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Background: Asthma self-management (e.g., trigger avoidance or correct medication use) is a cornerstone of therapy. Its successful implementation in everyday working life is determined by psychosocial working conditions, in particular by support from superiors and colleagues and the job decision latitude (i.e., when and how to carry out which tasks). To empower individuals with asthma to modify their working conditions, employees need to use certain communication skills and acquire specific knowledge. Both could be taught as part of patient education during pulmonary rehabilitation. Therefore, the aim of the planned study is the development and multicentre implementation of an education module for individuals with asthma during their rehabilitation and to generate evidence on its effectiveness., Methods: Participants (n ≥ 180) will be recruited, randomized into an intervention and a control group, trained and surveyed in two rehabilitation clinics. The intervention group will receive the supplementary patient education module "Asthma and Work" while the control group will participate in a program on " Eating behaviour" (both 2 × 50 min). The effectiveness of the intervention will be examined based on pre-post measurements (T1 and T2) and a 3-month follow-up (T3). We will consider behavioural intention (T2) and asthma self-management at work (T3) as primary outcomes. Secondary outcomes will include self-management-related knowledge, self-efficacy, number of sick days, number of exacerbations, asthma control (Asthma Control Test), asthma-related quality of life (Marks Asthma Quality of Life Questionnaire), and subjective employment prognosis (Brief Scale Measuring the Subjective Prognosis of Gainful Employment). The pre-post comparisons are to be evaluated using univariate analyses of covariance., Discussion: Improving asthma self-management at work could increase the work ability and social participation of employees with asthma. This could reduce costs, e.g. in terms of asthma-related sick leave., Trial Registration: German Clinical Trials Register (ID: DRKS00031843)., (© 2024. The Author(s).)

Background: Many patients with asthma report unmet health care needs. The Patient Needs in Asthma Treatment (NEAT) questionnaire is a validated instrument to quantify these unmet needs. We explored how health professionals evaluated the instrument's utility as well as patients' and professionals' perspectives of how NEAT could be incorporated into routine clinical practice., Methods: Qualitative interviews were conducted by telephone between February and September 2021 with 19 patients with asthma and 21 health professionals (i.e., general practitioners, pneumologists, health professionals in pulmonary rehabilitation, and medical assistants). Interview recordings were transcribed verbatim and content-analyzed using both deductive and inductive approaches using MAXQDA., Results: Health professionals could see the potential value of using NEAT to inform clinical decisions. However, health professionals tended to be skeptical towards the routine use of NEAT in outpatient settings, mainly due to a lack of time. Implementation of NEAT was seen as more valuable in the context of patient education (i.e., in Disease Management Programs [DMPs] or pulmonary rehabilitation) by patients and health professionals alike, because it offered greater opportunities to address any unmet needs identified. Both patients and health professionals considered it more useful to use the questionnaire for the first time some time after the initial diagnosis has been made (e.g., when the treatment regime is found rather than at time of initial diagnosis). In the context of DMPs and pulmonary rehabilitation, NEAT could be used twice, i.e., before and after patient education to support patient-centered planning and evaluation., Conclusion: Both patients and health professionals consider the use of the NEAT, in particular in educational programs (i.e., during DMPs or pulmonary rehabilitation), as feasible and useful. There is now a need to undertake a feasibility trial in routine care., (© 2023. The Author(s).)

Objective: Work engagement is considered a constructive and satisfying state of mind promoting well-being, whereas overcommitment contributes to ill-health. We investigated if these psychosocial factors are related to asthma self-management at the workplace (i.e. physical activity, trigger avoidance, acute symptom management, communication), asthma control, asthma-specific quality of life, and the subjective prognosis of gainful employment among employees with asthma., Methods: Questionnaires were distributed in three pulmonary rehabilitation clinics (10/2017-05/2018) in Germany. Work engagement was measured by three items from the Copenhagen Psychosocial Questionnaire and overcommitment by six items from the effort-reward imbalance questionnaire. Asthma self-management was mainly assessed by self-developed items, asthma morbidity by the Asthma Control Test and the Marks Asthma Quality of Life Questionnaire, and the subjective prognosis of gainful employment by a validated three-item scale. After dichotomization of all variables we ran Poisson regression analyses to calculate multivariable prevalence ratios with 95% confidence intervals., Results: The sample comprised 221 individuals with asthma. Low work engagement was related to physical inactivity. Low work engagement and high overcommitment were associated with inadequate trigger avoidance and acute symptom management, reduced asthma-specific quality of life, and a poor prognosis of gainful employment. No relationships were observed with communication or asthma control., Conclusions: Our findings highlight the potential contribution of high levels of work engagement to adequate asthma self-management, good quality of life, and a positive subjective prognosis of gainful employment among employees with asthma. Overcommitment shows associations with those outcomes in the opposite direction, which suggests a detrimental role in asthma.

