Impact of chronic obstructive pulmonary disease on work ability and employment: a systematic review

Background

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and may affect work ability and labour market participation. However, evidence on the impact of COPD on work-related outcomes remains heterogeneous and fragmented.

Methods

As part of the Joint Action on Respiratory Diseases-JARED, a systematic review was conducted according to a PROSPERO-registered protocol. PubMed, Embase, and Scopus were searched for studies published between January 2006 and January 2026. Eligible studies included working-age adults with COPD and reported work-related outcomes. Data were extracted independently and narratively synthesised. Risk of bias was assessed using the Joanna Briggs Institute tools.

Results

Eleven studies were included, with sample sizes ranging from 140 to 38.470 participants; most were cross-sectional, with two prospective cohort studies. COPD was consistently associated with reduced work ability and lower levels of work functioning. Results based on validated work ability measurement tools (e.g. WPAI, SPS-6, WRFQ) showed a negative impact on work productivity. Presenteeism reached up to 24%, while absenteeism ranged from a few days to several weeks per year, depending on the population and measurement approach. COPD was also associated with adverse employment outcomes, including job loss (up to 11%), work disability (up to 39%) and early exit from the workforce, affecting approximately 11% to 39% of workers across studies. Disease-related factors, particularly airflow limitation, dyspnoea, symptom burden and comorbidities, were consistently associated with poorer work-related outcomes.

Conclusions

COPD significantly impairs work ability and employment outcomes. Despite heterogeneity, studies consistently show negative effects across multiple work outcomes. Standardized measures and more longitudinal research are needed to better inform occupational health policies and support sustained work participation of individuals with COPD.

Key messages

• COPD reduces work ability and productivity, increasing presenteeism, absenteeism, and the risk of job loss and work disability.

• Disease severity, symptom burden, and comorbidities worsen work outcomes, highlighting the need for better clinical management and workplace support.