The AHRQ review examined socioeconomic outcomes among workers with OA in seven studies. Four studies assessed the change in financial situation after an OA diagnosis and consistently found that workers who had been removed from their job experienced a loss in income. Two studies assessed workers’ compensation claims and acceptances. In one study, a national workers’ compensation board accepted more claims from workers who were removed from the workplace than those who only reduced exposure. A second study concluded that the acceptance rate was similar, regardless of exposure status. Compared to workers who were removed from the workplace, there was a greater increase in medication costs among workers who remained exposed or reduced their exposure.

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Overall, the economic consequences of the development of OA are impressive. Among the workers included in the studies, those who left the workplace experienced economic repercussions of reduced income and/or unemployment. Even workers who reduced their exposure or stayed employed at the same workplace appeared to lose some income over time; meanwhile, their medication costs increased.

As with typical asthma, the natural history of WEA can be variable. Patients with asthma are more likely to miss work and to report being less effective when at work, even without workplace exacerbations. Studies investigating socioeconomic outcomes in those patients with WEA have generally shown rates of unemployment and income loss comparable to those with new-onset OA. The economic consequences for these groups should be considered strongly in any management plan.

Compensation

Given the substantial adverse economic and employment consequences of WRA, the physician should attempt to obtain as much objective evidence as possible to clarify the diagnosis of WRA, using the approaches discussed above, and in particular while the worker is still employed. Medical and workplace management should be coordinated with the management of compensation.