BACKGROUND: Effective patient-physician communication is the key component of the patient-physician relationship. OBJECTIVE: To assess the proportion of ever-employed adults with current asthma who talked about asthma associated with work with their physician or other health professional and to identify factors associated with this communication. METHODS: The 2006 to 2010 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey data from 40 states and the District of Columbia for ever-employed adults (≥18 years old) with current asthma (N = 50,433) were examined. Multivariable logistic regression analyses were conducted to identify factors associated with communication with a health professional about asthma and work. RESULTS: Among ever-employed adults with current asthma, 9.1% were ever told by a physician that their asthma was related to any job they ever had and 11.7% ever told a physician or other health professional that this was the case. When responses to the 2 questions were combined, the proportion of those who communicated with a health professional about asthma and work was 14.7%. Communication with a health professional about asthma and work was associated with age, race or ethnicity, employment, education, income, insurance, and urgent treatment for worsening asthma. CONCLUSION: A small proportion of patients with asthma might communicate with a health professional about asthma associated with work. Future studies should examine whether patients with asthma ever discussed with a health professional the possibility that their asthma might be related to work to provide information on the frequency of patient-clinician communication about asthma related to work.

INTRODUCTION: Monitoring the level of asthma control is important in determining the effectiveness of current treatment which may decrease the frequency and intensity of symptoms and functional limitations. Uncontrolled asthma has been associated with decreased quality of life and increased health care use. The objectives of this study were to assess the level of asthma control and identify related risk factors among persons with current asthma. METHODS: Using the 2006 to 2010 BRFSS child and adult Asthma Call-back Survey, asthma control was classified as well-controlled or uncontrolled (not-well-controlled or very-poorly-controlled) using three impairment measures: daytime symptoms, nighttime symptoms, and taking short-acting beta2-agonists for symptom control. Multivariate logistic regression identified predictors of asthma control. RESULTS: Fifty percent of adults and 38.4% of children with current asthma had uncontrolled asthma. About 63% of children and 53% of adults with uncontrolled asthma were on long-term asthma control medications. Among children, uncontrolled asthma was significantly associated with being younger than 5 years, having annual household income < $15,000, and reporting cost as barriers to medical care. Among adults, it was significantly associated with being 45 years or older, having annual household income of < $25,000, being "other" race, having less than a 4-year college degree, being a current or former smoker, reporting cost as barriers, being obese, and having chronic obstructive pulmonary disease or depression. CONCLUSION: Identifying and targeting modifiable predictors of uncontrolled asthma (low educational attainment, low income, cigarette smoking, and co-morbid conditions including obesity and depression) could improve asthma control.

BACKGROUND: Racial disparities in childhood asthma have been a long-standing target for intervention, especially disparities in hospitalization and mortality. OBJECTIVES: Describe trends in racial disparities in asthma outcomes using both traditional population-based rates and at-risk rates (based on the estimated number of children with asthma) to account for prevalence differences between race groups. METHODS: Estimates of asthma prevalence and outcomes (emergency department [ED] visits, hospitalizations, and deaths) were calculated from national data for 2001 to 2010 for black and white children. Trends were calculated using weighted loglinear regression, and changes in racial disparities over time were assessed using Joinpoint. RESULTS: Disparities in asthma prevalence between black and white children increased from 2001 to 2010; at the end of this period, black children were twice as likely as white children to have asthma. Population-based rates showed that disparities in asthma outcomes remained stable (ED visits and hospitalizations) or increased (asthma attack prevalence, deaths). In contrast, analysis with at-risk rates, which account for differences in asthma prevalence, showed that disparities in asthma outcomes remained stable (deaths), decreased (ED visits, hospitalizations), or did not exist (asthma attack prevalence). CONCLUSIONS: Using at-risk rates to assess racial disparities in asthma outcomes accounts for prevalence differences between black and white children, and adds another perspective to the population-based examination of asthma disparities. An at-risk rate analysis shows that among children with asthma, there is no disparity for asthma attack prevalence and that progress has been made in decreasing disparities in asthma ED visit and hospitalization rates.

