[Working with the Dutch Standard of Care for COPD: using the 'Nijmegen Clinical Screening Instrument' as an aid]. / Werken met de Zorgstandaard COPD: het 'Nijmegen Clinical Screening Instrument' als hulpmiddel.

In the Dutch Standard of Care for chronic obstructive pulmonary disease (COPD) the patient, not the illness, is now central. Additionally, treatment is no longer exclusively guided by the degree of airway obstruction but by the burden of disease (also called 'integral health status'). Consequently, COPD care will be more intensive and more complex. The Nijmegen Clinical Screening Instrument (NCSI) method offers a guide for the patient and the caregiver to help execute the standard of care effectively and efficiently. Using this method, the burden of disease is assessed in detail. An integral intervention helps in formulating treatment goals (patient-tailored treatment), and in motivating patients to adhere to these treatment goals. A special condensed version of the NCSI is suitable for monitoring the patient. The method is web-based, which facilitates the assessment and monitoring of the patient.

Knowledge about asthma and COPD: associations with sick leave, health complaints, functional limitations, adaptation, and perceived control.

We sought to investigate associations between knowledge about the disease and sick leave, health complaints, functional limitations, adaptation and perceived control. Patients with asthma (n = 101) and COPD (n = 64) underwent lung function tests and completed questionnaires. In addition, all were asked the question: 'what is the diagnosis of your disease?', with the response categories: 'asthma' and 'COPD (chronic bronchitis or emphysema)'. Thirty-five percent of the asthma patients and 30% of the COPD patients did not know their correct diagnosis. Sick leave was not associated with knowledge about the disease in asthma and COPD. In asthma, much knowledge about management of the disease was associated with better adaptation (P = 0.01) and less perceived control over health by external factors (P = 0.02). Knowing the correct diagnosis was associated with less control over health by powerful others (P = 0.02). For COPD, more knowledge about management of the disease was associated with better adaptation (P = 0.02) and less control over health by internal factors (P = 0.01). Knowing the correct diagnosis was associated with less control over dyspnea at work (P = 0.01).

Predictors of changes in sick leave in workers with asthma: a follow-up study.

OBJECTIVE: The aim of this prospective study was to investigate predictors of 1-year changes in sick leave in workers with asthma. METHODS: The initial cohort consisted of 111 workers with asthma. One-hundred and one participants completed the follow-up after 1 year. Self-reported sick leave over the past 12 months was reported at baseline and at follow-up. At the start of this study, all participants completed questionnaires on adaptation to functional limitations, psychosocial variables, working conditions, lung function characteristics, disease history characteristics, health complaints and functional limitations, and person characteristics ('potential predictors'). Three multivariate logistic regression models were calculated, with an increase in sick leave, a decrease in sick leave, and stable high sick leave as dependent (outcome) variables, and the potential predictors as independent (explanatory) variables. RESULTS: An increase in sick leave was predicted by a lower level of education and perceiving more functional limitations in activities of daily life. A decrease in sick leave was predicted by spending all energy at work less often and perceiving fewer health complaints in social activities (adaptation criteria 4 and 5). Stable high sick leave was predicted by less job satisfaction, perceiving more support from the employer and perceiving more health complaints in social activities (adaptation criterion 5). Lung function characteristics, or disease history characteristics were not predictive for changes in sick leave in any of the groups. CONCLUSION: We conclude that adaptation to functional limitations played a major role in changes in sick leave in workers with asthma. Lung function characteristics hardly played a role.

Sick leave in patients with obstructive lung disease is related to psychosocial and work variables rather than to FEV1.

The aim of this exploratory study was to investigate associations between sick leave in workers with asthma or COPD and disease-related variables, psychosocial variables, and work characteristics. Hundred and eighty-nine patients with physician-diagnosed asthma (N=118) or COPD (n=71) who had paid work in the past 12 months completed questionnaires on sick leave, health complaints, functional limitations, work characteristics and psychosocial issues, and underwent a pulmonary function test (FEV1 and FVC before and after bronchodilation). Logistic regression analyses were performed to investigate variables independently associated with high sick leave (i.e. more than twice a year and/or longer than 1 month per episode). Asthma patients, not having an emotionally difficult job, with low job satisfaction, who had changed employers, utilized job control, and who encountered pulmonary aggravating factors at work were found to have a higher incidence of sick leave. COPD patients, who had informed the employer or colleagues about the disease, who did not have difficult tasks at work, who did not hide dyspnea and limitations, and who reported high fatigue were showing higher sick leave. FEV1 and FVC were not associated with sick leave in either group. It was concluded that psychosocial variables, work characteristics, functional limitations, and complaints play a more important role in sick leave in workers with asthma and COPD than FEV1.