Correlates of employment status in individuals with asthma: a cross-sectional survey

RESEARCH Open Access Co ela es o employmen s a us in indi iduals wi h as hma: a c oss-sec ional su ey Saa a Taponen 1,3* , Lau i Leh imäki 2,3 , Ki si Ka ala 4 , Ri a Luukkonen 5 and Jukka Ui i 3,4 Abs ac Backg ound: This s udy aims o elucida e ac o s ha among adul s wi h as hma a e associa ed wi h wo king ull- ime. Me hods: This c oss-sec ional su ey o 2613 wo king-age adul s wi h as hma included ques ions on as hma his o y, symp oms and use o as hma medica ion, socioeconomic ac o s and heal h beha io . Full- ime wo ke s we e compa ed o g oups acco ding o employmen s a us: unemployed, wo k disabili y and e i ed due o age. Resul s: Adul s wi h as hma wo king ull ime we e younge and mo e o en nonmanual wo ke s, expe ienced less as hma symp oms, used less as hma medica ion and smoked less han subjec s wi h wo k disabili y. A e adjus ing o age, gende , smoking and p o essional s a us, ha ing equen symp oms o as hma du ing las mon h was associa ed wi h an inc ease in he isk o unemploymen (OR 2.3, 95% CI 1.3–4.2)andwi haninc easein he isko wo kdisabili y (OR 4.4, 95% CI 2.3–8.2). Conclusions: Among adul s wi h as hma, ull- ime wo k was associa ed wi h younge age, less symp oma ic as hma despi e o less medica ion, nonmanual wo k and less smoking. Ha ing mo e se e e symp oms o as hma was associa ed wi h undesi able employmen s a us such as unemploymen o wo k disabili y. Possibili ies o change om manual o nonmanual wo k may be impo an in p e en ing wo k disabili y and ea ly exi om wo k. Keywo ds: As hma symp oms, As hma, Wo k abili y, Wo k Backg ound As hma is a common ch onic disease among wo king age adul s wi h p e alence in Finland as high as nea ly 10% [1] and globally, a ound 4.5% [2]. Wo k disabili y o adul s wi h espi a o y condi ions such as as hma is con inuously a majo conce n due o i s signi ican eco- nomic bu den [3]. Unemploymen a e among indi id- uals wi h as hma is high, sick lea e om wo k is mo e common among indi iduals wi h as hma han wi hou as hma [4] and e u n o wo k akes mo e ime om in- di iduals wi h as hma especially among blue-colla wo ke s. In cases o occupa ional as hma, job loss seems o be e en mo e likely wi h less educa ion [5]. In one p ospec i e s udy, adul s wi h se e e as hma we e 31% less likely o be cu en ly employed [6]. Respi a o y wo k disabili y has been de ined in many ways, e.g. as job changes due o espi a o y p oblems, sickness absences, o in i s mos se ious o m, comple e cessa ion o employmen due o espi a o y p oblems [7]. In gene al, wo k disabili y is associa ed wi h wo king condi ions, socioeconomic ac o s such as lowe le el educa ion, and heal h beha io such as smoking [8]. Based on ea lie s udies, wo kplace exposu e o dus s o o he impu i ies is associa ed wi h wo k- ela ed espi a- o y symp oms and disabili y [9] and among as hma ics, inc eased espi a o y sickness absence [10], wo k disabil- i y [6] and exace ba ion o as hma symp oms [11]. In in- di iduals wi h as hma, highe educa ional a ainmen indeed seems p o ec i e whe eas a his o y o smoking associa es wi h a g ea e isk o wo k disabili y [6, 12]. * Co espondence: [email p o ec ed] 1 Finla Occupa ional Heal h, Sa akunnanka u 18 B, 33210 Tampe e, Finland 3 Facul y o Medicine and Li e Sciences, Uni e si y o Tampe e, 33014 Tampe e, Finland Full lis o au ho in o ma ion is a ailable a he end o he a icle © The Au ho (s). 2017 Open Access This a icle is dis ibu ed unde he e ms o he C ea i e Commons A ibu ion 4.0 In e na ional License (h p://c ea i ecommons.o g/licenses/by/4.0/), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided you gi e app op ia e c edi o he o iginal au ho (s) and he sou ce, p o ide a link o he C ea i e Commons license, and indica e i changes we e made. The C ea i e Commons Public Domain Dedica ion wai e (h p://c ea i ecommons.o g/publicdomain/ze o/1.0/) applies o he da a made a ailable in his a icle, unless o he wise s a ed. Taponen e al. Jou nal o Occupa ional Medicine and Toxicology (2017) 12:19 DOI 10.1186/s12995-017-0165-6 Se e i y o as hma s ongly p edic s wo k disabili y among adul s wi h as hma [6, 12, 13]. Se e i y o as hma also dec eases he quali y o li e o as hma pa ien s, as