BACKGROUND: Seasonal influenza vaccination is recommended for all asthma patients. Persons with work-related asthma may have more severe disease than those with non-work-related asthma and may particularly benefit from receiving influenza vaccination. PURPOSE: To determine if influenza vaccination coverage differs among individuals aged 18-64 years with work-related and non-work-related asthma. METHODS: Data from the 2006-2009 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey collected in 38 states and the District of Columbia were analyzed in 2013. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with influenza vaccination among respondents aged 18-64 years with work-related asthma. RESULTS: Among adults aged 18-64 years with current asthma, an estimated 42.7% received influenza vaccination in the past 12 months. Although influenza vaccination coverage was significantly higher among adults with work-related asthma than those with non-work-related asthma (48.5% vs 42.8%), this association became non-significant after adjustment for demographic and clinical characteristics (prevalence ratio=1.08, 95% CI=0.99, 1.20). Among individuals with work-related asthma, receiving the influenza vaccine was associated with being 50-64 years old, being unemployed in the prior year, and seeking urgent treatment for worsening asthma symptoms. CONCLUSIONS: Among persons with work-related and non-work-related asthma, less than half received influenza vaccination in the prior year, both below the Healthy People 2010 target of 60%. These results suggest the need for strengthening current vaccination interventions to meet the updated Healthy People 2020 objective of achieving at least 70% influenza vaccination coverage.

BACKGROUND: Asthma severity is a key indicator to assess asthma care and management. Severity status may vary over time. Assessing asthma severity periodically is important for monitoring the health and well-being of people with asthma. OBJECTIVE: To assess population-based asthma severity and to identify related-risk factors among children and adults with asthma. METHODS: We used the 2006 to 2010 BRFSS child and adult Asthma Call-back Survey. Asthma severity was classified as intermittent or persistent. We performed multivariate logistic regression to identify related-risk factors. RESULTS: Overall, 63.8% of persons with asthma had persistent asthma. Persistent asthma was more prevalent among children aged 0-4 years (71.8%; prevalence rate ratio [PR]=1.3). Among adults with current asthma, persistent asthma was more prevalent among those who were 45 years or older (aged 45-54: 69.4%; PR=1.1, aged 55-64: 72.6%; PR=1.2, and aged 65+: 77.8%; PR=1.3); annual household incomes of <$15,000 (74.1%; PR=1.1); and first diagnosed at age 55 years or older (first diagnosed at age 55-64: 80.4%; PR=1.1, at age 65+: 81.5%; PR=1.1). The prevalence of persistent asthma was also higher among current smokers who were also exposed to secondhand smoke (SHS) (74.7%; PR=1.1); and among those with Chronic Obstructive Pulmonary Disease (COPD) (77.1%; PR=1.2). CONCLUSIONS: Nearly two-thirds of children and adults with asthma had persistent asthma. Identifying related-risk factors could help improve targeted interventions or strategies to reduce modifiable predictors (low income, smoking, and SHS) of increased asthma severity. Such strategies could improve asthma care and quality of life.

OBJECTIVE: To estimate the prevalence of current asthma and the proportion of asthma that is work-related among health care and non-health care workers. METHODS: We used 2008 and 2010 Behavioral Risk Factor Surveillance System High Risk/Health Care Worker Module and Asthma Call-Back Survey data collected in 35 states and the District of Columbia to estimate prevalence ratios (PRs). RESULTS: Significantly more health care workers/volunteers than non-health care workers/volunteers with current asthma had asthma attacks (PR = 1.23; 95% confidence interval = 1.03 to 1.46) and asthma symptoms within the past year (PR = 1.07; 95% confidence interval = 1.00 to 1.14). There was no significant difference in the proportion of health care and non-health care workers/volunteers diagnosed with current asthma or work-related asthma. CONCLUSIONS: The results of this study are consistent with previous research showing that health care workers with asthma have higher proportions of asthma attacks than non-health care workers.

