Pitfalls in Respiratory Allergy Management: Alexithymia and Its Impact on Patient-Reported Outcomes

Abstract

Objectives. Alexithymia is a personality trait characterized by a limited ability to identify and express emotions and it represents a possible risk factor for disease development and management. The objective of the study is to evaluate alexithymia in patients with persistent asthma and comorbid rhinitis and its relation with patient-reported outcomes (PROs). Methods. Alexithymia, quality of life, illness perception, and stress were assessed, as well as rhinitis symptoms and asthma control in out-patients classified according to GINA and ARIA guidelines. Results. Out of 115 patients, 19% turned out to be alexithymic (TAS-20 ≥ 61). Concerning alexithymia level, no difference was detected between males and females (χ² = 0.317) and among GINA levels (χ² = 0.22). Alexithymics had significantly lower Asthma Control Test scores when compared with non-alexithymics (15.86 vs. 19; p = .02). Alexithymics had a worse quality of life (p< .001) and, concerning illness perception, they ascribed to respiratory allergy symptoms that are not strictly disease related and referred to asthma and rhinitis more serious negative consequences (p < .001) and emotional representations (p < .035). Moreover, they had lower illness coherence (p < .001) and lived their disease as a cyclical rather than a chronic disorder (p < .035). As regards stress, alexithymics reported less energy (p < .001), higher levels of tension (p < .001), depression (p < .001), confusion (p > .001), and inertia (p < .001). Conclusion. Alexithymia is present in a relevant percentage of subjects and, as it can modulate illness perception, quality of life, and stress, it should be considered in disease management.

• alexithymia
• asthma
• patient-reported outcomes
• rhinitis

Acknowledgments

Authors thank ARMIA (Associazione Ricerca Malattie Immunologiche e Allergiche) and ASPADIRES (Associazione Disturbi Respiratori nel Sonno).

Authors acknowledge Dr Marianna Bruzzone and Dr Patricia Gennari for linguistic assistance with the manuscript.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.