Purpose: The present study set out to examine whether low job decision latitude (JDL, i.e., limited work autonomy) and low social support at work are related to a poor subjective prognosis of gainful employment (SPE) among working rehabilitants with asthma., Methods: JDL and support were assessed by the Copenhagen Psychosocial Questionnaire. The SPE was measured by a validated three-item scale. Separate logistic regression analyses were conducted for all variables to calculate odds ratios (ORs) with 95% confidence intervals (CIs)., Results: Among the 221 participants (response rate = 29.3%), those reporting low JDL or low support had more than doubled odds of being unsure that they would be working until retirement age (OR = 2.28; 95% CI = 1.19-4.37; OR = 2.78; 95% CI = 1.43-5.40, respectively) and of considering their work ability permanently at risk due to ill-health (OR = 3.89; 95% CI = 2.03-7.46; OR = 2.05; 95% CI = 1.08-3.90, respectively) compared to those with good working conditions. The associations of JDL or support were weaker with one's consideration to apply for premature pension (OR = 1.54; 95% CI = 0.60-3.98; OR = 2.18; 95% CI = 0.83-5.77, respectively). Additional analyses identified job satisfaction as a possible explanatory factor for the observed relationships., Conclusions: Adverse psychosocial working conditions are related to a poor SPE, and low job satisfaction may explain those relationships. Future prospective research is needed to confirm our findings.Implications for rehabilitationEarlier research suggested that asthma increases the risk of disability retirement and thus causes high direct and indirect costs.Prior findings showed that adverse psychosocial working conditions are related to poorer asthma self-management and increased asthma morbidity among rehabilitants with asthma.Consistent with earlier work the present study found that job decision latitude and social support at work are associated with the subjective prognosis of gainful employment among working rehabilitants with asthma.If the reported findings are confirmed by prospective studies, interventions could be developed to improve the working conditions for rehabilitants with asthma and to thereby reduce their risk of disability retirement.

Background: Pulmonary rehabilitation offers potential benefits to people with asthma. It is however unknown if rehabilitation favourably affects patients' health care needs. We therefore examined if rehabilitation reduced needs and, in addition, if it improved asthma control., Methods: One hundred fifty patients with asthma were surveyed in three rehabilitation clinics at admission and at discharge. Additionally, we surveyed 78 participants with asthma twice 4 weeks apart. The latter sample (i.e. the control group) was recruited through other pathways than rehabilitation clinics. The Patient Needs in Asthma Treatment (NEAT) questionnaire and the Asthma Control Test (ACT) were completed at baseline and follow-up. Differences between baseline and follow-up and between rehabilitation and control group were examined by t-tests and chi-squared-tests. Univariate ANCOVAS were used to examine if NEAT and ACT follow-up scores differed significantly between groups. Within the rehabilitation group, linear regressions were used to examine if self-reported utilization of more interventions that addressed needs were associated with NEAT scores at follow-up., Results: At baseline, there were no differences between the rehabilitation and the control group regarding needs and asthma control. At follow-up, the rehabilitation group showed reduced needs (t(149) = 10.33, p <  0.01) and increased asthma control (t(130) = -6.67, p <  0.01), whereas members of the control group exhibited no changes. Univariate ANCOVAS showed that unmet follow-up needs (F(1, 212) = 36.46, p <  0.001) and follow-up asthma control (F(1, 195) = 6.97, p = 0.009) differed significantly between groups. In the rehabilitation group, self-reported utilization of more interventions was associated with reduced needs (β = 0.21; p = 0.03)., Conclusions: This study provides preliminary evidence suggestion that pulmonary rehabilitation in adults with asthma may reduce asthma-related needs and confirms previous findings that rehabilitation may improve asthma control.

Objective: This study sought to identify psychological resources, which are associated with improved asthma outcomes. Methods: A total of 205 patients who reported physician-diagnosed asthma were surveyed between September 2017 and March 2018. Psychological resources included self-efficacy (i.e. the belief in one's capabilities to organize and execute required behavior [SE]; assessed by the Short Scale for Measuring General Self-Efficacy Beliefs), and internal and external locus of control (i.e. one's beliefs about whether a given event is the result of one's behavior or of forces outside one's control [LoC]; Scale for Internal External Locus of Control-4). Outcome variables included asthma control (Asthma Control Test), asthma-related quality of life (QoL; Asthma Quality of Life Questionnaire-Sydney) and patient needs (Patient Needs in Asthma Treatment Questionnaire). Associations were estimated by linear regressions. Results: We observed that higher self-efficacy and internal LoC scores, but lower scores on the external LoC subscale were associated with improved asthma control (SE: β = 0.19, p = 0.01; internal LoC: β = 0.17, p = 0.02; external LoC: β = -0.18, p = 0.01), better asthma-related QoL (SE: β = -0.38, p < 0.01; internal LoC: β = -0.40, p < 0.01; external LoC: β = 0.46, p < 0.01) and less unmet needs (SE: β = -0.16, p = 0.02; internal LoC: β = -0.18, p < .01; external LoC: β = 0.32, p < 0.01). Conclusions: Our study provides novel evidence on psychological resources among patients with asthma, which are associated with improved asthma outcomes.

Purpose: Psychosocial working conditions-in terms of job decision authority, among others-may influence asthma self-management at work and in leisure time, as recent qualitative research has shown. We sought to statistically investigate potential relationships between job decision authority and two types of self-management behaviours: physical activity (PA) and visits to the general practitioner (GP)., Methods: We combined data from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe (SHARE) for cross-sectional analyses. The sample was restricted to participants who were employed and reported asthma but no other chronic lung disease (n = 387). The three key variables were each measured by one item. We estimated the prevalence ratios of adequate PA (i.e., more than once a week) and regular GP visits (i.e., ≥ 4 per year) according to job decision authority (low vs. high) using Poisson regression with the robust variance., Results: We found no evidence of a relationship between job decision authority and PA. However, employees with low levels of job decision authority had a higher prevalence of reporting that they consulted their GP at least four times per year (prevalence ratio = 1.30; 95% confidence interval = 1.03-1.65)., Conclusions: This study was the first to quantitatively investigate the relationship between job decision authority and PA specifically among individuals with asthma. Our results contradict prior epidemiological studies among general working populations, which reported a positive relationship between job decision authority and PA. Our results concerning the association between low job decision authority and more GP visits are inconsistent with our qualitative findings but supported by epidemiological studies among general occupational samples.