Asthma is a chronic inflammatory disorder of the airways that is characterized by episodic and reversible airflow obstruction, airway hyper-responsiveness, and underlying inflammation. Common asthma symptoms include wheezing, coughing, and shortness of breath. With correct treatment and avoidance of exposure to environmental allergens and irritants that are known to exacerbate asthma, the majority of persons who have asthma can expect to achieve optimal symptom control.

INTRODUCTION: Little is known about the extent to which the age at which asthma first began influences respiratory health later in life. We conducted these analyses to examine the relationship between age at asthma onset and subsequent asthma-related outcomes. METHODS: We used data from 12,216 adults with asthma who participated in the 2010 Behavioral Risk Factor Surveillance System Asthma Call-back Survey to describe the distribution of age at asthma onset. Linear regression was used to estimate associations of age at asthma onset with asthma-related outcomes, including symptoms in the past 30 days and asthma-related emergency visits. RESULTS: Asthma onset before age 16 was reported by an estimated 42% of adults with active asthma, including 14% with onset at 5-9 years of age who reported experiencing any asthma symptoms on 21% of days in the past month. Compared to this group, the percentage of days in the past month with any asthma symptoms was 14.8% higher (95% confidence interval (CI): 5.4, 24.1) among those whose asthma onset occurred at <1 year. When age at onset occurred at 10 years or older there was little change in the prevalence of asthma-related emergency visits across age at onset categories. CONCLUSION: Age at asthma onset may affect subsequent asthma-related outcomes.

OBJECTIVES: To examine differences in current employment status between persons with health professional-diagnosed work-related asthma and non-work-related asthma and to examine factors associated with unemployment in these groups. METHODS: We analyzed the 2006-2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey for ever-employed adults (excluding those who were retired, homemakers, and students at the time of the interview) with current asthma in 38 states and District of Columbia (N=25,680). We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, and income. RESULTS: Among adults with current asthma, individuals with work-related asthma were less likely to be currently employed for wages (PR=0.89; 95% confidence interval [CI]=0.84-0.95) and more likely to be unable to work (PR=1.44; 95% CI=1.24-1.67) than those with non-work-related asthma. Among adults with current asthma who were unemployed at the time of the interview, adults with work-related asthma did not differ from those with non-work-related asthma in naming disability as reason for unemployment (PR=1.09; 95% CI=0.94-1.26). However, those with work-related asthma were more likely to be unable to work for health reasons other than disability (PR=1.46; 95% CI=1.01-2.12) than adults with non-work-related asthma. CONCLUSIONS: Additional studies are needed to determine what health reasons prevent individuals with work-related asthma from working and if the health reasons are asthma-related.

OBJECTIVE: To examine the number of days with asthma symptoms among individuals with work-related asthma (WRA) and non-WRA. METHODS: We calculated adjusted prevalence ratios and compared mean number of days with asthma symptoms using 2006-2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data for ever-employed adults with current asthma from 38 states and District of Columbia. RESULTS: Compared with persons with non-WRA, those with WRA had higher mean number of days with asthma symptoms. Regardless of WRA status, individuals with higher number of days with asthma symptoms were more likely to be unable to work or carry out their usual activities due to asthma. Associations between frequency of asthma symptoms and activity limitation due to asthma were weaker among currently employed adults and stronger among adults not currently employed than the observed associations for all ever-employed adults. CONCLUSIONS: These results suggest higher frequency of asthma symptoms among adults with WRA and underscore the need for optimal asthma management in individuals with WRA.

