Psycho-demographic profile in severe asthma and effect of emotional mood disorders and hyperventilation syndrome on quality of life

Lucía Dafauce, David Romero, Carlos Carpio, Paula Barga, Santiago Quirce, Carlos Villasante, María Fe Bravo, Rodolfo Álvarez-Sala, Lucía Dafauce, David Romero, Carlos Carpio, Paula Barga, Santiago Quirce, Carlos Villasante, María Fe Bravo, Rodolfo Álvarez-Sala

Abstract

Background: Severe asthma affects a small population but carries a high psychopathological risk. Therefore, the psychodemographic profile of these patients is of interest. A substantial prevalence of anxiety, depression, alexithymia and hyperventilation syndrome in severe asthma is known, but contradictory results have been observed. These factors can also affect patients' quality of life. For this reasons, our purpose is to evaluate the psychodemographic profile of patients with severe asthma and assess the prevalence of anxiety, depression, alexithymia and hyperventilation syndrome and their impact on the quality of life of patients with severe asthma.

Methods: A cross-sectional study of 63 patients with severe asthma. Their psychodemographic profile was evaluated using the Hospital Anxiety and Depression Scale (HADS), Toronto Alexithymia Scale (TAS-20), Nijmegen questionnaire and Asthma Control Test (ACT) to determine the state of anxiety and depression, alexithymia, hyperventilation syndrome and control of asthma, respectively. Quality of life was assessed with the Mini Asthma Quality of Life Questionnaire (Mini-AQLQ).

Results: The mean age was 60 ± 13.6 years. Personal psychopathological histories were found in 65.1% of participants, and 8% reported previous suicidal attempts. The rate of anxiety and/or depression (HADS ≥ 11) was 68.3%. These patients present higher scores on the TAS-20 (p < 0.001) for the level of dyspnea (p = 0.021), and for emotional function (p = 0.017) on the Mini-AQLQ, compared with patients without anxiety or depression. Alexithymia (TAS-20 ≥ 61) was observed in 42.9% of patients; these patients were older (p = 0.037) and had a higher HADS score (p = 0.019) than patients with asthma without alexithymia. On the other hand, patients with hyperventilation syndrome (Nijmegen ≥ 23) scored higher on the HADS (p < 0.05), on the Mini-AQLQ (p = 0.002) and on the TAS-20 (p = 0.044) than the group without hyperventilation syndrome. Quality of life was related to anxiety-depression symptomatology (r = - 0.302; p = 0.016) and alexithymia (r = - 0.264; p = 0.036). Finally, the Mini-AQLQ total score was associated with the Nijmegen questionnaire total score (r = - 0.317; p = 0.011), and the activity limitation domain of the Mini-AQLQ correlated with the ACT total score (r = 0.288; p = 0.022).

Conclusions: The rate of anxiety, depression, alexithymia and hyperventilation syndrome is high in patients with severe asthma. Each of these factors is associated with a poor quality of life.

Keywords: Alexithymia; Anxiety; Asthma; Depression; Hyperventilation syndrome; Quality of life.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Correlation between anxiety and depression, as evaluated with the Hospital Anxiety and Depression Scale and quality of life as evaluated with the Mini-Asthma Quality of Life Questionnaire. HADS Hospital Anxiety and Depression Scale, Mini-AQLQ Reduced version of the Asthma Quality of Life Questionnaire
Fig. 2
Fig. 2
Correlation between alexithymia, as evaluated with the Toronto Alexithymia Scale, and quality of life as evaluated with the Mini- Asthma Quality of Life Questionnaire. Mini-AQLQ Reduced version of the Asthma Quality of Life Questionnaire, TAS-20 Toronto Alexithymia Scale