also do lowe educa ion, p esence o s ess ul e en s and a poo con ol o as hma [14]. A su ey s udy in he U.S. compa ed he employmen s a us o subjec s wi h wo k- ela ed and non-wo k- ela ed as hma and ac o s asso- cia ed wi h unemploymen . The esul s showed ha hose who we e unable o wo k we e mo e likely o ha e mo e equen as hma symp oms, e y poo ly con olled as hma and inc eased heal h ca e u iliza ion han hei coun e pa s [15]. Como bidi y plays a majo ole as was shown in a p ospec i e popula ion-based s udy by Hakola e al. whe e he isk o all-cause long- e m wo k disabili y inc eased in he p esence o as hma [16]. Based on hese s udies i is appa en ha subjec s wi h as hma may ha e mo e di icul ies in wo king li e han subjec s wi h no as hma. Howe e , some adul s wi h as hma cope well in wo king li e while o he s ace p ob- lems. Iden i ying he ac o s ha suppo ull- ime wo k and holding on o a job among adul s wi h as hma is c ucial in o de o suppo hei wo king ca ee s. These ac o s likely p edic how adul s wi h as hma cope in wo king li e, i.e. who succeed o con inue as ull- ime wo ke s and who d i away om ac i e wo king li e due o e.g. sickness absence, disabili y pension, ea ly e i e- men o unemploymen . The aim o his s udy was o in es iga e which cha ac- e is ics o as hma a e associa ed wi h employmen s a- us. Using ull- ime wo k as an indica o o coping well in wo king li e, we assessed how as hma symp oms, use o as hma medica ion and socioeconomic ac o s a e e- la ed o employmen s a us among adul s wi h as hma in a gene al popula ion. Me hods This c oss-sec ional su ey s udy ec ui ed all as hma pa ien s (n= 2613) aged 20–65 yea s and li ing in he ci y o Tampe e ( o al popula ion 190,000), Finland. The cases we e iden i ied om he Medica ion Reim- bu semen Regis e o he Finnish Social Insu ance In- s i u ion. All hose who had been g an ed special eimbu semen igh s o as hma medica ion un il he end o 1997 and we e ali e in Oc obe 2000 we e se- lec ed. To be g an ed eimbu semen igh s by he Finnish Social Insu ance Ins i u ion, he disease mus ul ill he diagnos ic and se e i y c i e ia o as hma, in- cluding objec i e da a o e e sible/ a iable b onchial obs uc ion and a need o egula ea men wi h in- haled glucoco icoids o a leas 6 mon hs a e he diagnosis. Among hose g an ed special eimbu semen igh s o as hma medica ion, he eliabili y o he as hma diagnosis is high [11]. The ques ionnai e was sen in Oc obe 2000 and he esponse a e was 79%. Nine y eigh subjec s we e excluded om he analyses because i was double-checked ha he esponden s in- deed ha e as hma diagnosed by a physician (some may ha e had as hma-COPD o e lap) o because he em- ploymen s a us in o ma ion was missing. Fo his s udy, he esponden s we e di ided in o i e g oups ac- co ding o hei wo king li e s a us. The e we e 967 subjec s wo king ull- ime, 197 unemployed subjec s, 334 subjec s wi h wo k disabili y (including all-cause sickness absence, disabili y pension, and disabili y pension applied bu no ye g an ed) and 159 subjec s e i ed due o age (in Finland, age- ela ed pension s a s a age o app oxima ely 60–68 yea s depending on occupa ion and pe sonal p e e ences). The i h g oup consis ing o subjec s ou side o ull- ime wo k o o he easons (e.g. housewi es, s uden s, pa - ime wo ke s, ma e ni y lea e, e c.) we e excluded om his s udy (n=309). Ques ionnai e The sel -adminis e ed ques ionnai e included ques ions on as hma his o y, as hma symp oms and use o as hma medica ion, p o essional s a us, smoking, and leisu e ime ac i i ies. Addi ional ile 1: Appendix 1 lis s he speci ic ques ions o he pos al ques ionnai e ha we e used in his s udy. S a is ical analyses In ou s udy, we we e especially in e es ed in whe he he ull- ime wo ke s di e om he subjec s in o he h ee g oups (unemployed, hose wi h wo k disabili y and hose e i ed). Ou da a se consis ed o bo h con inuous and ca ego ical a iables. When compa ing he di e ences be ween g oups we applied ANOVA wi h Dunne ’s pos - es ( a iances we e no equal be- ween he g oups) o a con inued a iable age and Chi-squa ed es s o ca ego ical a iables. A e hese p elimina y s udies we buil logis ic eg es- sion models using ei he unemployed s. ull- ime wo k o wo k disabili y s. ull- ime wo k as an ou come