Prevalence of alexithymia and its association with anxiety and depression in a sample of Greek chronic obstructive pulmonary disease (COPD) outpatients

<p>Abstract</p> <p>Background</p> <p>Chronic obstructive pulmonary disease (COPD) is a major health problem, especially in adults over 40 years of age, and has a great social and economic impact. The psychological morbidity of COPD patients with regard to anxiety and depressive symptoms has been extensively studied in the past. However, few studies have investigated the prevalence of alexithymia in these patients, as well as its association with this comorbidity. Based on this fact, we studied the prevalence of alexithymia and its association with anxiety and depressive symptoms in COPD outpatients.</p> <p>Methods</p> <p>The present study included 167, randomly selected, outpatients diagnosed with COPD. Alexithymia, anxiety and depression were assessed using the Toronto Alexithymia Scale (TAS-20), Spielberger Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI), respectively.</p> <p>Results</p> <p>The mean BDI score was 12.88 (SD: 7.7), mean STAI score 41.8 (SD: 11.0) and mean TAS-20 score 48.2 (SD: 11.5). No differences were observed between genders regarding age and alexithymia (t test <it>P </it>> 0.05), while female patients presented higher depression and trait anxiety scores than males (t test <it>P </it>< 0.05). Clinically significant levels of anxiety were present in 37.1% of men, and in 45.7% of women. The mean depression score was also higher than the corresponding mean score in the general population (one-sample t test <it>P </it>< 0.01), while 27.7% and 30.5% of the sample presented mild and moderate to severe depression, respectively. Finally, a strong correlation was observed between alexithymia, depression and anxiety.</p> <p>Conclusions</p> <p>This study confirms the high prevalence of anxiety and depression symptoms in Greek outpatients with COPD. The prevalence of alexithymia in COPD patients, contrary to what has been observed in patients with other chronic respiratory diseases, seem to be lower. However, we observed a strong association between alexithymia, depression and anxiety levels. This observation suggests that alexithymia should be taken into consideration when drafting specific psychotherapeutic interventions for these patients.</p

Exercise testing and exercise-limiting factors in patients with bilateral bronchiectasis

SUMMARY. Introduction: Exercise capacity is reduced in many patients with bronchiectasis, but there is little information available regarding exercise responses in these patients. Objectives: The aim of this study was to investigate exercise capacity and exercise responses in patients with bilateral bronchiectasis in order to identify possible exercise-limiting factors. Population and Methods: Fifteen patients with bronchiectasis aged 50±16 years underwent lung function testing, including assessment of tidal expiratory flow limitation (EFL), and performed a maximum incremental (20 watts/min) symptom-limited bicycle exercise test. Results: Exercise performance was reduced in 7 of the 15 patients, particularly in those with a greater degree of impairment of lung function, and specifically lower FEV1 (p<0.001) and FVC (p<0.001). EFL was detected in 5 of the 7 patients with exercise limitation and absent in all with normal exercise capacity. Patients with reduced exercise capacity exhibited significantly lower maximal ventilation (V.Emax %pred; p<0.001), maximal tidal volume (VTmax; p= 0.03), breathing reserve (higher V.Emax/MVV; p<0.001), peak-exercise oxygen saturation measured by pulse oximetry (SpO2, p<0.001), O2-pulse (p<0.001) and anaerobic threshold (AT, p<0.001) and perceived a higher degree of dyspnoea (Borg score; p=0.007). The best correlate of maximal work rate (WRmax, %pred) was the AT (r= 0.90, r2 = 0.81, p<0.001), while for peak oxygen uptake (V.O2max, %pred) the most significant correlation was the peak-exercise SpO2 (r=0.83, r2 = 0.69, p<0.001). Conclusions: Patients with bronchiectasis who have tidal EFL and a low FEV1 exhibit a reduction in exercise capacity. Ventilatory limitation, desaturation and impaired O2-transport/utilization to the periphery appear to be the principal factors limiting exercise. V.O2max can be predicted accurately from parameters obtained by simple means, such as peak-exercise SpO2 obtained by pulse oximetry. Pneumon 2009, 22(4):296-314