Respiratory disability: what is it, how can we measure it, what causes it and is it important?

Respiratory disability is a significant health outcome that has important implications both for the individual patient and for society. First, “disability” represents the actual impact of the disease on the patient’s life. While “impairment” (eg, loss of 200 ml forced expiratory volume in 1 s (FEV₁)) is an abstract concept, patients are directly impacted by the ability to work or care for themselves (ie, respiratory disability). Second, functional status as manifested by respiratory disability is an integrated measure of health status and can be an effective indicator of response to treatment. Third, by working together, physicians, patients and employers may institute specific interventions to ameliorate respiratory disability. Fourth, in aggregate, disability for work due to respiratory disease has significant societal impact on overall work productivity of a society. Fifth, estimates of disease burden or years of life saved by medical interventions are commonly adjusted for the degree of disability using disability-adjusted life years.1 Finally, in many countries, regulations specify methods of evaluating the magnitude of respiratory disability for determining financial payments to patients, whether or not the underlying respiratory illness was or was not actually caused by work.

This issue contains an important report by Torén et al2 in which they showed that respiratory disability was frequent and identified several broad categories of occupational exposures (eg, dust, gas, fumes) as causes of respiratory disability (see page 339). They defined “respiratory disability” based on self-reported change in job location or job activities because of respiratory illness. Their large community-based samples and sophisticated analysis showed that certain job characteristics were significantly associated with respiratory disability. …