The respiratory system is one of the most important body systems particularly from the viewpoint of occupational medicine because it is the major route of occupational exposure. In 2013, there were significant changes in the specific criteria for the recognition of occupational diseases, which were established by the Enforcement Decree of the Industrial Accident Compensation Insurance Act (IACIA). In this article, the authors deal with the former criteria, implications of the revision, and changes in the specific criteria in Korea by focusing on the 2013 amendment to the IACIA. Before the 2013 amendment to the IACIA, occupational respiratory disease was not a category because the previous criteria were based on specific hazardous agents and their health effects. Workers as well as clinicians were not familiar with the agent-based criteria. To improve these criteria, a system-based structure was added. Through these changes, in the current criteria, 33 types of agents and 11 types of respiratory diseases are listed under diseases of the respiratory system. In the current criteria, there are no concrete guidelines for evaluating work-relatedness, such as estimating the exposure level, latent period, and detailed examination methods. The results of further studies can support the formulation of detailed criteria.
Alveolitis, Extrinsic Allergic/economics/pathology ; Asbestosis/economics/pathology ; Asthma/economics/pathology ; Humans ; Lung Diseases/*economics ; Occupational Diseases/*economics ; Occupational Exposure ; Pneumoconiosis/economics/pathology ; Pulmonary Disease, Chronic Obstructive/economics/pathology ; Republic of Korea ; Workers' Compensation/*economics

PURPOSE: Allergic rhinitis (AR) is common among children with asthma and exacerbates asthma symptoms. To assess the incremental utilization and cost of asthma-related health services due to concomitant AR among asthmatic children. MATERIALS and METHODS: Asthma-related claims were extracted from the Korean National Health Insurance (NHI) claims database, which covers 97% of the population. Per-capita utilization and costs of asthma-related services were determined from the societal perspective. RESULTS: Of 319,714 children (1-14 years old) with chronic asthma in 2003, 195,026 had concomitant AR (prevalence 610 per 1,000 asthmatic children). Children with AR had 1.14 times more outpatient visits, 1.30 times more emergency department (ED) visits, and 1.49 times more hospitalizations than children without AR. More children with AR used general hospitals (7.17%) than children without AR (3.23%). The ratios of unit pharmaceutical costs per outpatient visit, ED visit, and admission between children with and without AR were 1.27, 1.20, and 1.14. Total annual expenditure combining direct health care, transportation, and caregivers' costs, were dollar 273 and dollar 217 for children with and without AR, respectively. CONCLUSION: Health service utilization and costs for asthma were greater for asthmatic children with AR. More frequent ED visits and admissions among asthmatic children with AR suggest poorer control and more frequent exacerbations. Higher unit cost of pharmaceuticals during visits, tendency to receive asthma care from a higher-level facility, and greater risk of ED visit or admission all contributed to the additional economic burden of AR.
Adolescent ; Asthma/*economics/*epidemiology ; Child ; Child, Preschool ; Female ; Health Services/economics/statistics & numerical data ; Humans ; Hypersensitivity/economics/epidemiology ; Infant ; Male ; Rhinitis/*economics/*epidemiology

OBJECTIVE: To investigate the cost-effectiveness of standardized specific immunotherapy (SIT) for allergic rhinitis patients accompanied with asthma (ARAS) in China. METHOD: Forty ARAS patients sensitized with house dust mite (HDM) were administered with SIT (SIT group) or merely medicine treatment (control group). Alutard dermatophagoides pteronyssinus vaccine from ALK company was used for immunotherapy. The usage of symptom control medicine was according to the ARIA and GINA guideline. Cost-effectiveness ratio (CER) and Incremental cost-effectiveness ratio(ICER) analysis was conducted. The effectiveness was measured in terms of symptom scores, quality of life, objective improvement of rhinitis and asthma. Sensitive analysis was conducted to verify the stability of the results. RESULT: The cost of SIT group for 1 year (6578 yuan) was higher than that of control group (1733.3 yuan), while the cost-effectiveness ratio and incremental cost-effectiveness ratio of SIT group were significant better than that of control group in all items. CER was 1686.7 yuan in SIT group compared with 3466.6 yuan in control group for nasal symptom scores, 4698.6 yuan in SIT group compared with 5777.8 yuan in control group for asthma symptom scores, 3462.1 yuan in SIT group compared with 8666.7 yuan in control group. The sensitive analysis of the price 10 percent higher or lower showed the same results. CONCLUSION The cost-effectiveness of specific immunotherapy (SIT) for mite sensitized ARAS patients was better than that of merely medicine treatment.
Adolescent ; Adult ; Asthma ; economics ; therapy ; Child ; Costs and Cost Analysis ; Female ; Humans ; Immunotherapy ; economics ; Male ; Rhinitis, Allergic ; Rhinitis, Allergic, Perennial ; economics ; therapy ; Young Adult