BACKGROUND: Occupational asthma (OA) is new-onset asthma or the recurrence of previously quiescent asthma caused by workplace exposures. OBJECTIVE: To estimate population-based new-onset OA incidence and the proportion of incident asthma that is work-related. METHODS: Behavioral Risk Factor Surveillance System and Asthma Call-back Survey data collected from persons aged ≥18 years during 2006-2009 in 38 states and the District of Columbia were analyzed. Incident health professional-diagnosed new-onset OA cases were persons with asthma diagnosed within the past 12 months who had health professional-diagnosed work-related asthma. Incident potential new-onset OA cases were persons with asthma diagnosed within the past 12 months who did not have health professional-diagnosed work-related asthma but described their asthma as caused by workplace exposures. The proportion of incident asthma that is work-related was calculated using the 2006-2008 estimate of adult asthma incidence (3800 per million). RESULTS: The estimated annual incidence of health professional-diagnosed new-onset OA was 179 (95% CI: 113-245) per million population. For combined health professional-diagnosed and potential new-onset OA the incidence was 692 (95% CI: 532-853) per million population. The proportion of incident asthma among adults that is work-related was 4.7% for health professional-diagnosed new-onset OA and 18.2% for combined health professional-diagnosed and potential new-onset OA. CONCLUSIONS: New-onset asthma in as many as one of six adult patients might be associated with work. Clinicians should consider the role of occupational exposures when evaluating adults with incident asthma which may uncover opportunities for early intervention and reversal of an otherwise chronic disease.

PURPOSE: The objective of this study was to examine health-related quality of life among adults with work-related asthma. METHODS: We analyzed 2006-2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data for ever-employed adults with current asthma from 38 states and District of Columbia. Individuals with work-related asthma had been told by a doctor or other health professional that their asthma was related to any job they ever had. Health-related quality of life indicators included poor self-rated health, impaired physical health, impaired mental health, and activity limitation. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, employment, and health insurance. RESULTS: Of ever-employed adults with current asthma, an estimated 9.0 % had work-related asthma, 26.9 % had poor self-rated health, 20.6 % had impaired physical health, 18.2 % had impaired mental health, and 10.2 % had activity limitation. Individuals with work-related asthma were significantly more likely than those with non-work-related asthma to have poor self-rated health [PR, 1.45; 95 % confidence interval (CI), 1.31-1.60], impaired physical health (PR, 1.60; 95 % CI, 1.42-1.80), impaired mental health (PR, 1.55; 95 % CI, 1.34-1.80), and activity limitation (PR, 2.16; 95 % CI, 1.81-2.56). CONCLUSIONS: Future research should examine opportunities to improve health-related quality of life among individuals with work-related asthma.

OBJECTIVE: To identify factors associated with health care professional-diagnosed work-related asthma (WRA) among adults who describe their asthma as being caused or made worse by workplace exposures (possible WRA). METHODS: We calculated prevalence ratios adjusted for age and sex using data from the 2006 to 2008 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey from 37 states and the District of Columbia for ever-employed adults with current asthma and possible WRA. RESULTS: An estimated 17.6% of ever-employed adults with current asthma and possible WRA had health care professional-diagnosed WRA. Health care professional-diagnosed WRA was associated with age, income, employment status, asthma control level, asthma attack, emergency department visit, hospitalization, urgent treatment, and changing/quitting a job due to asthma. CONCLUSIONS: Among ever-employed adults with possible WRA, health care professional-diagnosed WRA is associated with poorer asthma control and frequent unscheduled health care visits.

BACKGROUND: Patient self-management, besides expert care, is necessary to improve health outcomes among persons with asthma. Our objective was to describe the characteristics of persons with asthma likely to receive asthma self-management education. METHODS: The 2006 and 2007 Behavioral Risk Factor Surveillance System (BRFSS) Child and Adult Asthma Call-back Survey (ACBS) data were analyzed. Binary and multinomial response logistic regression models were used to examine the association between asthma self-management education and explanatory variables. RESULTS: Of the 31,278 persons who ever had asthma, 3953 of the children (75.8%) and 19,723 of the adults (72.8%) were classified as having active asthma. For both children and adults, the three most commonly reported asthma education components were being taught how to use an inhaler (78.6% and 89.8%, respectively); being taught what to do during an asthma episode (86.3% and 74.6%); and to recognize early signs or symptoms of an asthma episode (82.0% and 64.4%). Children and adults who reported routine care visits, hospitalization, and asthma episodes in the past 12 months because of asthma were more likely to report several asthma education components and higher asthma education scores. Children aged 12-17 years were more likely to report having instruction in peak flow meter use (1.3; 1.1-1.6) and inhaler use (1.3; 1.2-1.4), whereas older adults (aged 54-64 years or 65+ years), adults who were not high school (HS) graduates, and smokers were less likely to report having asthma management education than the corresponding comparison groups. CONCLUSIONS: Having a routine care visit, being hospitalized, and having an asthma episode were significantly associated with reporting multiple asthma education components, whereas being an older adult, having less than a HS degree, and being a smoker were associated with reporting fewer asthma education components. Asthma control programs should continue to monitor asthma self-management education and promote asthma education to all persons with asthma, especially for older adults, persons with less education, and smokers.