References

    1. Spanish Guideline on the Management of Asthma. GEMA 5.0, 2019. .
    1. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2020. .
    1. Álvarez FJ, Blanco-Aparicio M, Plaza V, Cisneros C, Domingo C, García-Rivero JL, et al. Guidelines Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) Monogr Arch Bronconeumol. 2018;5:00158.
    1. Cisneros C, Melero C, Almonacid C, Perpiñá-Tordera M, Picado C, Martínez-Moragón E, et al. Guidelines for severe uncontrolled asthma. Arch Bronconeumol. 2015;51(5):235–246. doi: 10.1016/j.arbres.2014.12.007.
    1. SEPAR. La comorbilidad en el asma. En Martinez-Moragón E, editor. La comorbilidad en el asma. Madrid: Respira; 2015. p. 97–109.
    1. Sastre J, Crespo A, Fernandez-Sanchez A, Rial M, Plaza V, González FC, et al. Anxiety, depression, and asthma control: changes after standardized treatment. J Allergy Clin Immunol Pract. 2018;6(6):1953–1959. doi: 10.1016/j.jaip.2018.02.002.
    1. Álvarez FJ, Ruiz A, Romero A, Paredes AP, Ferrer M, Medina JF. Analysis of psychological factors in patients with severe asthma (PSICOASMA study) Rev Esp Patol Torac. 2018;30(3):163–169.
    1. Adewuya AO, Adeyeye OO. Anxiety and depression among Nigerian patients with asthma; association with sociodemographic, clinical, and personality factors. J asthma. 2017;54(3):286–293. doi: 10.1080/02770903.2016.1208224.
    1. Akçakaya N, Aydogğan M, Hassanzadeh A, Camciogğlu Y, Çokugğras H. Psychological problems in Turkish asthmatic children and their families. Allergol Immunopathol. 2003;31(5):282–287. doi: 10.1016/S0301-0546(03)79197-6.
    1. Ritz T, Wittchen HU, Klotsche J, Mühlig S, Riedel O. Asthma trigger reports are associated with low quality of life, exacerbations, and emergency treatments. Ann Am Thorac Soc. 2016;13(2):204–211. doi: 10.1513/AnnalsATS.201506-390OC.
    1. Lomper K, Chudiak A, Uchmanowicz I, Rosińczuk J, Jankowska-Polanska B. Effects of depression and anxiety on asthma-related quality of life. Pneumonol Alergol Pol. 2016;84(4):212–221. doi: 10.5603/PiAP.2016.0026.
    1. Schatz M, Zeiger RS, Mosen D, Vollmer WM. Asthma-specific quality of life and subsequent asthma emergency hospital care. Am J Manag Care. 2008;14(4):206–211.
    1. Lavoie KL, Bacon SL, Barone S, Cartier A, Ditto B, Labrecque M. What is worse for asthma control and quality of life: depressive disorders, anxiety disorders, or both? Chest. 2006;130(4):1039–1047. doi: 10.1378/CHEST.130.4.1039.
    1. Martínez-Rivera C, Vennera MC, Cañete C, Bardagí S, Picado C. Psychological profile of patients with bronchial asthma and functional dyspnea: a comparison with a non-asthmatic population and impact on the disease. Arch Bronconeumol. 2011;47(2):73–78. doi: 10.1016/j.arbres.2010.10.003.
    1. Martínez-Moragón E, Belloch A, Perpiñá M, De Diego A, Martínez-Francés ME. Perception of improvement in asthma patients. Arch Bronconeumol. 2002;38(10):468–472. doi: 10.1016/S0300-2896(02)75267-8.
    1. Montalbano L, Ferrante G, Montella S, Cillufo G, Di Marco A, Bozzetto S, et al. Relationship between quality of life and behavioural disorders in children with persistent asthma: a multiple indicators multiple causes (MIMIC) model. Sci Rep. 2020;10(1):1–9. doi: 10.1038/s41598-020-62264-9.
    1. Gada E, Khan DA, DeFina LF, Brown ES. The relationship between asthma and self-reported anxiety in a predominantly healthy adult population. Ann Allergy Asthma Immunol. 2014;112(4):329–332. doi: 10.1016/j.anai.2013.08.027.
    1. Baeza C, Bulbena A, Fenetrier C, Gély-Nargeot MC. Psychosomatic disorders and their relationship with alexithymia, anxiety, depression and seeking for psychological help. Psicol Salud. 2011;21(2):227–237. doi: 10.25009/pys.v21i2.575.
    1. Sifneos P. The prevalence of ‘Alexithymic’ characteristics in psychosomatic patients. Psychother Psychosom. 1973;22(6):255–262. doi: 10.1159/000286529.
    1. Serrano J, Plaza V, Sureda B, De Pablo J, Picado C, Bardagí S, et al. Alexithymia: a relevant psychological variable in near-fatal asthma. Eur Respir J. 2006;28(2):296–302. doi: 10.1183/09031936.06.00008105.
