Clinical Psychology and Clinical Immunology: is there a link between Alexithymia and severe Asthma?

Background: Severe asthma patients are those suffering from asthma exacerbations despite adherence to maximal optimized asthma treatment such as high dose inhalant corticosteroids and long-acting beta2 agonists (ICS-LABA). It is estimated that about 300 million people in the world are affected from asthma and among them a percentage between 3-10% suffer from severe asthma. The prevalence of Alexithymia in chronic illness is notably high and it is strictly related to clinical severity of chronic diseases. Methods: Pub Med and Google Scholar databases were consulted using the terms “severe asthma” AND “alexithymia” to search English-language articles. According to inclusion criteria 37 articles were finally included and analyzed. Alexithymia may interfere with the perception of the disease and the patients’ awareness of the need of a strict follow-up, to adhere to the physicians’ treatment plans. Results: Alexithymia and related psychological distress as anxiety and depression may compromise the patient’s compliance and adherence, leading to a severe clinical presentation and pathologies’ course. This review highlights a potential relationship between alexithymia and severe asthma as a chronic inflammatory disease and the ways this correlation can be assessed and managed in the Outpatient Asthma Clinic to ensure a global approach to SA patients. Findings reported in literature suggest that, among severe asthma patients, alexithymia is present even if the prevalence of this disorder has not yet been defined. Conclusions: It is likely that the introduction of a gold standard clinical psychological evaluation in medical settings, such as clinical allergy and immunology, may allow to support suffering patients helping them to adequately elaborate their particular condition developing useful strategies to control and to manage with their severe asthma.