Misdiagnosis of Asthma in Patients with Anxiety/Depression

Year 2023, , 183 - 188, 01.11.2023

Barış Çil , Mehmet Kabak

https://doi.org/10.38175/phnx.1304577

Abstract

Objective: Anxiety/depression may lead to misdiagnosis of asthma if respiratory symptoms are prominent. In this study, we aimed to evaluate misdiagnosis due to anxiety and depression among patients diagnosed with asthma.
Material and Methods: This prospective study included patients who were previously diagnosed with asthma and evaluated by a psychiatrist through the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). The patients were divided into two groups in terms of their BDI/BAI status as positive (mild, moderate or severe category) or negative (normal category). The groups were compared in terms of clinical characteristics, pulmonary function tests, asthma control tests (ACT), and atopy parameters.
Results: We identified 54 patients (32.7%) in BDI/BAI(+) group. Compared to that in BDI/BAI(+) group, patients in the BDI/BAI(-) group were more likely to have family history of asthma (37.0% vs. 65.7%, p<0.001). The mean ACT score in the BDI/BAI(+) group was significantly lower than that in the BDI/BAI(-) group (15.9 vs. 19.3, respectively, p<0.001). Significantly less patients in BDI/BAI(+) group had evidence of obstruction (14.8%) and reversibility (14.8%) compared to those in BDI/BAI(-) group (57.7% and 54.1%, respectively; p<0.001 for each). While total IgE and ACT were the tools with highest sensitivity (72% and 70%, respectively), skin prick test had the highest specificity (92%). Obstruction (88%) and reversibility (88%) had the highest positive predictive values.
Conclusion: The presence of dyspnea on the basis of asthma diagnosis may lead to misdiagnosis in some patients, especially in individuals with anxiety/depression. The history of patients presenting dyspnea symptoms should be taken carefully and examined in detail by spirometric and laboratory workup.

Keywords

misdiagnosis of asthma, anxiety, depression, dyspnea, pulmonary function test

Anksiyete/Depresyon Hastalarında Yanlış Astım Tanısı

Abstract

Amaç: Anksiyete/depresyon, solunum semptomlarının ön planda olması durumunda yanlış astım tanısına yol açabilir. Bu çalışmada astım tanısı alan hastalarda anksiyete ve depresyona bağlı yanlış astım tanılarını değerlendirmeyi amaçladık.
Gereç ve Yöntem: Bu prospektif çalışmaya daha önce astım tanısı konulan ve bir psikiyatrist tarafından Beck Anksiyete İndeksi (BAİ) ve Beck Depresyon İndeksi (BDİ) ile değerlendirilen hastalar dahil edildi. Hastalar BDİ/BAİ durumuna göre pozitif (hafif, orta ve şiddetli kategori) ve negatif (normal kategori) olmak üzere iki gruba ayrıldı. Gruplar klinik özellikler, solunum fonksiyon testleri, astım kontrol testleri (AKT) ve atopi parametreleri açısından karşılaştırıldı.
Bulgular: BDİ/BAİ(+) grubunda 54 (%32,7) hasta tespit ettik. BDİ/BAİ(+) grubuyla karşılaştırıldığında BDİ/BAİ(-) grubundaki hastaların ailede astım öyküsüne sahip olma olasılığı daha yüksekti (%37,0 vs. %65,7, p<0,001). BDİ/BAİ(+) grubu BDİ/BAİ(-) grubuna göre anlamlı derecede düşüktü (sırasıyla 15,9’a karşı 19,3, p<0,001). BDİ/BAİ(+) grubunda anlamlı olarak daha az hastada obstrüksiyon (%14,8) ve geri dönüşlülük (%14,8) bulgusu, BDİ/BAİ(-) grubuna (sırasıyla %57,7 ve %54,1; her biri için p<0,001) göre görüldü. ).Total IgE ve AKT duyarlılığı en yüksek araçlar iken (sırasıyla %72 ve %70), özgüllüğü en yüksek olanı deri prick testiydi (%92). Obstrüksiyon (%88) ve reversibilite (%88) en yüksek pozitif öngörü değerlerine sahipti.
Sonuç: Astım tanısına dayalı nefes darlığının varlığı bazı hastalarda, özellikle de anksiyete/depresyon hastalarında yanlış tanıya yol açabilmektedir. Nefes darlığı semptomları gösteren hastaların öyküsü dikkatlice alınmalı ve spirometrik ve laboratuvar incelemeleriyle ayrıntılı olarak incelenmelidir.