Background: Building on previous psychometric work, we sought to assess the Patient Needs in Asthma Treatment (NEAT) questionnaire's validity, responsiveness to change, and the minimal important change (MIC) over a 3-year period (Study 1) and its reliability and the smallest detectable change (SDC) in a test-retest study (Study 2) among patients self-reporting physician-diagnosed asthma., Methods: In Study 1, a total of 207 patients completed a survey which included the NEAT, the Asthma Control Test (ACT), the Asthma Quality of Life Questionnaire-Sydney (AQLQ-S), and a question on treatment satisfaction in 2014 and 2017. In Study 2, a total of 78 patients completed NEAT twice on average four weeks apart in 2018., Results: Concurrent validity: In linear regressions, unmet patient needs were cross-sectionally associated with poorer asthma control (β = -0.21; P = 0.01), asthma-related quality of life (QoL) (β = 0.31; P < 0.01), and treatment satisfaction (β = -0.59; P < 0.01). Predictive Validity: Higher unmet needs at baseline predicted worse treatment satisfaction at follow-up (β = -0.28; P < 0.01), but neither asthma control nor asthma-related QoL. Responsiveness to change was demonstrated by linear regressions of changes in the total NEAT score and changes in AQLQ-S (β = 0.21; P < 0.01) and treatment satisfaction (β = -0.36; P < 0.01). MIC: Patients whose NEAT score increased between baseline and follow-up by the identified MIC (0.301) reported lower treatment satisfaction at follow-up (β = -0.17; P = 0.01). Test-retest reliability was demonstrated by correlations between NEAT baseline and follow-up scores (eg, intra-class correlation coefficients for total score = 0.78). The SDC (0.384) was slightly larger than MIC., Conclusion: NEAT is a promising tool for assessing asthma treatment needs., (© 2019 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Objective: Asthma exerts a considerable impact on patients and their employers. While adequate self-management is able to improve patients' prognosis, its actual implementation in everyday life may depend on contextual factors. We aimed to review the literature on the potential determinants of asthma self-management at the workplace., Data Sources: We systematically searched Medline and PsycINFO using terms related to the key concepts of interest (i.e., adult asthma, working conditions, and self-management)., Study Selection: We included original studies published in peer-reviewed journals in English or German since 1992 addressing any type of asthma self-management behavior as the outcome and any type of working condition as the determinant., Results: Upon implementation of a multi-stage selection process, seven articles were included. As those studies showed considerable methodological heterogeneity, a qualitative analysis was applied. A first study identified three different adaptation profiles among employees with asthma with implications for self-management behavior. Another study suggested that concerns about taking time off from work may be associated with the utilization of emergency ambulance services for asthma. Five studies among workers with various chronic illnesses addressed determinants of self-disclosure, coping with acute symptoms (e.g., medication use at work), and the potential effect of practical and emotional support from line managers or colleagues on self-management., Conclusion: Our review indicates that the evidence for a potential link of occupational factors with asthma self-management at work is relatively sparse. Future research should take a more comprehensive approach by considering multiple types of working conditions and asthma self-management behaviors simultaneously.

