Systematic review: Chronic obstructive pulmonary disease and work-related outcomes

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Background Several studies have assessed the impact of chronic obstructive pulmonary disease (COPD) on work ability and work productivity, however this relationship is poorly understood.

Aims To undertake a systematic review to assess the effects of COPD on employment, absenteeism and presenteeism.

Methods A comprehensive search using CINAHL, Embase, MEDLINE and The Cochrane Library, was conducted to include epidemiological studies from 1937 to August 2017. One reviewer screened all citations. Shortlisted full-text articles were independently assessed by a second reviewer. Data were extracted by one reviewer with a random sample of papers (45%) checked by a second reviewer.

Results Forty-four studies were included; the majority of evidence was from cross-sectional studies, and some cohort studies. COPD patients had lower employment rates than those without COPD. Among those in work, most studies showed patients with COPD took more time off work than those without and reported poorer work performance (presenteeism), although evidence for this association was weaker. The influence of disease severity on these outcomes was unclear, however it appeared that increasing severity of airflow obstruction was associated with reduced likelihood of being employed. A number of methodological limitations were found amongst the evidence, including the lack of adjustment for important confounders.

Conclusions Future studies are required which assess the impact of COPD on presenteeism using validated presenteeism instruments and consistent reporting methods. Robust studies are now needed to identify modifiable factors associated with these poorer working outcomes to inform future interventions aimed at improving work productivity among those with COPD.
Original languageEnglish
JournalOccupational Medicine
Early online date8 Mar 2018
Publication statusE-pub ahead of print - 8 Mar 2018


  • Chronic obstructive pulmonary disease; absenteeism; sickness absence
  • systematic review
  • employment
  • work productivity
  • work performance
  • presenteeism


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