Keywords

Yanlış astım tanısı, Anksiyete, Depresyon, Nefes darlığı, Solunum fonksiyon testi

References

• Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2021. Available from: www.ginasthma.org.Accessed July 24, 2021.
• Gibson GJ, Loddenkemper R, Lundbäck B, Sibille Y. Respiratory health and disease in Europe: the new European Lung White Book. Eur Respir J. 2013;42(3):559-63.
• Turkish Thoracic Society.Guidelines for the Diagnosis and Treatment of Asthma. 2019;2-16.
• Mattiuzzi C, Lippi G. Worldwide asthma epidemiology: insights from the Global Health Data Exchange database. Int Forum Allergy Rhinol. 2020;10(1):75-80.
• MacNeil J, Loves RH, Aaron SD. Addressing the misdiagnosis of asthma in adults: where does it go wrong? Expert Rev Respir Med. 2016;10(11):1187-1198.
• Chen W, Lynd LD, FitzGerald JM, Marra CA, Balshaw R, To T, et al. Canadian Respiratory Research Network. Excess medical costs in patients with asthma and the role of comorbidity. Eur Respir J. 2016;48(6):1584-1592. doi: 10.1183/13993003.01141-2016.
• Jin R, Choi BC, Chan BT, McRae L, Li F, Cicutto L, et al. Physician asthma management practices in Canada. Can Respir J. 2000;7(6):456-65. doi: 10.1155/2000/587151.
• Sharpe HM, Sin DD, Andrews EM, Cowie RL, Man P. Alberta Strategy to Help Manage Asthma (ASTHMA): a provincial initiative to improve outcomes for individuals with asthma. Healthc Q. 2004;7(3):55-60.
• Heffler E, Pizzimenti S, Guida G, Bucca C, Rolla G. Prevalence of over-/misdiagnosis of asthma in patients referred to an allergy clinic. J Asthma. 2015;52(9):931-4.
• Magnoni MS, Caminati M, Senna G, Arpinelli F, Rizzi A, Dama AR, et al. Asthma under/misdiagnosis in primary care setting: an observational community-based study in Italy. Clin Mol Allergy. 2015;13:26. doi: 10.1186/s12948-015-0032-x.
• Wu AC, Greenberger PA. Asthma: Overdiagnosed, underdiagnosed, and ineffectively treated. J Allergy Clin Immunol Pract. 2018;6(3):801-802.
• David J Kupfer. Anxiety and DSM-5. Dialogues Clin Neurosci. 2015;17(3):245-6.
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.4th Edition, Washington DC: American Psychiatric Press, 2000: 429-85.
• Li HL, He XL, Liang BM, Zhang HP, Wang Y, Wang G. Anxiety but not depression symptoms are associated with greater perceived dyspnea in asthma during bronchoconstriction. Allergy Asthma Proc. 2015;36(6):447-57.
• Crespo-Lessmann A, Curto E, Mateus E, Soto L, García-Moral A, Torrejón M, et al. Total and specific immunoglobulin E in induced sputum in allergic and non-allergic asthma. PLoS One. 2020;15(1):e0228045. doi: 10.1371/journal.pone.0228045.
• Ulubay G, Köktürk N, Görek Dilektaşlı A, Şen E, Çiftci F, Demir T, et al. Türk Toraks Derneği ulusal spirometri ve laboratuvar standartları [Turkish Thoracic Society national spirometry and laboratory standards]. Tuberk Toraks. 2017;65(2):117-130. Turkish. doi: 10.5578/tt.50748.
• Uysal MA, Mungan D, Yorgancioglu A, Yildiz F, Akgun M, Gemicioglu B, Turktas H; Study Group, Turkish Asthma Control Test (TACT), Turkey. Asthma control test via text messaging: could it be a tool for evaluating asthma control? J Asthma. 2013;50(10):1083-9. doi: 10.3109/02770903.2013.832294.
• Calderón MA, Linneberg A, Kleine-Tebbe J, De Blay F, Hernandez Fernandez de Rojas D, Virchow JC, Demoly P. Respiratory allergy caused by house dust mites: What do we really know? J Allergy Clin Immunol. 2015;136(1):38-48. doi: 10.1016/j.jaci.2014.10.012.