a i- able. Di e en as hma symp oms and in o ma ion o as hma medica ion we e used as independen a iables one a a ime. Ou model building s a egy was as ol- lows. A i s we es ima ed c ude models and hen adjus ed models wi h age, gende , smoking, and p o es- sional s a us. The odds a ios wi h 95% con idence in e - als only o he highes le els (“wo s ” s. “none”) ha e been p esen ed in Table 3. A p- alue o <.05 was consid- e ed s a is ically signi ican . All analyses we e ca ied ou using SPSS ( e sion 23) p og am. Resul s Table 1 shows he cha ac e is ics o subjec s in ou di e en g oups di ided acco ding o hei s a us in wo king li e. Taponen e al. Jou nal o Occupa ional Medicine and Toxicology (2017) 12:19 Page 2 o 7 Theg oupsconsis ingo subjec swo king ull ime and o hose unemployed we e younges and hose wi h wo k disabili y and hose e i ed we e oldes . The e we e mo e women han men in all g oups bu he p o- po ion o women was g ea es among he unemployed and he e i ed. Smoking and physical exe cise The smoking habi s o ull- ime wo ke s we e o e all ligh e han in he wo k disabili y g oup. Among he unemployed, he p opo ion o cu en smoke s was g ea es and o ne e -smoke s smalles o all g oups. The p opo ion o ex-smoke s was g ea es in he wo k disabili y g oup. Smoking in gene al was less common in he e i ed g oup: he e we e less cu en smoke s and occasional smoke s and mo e ne e -smoke s in he e i ed g oup han in he ull- ime wo k g oup. The g oups we e qui e simila acco ding o physical exe cise equency. Full- ime wo ke s epo ed less o en no exe cise a all han subjec s wi h wo k disabili y. P o essional s a us The e we e mo e uppe le el (20.7 s. 6.7%) and lowe le el (29.5 s. 18.8%) nonmanual wo ke s and less manual wo ke s (36.7 s. 62.1%) in he ull- ime wo king g oup compa ed o he wo k disabili y g oup, espec i ely. Compa ed o he unemployed g oup, he e we e mo e uppe le el nonmanual wo ke s and less manual wo ke s in he ull- ime wo king g oup. Also in he e i ed g oup, he e we e mo e manual wo ke s (52.3 s. 36.7%) and less nonmanual wo ke s 39.1 s. 50.2%) han in he ull- ime wo king g oup. As hma symp oms and medica ion Table 2 shows he occu ence and equency o as hma symp oms and he use o as hma medica ion in di e en employmen s a us g oups. Full- ime wo ke s expe ienced al oge he leas as hma symp oms: yea - ound symp oms, daily symp oms and wake-ups a nigh we e less common among ull ime wo ke s han among o he g oups, o whom pe sons wi h wo k disabili y seemed o be he mos symp oma ic. Fo example, 10.7% o ull ime wo ke s s. 45.0% o hose wi h wo k disabili ies expe ienced as hma symp- oms daily o almos daily du ing he las mon h. While ha ing less symp oms o as hma, ull- ime wo ke s used less medica ion o as hma han subjec s wi h wo k dis- abili y. Use o pe o al co icoids was mo e common among pe sons wi h wo k disabili y han among ull- ime wo ke s. Table 3 shows he associa ions be ween as hma symp- oms and employmen s a us (unemployed s. ull- ime Table 1 Cha ac e is ics acco ding o wo king li e s a us Full- ime wo k (1) n= 967 Unemployed (2) n= 197 Wo k disabili y (3) n= 334 Re i ed (4) n= 159 p- alue 1 s. 2 p- alue 1 s. 3 p- alue 1 s. 4 Age, mean yea s (SD) 44.1 (10.2) 46.2 (11.0) 57.9 (8.2) 62.9 (3.8) 0.064 <.001 <.001 Gende 0.007 0.346 0.028 Women 568 (58.7) 136 (69.0) 206 (61.7) 108 (67.9) Men 399 (41.3) 61 (31.0) 128 (38.3) 51 (32.1) Smoking s a us 0.004 0.002 <.001 Ne e smoke 432 (45.0) 70 (36.1) 132 (40.0) 92 (58.2) Ex-smoke 217 (22.6) 40 (20.6) 98 (29.7) 38 (24.1) Cu en smoke 155 (16.1) 52 (26.8) 66 (20.0) 20 (12.7) Occasional smoke 157 (16.3) 32 (16.5) 34 (10.3) 8 (5.1) P o essional s a us <.001 <.001 0.001 Sel -employed 98 (10.2) 10 (5.2) 25 (8.0) 7 (4.6) Uppe le el nonmanual wo ke 199 (20.7) 11 (5.8) 21 (6.7) 24 (15.9) Lowe le el nonmanual wo ke 284 (29.5) 50 (26.2) 59 (18.8) 35 (23.2) Manual wo ke 353 (36.7) 113 (59.2) 195 (62.1) 79 (52.3) Wo king om home, s uden , o he 28 (2.9) 7 (3.7) 14 (4.5) 6 (4.0) Physical exe cise equency 0.133 <.001 0.007 No a all 50 (5.2) 14 (7.3) 33 (10.1) 6 (3.8) Less han once a week 224 (23.3) 38 (19.7) 60 (18.3) 24 (15.3) 1–2 imes a week 423 (44.0) 75 (38.9) 125 (38.2) 64 (40.8) > = 3 imes a week 265 (27.5) 66 (34.2) 109 (33.3) 63 (40.1) Da a is p esen ed as