Quality of Life Research

, Volume 22, Issue 4, pp 771–780 | Cite as

Health-related quality of life among adults with work-related asthma in the United States

  • Gretchen E. Knoeller
  • Jacek M. Mazurek
  • Jeanne E. Moorman



The objective of this study was to examine health-related quality of life among adults with work-related asthma.


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.


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).


Future research should examine opportunities to improve health-related quality of life among individuals with work-related asthma.


Occupational asthma Quality of life Occupational health Behavioral Risk Factor Surveillance System Asthma 



We would like to thank Karen R. Cummings, MPH, New York State Department of Health, and Hatice Zahran, MD, MPH, Centers for Disease Control and Prevention, for their review of this manuscript and the BRFSS state coordinators for their assistance in collecting the data used in this analysis.

Supplementary material

11136_2012_206_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 23 kb)


  1. 1.
    National Center for Health Statistics. (2010). Summary Health Statistics for US Adults: National Health Interview Survey, 2009. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.Google Scholar
  2. 2.
    Tarlo, S. M., Balmes, J., Balkissoon, R., Beach, J., Beckett, W., Bernstein, D., et al. (2008). Diagnosis and management of work-related asthma: ACCP Consensus Statement. Chest, 134, 1–41.CrossRefGoogle Scholar
  3. 3.
    Balmes, J., Becklake, M., Blanc, P., Henneberger, P., Kreiss, K., Mapp, C., et al. (2003). American Thoracic Society Statement: Occupational contribution to the burden of airway disease. American Journal of Respiratory and Critical Care Medicine, 5, 787–797.Google Scholar
  4. 4.
    Knoeller, G. E., Mazurek, J. M., & Moorman, J. E. (2011). Work-related asthma, financial barriers to asthma care, and adverse asthma outcomes: Asthma Call-back Survey, 37 states and District of Columbia, 2006 to 2008. Medical Care, 49, 1097–1104.PubMedCrossRefGoogle Scholar
  5. 5.
    Lemiere, C., Forget, A., Dufour, M. H., Boulet, L. P., & Blais, L. (2007). Characteristics and medical resource use of asthmatic subjects with and without work-related asthma. Journal of Allergy and Clinical Immunology, 6, 1354–1359.CrossRefGoogle Scholar
  6. 6.
    Breton, C. V., Zhang, Z., Hunt, P. R., Pechter, E., & Davis, L. (2006). Characteristics of work related asthma: results from a population based survey. Occupational and Environmental Medicine, 63, 411–415.PubMedCrossRefGoogle Scholar
  7. 7.
    National Asthma Education and Prevention Program. (2007). Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma—Summary Report 2007. Journal of Allergy and Clinical Immunology, 5, S94–138.Google Scholar
  8. 8.
    Stahl, E., Postma, D. S., Juniper, E. F., Svensson, K., Mear, I., & Lofdahl, C. G. (2003). Health-related quality of life in asthma studies. Can we combine data from different countries? Pulmonary Pharmacology & Therapeutics, 16, 53–59.CrossRefGoogle Scholar
  9. 9.
    Gill, T. M., & Feinstein, A. R. (1994). A critical appraisal of the quality of quality-of-life measurements. Journal of the American Medical Association, 272, 619–626.PubMedCrossRefGoogle Scholar
  10. 10.
    Juniper, E. F., Wisniewski, M. E., Cox, F. M., Emmett, A. H., Nielsen, K. E., & O’Byrne, P. M. (2004). Relationship between quality of life and clinical status in asthma: A factor analysis. European Respiratory Journal, 23, 287–291.PubMedCrossRefGoogle Scholar
  11. 11.
    Jacobs, J. E., van de Lisdonk, E. H., Smeele, I., van Weel, C., & Grol, R. P. T. M. (2001). Management of patients with asthma and COPD: Monitoring quality of life and the relationship to subsequent GP interventions. Family Practice, 18, 574–580.PubMedCrossRefGoogle Scholar
  12. 12.
    Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21–37.PubMedCrossRefGoogle Scholar
  13. 13.
    Mossey, J. M., & Shapiro, E. (1982). Self-rated health: A predictor of mortality among the elderly. American Journal of Public Health, 72, 800–808.PubMedCrossRefGoogle Scholar
  14. 14.
    Syk, J., Alving, K., & Unden, A. L. (2011). Association between self-rated health and asthma: A population-based study. The Clinical Respiratory Journal. doi: 10.1111/j.1752-699X.2011.00259.x.PubMedGoogle Scholar
  15. 15.
