Asthma morbidity and treatment in children with sickle cell disease

Anim, Samuel O.; Strunk, Robert C.; DeBaun, Michael R.

doi:10.1586/ers.11.64

Cited by 32 publications

(39 citation statements)

References 78 publications

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“…6,8,10,18–28 The few studies that have directly addressed the effects of wheezing in SCD morbidity suggest that the adverse associations between asthma and SCD complications may be in part due to collinearity with wheezing. We propose a conceptual model whereby wheezing, a sign of severe narrowing of small airways, results in regional hypoxia within the lung thereby limiting the lung’s ability to reverse red cell sickling and promoting increased systemic complications of SCD (figure 1).…”

Section: Associations Between Wheezing and Scd Morbiditymentioning

confidence: 99%

Wheezing in children with sickle cell disease

Glassberg

Strunk

DeBaun

2014

Current Opinion in Pediatrics

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Purpose of review The purpose of this article is to provide a comprehensive review of wheezing in sickle cell disease (SCD) including epidemiology, pathophysiology, associations between wheezing and SCD morbidity and finally the clinical approach to evaluation and management of individuals with SCD who wheeze. Recent findings Wheezing is common in SCD and in some individuals represents an intrinsic component of SCD related lung disease rather than asthma. Emerging data suggest that regardless of the etiology, individuals with SCD and with recurrent wheezing are at increased risk for subsequent morbidity and premature mortality. We believe Individuals that acutely wheeze and have respiratory symptoms should be managed with a beta agonist and short term treatment of oral steroids, typically less than 3 days to attenuate rebound vaso-occlusive disease. For those that wheeze and have a history or examination associated with atopy, we consider asthma treatment and monitoring per NHLBI asthma guidelines. Summary Wheezing in SCD should be treated aggressively in both the acute setting and with controller medications. Prospective SCD-specific clinical trials will be necessary to address whether anti-inflammatory asthma therapies (leukotriene antagonists, inhaled corticosteroids) can safely mitigate the sequelae of wheezing in SCD.

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Section: Associations Between Wheezing and Scd Morbiditymentioning

confidence: 99%

Wheezing in children with sickle cell disease

Glassberg

Strunk

DeBaun

2014

Current Opinion in Pediatrics

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“…Asthma in a child with sickle cell anemia (SCA) is associated with an increased rate of pain and acute chest syndrome (ACS) 12345678 and premature death 9 . Thus, determining the clinical symptoms and historical and laboratory features associated with a doctor diagnosis of asthma within the context of SCA would be important to identify patients at increased risk for complications.…”

mentioning

confidence: 99%

Wheezing Symptoms and Parental Asthma Are Associated with a Physician Diagnosis of Asthma in Children with Sickle Cell Anemia

Strunk

Cohen

Cooper

et al. 2014

The Journal of Pediatrics

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Objective To identify factors associated with asthma associated with increased sickle cell anemia (SCA). Study design Children with SCA (n=187; mean age 9.6 years, 48% male) were classified as having “asthma” based on parent report of doctor diagnosis plus prescription of asthma medication (n=53) or “no asthma” based on the absence of these features (n=134). Pain and acute chest syndrome (ACS) events were collected prospectively. Results Multiple variable logistic regression model identified three factors associated with asthma: parent with asthma (p=0.006), wheezing causing shortness of breath (p=0.001), and wheezing after exercise (p < 0.001). When two or more features were present, model sensitivity was 100%. When none of the features were present, model sensitivity was 0%. When only one feature was present, model sensitivity was also 0% and presence of 2 or more positive allergy skin tests, airway obstruction on spirometry, and bronchodilator responsiveness did not improve clinical utility. ACS incident rates were significantly higher in individuals with asthma than those without asthma (IRR 2.21, CI 1.31-3.76); pain rates were not (IRR 1.28, CI 0.78-2.10). Conclusions For children with SCA, having a parent with asthma and specific wheezing symptoms are the best features to distinguish those with and without parent report of a doctor diagnosis of asthma and identify those at higher risk for ACS events. The value of treatment for asthma in prevention of SCA morbidity needs to be studied.

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“…However, many authors use this term to describe common features of the pulmonary manifestations of SCD, which have some similarities with typical childhood asthma, and a separate term for the syndrome is not currently being used. Between 20% and 48% of children with SCD have a comorbid diagnosis of asthma [36,37,38], and an asthma diagnosis is associated with more frequent pain and ACS compared to children with SCD without a diagnosis of asthma [39]. There is also a two-fold higher risk of mortality in adults with SCD and asthma compared to those with SCD and without asthma [40].…”

Section: Resultsmentioning

confidence: 99%

Secondhand Smoke Is an Important Modifiable Risk Factor in Sickle Cell Disease: A Review of the Current Literature and Areas for Future Research

Sadreameli¹,

Kopp

Creary

et al. 2016

IJERPH

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Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy that causes significant morbidity and mortality related to chronic hemolytic anemia, vaso-occlusion, and resultant end-organ damage. Tobacco smoke exposure (TSE) through secondhand smoke exposure in people with SCD of all ages and through primary smoking in adolescents and adults is associated with significantly increased morbidity, with increased rates of emergency department visits and hospitalizations for painful vaso-occlusive crises and acute chest syndrome (ACS). Secondhand smoke is also associated with pulmonary function abnormalities in children with SCD who are already at risk for pulmonary function abnormalities on the basis of SCD. TSE is emerging as one of the few modifiable risk factors of SCD. This review discusses the current state of the evidence with respect to TSE and SCD morbidity, discusses potential mechanisms, and highlights current gaps in the evidence and future research directions.

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Asthma morbidity and treatment in children with sickle cell disease

Cited by 32 publications

References 78 publications

Wheezing in children with sickle cell disease

Wheezing in children with sickle cell disease

Wheezing Symptoms and Parental Asthma Are Associated with a Physician Diagnosis of Asthma in Children with Sickle Cell Anemia

Secondhand Smoke Is an Important Modifiable Risk Factor in Sickle Cell Disease: A Review of the Current Literature and Areas for Future Research

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