n (%) unless o he wise s a ed Taponen e al. Jou nal o Occupa ional Medicine and Toxicology (2017) 12:19 Page 3 o 7 wo k and wo k disabili y s. ull- ime wo k) in adul s wi h as hma. E en a e adjus ing o age, gende , smok- ing and p o essional s a us, ha ing mo e equen as hma symp oms du ing las mon h o nigh ly wake- ups because o as hma was associa ed o undesi able employmen s a us such as unemploymen o wo k dis- abili y. Occu ence o pe sis en as hma symp oms was associa ed wi h unemploymen and use o pe o al co i- cos e oids was associa ed wi h wo k disabili y. Discussion We ound ha among indi iduals wi h as hma, ull- ime wo k is associa ed wi h younge age, less symp oma ic as hma despi e o less as hma medica ion, nonmanual wo k and less smoking. Ha ing equen as hma symp- oms o nigh ly wake-ups because o as hma is associ- a ed wi h less desi able employmen s a us such as unemploymen and wo k disabili y, e en a e adjus ing o age, gende , smoking and p o essional s a us. Full- ime wo k was in e p e ed as an indica o o success ul coping in wo king li e while all-cause sickness absence, disabili y pension applied o g an ed, unemploymen o ea ly e i emen we e in e p e ed as less desi able em- ploymen s a us, d i ing away om wo king li e, in his s udy. All subjec s had clinically diagnosed as hma and he s udy co e ed all wo king-age adul s wi h as hma in he ci y o Tampe e, Finland, being well ep esen a i e on popula ion le el. Younge age was associa ed wi h ull- ime wo k. I may be independen o as hma, as younge people may be o e all heal hie wi hou como bidi ies. Wi h jus one heal h condi ion such as as hma, i may be easie o ind ways o cope well a wo k compa ed o ha ing mul iple heal h issues. On he o he hand, he asks may di e be ween younge and olde as hma ics as wo king li e has changed and educa ional le el is highe among younge people. As hma may also be o di e en Table 2 As hma symp oms in g oups acco ding o employmen s a us Full- ime wo k n= 870–960 Unemployed n= 193 Wo k disabili y n= 309–327 Re i ed n= 153 p- alue 1 s. 2 p- alue 1 s. 3 p- alue 1 s. 4 Occu ence o as hma symp oms du ing las yea Pe sis en ly 257 (26.8) 73 (37.8) 189 (57.8) 69 (45.1) 0.003 <.001 <.001 Seasonally 162 (16.9) 34 (17.6) 55 (16.8) 26 (17.0) Occasionally 450 (46.9) 78 (40.4) 66 (20.2) 42 (27.5) None 91 (9.5) 8 (4.1) 17 (5.2) 16 (10.5) F equency o as hma symp oms du ing las mon h Daily o almos daily 93 (10.7) 39 (21.3) 139 (45.0) 38 (27.7) <.001 <.001 <.001 3–5 imes a week 71 (8.2) 14 (7.7) 38 (12.3) 12 (8.8) 1–2 imes a week 176 (20.2) 45 (24.6) 44 (14.2) 26 (19.0) Less han once a week 336 (38.6) 58 (31.7) 58 (18.8) 40 (29.2) None 194 (22.3) 27 (14.8) 30 (9.7) 21 (15.3) F equency o as hma symp oms du ing las yea Daily o almos daily 121 (14.6) 46 (27.2) 113 (42.3) 37 (30.3) <.001 <.001 <.001 3–5 imes a week 84 (10.1) 23 (13.6) 44 (16.5) 16 (13.1) 1–2 imes a week 187 (22.6) 41 (24.3) 46 (17.2) 23 (18.9) Less han once a week 415 (50.1) 57 (33.7) 58 (21.7) 40 (32.8) None 22 (2.7) 2 (1.2) 6 (2.2) 6 (4.9) Nigh ly wake-ups because o as hma symp oms du ing las mon h > = 3 imes a mon h 162 (18.4) 72 (39.1) 170 (55.4) 49 (34.8) <.001 <.001 <.001 <3 imes a mon h 191 (21.7) 34 (18.5) 50 (16.3) 31 (22.0) None 526 (59.8) 78 (42.4) 87 (28.3) 61 (43.3) Nigh ly wake-ups because o as hma symp oms du ing las yea > = 3 imes a mon h 151 (17.8) 61 (35.3) 129 (46.2) 34 (27.4) <.001 <.001 0.004 <3 imes a mon h 396 (46.7) 69 (39.9) 99 (35.5) 62 (50.0) None 301 (35.5) 43 (24.9) 51 (18.3) 28 (22.6) Use o as hma medica ion du ing las yea No 105 (10.9) 13 (6.6) 19 (5.7) 12 (7.6) 0.066 <.001 0.010 I egula ly 190 (19.7) 39 (19.9) 38 (11.5) 18 (11.4) Seasonally (e.g. sp ing ime) 113 (11.7) 15 (7.7) 23 (6.9) 15 (9.5) Con inuosly daily o almos daily 556 (57.7) 129 (65.8) 251 (75.8) 113 (71.5) Subjec s ha ing used pe o al co icoids because o as hma du ing las yea 225 (23.5) 53 (27.3) 143 (43.7) 41 (26.6) 0.258 <.001 0.401 Da a is p esen ed as n (%) Taponen e al. Jou nal o Occupa ional Medicine and Toxicology (2017) 12:19 Page 4 o 7 pheno ypes in hese age g oups and he e o e espond di e en ly o cu en he apies [17]. We ound ha hose who we e wo king ull ime expe- ienced less as hma symp oms al oge he and also du - ing leisu e ime han o he g