Influence of alexithymia on the management of Latin American patients with asthma: A cross-sectional study

Abstract

Objectives: In asthmatic patients, studies suggest that alexithymia leads to negative consequences and emotions that can affect physical, psychological, and social aspects of life. We designed this study to determine the frequency of alexithymia in Latin American patients with asthma, as well as to understand how this personality trait and each of its components interact with asthma severity and demographic variables, and their implications on treatment adherence and disease control under such setting. Methods: We conducted a cross-sectional study, involving 265 Latin American patients with asthma. Patient demographics and clinical characteristics were reported. The presence of alexithymia, asthma severity, and control, as well as treatment adherence, was analyzed. To assess the presence of alexithymia, the 20-item Toronto Alexithymia Scale was used. For the statistical analyses, we performed Kendall’s tau-b correlation coefficient, chi-square tests for association, and one-way analysis of variance. Results: A total of 265 patients participated in the study with a gender distribution of 69.4% female and an average age of 54.7 years. In total, 30.2% of individuals presented alexithymia. There was a statistically significant correlation between educational level and 20-item Toronto Alexithymia Scale categories ( p < .001), as well as a higher proportion of severe (35.1%, p = .001) and uncontrolled (50.0%, p = .185) asthma in patients with alexithymia. A higher proportion of patients with some level of non-adherence was seen on those with uncontrolled asthma (68.5%, p = .008). Conclusion: Our results suggest that in our sample, 3 in 10 Latin American asthma patients have alexithymia, and such mental condition is more common in those individuals with lower educational levels. Individuals with alexithymia present with severe asthma more frequently than do patients with possible or no alexithymia and are also more likely to have their disease uncontrolled.

Prevalence of and factors associated with alexithymia among patients with chronic obstructive pulmonary disease in China: a cross-sectional study

“…Men had more symptoms of alexithymia than women, which might be attributable to the women’s role of being more emotional and extroverted than men [ 32 , 33 ]. A higher TAS-20 score (> 60) was not only associated with a lower FEV 1 (%predicted) value, but related to the severity of the disease in our study, which was consistent with those in the literature [ 10 , 19 ]. Among patients with asthma, patients with alexithymia cannot perceive dyspnea in a time and clearly, which underestimates the severity of asthma deterioration and increases the risk of fatal or near-fatal asthma attack [ 10 ]; this disease also influences treatment effects [ 19 ].…”

“…A higher TAS-20 score (> 60) was not only associated with a lower FEV 1 (%predicted) value, but related to the severity of the disease in our study, which was consistent with those in the literature [ 10 , 19 ]. Among patients with asthma, patients with alexithymia cannot perceive dyspnea in a time and clearly, which underestimates the severity of asthma deterioration and increases the risk of fatal or near-fatal asthma attack [ 10 ]; this disease also influences treatment effects [ 19 ]. Therefore, patients with COPD and alexithymia may not be able to clearly and timely perceive their real condition; may underestimate the severity of the condition; and may be unwilling to seek medical treatment.…”

Alexithymia and asthma: a systematic review

“…All 26 studies presented participants suffering from asthma, leading to a total of 4,282 subjects. Fifteen studies included adults ( Feldman et al, 2002 ; Smyth et al, 2002 ; Vliet et al, 2002 ; Chugg et al, 2009 ; Vázquez et al, 2010a ; Vazquez et al, 2010b ; Baiardini et al, 2011 ; Barbosa et al, 2011 ; Martínez-Rivera et al, 2011 ; Innamorati et al, 2015 ; Khosravani et al, 2016 , 2020 ; Vanegas et al, 2020 ; Dafauce et al, 2021 ; Liotta et al, 2021 ) and eight also included adolescents ( Kleiger and Dirks, 1980 ; Kleiger and Jones, 1980 ; Dirks et al, 1981 ; Feiguine et al, 1982 ; Nielsen et al, 1997 ; Serrano et al, 2006 ; Amore et al, 2013 ; Ghorbani et al, 2017 ). Finally, three studies ( Brown et al, 1981 ; Plaza et al, 2006 ; Moes-Wójtowicz et al, 2012 ) did not provide clear data on the age range of participants.…”

“…Specifically, eight studies ( Brown et al, 1981 ; Feiguine et al, 1982 ; Nielsen et al, 1997 ; Feldman et al, 2002 ; Smyth et al, 2002 ; Vliet et al, 2002 ; Barbosa et al, 2011 ; Moes-Wójtowicz et al, 2012 ) selected subjects with asthma of varying degrees and did not report data on disease severity. Four studies ( Khosravani et al, 2016 ; Ghorbani et al, 2017 ; Khosravani et al, 2020 ; Vanegas et al, 2020 ) analyzed patients affected by chronic asthma, with severity ranging from mild to severe. Additionally, Martínez-Rivera et al (2011) included participants with intermittent asthma.…”

“…All studies used a standardized instrument to assess alexithymia. TAS-20 was used in more than half of the studies ( Smyth et al, 2002 ; Chugg et al, 2009 ; Vázquez et al, 2010a ; Vazquez et al, 2010b ; Baiardini et al, 2011 ; Barbosa et al, 2011 ; Martínez-Rivera et al, 2011 ; Amore et al, 2013 ; Innamorati et al, 2015 ; Khosravani et al, 2016 , 2020 ; Ghorbani et al, 2017 ; Vanegas et al, 2020 ; Dafauce et al, 2021 ; Liotta et al, 2021 ), followed by the previous 26-item version of the instrument ( Nielsen et al, 1997 ; Feldman et al, 2002 ; Vliet et al, 2002 ; Plaza et al, 2006 ; Serrano et al, 2006 ; Moes-Wójtowicz et al, 2012 ). Four studies ( Kleiger and Dirks, 1980 ; Brown et al, 1981 ; Dirks et al, 1981 ; Feiguine et al, 1982 ) measured alexithymia as a personality trait through the MMPI subscale.…”