1. Asthma impacts on workplace productivity and daily activities in employed patients who are symptomatic despite background therapy: a multi-national survey
Kevin Gruffydd-Jones,1 Mike Thomas,2 Miguel Roman Rodríguez,3 Antonio Infantino,4 Katharina Opitz,5 Valerie Hargreaves6
1Box Surgery, Box, Corsham, Wiltshire, UK; 2Primary Care and Population Sciences, University of Southampton, Southampton, UK; 3Primary Care Respiratory Research Unit, IdISPa, Palma de Mallorca, Spain; 4Respiratory Area, Italian Interdisciplinary Society for Primary Care, Bari, Italy; 5Media & PR, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany; 6Cohn & Wolfe, London, UK

2. Introduction
Despite treatment according to current guidelines, ≥40% of patients with asthma have poorly controlled disease1,2
Poorly controlled asthma is associated with reduced work productivity versus well-controlled asthma3–5
In a US study, workers with poorly controlled asthma (39.7%) had greater work and activity impairment versus those with well-controlled asthma3
In a study in Spain, indirect costs were significantly higher in the 57.6% of patients with poorly controlled asthma4
In a European survey, 24–59% of asthma patients per country reported ≥1 days of absence from work / education in the past year5
1. Demoly P et al. Eur Respir Rev 2012; 21: 66–74;
2. Price D et al. NPJ Prim Care Respir Med 2014; 24: 14009;
3. Vietri J et al. J Occup Environ Med 2014; 56: 425–430;
4. Ojeda P et al. J Investig Allergol Clin Immunol 2013; 23: 234–241;
5. Fletcher M et al. Adv Ther 2015; 32: 370–380

3. Aim
To increase understanding of the impact of symptomatic asthma on work productivity and daily activities in adults receiving maintenance therapy, by collecting quantitative data via a multi-national survey

4. Work Productivity and Activity Impairment (WPAI) Specific Health Problem (SHP) questionnaire1
A patient-reported quantitative assessment of the amount of:
absenteeism
presenteeism (reduced on-the-job effectiveness)
daily activity impairment attributable to a specific health problem (eg asthma) during the past 7 days
1. Reilly MC et al. Pharmacoeconomics 1993; 4: 353–365

5. WPAI:SHP questions1
Six questions; questions 2–6 relating to the past 7 days:1
Are you currently employed (working for pay)?
How many hours did you miss from work because of your asthma?
How many hours did you miss from work because of any other reason, such as vacation, holidays?
How many hours did you actually work?
How much did asthma affect your productivity while you were working?
How much did asthma affect your ability to do your regular daily activities, other than work at a job?
1. Reilly MC et al. Pharmacoeconomics 1993; 4: 353–365

6. Definitions and scoring methodology
Absenteeism = percentage of work time missed
Questions 2 and 4: patients record number of hours missed
Presenteeism = impairment at work; reduced on-the-job effectiveness
Question 5: patients circle a number from 0 to 10
Scores were then categorised as follows:
Asthma had no
effect on my work
Asthma completely prevented me from working
1–3 = Bottom three scores
4–7 = Middle four scores
8–10 = Top three scores
0 = No effect
Q2: How many hours did you miss from work because of your asthma?
Q4: How many hours did you actually work?
Q5: How much did asthma affect your productivity while you were working?
1. Reilly MC et al. Pharmacoeconomics 1993; 4: 353–365

7. Screening criteria
Individuals (n=6140) from a consumer panel were screened for eligibility:
Adults (aged ≥18 years) with asthma diagnosed by a healthcare professional
In full- or part-time employment
Currently receiving inhaler / preventer medication for long-term asthma control
Confirmed as symptomatic using the RCP3Q tool
RCP3Q, Royal College of Physicians three questions

8. Screening
Consumer panel participants N=6140
Not currently employed n=2140
In full- or part-time employment n=4000
Inhaler / preventer medication for long-term asthma control NOT selected n=1945
Receiving inhaler / preventer medication for long-term asthma control n=2055
‘No’ selected for all three RCP3Q questions n=457
Symptomatic asthma despite controller medication n=1598
1598 participants completed the WPAI:SHP via an internet-based questionnaire

9. Demographic characteristics
Age, years
Employment status (%)
Participants (%)
Geographical location
n=293
Germany
n=300
Spain
n=200
Brazil
Canada UK
n=305
Japan

10. Impact of asthma on daily activities, in symptomatic participantsa
Most participants screened had symptomatic asthma despite controller medication
Of 2055 people in employment and receiving inhaler / preventer medication for long-term asthma control:
only 457 were asymptomatic
1598 remained symptomatic
Impact of asthma on daily activities, in symptomatic participantsa
Participants (%)
aBased on screening questions:
S5. In the past month, have you had any difficulty sleeping because of your asthma symptoms (including cough)?
S6. In the past month, have you had your usual asthma symptoms during the day?
S7. In the past month, has your asthma interfered with your usual activities?

11. Working hours missed because of asthma
Absenteeism: percent of work time missed because of asthma was 9.1% overalla
Percent of work time missed ranged from 3.3% in the UK to 17.2% in Brazila
Participants reported missing, on average, 3 working hours a week because of asthma
Overall, participants reported working an average of 32 hours a week
Working hours missed because of asthma
Hours of work per week
aPercent of work time missed because of problem = Q2/(Q2+Q4), based on mean scores at the respondent level1 Q2: How many hours did you miss from work because of your asthma?
Q4: How many hours did you actually work? 1.

12. 73.6% of respondents experienced a reduction in presenteeism
Work productivity impairment, on average, because of asthma:
73.6% of participants reported some reduction (score ≥1 / 10)
42.3% reported a prominent reduction (score ≥4 / 10)
Impairment in productivity while working; by score category
1–3 = Bottom three scores
4–7 = Middle four scores
8–10 = Top three scores
0 = No effect
26.4%
31.3%
32.9%
9.4%
Percent of impairment while working because of asthma = Q5/10, based on mean scores at the respondent level, then converted to a percentage1 Q5: How much did asthma affect your productivity while you were working? 1.

13. Impairment in productivity while working; by score category (%)
Work productivity impairment was lowest in the UK and highest in Brazil
Impairment in productivity while working; by score category (%)
1–3 = Bottom three scores
4–7 = Middle four scores
8–10 = Top three scores
0 = No effect
Germany
Spain
Brazil
Canada UK
Japan
Q5: How much did asthma affect your productivity while you were working?
Because of rounding, percentages within each country may not add up to 100

14. How asthma at work makes people feel
The majority of participants indicated that asthma at work affects them physically and mentally
How asthma at work makes people feel
Participants (%)
Only 13% of participants indicated no impact of asthma
Q7: How does asthma at work make you feel? (Open question; additional to the WPAI:SHP questionnaire)

15. Conclusions (1)
For a substantial proportion of adult patients in employment with symptomatic asthma despite long-term maintenance medication, asthma has a large negative impact on work productivity and daily activity

16. Conclusions (2)
Employers and occupational health teams should be more aware of the impact of asthma on workers
While clinicians tend to ask patients whether their job affects their asthma, it is important to also ask patients how their asthma affects their ability to do their job and to perform daily activities

17. Acknowledgements
Kantar Health received funding from Boehringer Ingelheim to conduct the WPAI:SHP survey
Laura Gibbons, PhD, at Complete HealthVizion provided editorial assistance in the development of this presentation, funded by Boehringer Ingelheim