    Ford, E. S., Mannino, D. M., Homa, D. M., Gwynn, C., Redd, S. C., Moriarty, D. G., et al. (2003). Self-reported asthma and health-related quality of life: Findings from the behavioral risk factor surveillance system. Chest, 2003(123), 119–127.CrossRefGoogle Scholar
  16. 16.
    Guilbert, T., Garris, C., Jhingran, P., Bonagede, M., Tomaszewski, K. J., Bonus, T., et al. (2011). Asthma that is not well-controlled is associated with increased healthcare utilization and decreased quality of life. Journal of Asthma, 48, 126–132.PubMedCrossRefGoogle Scholar
  17. 17.
    Schatz, M., Mosen, D., Apter, A. J., Zeiger, R. S., Vollmer, W. M., Stibolt, T. B., et al. (2005). Relationships among quality of life, severity, and control measures in asthma: An evaluation using factor analysis. Journal of Allergy and Clinical Immunology, 115, 1049–1055.PubMedCrossRefGoogle Scholar
  18. 18.
    Schatz, M., Mosen, D. M., Kosinski, M., Vollmer, W. M., Magid, D. J., O’Connor, E., et al. (2007). The relationship between asthma-specific quality of life and asthma control. Journal of Asthma, 44, 391–395.PubMedCrossRefGoogle Scholar
  19. 19.
    Schatz, M., Zeiger, R. S., Yang, S. J., Chen, W., Crawford, W., Sajjan, S., et al. (2011). The Relationship of Asthma Impairment Determined by Psychometric Tools for Future Asthma Exacerbations. Chest. doi: 10.1378/chest.11-0574.PubMedGoogle Scholar
  20. 20.
    Lowery, E. P., Henneberger, P. K., Rosiello, R., Sama, S. R., Preusse, P., & Milton, D. K. (2007). Quality of life of adults with workplace exacerbation of asthma. Quality of Life Research, 10, 1605–1613.CrossRefGoogle Scholar
  21. 21.
    Malo, J. L., Boulet, L. P., Dewitte, J. D., Cartier, A., L’Archeveque, J. L., Cote, J., et al. (1993). Quality of life of subjects with occupational asthma. Journal of Allergy and Clinical Immunology, 6, 1121–1127.CrossRefGoogle Scholar
  22. 22.
    Centers for Disease Control and Prevention. (2010). Behavioral Risk Factor Surveillance System. http://www.cdc.gov/brfss/. Accessed May 24, 2010.
  23. 23.
    Jia, H., Muennig, P., Lubetkin, E. I., & Gold, M. R. (2004). Predicting geographical variations in behavioural risk factors: an analysis of physical and mental healthy days. Journal of Epidemiology and Community Health, 58, 150–155.PubMedCrossRefGoogle Scholar
  24. 24.
    Andresen, E. M., Catlin, T. K., Wyrwich, K. W., & Jackson-Thompson, J. (2003). Retest reliability of surveillance questions on health related quality of life. Journal of Epidemiology and Community Health, 57, 339–343.PubMedCrossRefGoogle Scholar
  25. 25.
    Newschaffer, C. J. (1998). Validation of Behavioral Risk Factor Surveillance System (BRFSS) HRQOL measures in a statewide sample. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
  26. 26.
    Dominick, K., Ahern, F., Gold, C., & Heller, D. (2002). Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clinical and Experimental Research, 14, 499–508.PubMedGoogle Scholar
  27. 27.
    Nelson, D. E., Holtzman, D., Bolen, J., Stanwyck, C. A., & Mack, K. A. (2001). Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Social and Preventive Medicine, 46, S3–S42.PubMedCrossRefGoogle Scholar
  28. 28.
    Centers for Disease Control and Prevention. (2000). Measuring healthy days: Population assessment of health-related quality of life. GA: Atlanta.Google Scholar
  29. 29.
    Mazurek, J. M., Knoeller, G. E., & Moorman, J. E. (2011). Effect of current depression on the association of work-related asthma with adverse asthma outcomes: A cross-sectional study using the Behavioral Risk Factor Surveillance System. Journal of Affective Disorders, 136, 1135–1142.PubMedCrossRefGoogle Scholar
  30. 30.
    Thompson, M. L., Myers, J. E., & Kriebel, D. (1998). Prevalence odds ratio or prevalence ratio in the analysis of cross sectional data: What is to be done? Occupational and Environmental Medicine, 55, 272–277.PubMedCrossRefGoogle Scholar
  31. 31.
    Larsson, U., Taft, C., Karlsson, J., & Sullivan, M. (2007). Gender and age differences in the relative burden of rhinitis and asthma on health-related quality of life—A Swedish population study. Respiratory Medicine, 101, 1291–1298.PubMedCrossRefGoogle Scholar
  32. 32.
    Wijnhoven, H. A. H., Kriegsman, D. M. W., Snoek, F. J., Hesselink, A. E., & de Haan, M. (2003). Gender differences in health-related quality of life among asthma patients. Journal of Asthma, 40, 189–199.PubMedCrossRefGoogle Scholar
  33. 33.