Objectives: Asthma can represent a substantial challenge to the affected individual, but is usually well controlled by adequate asthma self-management behaviour (SMB). Asthma SMB comprises symptom prevention, symptom monitoring, acute symptom management and communication with important others. The implementation of asthma SMB seems to depend on contextual factors. For employed adults, working conditions may be important in this respect. We, therefore, aimed to explore the perceived influences on effective asthma SMB at work., Design: Our qualitative study built on semi-structured interviews and qualitative content analysis., Setting: Participants were recruited in two pulmonary rehabilitation clinics in Northern Germany., Participants: We conducted 27 interviews among employees with asthma (female: n=15) who worked at least 20 hours per week and were diagnosed with asthma at least 6 months prior to interviewing. Patients with chronic obstructive pulmonary disease were excluded., Results: According to participants, the most influential factors with regard to asthma SMB at work appeared to be job decision latitude (JDL) and social support. JDL (ie, the control over one's tasks and when and how things were done) was perceived to affect symptom prevention, symptom monitoring, and acute symptom management, but not communication. Support by colleagues, line managers, and the employer, for example, practical, emotional, or structural support, was perceived to exert effects on symptom prevention, acute symptom management, and communication (ie, self-disclosure of one's condition)., Conclusions: Perceived JDL and social support were experienced as influencing successful implementation of asthma SMB at the workplace., Trial Registration Number: German Clinical Trials Register no: DRKS00011309., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: We sought to investigate whether there are associations between asthma and social functioning in adults from Western and non-Western countries., Methods: We analyzed data on individuals (94% aged 20+, 52% female) from 50 countries participating in the cross-sectional World Health Survey. We used information on self-reports of wheezing and an asthma diagnosis. Social functioning was defined by reports of severe or extreme difficulties related to personal relationships or participation in the community. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs)., Results: Wheezing was associated with impaired social functioning both in the overall sample (OR=2.40, 95%CI=2.09-2.75) and in Africa, South America and Asia (ORs≥2.47), but not in Europe (aOR=1.26, 95%CI=0.90-1.77). Analyses with self-reports of diagnosed asthma yielded similar, albeit weaker, associations (e.g. OR for the overall sample=1.63, 95%CI=1.38-1.92). We also combined asthma and wheezing into a single variable (reference group: no asthma diagnosis/no wheezing). We observed that in particular reports of wheezing were associated with impaired social functioning regardless of whether a concomitant asthma diagnosis was reported (OR=2.19, 95%CI=1.81-2.64) or not (OR=2.50, 95%CI=2.09-2.99)., Conclusion: Self-reports of wheezing and of diagnosed asthma are associated with impaired social functioning among adults in Africa, South America and Asia, but less so in Europe. These relationships are mainly driven by the experience of respiratory symptoms (i.e. wheezing). Our findings may partly be explained by regional variations in asthma control. Further research should elucidate the determinants and mechanisms of asthma-related impaired social functioning., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: Research addressing links of work stress or family stress with asthma is constrained by (1) inconsistent evidence, (2) failure to consider the combined exposure to work stress and family stress, and (3) its primary focus on Western study populations. We aimed to address these knowledge gaps., Methods: We used cross-sectional data collected in 2015 among 7816 women from five professional groups in five Chinese cities. Work stress was measured by the 10-item effort-reward imbalance (ERI) questionnaire. Family stress was assessed by a psychometrically evaluated instrument comprising five items on, e.g., familial conflicts or domestic workload. Asthma was operationalized by self-reports of a physician diagnosis. Associations were examined by multivariable logistic regression estimating odds ratios (ORs) and 95% confidence intervals (CIs)., Results: Both high work stress (i.e., ERI score >1) and high family stress (i.e., score above the median) were associated with asthma (OR 1.66, 95% CI 1.22-2.27 and OR 1.48, 95% CI 1.10-1.99, respectively). Women with combined exposure (versus none) had somewhat higher odds of asthma (OR 2.13, 95% CI 1.42-3.19) than those with sole exposure to either work stress (OR 1.89, 95% CI 1.20-2.96) or family stress (OR 1.71, 95% CI 1.03-2.84). Interaction terms were significant for continuous variables (p = 0.046), but not for dichotomized variables (p = 0.199)., Conclusions: The present study suggests that both work stress and family stress are positively associated with asthma in women in China. Further, the combined exposure may be associated with a further excess of asthma occurrence. Longitudinal studies are needed to confirm our findings and to explore potential temporal relationships.

Objective: Research has suggested that psychological stress is positively associated with asthma morbidity. One major source of stress in adulthood is one's occupation. However, to date, potential links of work stress with asthma control or asthma-specific quality of life have not been examined. We aimed to address this knowledge gap., Methods: In 2014/2015, we conducted a cross-sectional study among adults with asthma in Germany (n = 362). For the current analyses that sample was restricted to participants in employment and reporting to have never been diagnosed with chronic obstructive pulmonary disease (n = 94). Work stress was operationalized by the 16-item effort-reward-imbalance (ERI) questionnaire, which measures the subcomponents "effort", "reward" and "overcommitment." Participants further completed the Asthma Control Test and the Asthma Quality of Life Questionnaire-Sydney. Multivariable associations were quantified by linear regression and logistic regression., Results: Effort, reward and their ratio (i.e. ERI ratio) did not show meaningful associations with asthma morbidity. By contrast, increasing levels of overcommitment were associated with poorer asthma control and worse quality of life in both linear regression (ß = -0.26, p = 0.01 and ß = 0.44, p < 0.01, respectively) and logistic regression (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.14-3.07 and OR = 2.34, 95% CI = 1.32-4.15, respectively)., Conclusions: The present study provides initial evidence of a positive relationship of work-related overcommitment with asthma control and asthma-specific quality of life. Longitudinal studies with larger samples are needed to confirm our findings and to disentangle the potential causality of associations.

Patients' needs in asthma remain insufficiently understood and met. We therefore aimed to investigate the potential determinants of patients' needs in asthma treatment. Our study was based on survey data on 189 adults with asthma. Needs were measured using the 13-item Needs in Asthma Treatment questionnaire, which yields a total score and subscale-specific scores ('exacerbations', 'patient expertise', 'handling drugs' and 'drug effects'). We considered age, sex, education, years since diagnosis and anxiety/depression (measured by the Patient Health Questionnaire-4) as potential determinants. Associations were estimated by multivariable linear regression. Overall, we observed that younger age, poor mental health and a more recently established asthma diagnosis were independently associated with increased needs. Information on drug effects was an exception to this pattern as the need in that domain was solely determined by sex (being greater in men). In conclusion, our study provides novel evidence on patient characteristics that are associated with needs in asthma treatment. If confirmed by future studies, our observations may assist healthcare professionals to identify asthma patients with potentially elevated information, support and training needs and could contribute to the development of tailored interventions.

