Factsheet – Fluctuating and recurring conditions

Factsheet – Fluctuating and recurring conditions

This resource is part of our Disability Essentials range. You can find the other free resources that are included in this range by clicking here.

What does ‘fluctuating’ mean?

Fluctuating and recurring conditions are not specific ‘conditions’; instead, they are features of some health conditions and disabilities.

A fluctuating condition is one that is always present but will vary in severity, the frequency of flare-ups, and sometimes the symptoms. Examples include conditions such as asthma, which will result in an ebb and flow of symptoms even with excellent medical and self-management. The skin condition psoriasis is another example.

The diagnostic label makes it easier for a clinician to advise if a condition is likely to be a fluctuating one. Using the example of asthma again, we can predict that people with asthma will usually experience flare-ups with specific triggers such as allergens and respiratory infections.

What does ‘recurring’ mean?

A recurring condition can be absent for long periods of time, but will return periodically due to an increased sensitivity to specific triggers. For example, a person may experience episodes of depression throughout their life with long periods between episodes where they are not taking medication or require any adjustments.

It is usually impossible to predict whether a condition will be a recurring one or not for an individual during the first episode. For example, some people may experience depression once in their lives, whereas others may experience it frequently over several years.

What conditions can be fluctuating or recurring?

There is no definitive list but below are some common examples of conditions seen in the workplace which can fluctuate or recur:

• systemic lupus erythematosus (SLE)
• diabetes
• arthritis
• multiple sclerosis (MS) and other neurodegenerative conditions
• chronic fatigue
• inflammatory bowel disease
• skin conditions such as psoriasis
• sickle cell disease
• conditions affecting mental health – for example depression and bipolar disorder
• asthma and other respiratory conditions
• migraines
• recurrent infections – for example, ear infections.

Impact on the individual

The impact on a specific individual will depend on what fluctuating or recurring conditions they have.

However, there are some common impacts that fluctuating and recurring conditions can have.

• Planning ahead – A person may find it hard to predict when a flare-up of their condition will occur, particularly if it is a condition they have recently acquired. This can make it hard to plan ahead or mean that they need to cancel or alter plans at short notice.
• Mental health – they may find that other people don’t understand their condition, and perhaps feel blamed or disbelieved when they have a flare-up. For example, if someone is having a flare-up, some people around them may not understand why they are temporarily unable to do something they usually can do.
• Avoiding triggers – Someone with a fluctuating or recurring condition may need to avoid specific triggers that can cause their condition to flare up. For example, someone with asthma may need to avoid polluted environments or aerosols, and someone with a mental health condition may need to avoid excessive stress.
• Treatments – They may need to take medication, treatments or therapies, which can mean scheduling specific times or days when they will be temporarily unavailable while they do this. Alternatively, they may need to monitor their health to determine whether they need to take some medication to avoid or mitigate against a flare-up of their condition. For example, someone with diabetes may need to check their blood sugar levels at different times.
• Side effects – If they need to take medication, they may also need to manage the side effects of their medication.

Flare-ups and increased severity of symptoms can often be challenging to predict. They can occur rapidly and with no warning, even the best proactive preventative measures in place. In addition, a person may feel that others will blame them and believe that they are not taking responsibility for managing their condition better, despite evidence to the contrary.

Impact on work

Many people with fluctuating and recurring conditions are able to manage their conditions themselves without an impact on their work.

However, fluctuating and recurring conditions can impact work. Employees may need new adjustments to enable them to attend work and perform their usual role. In some cases, the person may need to take time off for treatment and recovery.

The often unpredictable nature of a person’s condition may also affect how they

• meet their work requirements
• organise their workload
• plan at an individual or team level.

Someone with a fluctuating or recurring condition may find it harder or even be unable to perform some parts of their role during a flare-up.

They may ask for adjustments at an early stage, and these requests should be addressed promptly. Early action may prevent severe flare-ups and allow the person to remain at work and function well. In addition, sometimes flare-ups will happen with no warning, so keeping previously agreed adjustments in place can help the individual and the manager.

Legal duties

The Equality Act 2010

In the UK, employers have duties to:

• prevent discrimination, and
• provide reasonable adjustments

for their disabled employees. This means that it is unlawful for employers to treat applicants, job candidates and employees unfavourably because of their disability.

The Equality Act also requires employers to make ‘reasonable adjustments’ for their disabled employees.

Workplace adjustments

Nobody with a fluctuating or recurring condition wants a flare-up; it is unpleasant at best and maybe even life-threatening in some cases. The individual will be keen to put measures in place to avoid or reduce the risk of triggering or exacerbating a flare-up.

Where it is likely that the person will experience flare-ups, factoring this into adjustments can be beneficial. Recognising and planning for flare-ups in advance is helpful for managers and individuals. Knowing a plan can be implemented quickly reduces the fears that often accompanies fluctuating and recurring conditions.

There may be long periods when a person has no symptoms of fluctuating or recurring conditions. Unfortunately, it can be tempting for both the individual and managers to assume that this will continue and adjustments are permanently removed.

Equally, there may be times when the opposite is true, and there are periods of frequent flare-ups, some of which may last many months. These periods can adversely affect a person’s physical and mental health, including self-confidence and self-esteem. They may feel angry, frustrated, exhausted, worried, unwell and be in pain.

The unpredictability of fluctuating and recurring conditions may mean that many adjustments are not required for lengthy periods. Unfortunately, this often leads to the permanent removal of these extra adjustments. This should be avoided. The ‘just-in-case’ adjustments are like having an insurance policy; you have the reassurance that it is there for when or if you need to use it.

Suggested adjustments

Some of the measures the person may request and benefit from include:

• flexible working – location, adjusted hours, flexible start and finish
• time off for treatment and related appointments
• adjusted work tasks – for example, reducing the physical demand of a role and being able to quickly access toilet facilities during a flare-up of inflammatory bowel disease.
• parking near the entrance to the building they work in
• reducing business travel to reduce fatigue
• temporarily or permanently switching to day shift if normally on a rotating shift pattern
• graded return to full duties as able
• regular review of any adjustments to see if they are helpful.

Further information

Business Disability Forum has resources available on many specific conditions, which can be fluctuating or recurring. We also have resources on energy limiting conditions and chronic pain, which are common symptoms of fluctuating and recurring conditions.

For more information on suggested adjustments, specific barriers for fluctuating and recurring conditions and information about the law, please see our other resources in the Knowledge Hub.

For more detailed information and advice about a specific situation, contact the Advice Service:

• Tel:+44-20-7403-3020
• Textphone: +44-20-7403-0040
• Email: advice@businessdisabilityforum.org.uk