Asthma is a chronic inflammatory disorder of the airways characterized by episodic and reversible airflow obstruction, airway hyper-responsiveness, and underlying inflammation. Common asthma symptoms include wheezing, coughing, and shortness of breath (1). With correct treatment and avoidance of exposure to environmental allergens and irritants that are known to exacerbate asthma, the majority of persons who have asthma can expect optimal symptom control (2). | | Multiple reports provide detailed surveillance information on asthma (1,3--6). A 1987 report that included asthma surveillance data for 1965--1984 identified differences among certain demographic groups by age, sex, and race/ethnicity (3). Subsequent asthma surveillance reports confirmed these differences and documented that the differences have persisted over time (1,4). These reports indicate that population-based asthma prevalence rates, emergency department visit rates, and hospitalization rates were higher among blacks than among whites, higher among females than among males, higher among children than among adults, and higher among males aged 0--17 years than among females in the same age group. In addition, more detailed analysis of ethnicity data demonstrated that different Hispanic groups had differing health outcomes. Among Hispanics, those of Puerto Rican descent (origin or ancestry) had higher asthma prevalence and death rates than other Hispanics (e.g., those of Mexican descent), non-Hispanic blacks, and non-Hispanic whites (5,6).

BACKGROUND: The prevalence of complementary and alternative medicine (CAM) use among adults with current asthma has been estimated to be 40%. To our knowledge, there is no information on the prevalence of CAM use among individuals with work-related asthma (WRA). OBJECTIVES: To examine the associations between WRA, CAM use, and adverse asthma events. METHODS: We analyzed data from the 2006-2008 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey from 37 states and the District of Columbia for ever-employed adults with current asthma. We defined WRA as health-professional-diagnosed WRA. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, health insurance, and geographic region of residence. RESULTS: Of ever-employed adults with current asthma, an estimated 38.1% used CAM and 8.6% had WRA. An estimated 56.6% of individuals with WRA reported using CAM compared with 27.9% of those with non-WRA (PR = 2.0). People with WRA were more likely than those with non-WRA to have adverse asthma events including an asthma attack in the past month (PR = 1.43), urgent treatment for worsening asthma (PR = 1.74), emergency room visit (PR = 1.95), overnight hospital stay (PR = 2.49), and poorly controlled asthma (PR = 1.27). The associations of WRA with adverse asthma events remained after stratifying for CAM use. CONCLUSIONS: Compared with non-WRA, individuals with WRA were more likely to use CAM to control their asthma. However, there was no evidence that the use of CAM modified the association of WRA with adverse asthma events.

BACKGROUND: Depression has been associated with a decreased level of asthma control. The aim of our study was to examine associations between health-professional diagnosed work-related asthma (WRA) and current depression and the effect of current depression on the associations of WRA with adverse asthma outcomes. METHOD: We analyzed data from the 2006 and 2008 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey and the Anxiety and Depression Module conducted in 25 states and District of Columbia for ever-employed adults with current asthma. We computed weighted proportions and prevalence ratios adjusted for age, sex, race/ethnicity, education, current employment status, and smoking status. Survey participants who were ever told by a doctor or other health professional that their asthma was related to any job they ever had were determined to have WRA. Participants with current depression were identified using self-report of depressive symptoms. RESULTS: Of ever-employed adults with current asthma, an estimated 9.1% had WRA and 17.0% had current depression. Persons with WRA were significantly more likely than those with non-WRA to have current depression. Persons with either WRA, current depression, or both WRA and current depression were significantly more likely to have adverse asthma outcomes than persons with asthma and neither condition. The associations with adverse asthma outcomes were stronger when both current depression and WRA were present. LIMITATIONS: This is a cross-sectional and hypothesis-generating study. CONCLUSIONS: Depression may play an important role in asthma management and should be considered when assessing patients with asthma and, in particular, those with WRA.