oups. Also, when adjus ed o age, gende , smoking and p o essional s a us, ou e- sul s showed ha ha ing equen as hma symp oms o nigh ly wake-ups because o as hma is associa ed wi h unemploymen and wo k disabili y. This indica es ha coping in wo king li e may be mo e s ongly a ec ed by he se e i y o as hma a he han speci ic ac o s ha may agg a a e as hma symp oms a wo k. This suppo s ea lie indings o se e i y o as hma p edic ing wo k disabili y [6, 12, 13], al hough one ollow-up s udy o 111 wo ke s wi h as hma concluded ha adap a ion o unc ional limi a ions played a majo ole in changes in sick lea e in wo ke s wi h as hma whe eas lung unc ion cha ac e is ics o disease his o y ha dly played a ole [18]. Some occupa ions such as cooks, ga dene s, hai - d esse s and ag icul u al labo e s s ill may be iden i ied as “b ea h- aking jobs”, needing special a en ion o p e- en i e measu es [19]. This howe e does no explain why adul s wi h as hma o e all ha e dis up ions in hei wo king li e, including espi a o y sickness absences and all-cause long- e m wo k disabili y [7, 10, 16]. A s udy om he U.S. compa ed he employmen s a us o sub- jec s wi h wo k- ela ed and non-wo k- ela ed as hma and ound ha being unable o wo k was associa ed wi h mo e equen as hma symp oms and a e y poo ly con olled as hma [15]. Ou esul s sugges he same phenomena showing associa ions be ween equen symp oms o nigh ly wake-ups and undesi able employ- men s a us. In he U.S. s udy, as hma was sel - epo ed whe eas in ou s udy, all subjec s we e eliably diagnosed o as hma. I is possible ha in gene al, wo king en- i onmen s ha e imp o ed as indoo ai ac o s and hei e ec s on heal h ha e been ecognized [20] and he eby on popula ion le el inhe en se e i y o as hma is a mo e impo an ac o in coping in wo king li e han occupa ional exposu es. I is no iceable ha al hough wo ke s who we e wo king ull ime had less symp oms o as hma and hei p o essional s a us was nonmanual, hey did no use mo e egula as hma medica ion. On he con a y, hey used less medica ion, which indica es ha less desi able employmen s a us is no associa ed o insu icien medical ea men o as hma. Ou s udy shows ha indi iduals wi h as hma doing nonmanual wo k cope be e in wo king li e han hose doing manual wo k. This may pa ially be explained by a cleane wo k en i onmen . We ha e ound ea lie , in line wi h o he s udies, ha exposu e o impu i ies such as dus s, chemicals o poo indoo ai quali y inc eases agg a a ion o as hma symp oms a wo k as does phy- sically s enuous wo k [11, 21]. Al hough no always he case in indi idual le el, edu- ca ional le els a e gene ally lowe among wo ke s doing manual wo k han nonmanual. Ea lie s udies ha e shown ha lowe educa ion may inc ease he numbe o sickness absence days as much as 2.5- old [8] and i has also been shown among as hma ics ha lowe le el edu- ca ion inc eases he isk o wo k disabili y [6, 12]. Adap- a ion o unc ional limi a ions may play a majo ole in wo k abili y [18] and he possibili ies o adap , adjus and ha e in luence on one’s wo king en i onmen a e p obably be e among nonmanual wo ke s. The e we e mo e nonmanual wo ke s in he ull- ime wo king g oup and he e i ed g oup compa ed o he g oups wi h wo k disabili y and he unemployed, o Table 3 Associa ions be ween di e en as hma symp oms a and employmen s a us. C ude logis ic eg ession models and models adjus ed o age, gende , smoking and p o essional s a us Unemployed s. ull- ime wo k Wo k disabili y s. ull- ime wo k C ude OR (95% CI) Adjus ed OR (95% CI) C ude OR (95% CI) Adjus ed OR (95% CI) Occu ence o as hma symp oms du ing las yea Pe sis en ly s. none 3.2 (1.5–7.0) 2.4 (1.1–5.3) 3.9 (2.3–6.8) 1.6 (0.8–3.3) F equency o as hma symp oms du ing las mon h Daily o almos daily s. none 3.0 (1.7–5.2) 2.3 (1.3–4.2) 9.7 (6.1–15.4) 4.4 (2.3–8.2) F equency o as hma symp oms du ing las yea Daily o almos daily s. none 4.2 (0.9–18.5) 3.0 (0.7–14.1) 3.4 (1.3–8.8) 1.8 (0.5–6.0) Nigh ly wake-ups because o as hma symp oms du ing las mon h > = 3 imes a mon h s. none 3.0 (2.1–4.3) 2.5 (1.7–3.8) 6.3 (4.6–8.7) 3.2 (2.1–4.8) Nigh ly wake-ups because o as hma symp oms du ing las yea > = 3 imes a mon h s. none 2.6 (1.7–3.9) 2.4 (1.5–3.7) 4.4 (3.1–6.3) 2.6 (1.6–4.3) Use o as hma medica ion du ing las yea Con