    1. Plaza V, Giner J, Picado C, Sureda B, Serrano J, Casan P. Control of ventilation, perception of dyspnea and alexithymia in almost fatal asthma. J Asthma. 2006;43(8):639–644. doi: 10.1080/02770900600878990.
    1. Chugg K, Barton C, Antic R, Crockett A. The impact of alexithymia on asthma patient management and communication with health care providers: a pilot study. J Asthma. 2009;46(2):126–129. doi: 10.1080/02770900802468525.
    1. Rodríguez C, Cebrià J, Corbella S, Segura J, Sobreques J. Personality trait and psychic discomfort associated with frequent attendance in Primary Health Care. Medifam. 2003;143(3):143–150. doi: 10.4321/S1131-57682003000300003.
    1. Axelsson M, Emilsson M, Brink E, Lundgren J, Torén K, Lötvall J, et al. Personality, adherence, asthma control and health-related quality of life in young adult asthmatics. Respir Med. 2009;103(7):1033–1040. doi: 10.1016/J.RMED.2009.01.013.
    1. Vázquez I, Sández E, Gonzalez-Freire B, Romero-Frais E, Blanco-Aparicio M, Verea-Hernando H. The role of alexithymia in quality of life and health care use in asthma. J Asthma. 2010;47(7):797–804. doi: 10.3109/02770900903560217.
    1. Van Dixhoorn J. Hyperventilation and dysfunctional breathing. Biol Psychol. 1997;46:90–91.
    1. World Medical Association World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2091–2094. doi: 10.1001/jama.2013.281053.
    1. Sheehan D, Lecrubier Y, Harnett-Sheehan K, Janavs J, Weiller E, Keskiner A, et al. Reliability and validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. Eur Psychiat. 1997;12(5):232–241. doi: 10.1016/S0924-9338(97)83297-X.
    1. Ferrando L, Bobes J, Gibert M, Soto M, Soto O. M.I.N.I. Mini International Neuropsychiatric Interview. Versión en español 5.0.0. DSM-IV. Madrid: 1999.
    1. Juniper EF, Guyatt GH, Cox FM, Ferrie PJ, King DR. Development and validation of the Mini Asthma Quality of Life Questionnaire. Eur Respir J. 1999;14(1):32–38. doi: 10.1034/j.1399-3003.1999.14a08.x.
    1. Sanjuàs C, Alonso J, Sanchís J, Casan P, Broquetas JM, Ferrie PJ, et al. A mesure of quality of life for asthma patients: The Spanish version of the Asthma Quality of Life Questionnaire. Arch Bronconeumol. 1995;31(5):219–226. doi: 10.1016/S0300-2896(15)30927-3.
    1. Bateman E, Esser D, Chirila C, Fernandez M, Fowler A, Moroni-Zentgraf P, et al. Magnitude of effect of asthma treatments on asthma quality of life questionnaire and asthma control questionnaire scores: systematic review and network meta-analysis. J Allergy Clin Immunol. 2015;136(4):914–922. doi: 10.1016/j.jaci.2015.03.023.
    1. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Tejero A, Guimerá E, Farré J, Peri J. Uso clínico del HAD (Hospital Anxiety and Depression Scale) en población psiquiátrica: un estudio de su sensibilidad, fiabilidad y validez. Revista del Departamento de Psiquiatría de la Facultad de Medicina de Barcelona. 1986;13:233–238.
    1. Taylor G, Ryan D, Bagby M. Toward the development of a new self-report alexithymia scale. Psychother Psychosom. 1985;44(4):193–199. doi: 10.1159/000287912.
    1. Parker J, Bagby RM, Taylor G, Endler N, Schmiyz P. Factorial validity of the 20-item Toronto Alexithymia Scale. Eur J Pers. 1993;7(4):221–232. doi: 10.1002/per.2410070403.
    1. Martínez-Sánchez F. The Spanish version of the Toronto Alexithymia Scale (TAS-20) Clin Salud. 1996;7(1):19–32.
    1. Van Dixhoorn J, Duivenvoorden HJ. Efficacy of Nijmegen Questionnaire in recognition of the hyperventilation syndrome. J Psychosom Res. 1985;29(2):199–206. doi: 10.1016/0022-3999(85)90042-X.
    1. Martínez-Moragón E, Perpiñá M, Belloch A, De Diego A. Prevalence of hyperventilation syndrome in patients treated for asthma in a pulmonology clinic. Arch Bronconeumol. 2005;41(5):239–296. doi: 10.1157/13074593.
    1. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, Murray J, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004;113(1):59–65. doi: 10.1016/j.jaci.2003.09.008.
    1. Vega JM, Badia X, Badiola C, López-Viña A, Olaguíbel JM, Picado C, et al. Validation of the Spanish version of the Asthma Control Test (ACT) J Asthma. 2007;44(10):867–872. doi: 10.1080/02770900701752615.