    Knoeller, G. E., Mazurek, J. M., & Moorman, J. E. (2011). Work-related asthma among adults with current asthma: Evidence from the Asthma Call-Back Survey, 33 states and District of Columbia, 2006 to 2007. Public Health Reports, 126, 603–611.PubMedGoogle Scholar
  34. 34.
    Schatz, M., & Camargo, C. (2003). The relationship of sex to asthma prevalence, health care utilization, and medications in a large managed care organization. Annals of Allergy, Asthma & Immunology, 91, 553–558.CrossRefGoogle Scholar
  35. 35.
    Knoeller, G. E., Mazurek, J. M., & Moorman, J. E. (2012). Characteristics associated with health care professional diagnosis of work-related asthma among individuals who describe their asthma as being caused or made worse by workplace exposures. Journal of Occupational and Environmental Medicine, 54, 485–490.PubMedCrossRefGoogle Scholar
  36. 36.
    Miedinger, D., Lavoie, K., L’Archevque, J., Ghezzo, H., Zunzunuegui, M., & Malo, J. L. (2011). Quality-of-life, psychological, and cost outcomes 2 years after diagnosis of occupational asthma. Journal of Occupational and Environmental Medicine, 53, 231–238.PubMedCrossRefGoogle Scholar
  37. 37.
    Katz, P., Yelin, E., Eisner, M., & Blanc, P. (2002). Perceived control of asthma and quality of life among adults with asthma. Annals of Allergy, Asthma & Immunology, 89, 251–258.CrossRefGoogle Scholar
  38. 38.
    Hesselink, A. E., Penninx, B. W. J. H., Schlosser, M. A. G., Wignhoven, H. A. H., van der Windt, D. A. W. M., Kriegsman, D. M. W., et al. (2004). The role of coping resources and coping style in quality of life of patients with asthma or COPD. Quality of Life Research, 13, 509–518.PubMedCrossRefGoogle Scholar
  39. 39.
    Maes, S., Leventhal, H., & de Ridder, D. T. D. (1996). Coping with chronic illness. In M. Zeidner & N. S. Endler (Eds.), Handbook of coping (pp. 221–251). New York, NY: Wiley.Google Scholar
  40. 40.
    Adams, R. J., Wilson, D. H., Taylor, A. W., Daly, A., Tursan d’Espaignet, E., Dal Grande, E., et al. (2006). Coexistent chronic conditions and asthma quality of life: a population-based study. Chest, 129, 285–291.PubMedCrossRefGoogle Scholar
  41. 41.
    Graham, D. M., & Blaiss, M. S. (2000). Quality-of-life outcomes measures of asthma and allergic rhinitis. Pediatric Annals, 29, 438–443.PubMedGoogle Scholar
  42. 42.
    Ameille, J., Pairon, J. C., Bayeux, M. C., Brochard, P., Choudat, D., Conso, F., et al. (1997). Consequences of occupational asthma on employment and financial status: a follow-up study. European Respiratory Journal, 10, 55–58.PubMedCrossRefGoogle Scholar
  43. 43.
    Vollmer, W. M., Markson, L. E., O’Connor, E., Sanocki, L. L., Fitternman, L., Berger, M., et al. (1999). Association of asthma control with health care utilization and quality of life. American Journal of Respiratory and Critical Care Medicine, 160, 1647–1652.PubMedCrossRefGoogle Scholar
  44. 44.
    Leander, M., Cronqvist, A., Janson, C., Uddenfeldt, M., & Rask-Andersen, A. (2009). Health-related quality of life predicts onset of asthma in a longitudinal population study. Respiratory Medicine, 103, 194–200.PubMedCrossRefGoogle Scholar
  45. 45.
    Eisner, M. D., Katz, P. P., Yelin, E. H., Shiboski, S. C., & Blanc, P. D. (2001). Risk factors for hospitalization among adults with asthma: the influence of sociodemographic factors and asthma severity. Respiratory Research, 2, 53–60.PubMedCrossRefGoogle Scholar
  46. 46.
    Eisner, M. D., Ackerson, L. M., Chi, F., Kalkbrenner, A., Buchner, D., Guillermo, M., et al. (2002). Health-related quality of life and future health care utilization for asthma. Annals of Allergy, Asthma & Immunology, 89, 46–55.CrossRefGoogle Scholar
  47. 47.
    Schatz, M., Mosen, D., Apter, A. J., Zeiger, R. S., Vollmer, W. M., Stibolt, T. B., et al. (2005). Relationship of validated psychometric tools to subsequent medical utilization for asthma. Journal of Allergy and Clinical Immunology, 115, 564–570.PubMedCrossRefGoogle Scholar
  48. 48.
    Magid, D., Houry, D., Ellis, J., Lyons, E., & Rumsfeld, J. (2004). Health-related quality of life predicts emergency department utilization for patients with asthma. Annals of Emergency Medicine, 43, 551–557.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. (outside the USA) 2012

Authors and Affiliations

  • Gretchen E. Knoeller
    • 1
  • Jacek M. Mazurek
    • 1
  • Jeanne E. Moorman
    • 2
  1. 1.National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention (CDC)MorgantownUSA
  2. 2.National Center for Environmental HealthCDCAtlantaUSA

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