Objective: We aimed to develop and tentatively validate an instrument assessing patients' needs related to asthma treatment., Methods: Patients were recruited through various approaches (e.g. physicians, pharmacies and patient organizations). Utilizing a mixed methods design, we first conducted five focus groups to explore needs among patients. Next, we devised an item pool which was revised, reduced and evaluated by patients. Finally, data from a survey (n = 362) were used to further reduce the item pool and to examine the questionnaire's psychometric properties and validity., Results: Four broad needs categories emerged from the focus groups: (1) information needs; (2) consideration of patient views in diagnosis; (3) consideration of patient views in treatment planning; and (4) addressing patients' fears. We devised 45 items, which were reduced to 22 items based on patient feedback. The survey data suggested a 13-item scale with four subscales ("patient expertise", "drug effects", "handling drugs" and "exacerbations"). Cronbach's alpha was acceptable for those subscales (>0.7) and for the total score (0.9). Increasing scores on subscales and the total score (implying more unmet needs) showed close and consistent associations with poor asthma control, reduced quality of life and low treatment satisfaction., Conclusions: The development process of the Needs in Asthma Treatment (NEAT) questionnaire ensured that needs of asthma patient are captured with high validity. The NEAT questionnaire has been shown to be valid, thereby representing a promising tool for research and delivery of patient-centered care.

Objective: Traits conceptualized according to the five-factor model of personality have been found to predict numerous health outcomes and may also be predictive of asthma. Prior longitudinal studies on personality and asthma remain however sparse, have been restricted to only two traits (i.e., neuroticism and extraversion), and yielded inconsistent results. We therefore aimed to examine the potential relationships of all five-factor personality traits with incident asthma., Methods: We combined the 2009 and 2011 data from the population-based German Socio-Economic Panel study for longitudinal analyses (n=12,202). Personality traits were measured by an established 15-item version of the Big Five Inventory. Asthma was measured by participant-reports of having ever received such a diagnosis by a physician. We estimated multivariable risk ratios (RRs) and corresponding 95% confidence intervals (CIs) of trait-specific scores (continuous or categorized by tertiles) and incident asthma by Poisson regression., Results: Neuroticism was the only trait which was predictive of asthma (RR for the z-score=1.17, 95% CI=1.02-1.34; RR for the highest versus the lowest tertile=1.59, 95% CI=1.12-2.25). Associations between personality traits and asthma risk did not differ by sex (p-values for interaction ≥0.07). There were no two-way interactions between personality traits when we tested all potential combinations (all p-values for interaction ≥0.20)., Conclusion: The present study suggests that high levels of neuroticism may predispose adults to develop asthma. Future longitudinal studies are needed to confirm our findings and to shed light on the potential psychophysiological processes underlying the observed association., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: There is evidence to suggest that work stress is positively associated with the occurrence of asthma. A limitation is that the small number of prior studies utilized unestablished work stress measures, thus constraining interpretation and generalizability. The present study re-examined this association by assessing work stress based on the well-established effort-reward imbalance (ERI) model., Methods: We drew on data from two cross-sectional studies. Study 1 was conducted in a large pharmaceutical company in 2013 (n = 1,464). Study 2 was based on data from the 2011 wave of the population-based German Socio-Economic Panel (n = 8,388). ERI was assessed by validated questionnaires. Asthma was determined by self-report of a physician-based diagnosis. Associations between ERI or its subcomponents "effort", "reward" and "overcommitment" (z scores or categorized) with asthma were estimated by logistic regression models and reported as adjusted odds ratios (ORs) with 95 % confidence intervals (CIs)., Results: A one standard deviation increase of the ERI score (reflecting higher work stress) was associated with a 22-48 % elevated odds of asthma (Study 1: OR 1.48, 95 % CI 1.13-1.95, and Study 2: OR 1.22, 95 % CI 1.10-1.36). Z score-based analyses of the separate ERI components generally suggested moderate associations of effort, reward and overcommitment with asthma in both studies (Study 1: OR effort 1.25, 95 % CI 0.95-1.64, OR reward 0.67, 95 % CI 0.51-0.87, OR overcommitment 1.32, 95 % CI 1.01-1.72; and Study 2: OR effort 1.21, 95 % CI 1.09-1.34, OR reward 0.83, 95 % CI 0.76-0.92, OR overcommitment 1.12, 95 % CI 1.01-1.25). Analyses of categorized exposures largely confirmed these observations., Conclusions: This is the first study to demonstrate a link between an established work stress measure and asthma. Longitudinal studies are needed to determine the direction of these associations.

