The silent socioeconomic impact of COPD/asthma in Africa, Asia and Europe - a FRESH AIR study

Background: In low-resource settings such as Uganda, Vietnam, Kyrgyzstan and rural Greece, COPD/asthma is highly prevalent. Yet data on the indirect socioeconomic impact are largely lacking. Aim: To estimate work productivity and activity impairment due to COPD/asthma in low-resource settings, and identify predictors for a higher impairment. We hypothesised that as patients in these settings cannot afford to miss work, disease impact remains largely hidden in a decreased productivity. Method: This cross-sectional, observational study is part of the FRESH AIR study. In Uganda (N=102), Vietnam (N=491), Kyrgyzstan (N=308), and rural Greece (N=100), we assessed patients9 characteristics and administered the validated work productivity and activity impairment questionnaire (WPAI). We studied predictors for impairment using a multivariable logistic regression model including demographics, disease severity (MRC breathlessness scale 1-5) and comorbidities. Results: Patients9 mean age was 59.4 (SD 24.5), 47.8% was male, and 36.9% classified as working. Workers reported a median [IQR] overall work impairment of 30% [0.0-60.0] due to asthma/COPD, while worktime missed was only 0.0% [0.0-27.7]. The total group reported 40.0% [20.0-60.0] impairment of daily activities. Disease severity (MRC) was a strong predictor for a higher activity impairment (OR 2.2; 95%CI 1.9-2.6), whereas age, gender, and comorbidities were insignificant in the multivariable model. Conclusion: Although in these low-resource settings not much worktime is missed due to COPD/asthma, the productivity- and activity impairment is substantial. Awareness of this hidden impact and its (un)associated factors should inform public health policies.