Occupational Asthma Reference

Lipszyc JC, Silverman F, Holness DL, Liss GM, Lavoie KL, Tarlo SM, Comparison of clinic models for patients with work-related asthma, Occup Med, 2017;67:477-483,https://doi.org/10.1093/occmed/kqx100

Keywords: OA, work exacerbated asthma, prognosis, Canada, clinic management, teturn to work councellor, QOL

Known Authors

Garry Liss, Toronto Garry Liss

Kim Lavoie, Hôpital de Sacré Coeur, Montreal, Quebec, Canada Kim Lavoie

Susan Tarlo, Toronto Susan Tarlo

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Abstract

Background
Work-related asthma (WRA) is a prevalent occupational lung disease that is associated with undesirable effects on psychological status, quality of life (QoL), workplace activity and socioeconomic status. Previous studies have also indicated that clinic structure may impact outcomes among patients with asthma.

Aims
To identify the impact of clinic structure on psychological status, QoL, workplace limitations and socioeconomic status of patients with WRA among two different tertiary clinic models.

Methods
We performed a cross-sectional analysis between two tertiary clinics: clinic 1 had a traditional referral base and clinical staffing while clinic 2 entirely comprised Worker’s Compensation System referrals and included an occupational hygienist and a return-to-work coordinator. Beck Anxiety and Depression II Inventories (BAI and BDI-II), Marks’ Asthma Quality of Life Questionnaire (M-AQLQ) and Work Limitation Questionnaire (WLQ) were used to assess outcomes for patients with WRA.

Results
Clinic 2 participants had a better psychological status across the four instruments compared with clinic 1 (for Beck ‘Anxiety’: P < 0.001 and ‘Depression’: P < 0.01, ‘Mood’ domain of M-AQLQ: NS and ‘Mental Demands’ domain of WLQ: P < 0.01). Clinic 2 had a greater proportion of participants with reduced income.

Conclusions
Our study indicates that clinic structure may play a role in outcomes. Future research should examine this in larger sample sizes.

Plain text: Background Work-related asthma (WRA) is a prevalent occupational lung disease that is associated with undesirable effects on psychological status, quality of life (QoL), workplace activity and socioeconomic status. Previous studies have also indicated that clinic structure may impact outcomes among patients with asthma. Aims To identify the impact of clinic structure on psychological status, QoL, workplace limitations and socioeconomic status of patients with WRA among two different tertiary clinic models. Methods We performed a cross-sectional analysis between two tertiary clinics: clinic 1 had a traditional referral base and clinical staffing while clinic 2 entirely comprised Worker's Compensation System referrals and included an occupational hygienist and a return-to-work coordinator. Beck Anxiety and Depression II Inventories (BAI and BDI-II), Marks' Asthma Quality of Life Questionnaire (M-AQLQ) and Work Limitation Questionnaire (WLQ) were used to assess outcomes for patients with WRA. Results Clinic 2 participants had a better psychological status across the four instruments compared with clinic 1 (for Beck 'Anxiety': P < 0.001 and 'Depression': P < 0.01, 'Mood' domain of M-AQLQ: NS and 'Mental Demands' domain of WLQ: P < 0.01). Clinic 2 had a greater proportion of participants with reduced income. Conclusions Our study indicates that clinic structure may play a role in outcomes. Future research should examine this in larger sample sizes.

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Comments

This is an interesting paper comparing two clinics run by the same physician; in one patients seeking compensation are seen usually once only by a multidisciplinary team including an occupational hygienist who takes the exposure history, and a return to work coordinator who handles communication between the clinicians and the workplace, visits the workplace if necessary and facilitates redeployment; the other clinic follows up workers and has a respiratory therapist who educates workers about their treatment, compliance and disease management.
The paper compares mainly psychological factors of anxiety and depression, and asthma quality of life and work limitation all by questionnaires between the two clinics. The data was collected prospectively in a retrospective cohort initially seen between 1991 (or 2002 in one clinic) and 2014, importantly including both those thought to have occupational asthma and those judged to have work-exacerbated asthma. The problem related to the numbers; there were 166 eligible workers. Even assuming a 2002 start for both clinics this is only 14 workers a year, or about one every 2 months per clinic. They collected data on only 46% of these. Workers seen in the compensation clinic lost more money, but had better psychological status and importantly well all removed from the original provoking agent.
9/19/2017

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