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How comorbid respiratory diseases & smoking impact injured claimant outcomes: Part four

by
Clinical Connection team
| Oct 31, 2019

Respiratory health is an important but often overlooked component of a person’s overall health and well-being. Respiratory issues not only can worsen an injured person’s prognosis, but can increase the risk of adverse health effects in some working environments.

Chronic respiratory disease is a major health issue and can exacerbate injuries

  • As of 2017, it was the fourth leading cause of death in the United States.1
    • 22.5 million U.S. adults have asthma
    • 16.3 million U.S. adults have chronic obstructive pulmonary disease (COPD)
    • 33.2 million U.S. adults have other diagnosed chronic lung conditions2
 Hazardous working conditions can contribute to respiratory diseases

Jobs such as mining, working in machine shops, firefighting, farming, cleaning and construction may expose workers to respiratory irritation from aerosolized particulates.3 For example, it is well established that workers with asbestos exposure have a greater risk of respiratory disorders, including asbestosis, pleurisy and lung cancer.4 Working in the presence of respiratory irritants can cause reactive airway disease and worsen pre-existing respiratory conditions.

Conversely, comorbid respiratory disorders increase the risk of developing an exposure-related condition and can result in long-term disability and increased costs.

Smoking can impact wound healing
Smoking is the most recognized cause of respiratory diseases and lung cancer. While it is associated with increased rates of respiratory infections such as pneumonia, smoking also has been linked to higher rates of infection in wounds, post injury ― impairing wound healing.

A 2005 study shows smokers with open leg fractures did not achieve complete bone healing and had an increased risk – nearly three times that of non-smokers – of developing bone infections (osteomyelitis).5

Potential long-term effect smoking-related cancers may have on return to work
Smoking is a well-known contributing factor for a multitude of cancers beyond lung cancer, such as bladder cancer and pancreatic cancer.6

With advances in oncology medicine, some cancers may evolve into chronic conditions that are treated and followed for years. An estimated 41 to 84 percent of cancer survivors return to work.7 Most can return to full duty. However, there is a subset that may require work modifications and/or a change in job function. These functional restrictions could hinder a return to work.

Strategies to prevent and manage respiratory issues
Clearly, respiratory health is vitally important. While employers may be able to limit environmental exposure to irritants, it is up to individuals to manage personal contributors. One way employers can assist is by offering smoking cessation programs to support employees’ efforts to quit smoking.

Clinical intervention improves claimant health and financial outcomes
Clinical management of respiratory conditions is critical to improving overall care of impacted individuals. After smoking cessation, clinician management can provide oversight of any complex medication regimens. Claimant and clinician review of medication history can identify potential compliance concerns, address medication adverse effects and assure the claimant is utilizing all treatments as appropriate. Routine clinical review of all medications can help reduce costs and potentially improve quality of care.

See below how clinical interventions improved financial results and clinical outcomes for a claimant with respiratory and other comorbidities in the accompanying case study.

Clinical intervention success story
67-year-old male with multiple comorbidities and reactive airway disease due to a work exposure. Annual spend $21,532.

Multiple comorbidities include:

  • Hypertension
  • Cardiac disease including congestive heart failure
  • Obstructive lung disease

*Recent smoking cessation noted

 Medication-related issues:

  • Multiple duplications of therapy noted with both metered dose inhalers and nebulized medications
  • Drug-disease state interactions were identified with the use of several inhalers and cardiac diseases and hypertension

Peer-to-Peer evaluation with prescriber to evaluate the identified medication-related concerns resulted in an estimated 25% reduction in annual spend of $5,374.

Coming Up
Next week, we’ll release another blog post in our five-part comorbidity series ― comorbid diabetes/obesity, which can aggravate an injured person’s condition. Check out parts one, two and three of our series on comorbid conditions in workers’ comp, on our Clinical Connection page, here.

Sources:

  1. Heron, M. National Vital Statistics Reports. 68(6). June 24, 2019
  2. American Lung Association. Methodology: Estimated Prevalence and Incidence of Lung Disease. Accessed August 30, 2019. https://www.lung.org/our-initiatives/research/monitoring-trends-in-lung-disease/estimated-prevalence-and-incidence-of-lung-disease/methodology.html
  3. Babcock, P. 10 Risky Jobs for Your Lungs. WebMD Feature. May 26, 2014
  4. National Heart, Lung, and Blood Institute. Asbestos-related lung disease. Accessed August 30, 2019. https://www.nhlbi.nih.gov/health-topics/asbestos-related-lung-diseases
  5. Castillo RC, Bosse MJ, MacKenzie EJ, et al. Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. J Orthop Trauma. 2005;19(3):151-157.
  6. National Cancer Institute. Harms of Cigarette Smoking and Health Benefits of Quitting. December 19,2017. Accessed August 30, 2019. https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet
  7. Taskila T, Lindbohm L. Factors affecting cancer survivors’ employment and work ability. Acta Oncolagica. 2007:46,446-451

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