inuosly daily o almos daily s. none 1.9 (1.0–3.4) 1.5 (0.8–2.9) 2.5 (1.5–4.2) 1.0 (0.5–2.0) Subjec s ha ing used pe o al co icoids because o as hma du ing las yea 1.2 (0.9–1.7) 1.0 (0.7–1.5) 2.5 (1.9–3.3) 1.5 (1.1–2.2) a Logis ic eg ession analyses included calcula ions o odds a ios o less se e e symp oms s. no symp oms (e.g. seasonally s. none and occasionally s. none bu da a is shown only on wo s symp oms s. none Taponen e al. Jou nal o Occupa ional Medicine and Toxicology (2017) 12:19 Page 5 o 7 whom abou 60% o pe sons we e manual wo ke s. In hese g oups, a se e e as hma and possible o he heal h issues may a ec hei esilience in wo king li e nega- i ely. As hma is he p ima y cause o disabili y pension in Finland in only less han 0,4% o disabili y pensions g an ed [22] whe eas mo bidi y in musculoskele al con- di ions and men al p oblems a e leading causes o wo k disabili y [23]. A weakness o ou s udy is he lack o in- o ma ion on co-mo bidi ies and hei possible e ec on wo k abili y. The unemployed g oup was closes o ull- ime wo ke s acco ding o age and like ull- ime wo ke s, hey we e younge han hose wi h wo k disabili y and he e- i ed. Howe e , he unemployed g oup expe ienced mo e as hma symp oms, cu en smoking was mo e common and p o essional s a us was mo e likely o be manual han nonmanual wo ke han among ull- ime wo ke s. In gene al, manual wo ke s ep esen lowe le el educa- ion han nonmanual wo ke s. Ea lie s udies ha e shown ha unemploymen among as hma ics is associ- a ed wi h no only lowe educa ion bu also mo e se e e as hma [5, 6]. I may be ha he mo i a ion o hold on o a manual job and pe o m well a wo k is dec eased due o ha ing mo e as hma symp oms. Smoking agg a a es as hma symp oms and dec eases he e ec o medica ion [24]. An 8-yea ollow-up s udy showed ha imp o emen s in wo king condi ions and educing smoking especially in he lowe educa ional g oups a e likely o educe he educa ional di e ences in sickness absence [8]. Eisne e al. showed ha pas smoking was associa ed wi h comple e wo k disabili y bu among he cu en ly employed, smoking s a us was no associa ed wi h pa ial wo k disabili y [6]. In his s udy, he p opo ion o ne e -smoke s and occasional smoke s was g ea es in he ull- ime wo king g oup and he e we e mo e ex-smoke s in he wo k disabili y g oup han among ull- ime wo ke s. I may be ha wi h in- c easing as hma symp oms and dec easing quali y o li e due o symp oms, he mo i a ion o qui smoking a ises. I could be assumed ha physical exe cise le els would be lowe among hose ha ing mos as hma symp oms compa ed o hose ha ing less symp oms. In ou s udy howe e , he e was no signi ican di e ence be ween he g oups in physical exe cise equency. I may be ha hose who a e ac i e in wo king li e ha e less ime o physical exe cise. The s eng h o ou s udy is ha i is e y well ep e- sen a i e on popula ion le el. We ec ui ed all wo king- age adul s wi h as hma in Tampe e ci y wi h es ablished as hma and special eimbu semen and diagnosis based on lung unc ion c i e ia. Also, he esponse a e was high (79%). Howe e , as a ques ionnai e-based s udy his lacks in o ma ion on clinical measu es and de ails o ea men s on indi idual le el. As a limi a ion o he s udy, we had da a on all-cause sickness absence and lacked as hma-speci ic da a. Also, he e a e limi a ions in he c oss-sec ional s udy design. As in all ques ionnai e- based s udies, selec ion bias is possible and we do no know whe he hose who answe ed his ques ionnai e ha e e.g. mo e se e e as hma o ice e sa. The heal hy wo ke e ec , meaning e.g. ha sicke indi iduals may be excluded om being hi ed o once hi ed, hey may may seek ans e o less exposed jobs o lea e wo k [25], may ha e con ibu ed o selec ion bias in ou s udy. Ou ma e ial was collec ed in yea 2000 and some aspec s in as hma ea men o wo king li e may ha e changed. In Finland, ou na ional as hma guidelines and as hma p og am ha e s essed ac i e ea men wi h inhaled co icos e oids (ICS) since ea ly 1990’s [26] and he use o ICS has no changed signi ican ly since he collec ion o ou da a. Long-ac ing be a2-agonis s (LABA) we e in oduced in mid- 1990’s bu he use o his class o d ugs has p obably inc eased a e yea 2000 since he in oduc ion o ixed ICS-LABA combina ions. Finland has o long