Blanc P D, Jones M, Besson C, Katz P, Yelin E
Division of Occupational and Environmental Medicine, University of California San Francisco.
Chest. 1993 Nov;104(5):1371-7. doi: 10.1378/chest.104.5.1371.
To estimate the incidence of work disability among adults with asthma and to evaluate a clinically based illness severity score as a predictor of such disability.
Baseline and follow-up telephone interviews and medical record review.
University-based outpatient pulmonary specialty practice.
Fifty-six patients interviewed at baseline; 42 reinterviewed 2 years later.
Work disability ascertained by interview report and defined as change in job duties, reduction in pay, or change in job or employment status attributed to asthma. Severity of asthma score derived from medical records and based on respiratory symptom frequency, asthma history, and prescribed medications. Pulmonary function by routine testing. Logistic regression analysis of the 5-year incidence of work disability on severity score and forced expiratory volume in 1 s (FEV1).
The 5-year work disability cumulative incidence was 19 percent for change in duties, 17 percent for reduction in pay, 20 percent for change in job or work status, and 36 percent for any of these measures. The median asthma score was 10 (range, 2 to 26). The mean FEV1 as a percent predicted (FEV1 percent) was 88 +/- 25 percent. Score and FEV1 percent were statistically correlated (r = -0.6, p < 0.0001). Severity of asthma score statistically predicted each measure of work disability (p < 0.01). Addition of FEV1 percent added little additional explanatory power to the logistic regression model (maximum chi 2 = 1.3, p > 0.2).
Work disability is common among adults with asthma. A severity of asthma score based on clinical variables is statistically correlated with lung function but appears to be a stronger predictor of disability than airflow measured at one point in time.
评估哮喘成年患者工作失能的发生率，并评价基于临床的疾病严重程度评分作为此类失能预测指标的价值。
基线及随访电话访谈与病历回顾。
大学附属医院门诊肺科专科诊所。
56例患者接受基线访谈；2年后42例接受再次访谈。
通过访谈报告确定工作失能，定义为因哮喘导致工作职责改变、薪资减少或工作或就业状态改变。根据病历得出哮喘严重程度评分，基于呼吸症状频率、哮喘病史及所开药物。通过常规检测评估肺功能。对工作失能的5年发生率进行逻辑回归分析，分析指标包括严重程度评分及1秒用力呼气容积（FEV1）。
5年工作失能累积发生率：工作职责改变为19%，薪资减少为17%，工作或工作状态改变为20%，上述任何一项改变为36%。哮喘评分中位数为10（范围2至26）。预计FEV1百分比（FEV1%）的平均值为88±25%。评分与FEV1%具有统计学相关性（r = -0.6，p < 0.0001）。哮喘严重程度评分在统计学上可预测每项工作失能指标（p < 0.01）。在逻辑回归模型中加入FEV1%几乎未增加额外的解释力（最大卡方值 = 1.3，p > 0.2）。
工作失能在哮喘成年患者中很常见。基于临床变量的哮喘严重程度评分与肺功能具有统计学相关性，但似乎比某一时刻测量的气流更能有力地预测失能。
