Effects on sick leave of an inpatient rehabilitation programme for asthmatics in a randomized trial

Abstract

Aim: Among adult asthmatics a major proportion of the cost of illness is attributed to productivity losses and societal costs in connection with sick leave compensation. The aim of the study was to evaluate an extensive structured four-week inpatient rehabilitation programme for asthmatics. Methods: A diagnosis of asthma was made in a structured way among people on sick leave due to a respiratory disorder. In total, 197 persons were randomized to either a rehabilitation programme, or to usual care. The main components of the rehabilitation programme were education, pharmacological optimization, physical training, and coping skill acquisition. Results: At the three-year follow-up, the median number of sick leave days in the rehabilitation group was 104, and in the usual care group 167 (p=0.12). An analysis of a subgroup consisting of persons not currently smoking with a previous diagnosis of asthma by a physician (n=57) showed a significant effect on sick leave at three years (median number of days 63 in the rehabilitation group vs 361 in the control group, p=0.02). All analyses were based on intention to treat. Conclusions: The long-term effects on sick leave of an extensive inpatient asthma rehabilitation programme are most evident for non-smokers and ex-smokers with a previous asthma diagnosis. It is therefore recommended that persons with asthma who are current smokers should be offered participation in smoking cessation programmes instead of asthma rehabilitation programmes.