    1. Kolawole MS, Olayemi AF, Gregory EE, Abiodun AO, Daniel OO, Bamidele AO. Health related quality of life and psychological variables among a sample of asthmatics in Ile-Ife South-Western Nigeria. Libyan J Med. 2011;6(5846):1–5. doi: 10.3402/ljm.v6i0.5846.
    1. Montalbano L, Ferrante G, Cilluffo G, Gentile M, Arrigo M, La Guardia D, et al. Targeting quality of life in asthmatic children: the MyTEP pilot randomized trial. Respir Med. 2019;2019(153):14–19. doi: 10.1016/j.rmed.2019.05.008.
    1. Ponce C, Jardines G, Rodríguez O. Alexitimia in patients with bronchial asthma treated in the allergy service of Previsora, Camagüey. Cuba Arch Alergia Inmunol Clin. 2017;48(1):26–30.
    1. Wilson SR, Rand CS, Cabana MD, Foggs MB, Halterman JS, Olson L, et al. Asthma outcomes: quality of life. J Allergy Clin Inmunol. 2012;129(3):S88–123. doi: 10.1016/j.jaci.2011.12.988.
    1. Oǧuztürk Ö, Ekici A, Kara M, Ekici M, Arslan M, Iteginli A, et al. Psychological status and quality of life in elderly patients with asthma. Psychosomatics. 2005;46(1):41–46. doi: 10.1176/appi.psy.46.1.41.
    1. Adeyeye OO, Adewumi TA, Adewuya AO. Effect of psychological and other factors on quality of life amongst asthma outpatients in Lagos. Nigeria Respir Med. 2017;2017(122):67–70. doi: 10.1016/j.rmed.2016.12.002.
    1. Arancibia M, Behar A. Alexithymia and depression: evidence, controversies and implications. Rev Chil Neuro-Psiquiat. 2015;53(1):24–34. doi: 10.4067/s0717-92272015000100004.
    1. Ahmedani BK, Peterson EL, Wells KE, Williams LK. Examining the relationship between depression and asthma exacerbations in a prospective follow-up study. Psychosom Med. 2013;75(3):305–310. doi: 10.1097/PSY.0b013e3182864ee3.
    1. Lehto K, Pedersen N, Almqvist C, Lu Y, Brew B. Asthma and affective traits in adults: a genetically informative study. Eur Respir J. 2019;53(5):1802142. doi: 10.1183/13993003.02142-2018.
    1. Calvo E, Trigueros JA, López A, Sánchez G. Asthma control in patients attending primary care in Spain (Actis study) Aten Prim. 2017;49(10):586–592. doi: 10.1016/j.aprim.2016.12.005.
    1. Chung JH, Sun-Hyun K, Won LY. Suicidal ideation and suicide attempts among asthma. Ann Gen Psychiatry. 2016;15(35):1–6. doi: 10.1186/s12991-016-0122-2.
    1. Clarke DE, Goodwin RD, Messias EL, Eaton WW. Asthma and suicidal ideation with and without suicide attempts among adults in the United States: what is the role of cigarette smoking and mental disorders? Ann Allergy Asthma Immunol. 2008;100(5):439–446. doi: 10.1016/S1081-1206(10)60468-1.
    1. Innamorati M, Chetta A, Antonucci C, Bettini E, Aiello M, Montali A, et al. Alexithymia and self-reflectiveness in bronchial asthma. Riv Psichiatr. 2015;50(5):245–252. doi: 10.1708/2040.22168.
    1. Behmanesh F, Moharreri F, Soltanifar A, Hamzeh M, Heidari E. Evaluation of anxiety and depression in mothers of children with asthma. Electron Physician. 2017;9(12):6058–6062. doi: 10.19082/6058.
    1. Wamboldt MZ, Weintraub P, Krafchick D, Wamboldt F. Psychiatric family history in adolescents with severe asthma. J Am Acad Child Adolesc Psychiatry. 1996;35(8):1042–1049. doi: 10.1097/00004583-199608000-00015.
    1. Potoczek A, Nizankowska-Mogilnicka E, Bochenek G, Szczeklik A. Difficult asthma and gender of patients versus the presence of profound psychological trauma. Psychiatr Pol. 2006;40(6):1081–1096.
    1. Campbell DA, Yellowlees PM, McLennan G, Coates JR, Frith PA, Gluyas PA, et al. Psychiatric and medical features of near fatal asthma. Thorax. 1995;50(3):254–259. doi: 10.1136/thx.50.3.254.
    1. Belloch A. Problemas psicológicos y asma. Rev Asma. 2018;3(3):75–81.
    1. Jauregui I, Tejedor MA. Asthma and psychosocial factors. Alergol Inmunol Clin. 2004;19(3):101–109.
    1. Lavoie KL, Bouthillier D, Bacon SL, Lemière C, Martin J, Hamid Q, et al. Psychologic distress and maladaptive coping styles in patients with severe vs moderate asthma. Chest. 2010;137(6):1324–1331. doi: 10.1378/chest.09-1979.
    1. Valença AM, Falcão R, Freire RC, Nascimento I, Nascentes R, Zin WA, et al. The relationship between the severity of asthma and comorbidites with anxiety and depressive disorders. Braz J Psyquiatry. 2006;28(3):206–208. doi: 10.1590/S1516-44462006005000005.

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