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Published online before print March 29, 2006
Eur Respir J 2006, doi:10.1183/09031936.06.00008105
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ORIGINAL ARTICLE

Alexithymia: a relevant psychological variable in near-fatal asthma

J. Serrano 1*, V. Plaza 1, B. Sureda 2, J. de Pablo 2, C. Picado 3, S. Bardagí 4, J. Lamela 5, J. Sanchis 1, the Spanish High Risk Asthma Research Group* , *Spanish High Risk Asthma Research Group: J. Abad, J. Ancochea, J. Armengol, S. Bardagí, J. Barrio, J.M. Benítez, J. Botey, E. Chacón, N. Cobos, F.J. Cosano, A. de Diego, A. Escribano, J.B. Gáldiz, G. García-Hernandez., I. González-M, E.G. Pérez-Yarza, J.L. Heredia, J. Izquierdo, J. Korta, J. Lamela, A. López-Viña, P. Martín Escribano, J.J. Martín-Villasclaras, E. Martínez-Moragón, R. Melchor, J.M. Merino, J. de Pablo, M. Perpiñá, C. Pellicer, C. Picado, C. Planell, V. Plaza, J. Ramos, R. Sánchez-Gil, J. Sanchis, J. Serra, J. Serrano and B. Sureda , * * Scientific Committee: S. Bardagí, A. de Diego, E. González-PY, A. López-Viña, J. de Pablo, C. Picado, V. Plaza, J. Sanchis and J. Serrano

1 Departament de Pneumologia, Hospital de la Santa Creu i Sant Pau (Barcelona)
2 Servei de Psiquiatria
3 Servei de Pneumologia i Al.lergia Respiratòria del Hospital Clínic (Barcelona)
4 Hospital de Mataró (Barcelona)
5 Hospital Cristal-Piñor (Orense), Spain

* To whom correspondence should be addressed. E-mail: jserrano{at}separ.es.


  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. Our objective was to determine the prevalence of alexithymia in NFA patients and to analyse their clinical characteristics.

Alexithymia was assessed by the Toronto Alexithymia Scale (TAS-26) in this multicentre, prospective, observational study. From 33 Spanish hospitals, we enrolled 179 NFA patients and 40 non-NFA patients as control group.

There was a higher proportion of alexithymia in the NFA group than in the non-NFA group (36% vs 13%; p=0.004). Patients with NFA and alexithymia were older than the rest of NFA group, 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% vs 27%; p=0.003). 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 NFA patients compared with the rest of asthmatics and is associated with recurrent very severe asthma exacerbations.

Keywords:  Affective symptoms, asthma/psychology, near-fatal asthma, perceptual distortion, status asthmaticus




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