At work with the CDC

Asthma management in the workplace

By Seymour Williams, MD, and Oona Powell

Poorly managed asthma in employees or their dependents can lead to unintended absenteeism, emergency room visits, hospitalizations and sometimes death. For an employer, it can mean lost productivity, higher health care costs and the potential loss of skilled and experienced employees.

Since 1998, the Centers for Disease Control and Prevention has worked with the National Business Coalition on Health, the Washington Business Group on Health, the Employers Managed Health Care Association and other partners to explore ways to reduce the burden on businesses and improve worker asthma management through education.

Achievable goals of asthma management are to prevent and control symptoms, maintain normal or near normal activity levels and lung function, minimize emergency room visits and hospitalizations and maintain optimal medication use with the fewest adverse side effects.

Asthma is a chronic disease of the lungs and airways that can cause wheezing, chest tightness and difficulty breathing. The number of U.S. people with asthma has doubled in the past 15 years to about 14.5 million—nearly 5 percent of the population. Almost two thirds of those with asthma are older than 18. More than 28,000 people per day visit a doctor for asthma, the CDC estimates, and 213 per hour go to an emergency room, 53 per hour are hospitalized, and 15 per day die.

The work environment can contribute to the problem. Some five to 25 percent of newly diagnosed cases of asthma and aggravation of previously diagnosed asthma in adults are work-related, due to substances in the workplace that act as triggers, including chemicals, airborne matter from production and tobacco smoke.

In 1994, $10.7 billion was spent in the United States for asthma care, mainly on direct medical care expenses. The estimated expense for 1998 was $12.7 billion, and the projection for 2020 is $18 billion. From 1985 to 1994 hospitalization costs dropped due to decreases in length of hospital stays, and medication costs replaced hospital costs as the largest component of direct medical expenditures.

Indirect costs of asthma, measured by school days and workdays lost, accounted for the largest cost increase from 1985 to 1994. In 1994, people 18 and older employed outside the home lost eight million workdays, costing an estimated $1.3 billion. Children ages five to 17 missed 11.8 million school days, accounting for $957 million in caretakers' time lost from work.

Business costs can be lowered and productivity improved through medical management of asthma. For people with persistent asthma, use of inhaled anti-inflammatory steroid medication and reduction of exposure to indoor allergens and triggers can lower absenteeism, improve health and productivity, reduce hospitalizations and emergency room visits and reduce the number of deaths. Occupational asthma can be prevented through environmental management of the workplace.

Seymour G. Williams, MD, is an epidemiologist and Oona Powell is a health communication specialist at the Air Pollution and Respiratory Health Branch of the National Center for Environmental Health.

Steps to improve productivity and help employees with asthma

Develop a healthy work environment.

• Designate the workplace as a "no smoking area."

• Identify and assess potential asthma "triggers" in the workplace, reduce or eliminate them and monitor their levels.

• Set policies and procedures to respond to strong odors and exposures to unavoidable workplace allergens.

Implement asthma-friendly policies.

• Grant time off for asthma-related doctor visits.

• Support smoking-cessation programs.

• Support the use of asthma medications in the workplace.

• Develop emergency response procedures for employees who may have asthma reactions.

Provide information to employees.

• Establish a health resource center with regularly updated asthma information.

• Establish education partnerships with asthma organizations.

• Promote and participate in community asthma activities.

• Ensure employee access to adequate health care coverage to manage asthma.

 

Asthma management in the workplace. Business and Health 2001;5:44.