had a high le el o social secu i y and in- su ance sys em ha has no signi ican ly changed du ing he las decades and he e o e ou esul s om 2000 a e s ill alid. The economic s uc u e in Finland is ypical o coun ies in wes e n Eu ope and has no changed un- damen ally a e he yea 2000. Conclusions Among indi iduals wi h as hma, ull- ime wo ke s a e on a e age younge , mo e equen ly nonmanual wo ke s, hey smoke less and ha e less as hma symp oms bo h a wo k and a leisu e ime despi e o using less as hma medi- ca ion. E en a e adjus ing o age, gende , smoking and p o essional s a us, logis ic eg ession analyses show ha ha ing equen as hma symp oms o nigh ly wake-ups be- cause o as hma is associa ed wi h less desi able employ- men s a us such as unemploymen and wo k disabili y. This sugges s ha in addi ion o ollowing con en ional p ocedu es such as guideline-based as hma medica ion, smoking cessa ion and educ ion o exposu e o as hma igge s, i may be o g ea impo ance o suppo possibil- i ies o change om manual o nonmanual wo k in p e- en ing wo k disabili y and ea ly exi om wo k. Addi ional ile Addi ional ile 1: Appendix 1. Ques ions on employmen s a us (wo k si ua ion Q28), p o essional s a us (Q6) and as hma symp oms used in his s udy. (DOCX 15 kb) Acknowledgemen s No applicable. Taponen e al. Jou nal o Occupa ional Medicine and Toxicology (2017) 12:19 Page 6 o 7 Funding The Finnish Wo k En i onmen Fund. A ailabili y o da a and ma e ials The da ase s used and/o analysed du ing he cu en s udy a ailable om he co esponding au ho on easonable eques . Au ho s’con ibu ions ST was he main au ho o he manusc ip and con ibu ed by analyzing and in e p e ing he da a. LL and KK con ibu ed by planning he s udy design, analyzing and in e p e ing da a and w i ing he manusc ip . Ri a Luukkonen con ibu ed by planning and pe o ming he s a is ical analyses and planning he design o his s udy. JU con ibu ed as he leade o he s udy g oup, by planning he s udy design, analyzing and in e p e ing da a and w i ing he manusc ip . All au ho s ead and app o ed he inal manusc ip . E hics app o al and consen o pa icipa e This is a ques ionnai e based s udy whe e pa icipa ion was olun a y and since he e was no in e en ion, he Finnish legisla ion does no equi e e hics commi ee handling. Consen o publica ion No applicable. Compe ing in e es s The au ho s decla e ha hey ha e no compe ing in e es s. Publishe ’sNo e Sp inge Na u e emains neu al wi h ega d o ju isdic ional claims in published maps and ins i u ional a ilia ions. Au ho de ails 1 Finla Occupa ional Heal h, Sa akunnanka u 18 B, 33210 Tampe e, Finland. 2 Alle gy Cen e, Tampe e Uni e si y Hospi al, PO Box 2000, 33521 Tampe e, Finland. 3 Facul y o Medicine and Li e Sciences, Uni e si y o Tampe e, 33014 Tampe e, Finland. 4 Finnish Ins i u e o Occupa ional Heal h, PO Box 40, 00251 Helsinki, Finland. 5 Clinicum, Facul y o Medicine, Uni e si y o Helsinki, PO Box 63, 00014 Helsinki, Finland. Recei ed: 23 Feb ua y 2017 Accep ed: 14 July 2017 Re e ences 1. Pallasaho P, Juusela M, Lindq is A, So ija i A, Lundback B, Ronma k E. Alle gic hinoconjunc i i is doubles he isk o inciden as hma– esul s om a popula ion s udy in Helsinki, Finland. Respi Med. 2011;105(10):1449–56. 2. To T, S anoje ic S, Moo es G, Ge shon AS, Ba eman ED, C uz AA, Boule LP. Global as hma p e alence in adul s: indings om he c oss-sec ional wo ld heal h su ey. BMC Public Heal h. 2012;12:204–2458. 12-204 3. Eh eshami-A sha S, Fi zGe ald JM, Doyle-Wa e s MM, Sada sa a i M. The global economic bu den o as hma and ch onic obs uc i e pulmona y disease. In J Tube c Lung Dis. 2016;20(1):11–23. 4. Hansen CL, Baelum J, Skadhauge L, Thomsen G, Omland O, Thilsing T, Dahl S, Sigsgaa d T, She son D. Consequences o as hma on job absen eeism and job e en ion. Scand J Public Heal h. 2012;40(4):377–84. 5. Pe e s J, Pick ance S, Wil o d J, Macdonald E, Blank L. P edic o s o delayed e u n o wo k o job loss wi h espi a o y ill-heal h: a sys ema ic e iew. J Occup Rehabil. 2007;17(2):317–26. 6. Eisne MD, Yelin EH, Ka z PP, Lac ao G, I iba en C, Blanc PD. Risk ac o s o wo k disabili y in se e e adul as hma. Am J Med. 2006;119(10):884–91. 