Benefit of pulmonary subspecialty care for children with sickle cell disease and asthma

Saxena, Shikha; Afolabi‐Brown, Olufunke; Ballester, Lance; Schmücker, N; Smith‐Whitley, Kim; Allen, Julian L.; Bhandari, Anita

doi:10.1002/ppul.25845

Cited by 10 publications

(3 citation statements)

References 42 publications

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“…Ideally, a multidisciplinary approach to the care of these patients is optimal with the active involvement of the pulmonary subspecialty. 31 In conclusion, while further studies are necessary, this study supports the importance of identifying SCD patients with asthma at increased risk for developing OSA, additional SCD-related comorbidities, and worsening hematological markers of severity.…”

Section: Discussionsupporting

confidence: 71%

The impact of obstructive sleep apnea in children with sickle cell disease and asthma

Feld,

Bhandari,

Allen

et al. 2023

Pediatric Pulmonology

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IntroductionAsthma and obstructive sleep apnea (OSA) are chronic diseases that disproportionately affect children with sickle cell disease (SCD). The literature describes the negative impact that both conditions have on children with SCD separately; however, the effect of OSA on asthmatic children with OSA is less specific. We hypothesized that the presence of OSA in children with SCD and asthma is associated with specific hematologic markers, worse clinical outcomes, and greater healthcare utilization.MethodsWe retrospectively evaluated children with both SCD and asthma who underwent polysomnography (PSG). We assessed their demographic information, PSG data, hematologic indices, and healthcare utilization based on the concurrent presence of OSA.ResultsFifty‐nine percent of the cohort had OSA with a lower oxygen saturation (SpO2) nadir (87% vs. 93%, p < 0.001) and a lower median daytime SpO2 (96.5% vs. 98.5%, p < 0.05); those with OSA were more likely to have the hemoglobin SS genotype (86% vs. 46.5%, p = 0.03). Additionally, those with OSA had a higher mean corpuscular volume (87 vs. 77.2 fL, p = 0.03) and reticulocyte count (10.1% vs. 5.5%, p < 0.01). There was no difference in asthma severity or healthcare utilization between those with OSA and those without OSA.DiscussionOverall, children with SCD and asthma might be at increased risk for developing OSA, and screening for sleep‐disordered breathing should be incorporated as part of their routine care.

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Section: Discussionsupporting

confidence: 71%

The impact of obstructive sleep apnea in children with sickle cell disease and asthma

Feld,

Bhandari,

Allen

et al. 2023

Pediatric Pulmonology

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“…These findings are consistent with a recent study on pulmonology involvement in a nonintegrated clinic and support the notion that improved preventive care reduces usage of acute health care. 17 , 18 For example, attaining better control of asthma or inflammatory airway disease from improved ICS use may lead to reduced asthma and ACS admissions and associated prescription of systemic corticosteroid. 19 Limiting systemic corticosteroids is particularly important for pwSCD because these medications are known to increase the risk of subsequent hospitalization for VOE.…”

Section: Discussionmentioning

confidence: 99%

Outcomes before and after providing interdisciplinary hematology and pulmonary care for children with sickle cell disease

et al. 2023

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People with sickle cell disease (pwSCD) are at risk of developing lung conditions that complicate their sickle cell disease (SCD) but often face healthcare access barriers. An interdisciplinary SCD-pulmonary clinic was created in 2014 at Nationwide Children's Hospital (NCH) to address access barriers that may prevent optimized treatment. We hypothesize that pwSCD and pulmonary disease would have fewer hospitalizations for acute chest syndrome (ACS), asthma, and vaso-occlusive episodes (VOEs) in the two years after their initial SCD-pulmonary clinic visit compared to the two years prior. From 2014-2020,119 pwSCD were evaluated in the SCD-pulmonary clinic and followed at NCH for at least two years before and after this visit. Acute care outcomes, pulmonary function, polysomnography, echocardiogram, laboratory, and medication prescribing data were collected and analyzed using the Wilcoxon signed ranked and McNemar's tests. The median number of acute care visits for ACS (p<0.001) and asthma (p=0.006) were significantly lower during the two years after pwSCD's initial SCD-pulmonary clinic evaluation compared to the two years prior. Asthma and allergic rhinitis were more frequently diagnosed and prescriptions for hydroxyurea (p=0.005) and inhaled corticosteroids (p=0.005) were more common in the post SCD-pulmonary clinic period. The median number of prescribed systemic corticosteroids was lower in the two years following SCD-pulmonary clinic evaluation (p<0.0001). Lactate dehydrogenase and white blood cell counts also significantly decreased. Implementing a multidisciplinary SCD-pulmonary clinic is feasible and may allow improved management of pulmonary problems and lead to improvements in health and acute care utilization.

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“…26 The expansion of this comprehensiveness to integrate other subspecialty medical providers into the comprehensive SCD clinic, such as pulmonology, has the potential to improve access and outcomes of children suffering from SCD and address significant deficits in their care. Prior examples of integrated pulmonary-SCD clinics have been reported including asthma specialists, 27 pulmonologists focused on asthma, 28 and small pilot cohorts, 2 but data on colocated comprehensive pulmonary care models and the resources to implement them are lacking. To this end, an integrated pediatric SCD and pulmonary comprehensive clinic, guided by the chronic care model, was implemented at Nationwide Children's Hospital (NCH) in 2014 to address the complex needs of youth with SCD with coexistent pulmonary disease.…”

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confidence: 99%

Description of a Colocated Comprehensive Care Model for People With Sickle Cell and Comorbid Pulmonary Disease

Pugh

Zeno²,

Stanek³

et al. 2023

Journal of Pediatric Hematology/Oncology

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Comorbid pulmonary complications in people with sickle cell disease (pwSCD) are associated with high rates of morbidity and mortality, and poor access to care contributes to poor outcomes among this particularly high-risk pwSCD. Our purpose was to describe the population served and the resources required for hematology, pulmonary, nursing, respiratory therapy, social work, genetics, psychology, and school liaison providers to see these patients in an integrated clinic. We abstracted demographic, medication, clinical, and diagnostics data of the pwSCD seen at least once in this clinic from February 1, 2014 to December 10, 2020 from the electronic medical record and identified 145 unique pwSCD. Abnormal lung function and bronchodilator responsiveness were detected in 31% and 42% of participants respectively. Sleep abnormalities were found in over two-thirds of those screened and 65% had ≥1 previous acute chest syndrome episode. This clinic also allowed for direct provider communication and required relatively limited resources to serve a large number of severely affected pwSCD. Given the degree of abnormal respiratory variables detected and the limited resources required to implement this model, studies are warranted to evaluate whether it has the potential to improve outcomes in high-risk populations.

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Benefit of pulmonary subspecialty care for children with sickle cell disease and asthma

Cited by 10 publications

References 42 publications

The impact of obstructive sleep apnea in children with sickle cell disease and asthma

The impact of obstructive sleep apnea in children with sickle cell disease and asthma

Outcomes before and after providing interdisciplinary hematology and pulmonary care for children with sickle cell disease

Description of a Colocated Comprehensive Care Model for People With Sickle Cell and Comorbid Pulmonary Disease

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