Background: Job insecurity has been identified as a risk factor for adverse health outcomes. Perceptions of job insecurity steeply increased during Europe's recent economic downturn, which commenced in 2008. The current study assessed whether job insecurity was associated with incident asthma in Germany during this period., Methods: We used prospective data from the German Socio-Economic Panel for the period 2009-2011 (follow-up rate=77.5%, n=7031). Job insecurity was defined by respondents' ratings of the probability of losing their job within the next 2 years and asthma as self-reports of physician-diagnosed asthma. Associations between job insecurity in 2009 (continuous z-scores or categorised variables) and incident asthma by 2011 were assessed using multivariable Poisson regression., Results: The risk of asthma increased significantly by 24% with every one SD increase of the job insecurity variable. In dichotomised analyses, a probability of job loss of ≥50% (vs <50%) was associated with a 61% excess risk of asthma. A trichotomous categorisation of job insecurity confirmed this finding., Conclusions: This study has shown, for the first time, that perceived job insecurity may increase the risk of new onset asthma. Further prospective studies may examine the generalisability of our findings and determine the underlying mechanisms., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: There is consistent evidence of the co-occurrence of poor mental health and asthma in Western populations. Since the experience and expression of mental health is partly culturally determined, it is of interest to examine if similar associations are found in other cultural settings. In that regard, very little is known about the association between mental health and asthma in Asian countries, such as China., Purpose: The aim of this study was to investigate the relationship between mental health and asthma in a large sample from China., Method: We used data from the Guangzhou Biobank Cohort Study phase 3 (n = 9,280). Participants reported physician-diagnosed asthma. Mental health measures included the 15-item Chinese version of the Geriatric Depression Scale (GDS-C) and the SF-12 Mental Component Summary (MCS) score. We compared the prevalence of asthma by GDS-C and MCS scores by estimating prevalence ratios (PRs) and their corresponding 95% confidence intervals (95% CI), using Poisson regression., Results: Compared to those without depression, the prevalence of asthma was higher in those with moderate or severe depression levels (PR = 2.63, 95% CI = 1.58–4.40 and PR = 4.43, 95% CI = 1.62–12.09, p for trend ≤0.0001). The prevalence of asthma increased by 46% with every 1 standard deviation increase of the GDS-C score (PR = 1.46, 95% CI = 1.24–1.73). The MCS score was not associated with asthma., Conclusion: Depressive symptoms were associated with asthma prevalence in a Chinese population. Further research into the mechanism and potential directions of causality is warranted.

Background: Epidemiological studies have shown that asthma is positively associated with depression. Most of this evidence stems from individual studies conducted in Western populations (e.g. Europe, North America and Australia). It is still unclear whether such findings generalize to non-Western countries. To address this question, the present study investigated the association of asthma and wheezing with depression in a large multi-national sample., Methods: We used data from the 2002 World Health Survey. Participants reported physician-diagnosed asthma and attacks of wheezing within the past 12 months. Questions on depressive symptoms, their duration and persistence were used to define presence of a major depressive episode (MDE) within the past 12 months. ORs and 95% CIs were estimated by logistic regression for the entire sample, by continent (Australia, Europe, South America, Asia and Africa) and by country. Complete information was available for 57 countries., Results: Both asthma and wheezing were associated with MDE in the entire sample (OR=2.37, 95% CI=2.10-2.66 and OR=3.06, 95% CI=2.75-3.40, respectively). Similar associations were found for all continents with generally stronger ORs in South America, Asia and Africa for both asthma (ORs ≥ 1.8) and wheezing (ORs  ≥ 2.8). On the country level, wheezing showed a consistent pattern of association with MDE. Similar patterns were found for asthma., Conclusions: Despite a range of country differences that could affect the association of asthma with depression, such as access to health care, the results of this study indicate that the co-occurrence of asthma and depression is a universal phenomenon.

Objective: It is unclear which of the commonly used asthma-specific quality of life (QoL) questionnaires best capture the lived experience of people with asthma. The objective of this study was to explore patients' views on three asthma-specific QoL questionnaires., Methods: Ten adult individuals with asthma were asked to complete three asthma-specific QoL questionnaires (Standardized Juniper Asthma Quality of Life Questionnaire (AQLQ-J-s), Sydney Asthma Quality of Life Questionnaire (AQLQ-S), and Fragebogen zur Lebensqualität bei Asthma (FLA)). Interviews were conducted to elicit patients' views on the questionnaires. Interviews were transcribed verbatim and thematic content analysis was performed., Results: Participants spoke about response format and options, missing and redundant/similar content as well as content that was perceived to be irrelevant. A lack of specificity was named for some items, and issues concerning layout were raised. Despite the diversity of views expressed, participants mostly agreed on the ranking of the questionnaires and, overall, favored the AQLQ-S., Conclusions: Patient involvement highlights shortcomings and strengths of various asthma-specific questionnaires in terms of both format and content. The AQLQ-S was the most positively perceived questionnaire. Future research will need to explore other settings and potentially involve a larger and more diverse sample.

Background: There is an extensive literature linking stressful work conditions to adverse health outcomes. Notwithstanding, the relationship with asthma has not been examined, although various other measures of psychological stress have been associated with asthma. Therefore, we aimed to investigate the relation between work stress and asthma prevalence and incidence., Methods: We used data from a population-based cohort study (n = 5114 at baseline in 1992-1995 and n = 4010 at follow-up in 2002/2003). Asthma was measured by self-reports. Two scales that assessed psychologically adverse work conditions were extracted from a list of work-condition items by factor analysis (these scales were termed 'work stress' and 'inability to relax after work'). For each scale, the derived score was employed both as continuous z-score and as categorized variable in analyses. Associations with asthma were estimated by prevalence ratios (PRs) and risk ratios (RRs) using Poisson regression with a log-link function adjusting for demographics, health-related lifestyles, body mass index and family history of asthma. Analyses were restricted to those in employment (n = 3341)., Results: Work stress and inability to relax z-scores were positively associated with asthma prevalence (PR = 1.15, 95%CI = 0.97, 1.36 and PR = 1.43, 95%CI = 1.12, 1.83, respectively). Prospective analyses using z-scores showed that for each 1 standard deviation increase in work stress and inability to relax, the risk of asthma increased by approximately 40% (RR for work stress = 1.46, 95%CI = 1.06, 2.00; RR for inability to relax = 1.39, 95%CI = 1.01, 1.91). Similar patterns of associations were observed in analyses of categorized exposures., Conclusions: This is the first study to show a cross-sectional and longitudinal association of work stress with asthma.