BACKGROUND: Proper asthma management and control depend on patients having affordable access to healthcare yet financial barriers to asthma care are common. OBJECTIVE: To examine associations of work-related asthma (WRA) with financial barriers to asthma care and adverse asthma outcomes. RESEARCH DESIGN: Cross-sectional, random-digit-dial survey conducted in 37 states and District of Columbia. SUBJECTS: A total of 27,927 ever-employed adults aged ≥18 years with current asthma. MEASURES: Prevalence ratios (PR) for the associations of WRA with financial barriers to asthma care and of WRA with adverse asthma outcomes stratified by financial barriers. RESULTS: Persons with WRA were significantly more likely than those with non-WRA to have at least 1 financial barrier to asthma care [PR, 1.66; 95% confidence interval (CI), 1.43-1.92]. Individuals with WRA were more likely to experience adverse asthma outcomes such as asthma attack (PR, 1.31; 95% CI, 1.22-1.40), urgent treatment for worsening asthma (PR, 1.57; 95% CI, 1.39-1.78), asthma-related emergency room visit (PR, 1.69; 95% CI, 1.41-2.03), and very poorly controlled asthma (PR, 1.54; 95% CI: 1.36-1.75). After stratifying for financial barriers to asthma care, the associations did not change. CONCLUSIONS: Financial barriers to asthma care should be considered in asthma management, and individuals with WRA are more likely to experience financial barriers. However, individuals with WRA are more likely to experience adverse asthma outcomes than individuals with non-WRA, regardless of financial barriers. Additional studies are needed to identify medical, behavioral, occupational, or environmental factors associated with adverse asthma outcomes among individuals with WRA.

Asthma is associated with a variety of physical, chemical, and biological stimuli1–4 including those found in the workplace.5 The term “work-related asthma” (WRA), representing a subset of all asthma, encompasses both occupational asthma (OA), which is asthma that is caused by workplace exposure to a sensitizing or irritant substance, and work-exacerbated asthma (WEA), which is asthma that is worsened by work-related factors.6 | WRA is a preventable7–9 and underdiagnosed10 occupational lung disease associated with adverse social and economic outcomes, disability, and mortality.11–16 Workers who leave their jobs due to WRA often experience loss in income and/or unemployment.11,17 A French study followed workers with WRA for an average of 3.1 years after diagnosis. At follow-up, 44% had left their jobs, 25% were unemployed, and 46% had experienced loss in income.18 Among adults with asthma, those with WRA have a lower quality of life11,15,19,20 and more frequent emergency department and doctors' visits for worsening asthma.21 WRA caused by a number of workplace agents may also lead to death.22

OBJECTIVES: This report presents recent data on asthma prevalence and health care use. Additional data on school and work absences and asthma management practices are also presented. Where possible, differences are examined by age, sex, race or ethnicity, geographic region, poverty status, and urbanicity. METHODS: Data from the National Health Interview Survey, the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the National Vital Statistics System were used to calculate national estimates. The most recent data available from each system are presented, and 3-year annual averages are used to increase the reliability of estimates for subgroups where necessary. RESULTS: In 2009, current asthma prevalence was 8.2% of the U.S. population (24.6 million people); within population subgroups it was higher among females, children, persons of non-Hispanic black and Puerto Rican race or ethnicity, persons with family income below the poverty level, and those residing in the Northeast and Midwest regions. In 2008, persons with asthma missed 10.5 million school days and 14.2 million work days due to their asthma. In 2007, there were 1.75 million asthma-related emergency department visits and 456,000 asthma hospitalizations. Asthma emergency visit and hospitalization rates were higher among females than males, among children than adults, and among black than white persons. Despite the high burden from adverse impacts, use of some asthma management strategies based on clinical guidelines for the treatment of asthma remained below the targets set by the Healthy People 2010 initiative.