Working while unwell: Workplace impairment in people with severe asthma.

BACKGROUND: Severe asthma affects quality of life; however, its impact on workplace productivity is poorly understood. OBJECTIVE: To compare workplace productivity-absenteeism and presenteeism-and impairment in daily activities in severe and non-severe asthma over time and identify characteristics associated with presenteeism in severe asthma. METHODS: The Severe Asthma Web-based Database is an ongoing observational registry from Australia, New Zealand and Singapore. At April 2017, 434 patients with severe asthma and 102 with non-severe asthma were enrolled (18-88 years; 59% female). Participants provided comprehensive clinical and questionnaire data at baseline and were followed-up every 6 months for 24 months. Absenteeism (percentage of time not at work), presenteeism (self-reported impairment at work) and impairment in daily activities outside work due to health problems in the last week were calculated. RESULTS: At baseline, 61.4% of participants with severe asthma and 66.2% with non-severe asthma under 65 years were employed. At younger ages (30-50 years), fewer severe asthma participants were employed (69% vs 100%). Presenteeism and impairment in daily activity were more frequently reported in severe asthma and in participants with poorer asthma control, poorer lung function and more past-year exacerbations (P < .01). Over time, deteriorating asthma control was associated with increasing presenteeism. Although absenteeism was not different between severe and non-severe asthma, worse asthma control was associated with absenteeism (P < .001). In participants with severe asthma, presenteeism was reported more frequently in those with poorer asthma control, poorer asthma-related quality of life and symptoms of depression or anxiety (P < .01). CONCLUSION AND CLINICAL RELEVANCE: Severe asthma was associated with impairment at work and outside the workplace. Improving asthma control and mental health may be important targets for optimizing workplace productivity in severe asthma. Presenteeism and absenteeism may represent key metrics for assessing intervention efficacy in people with severe asthma of working age.

Echocardiographic and electrocardiographic findings in patients with obesity hypoventilation syndrome.

BACKGROUND: Obesity is a risk factor for both sleep-related breathing disorders (SRBD), including obesity hypoventilation syndrome (OHS) and cardiovascular diseases (CVD). The development of CVD in patients with SRBD is usually attributed to the fact that most patients are obese in addition to conventional cardiovascular risk factors. AIMS: This study aims to measure the prevalence of certain CVD in patients with OHS in the Auckland region and highlight the importance of the effects of SRBD on the heart. METHODS: A dataset of all patients with a formal diagnosis of OHS that were under active follow up was compiled from Auckland District Health Board Sleep Disordered Breathing Service. Clinical notes were retrospectively reviewed for echocardiogram reports, blood pressure measurements and electrocardiograms. RESULTS: Forty-seven patients were included in the present study. The median age was 60 years, 24 were female (51%), 20 (42.5%) had diabetes, mean HbA1C was 53.5 mmol/mol, mean systolic blood pressure was 127 mmHg, mean body mass index was 49 kg/m(2) , mean forced expiratory volume in 1 s was 1.7 L, mean estimated glomerular filtration was 71 mL/min/1.73 m(2) and there was anti-hypertensive use in 31 (65.9%) patients. Thirty-three patients had poor quality echocardiography views (70.2%). Left ventricular systolic and diastolic function was impaired in 8 (25%) and 18 (60%) respectively. Right ventricular dysfunction and pulmonary hypertension was present in 19 (63.3%) and 13 (52%) respectively. Sixteen patients (34%) had recurrent atrial or ventricular arrhythmias. CONCLUSION: There appears to be a high prevalence of right ventricular impairment, pulmonary hypertension, left ventricle hypertrophy, diastolic dysfunction and arrhythmias in patients with OHS. These findings would appear to be higher than expected in obese patients without OHS. A larger prospective matched cohort study would be needed to confirm the clinical significance of these findings.