Objective: To investigate the association between depressive symptoms, social support, and prevalent as well as incident asthma. Depressive symptoms and social support may affect the development of asthma. This relationship could be mediated by health behaviors and/or inflammatory processes. Evidence from prospective cohort studies on depressive symptoms and social support in relation to asthma risk in adults remains sparse., Methods: Between 1992 and 1995, a population-based sample of 5114 middle-aged adults completed questionnaires covering depressive symptoms, social support, self-reported asthma, and potential confounders. Among those alive in 2002/2003, 4010 (83%) were followed-up by questionnaires. Associations with prevalent and incident asthma were estimated by prevalence ratios (PR) and risk ratios (RR) along with corresponding 95% confidence intervals (CIs), using Poisson regression. PRs and RRs were adjusted for demographics, family history of asthma, smoking, alcohol consumption, body mass index, and physical exercise., Results: Cross-sectional analyses indicated that the prevalence of asthma was positively associated with depressive symptoms and inversely related to social support. Prospective analysis suggested a 24% increased risk of asthma with each 1-standard deviation increase in depressive symptoms (RR, 1.24; 95% CI, 1.02, 1.50), whereas the social support z score showed an inverse association with asthma incidence (RR, 0.71; 95% CI, 0.58, 0.88). Analyses with tertiles suggested similar, but nonsignificant, associations. Omitting health-related life-style variables from the multivariable models did not substantially alter these associations., Conclusions: Risk of adult asthma was found to increase with depressive symptoms and to decrease with social support. These associations do not seem to be explained by health-related life-style factors.

Background: Stressful life events can trigger asthma exacerbations, but could also contribute to the development of incident asthma. However, only few studies have investigated the association between stressful life events and adult asthma prospectively. Likewise, stress-related personality traits (e.g. neuroticism and extraversion) may increase asthma risk, but this has been examined in only one prospective study. We therefore aimed to investigate the association between neuroticism, extraversion, stressful life events and incident asthma., Methods: A population-based sample of 5114 middle-aged adults completed questionnaires between 1992 and 1995. Among those alive in 2002/2003, 4010 (83%) were followed-up by questionnaires. Exposures of interest included neuroticism, extraversion and three stressful life events (unemployment, having broken off a life partnership and death of a close person). Associations with incident asthma were estimated by multivariable risk ratios (RR) and 95% confidence intervals (95% CI) using Poisson regression., Results: High vs low neuroticism predisposed to developing asthma (RR = 3.07, 95% CI = 1.71-5.48), but high extraversion did not (RR = 1.30, 95% CI = 0.79-2.15). Having broken off a life partnership significantly increased asthma risk (RR = 2.24, 95% CI = 1.20-4.21) in contrast to death of a close person (RR = 1.06, 95% CI = 0.64-1.75) or unemployment (RR = 1.65, 95% CI = 0.72-3.78)., Conclusions: High levels of neuroticism may increase the risk of asthma in middle-aged adults. Having broken off a life partnership was the only stressful event, which was associated with incident asthma. Synthesized with evidence from earlier studies, this could reflect that interpersonal conflicts may increase asthma risk, possibly along an immunological pathway.

Purpose: First, we sought to estimate the magnitude of the cross-sectional associations between overweight/obesity and asthma stratified by gender and by self-reported hay fever and second we sought to assess both directions of causality in longitudinal analyses., Methods: We used cross-sectional and longitudinal data from a population-based cohort study (n=5114, ages 40-65 at baseline). After 8.5 years, 4010 adults were followed-up by questionnaires. Self-reported height and weight were used to calculate body mass index categories. Multivariate adjusted prevalence ratios (PRs), relative risks (RRs), and 95% confidence intervals (95% CI) were calculated using Poisson regression., Results: In cross-sectional analyses, adjusted PRs were comparable for overweight women and men but differed between obese women and men (PR 1.93, 95% CI 1.19-3.14 and PR 0.98, 95% CI 0.56-1.72). PRs were similar when stratified by hay fever. Longitudinal analyses suggested that overweight/obesity did not increase asthma risk substantially (RR 1.02, 95% CI 0.50-2.06), but a relation between asthma and subsequent weight gain could not be excluded (RR 1.34, 95% CI 1.01-1.77)., Conclusions: The prevalence of asthma is almost twice as high in obese versus normal weight women, but not in obese men. The association between overweight/obesity and asthma does not vary by hay fever. A causal relationship between asthma and incident weight gain cannot be excluded.

