'Stuck in catch-22': a qualitative study of perceived work ability and decision-making about employment in severe...

Severe asthma (SA) is characterised by persistent asthma symptomatology despite adherence to intensive treatment and control of asthma triggers. It is estimated that approximately 50% of individuals with SA have current employment, considerably less than rates in the general population. Poor physical and mental health status have been suggested as a potential explanation for this, but the relationship has not been investigated in depth. We investigated how bio-psycho-social and cultural factors influence work ability and employment in SA patients.

Participants were recruited from the Birmingham Regional NHS Severe Asthma Service via opportunity sampling, with the exclusion criteria being individuals who had never been employed, currently in full-time education, or non-English speakers. Subsequently, men and those with minority-ethnic backgrounds were purposefully selected to gain a balanced sample. Interviews were performed either face-to-face, online or via telephone, transcribed using software and edited manually. Data were analysed using Reflexive Thematic Analysis.

The study included 12 participants (9 females and 3 males). Four major themes were constructed: impact of patients' asthma control on work, psychological burden of living with SA, costs and benefits of being in employment, and adaptations and strategies for remaining in employment.

Our findings highlight the potential for physical, occupational, psychological, and social support to address the diverse job-related difficulties experienced by people with SA. Additionally, national policy reforms should be considered to improve work capacity and promote employment opportunities.