Misdiagnosis of Asthma in Patients with Anxiety/Depression

Year 2023, Volume: 5 Issue: 3, 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

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