframe. Also, asthma caused over 3,400 deaths in the U.S. in 2007, which translates to about 9 per day.  The increased cost to the American healthcare system is staggering. In 2002, asthma cost about $53 million. By 2007, that cost was up to $56 million - a 6% increase. The CDC concluded that due to these increases in frequency, mortality and cost, greater access to care is crucial (Centers for Disease Control, 2011).


Worker Productivity Impact


Asthma is a chronic condition effecting people of all ages. Asthma researchers Blanc and associates conducted a survey in order to evaluate the impact of asthma on worker productivity. They interviewed a total of 125 people with asthma (some of these patients also had allergic rhinitis). Of these individuals, 88% were still employed. Nonetheless, decreased job effectiveness was reported in around 20% of employed asthma sufferers. It was fairly common for them to report lost work due to their asthma, with greater than 20% reporting missing either all or part of a day’s work in a month’s time. This report shows that asthma has a negative impact on worker productivity and suggests that its economic impact may be under appreciated.


Risk Factors for Asthma


In 2004, asthma scientists King and colleagues published a review article on the risk factors for asthma.  They reviewed many studies that were conducted between 1994 and 2004. This search provided them with 36 articles with useful information. They divided factors into two categories describing the risk of developing childhood, as well as adult onset asthma. 


Risk factors for children included:


• Male sex
• Previous sensitization to allergens
• Family history
• Stress
• Obesity
• Tobacco smoke and pollution
Risk factors for adults identified included:
• female sex
• airway hyperresponsiveness
• lifestyle factors
• work-related exposures
(King, et al 2004)


Asthma Management


Treating asthma should be a two-pronged effort:  prevention of attacks before they hit as well as managing flare-ups as they occur. It is critical to recognize your individual triggers and take steps to cope with these. There are a variety of different medications and measures that treat asthma, and the correct choice for you can be best determined by your physician. Most people benefit from a combination of preventive, long-term medications and a rescue medication to use in the event of an attack. These medicines and treatments include:


Quick-relief inhalers (bronchodilators): These are effective for opening swollen airways rapidly. Some examples of rapidly acting bronchodilators are albuterol, levalbuterol pirbuterol.


Preventive long-term medications: These agents reduce the inflammation in your airways that can lead to symptoms of asthma. Typically, these medications are taken daily and may include:


• Inhaled corticosteroids: Examples are fluticasone, budesonide, ciclesonide, flunisolide and beclomethasone. These products may need to be used for several weeks to realize their benefit.


• Leukotriene inhibitors:  These are orally administered medications that include montelukast, zafirlukast and zileuton.

• Inhaled long acting inhaled beta agonists: These include salmeterol and formoterol. It is critical that these medications are used regularly for prevention, and not in the case of an acute attack or flare-up.

• Oral or injectable corticosteroids:  Medicines such as prednisone or methylprednisolone are useful for relieving airway inflammation. However, they can cause serious side effects, so they should be used only on a short term basis and only for the treatment of severe symptoms.


• Allergy management: Some people can control asthma by managing their allergies. Such approaches could include medications, allergy shots, or omalizumab (an injectable medication).


References


Blanc PD, Trupin L, Eisner M, et al. The work impact of asthma and rhinitis: Findings from a population-based survey. Journal of Clin Epid. 2001; 54:610-618.


CDC (2011). Asthma in the U.S. Retrieved from:                            http://www.cdc.gov/VitalSigns/Asthma/index.html
Jeffrey PK. Pathology of asthma. Br Med Bull. 1992; 48: 23-39


King ME, Mannino DM, Holguin F. Risk factors for asthma incidence. A review of recent prospective evidence. Panminerva Medica. 2004; 46:97-110.


Mayo Clinic (2013). Asthma symptoms. Retrieved from: http://www.mayoclinic.com/health/asthma/DS00021/DSECTION=symptoms

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