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Objectives: Asthma can be associated with substantial productivity loss and activity impairment, particularly among those with the most severe disease. We sought to assess the performance characteristics of an asthma-specific adaptation of the Work Productivity and Activity Impairment Questionnaire (WPAI:Asthma) in patients with either severe or difficult-to-treat asthma. Methods: We analyzed 2529 subjects from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. The WPAI:Asthma was administered at baseline and at 12 months. Asthma control and quality-of-life were simultaneously assessed using the Asthma Therapy Assessment Questionnaire and Mini-Asthma Quality-of-Life Questionnaire, respectively. Results: Severe versus mild-to-moderate asthma was associated with a greater percentage of impairment at work (28% vs. 14%), at school (32% vs. 18%), and in daily activities (41% vs. 21%). At baseline, greater asthma control problems correlated with higher levels of impairment as measured by the WPAI (work: r = 0.54, school: r = 0.37, activity: r = 0.55). Over the 12-month follow-up period, improved quality-of-life correlated with decreased levels of impairment (work: r = −0.42, school: r = −0.36, activity: r = −0.48). In multivariate analyses, greater than 10% overall work impairment at baseline predicted emergency visits (OR 2.6 [1.6, 4.0]) and hospitalization (OR 4.9 [1.8, 13.1]) at 12 months. Conclusions: The WPAI:Asthma correlates with other self-reported asthma outcomes in the expected manner and predicts health-care utilization at 12 months when administered to patients with severe or difficult-to-treat asthma. [ABSTRACT FROM AUTHOR]

The article discusses the role of primary care providers (PCPs) in the diagnosis, assessment, monitoring, and management of patients with chronic obstructive pulmonary disease (COPD). Topics include the diagnosis of COPD, the assessment of airflow limitation, as well as the assessment of the symptoms and exacerbations of COPD. The consideration of nonpharmacologic interventions, including smoking cessation and pulmonary rehabilitation, as important features of COPD management is tackled.

The article discusses the evolution of concepts in the asthma management landscape in the U.S. being considered as a common condition that imposes substantial patient, health care system, and socioeconomic burdens. Topics include the understanding of asthma etiology, the progress in the diagnosis of asthma, and the management of asthma in primary care. The role of primary care providers (PCPs) in teaching patients for effective self-management is also tackled.