Preferences of patients with asthma or COPD for treatments in pulmonary rehabilitation.

INTRODUCTION: Pulmonary rehabilitation (PR) aims to improve disease control in patients with chronic obstructive pulmonary disease (COPD) and asthma. However, the success of PR-programs depends on the patients' participation and willingness to cooperate. Taking the patients' preferences into consideration might improve both of these factors. Accordingly, our study aims to analyze patients' preferences regarding current rehabilitation approaches in order to deduce and discuss possibilities to further optimize pulmonary rehabilitation. METHODS AND ANALYSIS: At the end of a 3 weeks in-house PR, patients' preferences concerning the proposed therapies were assessed during two different time slots (summer 2015 and winter 2015/2016) in three clinics using a choice-based conjoint analysis (CA). Relevant therapy attributes and their levels were identified through literature search and expert interviews. Inclusion criteria were as follows: PR-inpatient with asthma and/or COPD, confirmed diagnosis, age over 18 years, capability to write and read German, written informed consent obtained. The CA analyses comprised a generalized linear mixed-effects model and a latent class mixed logit model. RESULTS: A total of 542 persons participated in the survey. The most important attribute was sport and exercise therapy. Rehabilitation preferences hardly differed between asthma and COPD patients. Health-related quality of life (HRQoL) as well as time since diagnosis were found to have a significant influence on patients' rehabilitation preferences. CONCLUSIONS: Patients in pulmonary rehabilitation have preferences regarding specific program components. To increase the adherence to, and thus, the effectiveness of rehabilitation programs, these results must be considered when developing or optimizing PR-programs.

Costs of isocyanate-related occupational diseases: A systematic review.

Although isocyanates are increasingly used in manufacturing and workplace exposure to isocyanates is widely recognized as one of the most frequent causes for occupational lung and skin diseases, little is known about the economic burden on the affected individual and the society. This study provides an overview on costs of occupational diseases related to isocyanates. We performed a systematic literature search of studies in the electronic databases of the German Institute of Medical Documentation and Information, and the Canadian Centre for Occupational Health and Safety. We extracted the key characteristics of the studies and performed a study quality assessment. We identified eight studies on the costs of illness, of which five focused on occupational lung diseases and three on occupational skin diseases. Further, eight studies calculated loss of income/compensation payments. Out of the 16 identified articles, only two reported costs directly attributable to isocyanate-induced diseases (asthma). Studies were hardly comparable because they differed substantially in their methodological approaches. Moreover, the quality assessment of the studies revealed substantial limitations. While a wide range of isocyanate-related costs was identified, consequences of isocyanate-related occupational diseases were considerable in terms of societal costs and loss of income. In most studies, indirect costs were the main cost driver. There is a need for high-quality cost of illness studies on isocyanate-induced diseases stratified by degree of severity and sex. Such studies provide valuable information to develop preventive strategies and set priorities for measures to lower the burden of professional health risks.

[Patient perspective of the importance of asthma- and COPD-specific rehabilitation components: A secondary data analysis]. / Reha-Komponenten im Patientenfokus ­ Sekundärdatenauswertung der Befragungen von COPD- und Asthma-Rehabilitanden.

Little is known about the importance that patients attribute to individual rehabilitation components (RCs) and about which factors influence the patients' perspective and the impact of this judgment on the perceived success of the rehabilitation process. To address these questions, the data of 759 patients with chronic obstructive pulmonary disease (COPD) or bronchial asthma, who were interviewed at the end of their rehabilitation about the subjective importance of various RCs, were analysed retrospectively. The patients were pooled from our previous studies "Prospektive Katamnesestudie zur Asthma-Rehabilitation" (ProKAR) and "Routinemäßiges Inspirationsmuskeltraining in der COPD-Rehabilitation" (RIMTCORE). Asthma patients and COPD patients differed in their assessments. Their evaluation was also affected by personal parameters such as sex, comorbidities, quality of life and the perceived effectiveness of the "rehabilitation as a whole". Patients considered all RCs to be essential, with minor differences. However, the patients' assessment of the importance of the RCs was in the closest possible agreement with the evidence available for the effectivity of multimodal rehabilitation. The added value of the proposed study is to generate further insight into the upcoming scientific field of personal rating of therapy components.