7. To en K, Zock JP, Koge inas M, Plana E, Sunye J, Radon K, Ja is D, K omhou H, d'E ico A, Payo F, An o JM, Blanc PD. An in e na ional p ospec i e gene al popula ion-based s udy o espi a o y wo k disabili y. Tho ax. 2009;64(4):339–44. 8. Kaikkonen R, Ha kanen T, Rahkonen O, Gould R, Koskinen S. Explaining educa ional di e ences in sickness absence: a popula ion-based ollow-up s udy. Scand J Wo k En i on Heal h. 2015;41(4):338–46. 9. Blanc PD, Bu ney P, Janson C, To en K. The p e alence and p edic o s o espi a o y- ela ed wo k limi a ion and occupa ional disabili y in an in e na ional s udy. Ches . 2003;124(3):1153–9. 10. Kim JL, Blanc PD, Villani S, Oli ie i M, U u ia I, an Sp undel M, S o aas T, Le Moual N, Zock JP, To en K. P edic o s o espi a o y sickness absence: an in e na ional popula ion-based s udy. Am J Ind Med. 2013;56(5):541–9. 11. Saa inen K, Ka jalainen A, Ma ikainen R, Ui i J, Tammileh o L, Klaukka T, Ku ppa K. P e alence o wo k-agg a a ed symp oms in clinically es ablished as hma. Eu Respi J. 2003;22(2):305–9. 12. Linds om I, Pallasaho P, Luukkonen R, Suojaleh o H, Ka jalainen J, Laue ma A, Ka jalainen A. Reduced wo k abili y in middle-aged men wi h as hma om you h–a 20-yea ollow-up. Respi Med. 2011;105(6):950–5. 13. Gonzalez Ba cala FJ, La Fuen e-Cid RD, Al a ez-Gil R, Ta alla M, Nue o J, Caamano-Iso na F. Fac o s associa ed wi h a highe p e alence o wo k disabili y among as hma ic pa ien s. J As hma. 2011;48(2):194–9. 14. Gonzalez-Ba cala FJ, de la Fuen e-Cid R, Ta alla M, Nue o J, Caamano-Iso na F. Fac o s associa ed wi h heal h- ela ed quali y o li e in adul s wi h as hma. A c oss-sec ional s udy. Mul idiscip Respi Med. 2012;7(1):32–6958. 7-32 15. Whi e GE, Mazu ek JM, Moo man JE. Wo k- ela ed as hma and employmen s a us–38 s a es and Dis ic o Columbia, 2006-2009. J As hma. 2013;50(9):954–9. 16. Hakola R, Kauppi P, Leino T, Ojaja i A, Pen i J, Oksanen T, Haah ela T, Ki imaki M, Vah e a J. Pe sis en as hma, como bid condi ions and he isk o wo k disabili y: a p ospec i e coho s udy. Alle gy. 2011;66(12):1598–603. 17. Wenzel SE. As hma pheno ypes: he e olu ion om clinical o molecula app oaches. Na Med. 2012;18(5):716–25. 18. Boo CR, Ve coulen JH, an de Gulden JW, O bon KH, Rooijacke s JM, an Weel C, Folge ing HT. P edic o s o changes in sick lea e in wo ke s wi h as hma: a ollow-up s udy. In A ch Occup En i on Heal h. 2005;78(8):633–40. 19. Fell A, Ab ahamsen R, Hennebe ge PK, S endsen MV, Ande sson E, To en K, Konge ud J. B ea h- aking jobs: a case-con ol s udy o espi a o y wo k disabili y by occupa ion in No way. Occup En i on Med. 2016;73(9):600–6. 20. WHO, Regional O ice o Eu ope. WHO guidelines o indoo ai quali y: dampness and mould. Gene a: Wo ld Heal h O ganiza ion; 2009. 21. Hennebe ge PK, Liang X, Lillienbe g L, Dahlman-Hoglund A, To en K, Ande sson E. Occupa ional exposu es associa ed wi h se e e exace ba ion o as hma. In J Tube c Lung Dis. 2015;19(2):244–50. 22. Nyman H: S a is ics om he Finnish Cen e o Pensions: S a is ical yea book o pensione s in Finland 2015. 2016, 8/2016(h p://www.e k. i/wp-con en / uploads/S a is ical_yea book_o _pensione s_in_Finland_2015.pd ):. 23. Kannis o J, Nyman H: S a is ics om he Finnish Cen e o Pensions: Ea nings- ela ed pension ecipien s in Finland 2015. 2016, h p://www.e k. i/wp-con en / uploads/Ea nings_ ela ed_pension_ ecipien s_in_ inland_2015.pd :. 24. Polosa R, Thomson NC. Smoking and as hma: dange ous liaisons. Eu Respi J. 2013;41(3):716–26. 25. Le Moual N, Kau mann F, Eisen EA, Kennedy SM. The heal hy wo ke e ec in as hma: wo k may cause as hma, bu as hma may also in luence wo k. Am J Respi C i Ca e Med. 2008;177(1):4–10. 26. Haah ela T, Klaukka T, Koskela K, E hola M, Lai inen LA. Wo king G oup o he As hma P og amme in Finland 1994-2004: as hma p og amme in Finland: a communi y p oblem needs communi y solu ions. Tho ax. 2001;56(10):806–14. • We accep p e-submission inqui ies • Ou selec o ool helps you o ind he mos ele an jou nal • We p o ide ound he clock cus ome suppo • Con enien online submission • Tho ough pee e iew • Inclusion in PubMed and all majo indexing se ices • Maximum isibili y o you esea ch Submi you manusc ip a www.biomedcen al.com/submi Submi you nex manusc ip o BioMed Cen al and we will help you a e e y s ep: Taponen e al. Jou nal o Occupa ional Medicine and Toxicology (2017) 12:19 Page 7 o 7