Abstract Background Asthma self-management (e.g., trigger avoidance or correct medication use) is a cornerstone of therapy. Its successful implementation in everyday working life is determined by psychosocial working conditions, in particular by support from superiors and colleagues and the job decision latitude (i.e., when and how to carry out which tasks). To empower individuals with asthma to modify their working conditions, employees need to use certain communication skills and acquire specific knowledge. Both could be taught as part of patient education during pulmonary rehabilitation. Therefore, the aim of the planned study is the development and multicentre implementation of an education module for individuals with asthma during their rehabilitation and to generate evidence on its effectiveness. Methods Participants (n ≥ 180) will be recruited, randomized into an intervention and a control group, trained and surveyed in two rehabilitation clinics. The intervention group will receive the supplementary patient education module “Asthma and Work” while the control group will participate in a program on " Eating behaviour” (both 2 × 50 min). The effectiveness of the intervention will be examined based on pre-post measurements (T1 and T2) and a 3-month follow-up (T3). We will consider behavioural intention (T2) and asthma self-management at work (T3) as primary outcomes. Secondary outcomes will include self-management-related knowledge, self-efficacy, number of sick days, number of exacerbations, asthma control (Asthma Control Test), asthma-related quality of life (Marks Asthma Quality of Life Questionnaire), and subjective employment prognosis (Brief Scale Measuring the Subjective Prognosis of Gainful Employment). The pre-post comparisons are to be evaluated using univariate analyses of covariance. Discussion Improving asthma self-management at work could increase the work ability and social participation of employees with asthma. This could reduce costs, e.g. in terms of asthma-related sick leave. Trial registration German Clinical Trials Register (ID: DRKS00031843)

Abstract Background Many patients with asthma report unmet health care needs. The Patient Needs in Asthma Treatment (NEAT) questionnaire is a validated instrument to quantify these unmet needs. We explored how health professionals evaluated the instrument’s utility as well as patients’ and professionals’ perspectives of how NEAT could be incorporated into routine clinical practice. Methods Qualitative interviews were conducted by telephone between February and September 2021 with 19 patients with asthma and 21 health professionals (i.e., general practitioners, pneumologists, health professionals in pulmonary rehabilitation, and medical assistants). Interview recordings were transcribed verbatim and content-analyzed using both deductive and inductive approaches using MAXQDA. Results Health professionals could see the potential value of using NEAT to inform clinical decisions. However, health professionals tended to be skeptical towards the routine use of NEAT in outpatient settings, mainly due to a lack of time. Implementation of NEAT was seen as more valuable in the context of patient education (i.e., in Disease Management Programs [DMPs] or pulmonary rehabilitation) by patients and health professionals alike, because it offered greater opportunities to address any unmet needs identified. Both patients and health professionals considered it more useful to use the questionnaire for the first time some time after the initial diagnosis has been made (e.g., when the treatment regime is found rather than at time of initial diagnosis). In the context of DMPs and pulmonary rehabilitation, NEAT could be used twice, i.e., before and after patient education to support patient-centered planning and evaluation. Conclusion Both patients and health professionals consider the use of the NEAT, in particular in educational programs (i.e., during DMPs or pulmonary rehabilitation), as feasible and useful. There is now a need to undertake a feasibility trial in routine care.

Abstract Background Pulmonary rehabilitation offers potential benefits to people with asthma. It is however unknown if rehabilitation favourably affects patients’ health care needs. We therefore examined if rehabilitation reduced needs and, in addition, if it improved asthma control. Methods One hundred fifty patients with asthma were surveyed in three rehabilitation clinics at admission and at discharge. Additionally, we surveyed 78 participants with asthma twice 4 weeks apart. The latter sample (i.e. the control group) was recruited through other pathways than rehabilitation clinics. The Patient Needs in Asthma Treatment (NEAT) questionnaire and the Asthma Control Test (ACT) were completed at baseline and follow-up. Differences between baseline and follow-up and between rehabilitation and control group were examined by t-tests and chi-squared-tests. Univariate ANCOVAS were used to examine if NEAT and ACT follow-up scores differed significantly between groups. Within the rehabilitation group, linear regressions were used to examine if self-reported utilization of more interventions that addressed needs were associated with NEAT scores at follow-up. Results At baseline, there were no differences between the rehabilitation and the control group regarding needs and asthma control. At follow-up, the rehabilitation group showed reduced needs (t(149) = 10.33, p

Abstract Background Adverse psychosocial working conditions—in particular poor job decision latitude and poor social support at work—may impair the effective implementation of asthma self-management behaviour at work and may be associated with increased asthma morbidity. In this study, we investigate for the first time the association of job decision latitude and social support at work with (1) four asthma-specific self-management behaviours at work (i.e., physical activity, trigger avoidance, acute symptom management, and communication) and with (2) asthma morbidity. Methods A total of 221 employees with asthma recruited through three rehabilitation clinics completed questionnaires (response rate = 29.3%). Job decision latitude and social support were measured using items from the Copenhagen Psychosocial Questionnaire. The four asthma self-management behaviours were mainly assessed by self-developed items. We used the Asthma Control Test and the Marks Asthma Quality of Life Questionnaire to measure asthma morbidity. We dichotomized all variables and conducted logistic regression analyses to calculate odds ratios with 95% CIs. Results Low job decision latitude and low social support were significantly associated with poorer trigger avoidance (odds ratios ≥ 2.09) and poorer acute symptom management (odds ratios ≥ 2.29); low social support was further related to significantly less communication (odds ratio = 2.82). Low job decision latitude and low social support were also associated with significantly poorer asthma control (odds ratios ≥ 1.95) and poorer asthma-specific quality of life (odds ratios ≥ 2.05). The relationships with asthma morbidity were attenuated after adjustment for the four asthma self-management behaviours (odds ratios ranging from 1.1 to 1.9). Conclusions Adverse psychosocial working conditions are associated with poorer asthma self-management behaviour at work and with increased asthma morbidity. The latter association may be mediated by asthma self-management behaviour. Trial registration German Clinical Trials Register, registration number: DRK S00011309, date of registration: 22.12.2016.