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Vol. 41. Issue 5.
Pages 267-271 (May 2005)
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Vol. 41. Issue 5.
Pages 267-271 (May 2005)
Original Articles
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Prevalence of Hyperventilation Syndrome in Patients Treated for Asthma in a Pulmonology Clinic
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E. Martínez-Moragóna,
Corresponding author
emm01v@saludalia.com

Correspondence: Dra. E. Martínez-Moragón. Servicio de Neumología (Medicina Interna). Hospital de Sagunto. Avda. Ramón y Cajal, s/n. 46520 Port de Sagunt. Valencia. España
, M. Perpiñáb, A. Bellochc, A. de Diegob
a Servicio de Neumología, Hospital de Sagunto, Port de Sagunt, Valencia, Spain
b Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain
c Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Valencia, Valencia, Spain
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Objective

Although the presence of hyperventilation syndrome can affect the symptoms of patients with asthma, there is very little information available regarding its frequency in Spain. The aim of this study was to investigate the prevalence of hyperventilation syndrome in the asthmatic population treated as outpatients and establish its relationship with anxiety disorders.

Patients and methods

We studied 157 consecutive asthmatic patients (61 men and 96 women; mean [SD] age, 45 [17] years; forced expiratory volume in the first second, 84% [21%] of the predicted value) treated in our outpatients clinic. The patients had stable disease with varying degrees of severity. After collecting demographic data and medical histories, we asked the patients to complete the Spanish versions of the Anxiety Sensitivity Index, the Asthma Symptom Checklist, and the Nijmegen questionnaire; in the latter test, a score of 23 or over was considered diagnostic for hyperventilation syndrome. Finally, patients were evaluated to determine whether they had suffered from panic disorder in the last 6 months (according to the criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders).

Results

Hyperventilation syndrome was present in 57 asthmatic patients (36%) and panic disorder in 4 patients (2%). The majority of patients with hyperventilation syndrome were women (78% vs 51%; P = .001) and were older (49 vs 42; P = .01); they displayed more basal dyspnea (1.26 vs 0.89 on the Medical Research Council scale; P = .01), greater sensitivity to anxiety (P = .001), and went to the emergency room more often for exacerbations (P = .002). Patients with hyperventilation syndrome scored significantly higher on all subscales of the Asthma Symptoms Checklist. Finally, the variables introduced in the regression analysis (stepwise) to explain the score on the Nijmegen questionnaire (r2=0.57) were basal dyspnea and sensitivity to anxiety.

Conclusions

Approximately one third of the asthmatic patients treated in a pulmonology clinic also present hyperventilation syndrome. This cannot be explained by comorbidity of asthma with panic disorder, and is only partly linked to the symptoms associated with hyperventilation that appear during an asthma attack.

Key Words:
Asthma
Hyperventilation syndrome
Prevalence
Anxiety
Objetivo

Aunque la presencia del síndrome de hiperventilación (SH) puede influir en los síntomas de los pacientes con asma, existe escasa información acerca de su frecuencia en nuestro medio. Nuestro objetivo ha sido investigar la prevalencia de SH entre la población asmática controlada ambulatoria-mente y establecer su relación con los trastornos de ansiedad.

Patientes y métodos

Con este propósito hemos estudiado a 157 asmáticos consecutivos (61 varones, 96 mujeres; edad media ± desviación estándar de 45 ± 17 años; volumen espiratorio forzado en el primer segundo: 84 ± 21%), controlados en nuestras consultas externas, en situación estable y con diferentes grados de gravedad. Tras recoger los datos demográficos y los relativos a su enfermedad, cumplimentaron las versiones españolas del Índice de Sensibilidad a la Ansiedad, el Listado de Síntomas durante un Ataque de Asma y el cuestionario Nijmegen; en este último, una puntuación de 23 o superior se consideró diagnóstica del SH. Finalmente, se valoró si habían presentado un trastorno de pánico en los 6 últimos meses (criterios de la cuarta edición del Manual diagnóstico y estadístico de los trastornos mentales).

Resultados

Presentaron SH 57 asmáticos (36%) y trastorno de pánico, 4 (2%). Los pacientes con SH eran mayori-tariamente mujeres (un 78 frente a un 51%; p = 0,001) y te-nían más edad (49 frente a 42; p = 0,01), más disnea basal (1,26 en la escala del Medical Research Council frente a 0,89; p = 0,01), más sensibilidad a la ansiedad (p = 0,001) y acudían más veces a urgencias por agudizaciones (p = 0,002). Los pacientes con SH puntuaron significativamente más alto en todas las subescalas del Listado de Síntomas durante un Ataque de Asma. Por último, las variables introducidas en el análisis de regresión (pasos sucesivos) para explicar la puntuación en el cuestionario Nijmegen (r2 = 0,57) fueron: disnea basal y sensibilidad a la ansiedad.

Conclusiones

Aproximadamente un tercio de los asmáticos controlados en una consulta de neumología presentan además SH. Esto no puede explicarse por la comorbilidad asma-trastorno de pánico y tiene que ver sólo en parte con los síntomas relacionados con la hiperventilación que apare-ce durante un ataque de asma.

Palabras clave:
Asma
Síndrome de hiperventilación
Prevalencia
Ansiedad
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This study was funded in part by RED RESPIRA (RTIC G03/11), Health Research Fund (FIS), Instituto de Salud Carlos III.

Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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