We sought to assess continuity of care for elderly patients in Korea and to examine any association between continuity of care and health outcomes (hospitalization, emergency department visits, health care costs). This was a retrospective cohort study using the Korea National Health Insurance Claims Database. Elderly people, 65-84 yr of age, who were first diagnosed with diabetes mellitus (n=268,220), hypertension (n=858,927), asthma (n=129,550), or chronic obstructive pulmonary disease (COPD, n=131,512) in 2002 were followed up for four years, until 2006. The mean of the Continuity of Care Index was 0.735 for hypertension, 0.709 for diabetes mellitus, 0.700 for COPD, and 0.663 for asthma. As continuity of care increased, in all four diseases, the risks of hospitalization and emergency department visits decreased, as did health care costs. In the Korean health care system, elderly patients with greater continuity of care with health care providers had lower risks of hospital and emergency department use and lower health care costs. In conclusion, policy makers need to develop and try actively the program to improve the continuity of care in elderly patients with chronic diseases.
Aged ; Aged, 80 and over ; Asthma/*economics ; Cohort Studies ; Continuity of Patient Care/*economics ; Costs and Cost Analysis ; Databases, Factual ; Diabetes Mellitus/*economics ; Emergency Service, Hospital/economics ; Female ; Hospitalization/economics ; Humans ; Hypertension/*economics ; Male ; National Health Programs ; Pulmonary Disease, Chronic Obstructive/*economics ; Republic of Korea ; Retrospective Studies ; Risk

PURPOSE: To estimate annual health care and productivity loss costs attributable to overweight or obesity in working asthmatic patients. MATERIALS AND METHODS: This study was conducted using the 2003–2013 Medical Expenditure Panel Survey (MEPS) in the United States. Patients aged 18 to 64 years with asthma were identified via self-reported diagnosis, a Clinical Classification Code of 128, or a ICD-9-CM code of 493.xx. All-cause health care costs were estimated using a generalized linear model with a log function and a gamma distribution. Productivity loss costs were estimated in relation to hourly wages and missed work days, and a two-part model was used to adjust for patients with zero costs. To estimate the costs attributable to overweight or obesity in asthma patients, costs were estimated by the recycled prediction method. RESULTS: Among 11670 working patients with a diagnosis of asthma, 4428 (35.2%) were obese and 3761 (33.0%) were overweight. The health care costs attributable to obesity and overweight in working asthma patients were estimated to be $878 [95% confidence interval (CI): $861–$895] and $257 (95% CI: $251–$262) per person per year, respectively, from 2003 to 2013. The productivity loss costs attributable to obesity and overweight among working asthma patients were $256 (95% CI: $253–$260) and $26 (95% CI: $26–$27) per person per year, respectively. CONCLUSION: Health care and productivity loss costs attributable to overweight and obesity in asthma patients are substantial. This study's results highlight the importance of effective public health and educational initiatives targeted at reducing overweight and obesity among patients with asthma, which may help lower the economic burden of asthma.
Adult ; Asthma/*economics/epidemiology/therapy ; *Cost of Illness ; *Efficiency ; *Employment ; Female ; *Health Care Costs ; Health Expenditures ; Humans ; Male ; Middle Aged ; Obesity/*economics/epidemiology/therapy ; Overweight/economics/epidemiology/therapy ; United States/epidemiology ; Young Adult

