Alexithymia: a relevant psychological variable in near-fatal asthma

Abstract

Alexithymia is a psychological trait characterised by difficulty in perceiving and expressing emotions and body sensations. Failure to perceive dyspnoea could lead alexithymic asthmatics to underestimate the severity of an asthma exacerbation, and thereby increase the risk of developing a fatal or near-fatal asthma (NFA) attack. The objective of the present study was to determine the prevalence of alexithymia in NFA patients and to analyse their clinical characteristics.Alexithymia was assessed using the Toronto Alexithymia Scale in this multicentric prospective observational study. From 33 Spanish hospitals, 179 NFA patients and 40 non-NFA patients, as a control group, were enrolled.There was a higher proportion of alexithymia in the NFA group than in the non-NFA group (36 versus 13%). Patients with NFA and alexithymia were older than the rest of the NFA group, and had a lower level of education, a higher level of psychiatric morbidity, a higher proportion of severe persistent asthma and a greater number of prior very severe asthma exacerbations (49 versus 27%). Alexithymia, severe persistent asthma and a low level of education were identified as independent variables related to repeated very severe asthma exacerbations.The results show that alexithymia is more frequent in near-fatal asthma patients compared to the rest of asthmatics and is associated with recurrent very severe asthma exacerbations.

Global strategy for asthma management and prevention: GINA executive summary

“…These patients include those who: 1) have a history of near-fatal asthma requiring intubation and mechanical ventilation [323]; 2) have had a hospitalisation or emergency care visit for asthma in the previous year; 3) are currently using or have recently stopped using oral glucocorticosteroids; 4) are not currently using inhaled glucocorticosteroids [324]; 5) are overdependent on rapid-acting inhaled b 2 -agonists, especially those who use more than one canister of salbutamol (or equivalent) monthly [325]; 6) have a history of psychiatric disease or psychosocial problems [326], including the use of sedatives [327]; and 7) have a history of noncompliance with an asthma medication plan.…”

Alexithymia in Cancer Patients: Review of the Literature

“…Research suggests that alexithymia might play a role in the onset or development of several psychiatric and physical health problems such as substance abuse or pathological gambling [3,4,5], eating [6,7] and somatoform disorders [8,9], chronic pain [10], low back pain [11] or kidney failure [12], posttraumatic stress disorders [13,14] and stress-related disorders in general [15], asthma [16], myocardial infarction [17], inflammatory bowel disease [18], and also cancer [19]. Furthermore alexithymia is suspected to have an impact on treatment compliance and treatment outcome [20].…”

Management of acute asthma in adults in the emergency department: nonventilatory management

“…Psychosocial factors may be associated with poorly controlled and potentially fatal asthma. 36,37,46,68,69 Patients with a poor perception of dyspnea have been identified in some 62,64,79 but not all 27,36,63 studies of risk factors for potentially fatal asthma, but there is no simple, validated way to test for this factor in a primary care setting. 101 Failure of the treating physician to appreciate the severity of the acute asthma attack and to initiate appropriately aggressive therapy has also been shown to be a risk factor for a fatal outcome.…”

“…History of multiple visits to the emergency department for asthma 38,39,46 II-2 Failure to consult family physician for worsening asthma 27,29,40,42,47 II-2…”