• Hisli N. Beck Depresyon Envanteri’nin Universite Ogrencileri Icin Gecerligi, Guvenirligi [Validity and Reliability of Beck Depression Inventory in Undergraduate Students].PsikolojiDergisi 1989;61231:3-13.
• Ulusoy M, Şahin NH, Erkmen H. Turkish version of theBeck Anxiety Inventory: Psychometric properties. J CognPsychother. 1998;12:163-172.
• Akindele A, Daines L, Cavers D, Pinnock H, Sheikh A. Qualitative study of practices and challenges when making a diagnosis of asthma in primary care. NPJ Prim Care Respir Med. 2019;29(1):27.
• Luks VP, Vandemheen KL, Aaron SD. Confirmation of asthma in anera of overdiagnosis. Eur Respir J. 2010;36(2):255-60.
• Aaron SD, Vandemheen KL, FitzGerald JM, Ainslie M, Gupta S, Lemière C, et al. Canadian Respiratory Research Network. Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma. JAMA. 2017;317(3):269-279. doi: 10.1001/jama.2016.19627.
• Erdenen F. Asthma in terms of psychiatric medicine. Istanbul Medical Journal 2000;1:41-5.
• Tessier JF, Nejjari C, Letenneur L, Filleul L, Marty ML, Barberger Gateau P, Dartigues JF. Dyspnea and 8-year mortality among elderly men and women: the PAQUID cohort study. Eur J Epidemiol. 2001;17(3):223-9. doi: 10.1023/a:1017977715073.
• Rimington LD, Davies DH, Lowe D, Pearson MG. Relationship between anxiety, depression and morbidity in adult asthma patients. Thorax. 2001;56:266-71.
• Dales RE, Spitzer WO, Schechter MT, Suissa S. The influence of psychological statuson respiratory symptom reporting. Am Rev Respir Dis. 1989;139(6):1459-63.
• Licari A, Ciprandi R, Marseglia G, Ciprandi G. Anxiety/depression changes areassociated with improved asthma control perception in asthmatic adolescent safter adequatemanagement. Eur Ann Allergy Clin Immunol. 2019;51(4):190-192.
• Pourdowlat G, Hejrati R, Lookzadeh S. The effectiveness of relaxation training in the quality of life and anxiety of patients with asthma. Adv Respir Med. 2019;87(3):146-151.
• Di Marco F, Verga M, Santus P, Giovannelli F, Busatto P, Neri M, et al. Close correlation between anxiety, depression, and asthma control. Respir Med. 2010;104(1):22-8. doi: 10.1016/j.rmed.2009.08.005.
• González-Freire B, Vázquez I, Pértega-Díaz S. The relationship of psychological factors and asthma control to health-related quality of life. J Allergy Clin Immunol Pract. 2020;8(1):197-207.
• Chérrez-Ojeda I, Vanegas E, Félix M, Jiménez F, Mata V, Cano JA. Influencia de la ansiedad y depresiónsobreel control del asmaenpacientesecuatorianos. Estudiopiloto [The influence of anxiety and depression on asthma control in Ecuadorian patients. A pilot study]. Rev Alerg Mex. 2019;66(3):292-300.
• Brite J, Friedman S, de la Hoz RE, Reibman J, Cone J. Mental health, long-term medication adherence, and the control of asthma symptoms among persons exposed to the WTC 9/11 disaster. J Asthma. 2020;57(11):1253-1262.
• Comberiati P, Di Cicco ME, D’Elios S, Peroni DG. How much asthma is atopic in children? Front Pediatr. 2017;5:122.
• Del Giacco SR, Cappai A, Gambula L, Cabras S, Perra S, Manconi PE, et al. The asthma-anxiety connection. Respir Med. 2016;120:44-53.
• Ng B, Sadatsafavi M, Safari A, FitzGerald JM, Johnson KM. Direct costs of overdiagnosed asthma: a longitudinal, population-based cohort study in British Columbia, Canada. BMJ Open. 2019;9(11):e031306.