A systematic review of English and Korean articles published between 1990 and 2004 and a search of database and various online resources was conducted to determine the prevalences, mortality rates, socioeconomic burden, quality of life, and treatment pattern of asthma in Korean adults and children. Asthma morbidity and mortality in Korea are steadily increasing. The prevalence of asthma in Korea is estimated to be 3.9% and its severity is often underestimated by both physicians and patients. Mortality resulting from chronic lower respiratory diseases including asthma increased from 12.9 to 22.6 deaths per 100,000 of the population between 1992 and 2002. Disease severity, level of control, and symptom state were all found to negatively impact the quality of life of asthmatics. Although international and Korean asthma management guidelines are available, familiarity with and implementation of these guidelines by primary care physicians remain poor.
Risk Factors ; Quality of Life ; Practice Guidelines ; Korea/epidemiology ; Humans ; Costs and Cost Analysis ; Child ; *Asthma/economics/epidemiology/mortality/therapy ; Adult

OBJECTIVETo understand childhood asthma from age 0 to 14 in Kaifeng city and the relevant risk factors, effects of therapy and costs.

METHODSEleven thousand children aged 0 to 14 were chosen in Gulou area, Shunhe area using cluster sampling.

RESULTS(1) The overall prevalence of childhood asthma was 1.16% sex ratio 1.72:1. Significant difference was found among every age group (P < 0.001), with the highest from 0 to 3, the prevalence rate in industrial area was significantly higher than that of residential area, with a ratio of 2.13:1 (P < 0.001). (2) Major relevant factors were found to be: history of hypersensitivity, upper respiratory infection and family history; while nationalities, history of contact with pets were not found to be related to childhood asthma (P > 0.05). (3) The expenditure was significantly different between non-specific therapy and specified therapy (P < 0.001). Among those children with asthma, 89.8% did not get specified treatment and the average expenditure was 2,375.2 Yuan per year, which was 10.2% of accepted specified therapy, namely under GINA program, with average expenditure 653.68 Yuan every year.

CONCLUSIONThe result of this study provided scientific basis for child asthma prevention and cure in this area.

Adolescent ; Asthma ; economics ; epidemiology ; etiology ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Prevalence

OBJECTIVETo assess the efficacy of a nasally inhaled corticosteroid (ICS) through a spacer with mask aiming at simultaneous treatment of allergic rhinitis and asthma in children and make an analysis on the costs.

METHODA total of 72 children with allergic rhinitis (AR) and asthma were randomized into two groups. Experimental group received budesonide inhaler (400 microg/d) through the nose using a spacer attached to a face mask, control group children orally inhaled budesonide dry powder (400 microg/d) plus a nasal spray of budesonide aquae (256 microg/d).

RESULTThe patients were observed for 12 weeks. The symptom scores of rhinitis of both experimental group and control group declined (F=6.529 and 7.014, all P<0.01), symptom scores of asthma in both group were also reduced (F=4.132 and 4.950, P<0.01). The pulmonary function PEF (L/min) in both groups continuously increased (F=2.750 and 3.282, P<0.05). But the clinical scores, PEF value and FEV1 all did not differ between the two groups at admission or at nearly all follow-up visits (P>0.05 for all). The proportion of dry nose was lower in experimental group than in the control group (5.6% vs. 19.4%), but the difference was not statistically significant. The cost in the experimental group was lower than that in the control group (P<0.01).

CONCLUSIONNasal inhalation of ICS provides a therapeutic strategy for controlling AR and asthma in children, especially it result in higher compliance, lower costs, and fewer side effects.

Administration, Inhalation ; Asthma ; complications ; drug therapy ; Child ; Child, Preschool ; Costs and Cost Analysis ; Female ; Glucocorticoids ; administration & dosage ; economics ; therapeutic use ; Humans ; Male ; Masks ; Prospective Studies ; Rhinitis, Allergic, Perennial ; complications ; drug therapy