How to promote good work ability in patients with indoor air symptoms?

Introduction
Indoor air problems in work environment are associated with respiratory health effects and multiple non-specific symptoms. Symptoms are usually transient, but long-lasting symptoms and work limitation appear to be common in some individuals despite building repairs or change to an alternative work environment. The aim of the study was to characterize a group of patients with impaired work ability due to indoor air symptoms, and to develop strategies for occupational health professionals to support work ability.

Methods
We recruited participants to this study among patients that had been referred to the Finnish Institute of Occupational Health because of a suspected occupational disease (mainly occupational asthma) from moisture damaged workplaces. The inclusion criteria were: 1) self-assessed work ability 7 or less on a scale from zero to ten; 2) two or more weeks of sick leave due to indoor air symptoms during the past year. The intervention included clinical examinations, general information based on scientific knowledge, and psychological intervention using methods of cognitive and motivational psychology. We describe a case series of twelve patients.

Results
All the patients were female. Ten of twelve had a diagnosis of asthma. In spirometry, FEV1 was normal in all but two patients. Asthma was uncontrolled in one patient, partly controlled in five patients, and controlled in four patients. All the patients had concerns of a serious disease. In six of them the fears were considerable, at worst, fear of death.

Discussion
Considering environmental, individual and psychosocial factors, effective asthma and symptom management in addition to measures improving indoor air quality, are needed for promoting good work ability in these patients. Symptoms mimicking asthma may lead to overuse of asthma medication. To avoid catastrophic thinking, objective information and careful examinations are necessary. Psychological support may be beneficial, and could be given by occupational health professionals.