Alexithymia, the inability to recognize or describe one’s own emotions are among the psychological factors that can interfere with asthma management, according to a recent study. “Patients with asthma with alexithymia tend to perceive their disease as a cyclical disorder, not a chronic condition,” writes Marta Liotta, MD, and colleagues. “They have difficulty recognizing and communicating body sensations and emotional perceptions to others and underestimate both physical and emotional components of asthma exacerbations.” As a result, they add, patients with asthma with alexithymia have suboptimal control of asthma, increased risk for asthma exacerbations, and the potential to suffer more severe asthma attacks, including near-fatal asthma.

Although most patients with asthma can achieve symptom control with regular treatment, 5% to 10% suffer from severe allergic asthma (SAA) despite maximal pharmacologic therapy. However, the anti-IgE monoclonal antibody omalizumab has been shown to be an effective add-on treatment for SAA.

Alexithymia’s Effect on Treatment Effectiveness

For a paper published in the Asian Pacific Journal of Allergy and Immunology, Dr. Liotta and colleagues sought to evaluate if alexithymia influences the efficacy of omalizumab in patients with SAA. Data were collected from patients diagnosed with SAA after being referred to an asthma center during a 2-year treatment period with omalizumab.

Omalizumab treatment was prescribed according to patients’ total IgE levels and body weight every 2 or 4 weeks, with monthly doses ranging from 150-1,200 mg. Patients were evaluated before starting treatment with omalizumab (T0), after 1 year (T1), and at 2 years (T2). The researchers recorded the number of asthma exacerbations, and pulmonary function was evaluated with spirometry measuring the forced expiratory volume in 1 second % (FEV1%).

Patients’ asthma symptom control was assessed using the asthma control test (ACT), a five-item questionnaire about the impacts of asthma on home and work activities, shortness of breath, symptoms, rescue medication usage, and overall asthma control. QoL was measured by the standardized version of the asthma quality of life questionnaire (AQLQ), which consists of four domains (symptoms, activity limitation, emotional function, and environmental stimuli). The presence of alexithymia was measured by the total alexithymia score (TAS), a self-report scale that includes 20 items, rated using a five-point Likert scale. Group 1, with a TAS 20 of 61 or greater, consisted of patients with SAA with alexithymia, whereas Group 2, with a TAS 20 or 51 or lower, consisted of patients with asthma without alexithymia.

Patients Observed a Marked Improvement in Symptoms

the researchers observed that at T0, there were no differences in values of asthma exacerbations (Figure 1), ACT (Figure 2), FEV1%, and AQLQ scores related to symptoms, emotional function, and environmental stimuli. Instead, significantly lower AQLQ activity limitation scores were recorded in Group 1 patients with alexithymia compared with those in Group 2. Furthermore, Group 1 patients had a statistically significant decrease between T0 and T2 in the number of asthma exacerbations, while ACT and AQLQ scores related to symptoms, activity limitation, emotional function, and environmental stimuli increased significantly.

“Regardless of whether alexithymia was present or not, all patients with SAA obtained a marked improvement after starting treatment with omalizumab” concluded Dr. Liotta and colleagues. “Therefore, alexithymia does not seem to influence the treatment outcome of omalizumab.”

Previous studies on patients with alexithymia suffering from other chronic diseases report that the improvement of alexithymia after psychotherapeutic interventions seems to influence the clinical course of the underlying disease, the researchers noted. “It would, therefore, be interesting to evaluate whether the introduction of psychotherapeutic treatment in the management of patients with asthma with alexithymia could further improve the pharmacologically induced control of asthma,” they wrote.