Spirometry use in patients with sickle cell disease with and without asthma and acute chest syndrome: A multicenter study

Abstract

A de‐identified data repository of electronic medical record data, i2b2 (Informatics for Integrating Biology and the Bedside), including four geographically diverse academic medical centers, was queried to determine the use of diagnostic spirometry testing in African American children and young adults 5‐34 years of age with sickle cell disease (SCD) with or without a documented history of asthma and/or acute chest syndrome (ACS). A total of 2749 patients were identified with SCD, of these 577 had asthma and 409 had ACS. Cross‐referencing the CPT code for diagnostic spirometry showed that for patients identified as having SCD, a history of ACS, and a diagnosis of asthma, only 31% across all four centers had spirometry. Having an asthma diagnosis was associated with ACS. Among SCD patients with asthma, the proportion with ACS for the four centers was 47%, 75%, 38%, and 36% respectively. The bivariate association between asthma and ACS for each Center was significant for each (P < .001). To summarize, only one third of patients with co‐morbid SCD, ACS, and asthma received the spirometry procedure as recommended in evidence‐based guidelines, suggesting limited testing for changes in pulmonary function. Future studies to determine barriers and facilitators to implementation of pulmonary testing in SCD are warranted.

Exploring the Interplay between Asthma and Hemoglobinopathies: A Comprehensive Review

“…The findings discussed have important clinical implications for the diagnosis and management of asthma in individuals with hematologic disorders. Screening protocols, such as those proposed by Duckworth et al and Sadreameli et al, offer valuable strategies for identifying asthma and pulmonary function abnormalities in pediatric SCD patients, facilitating early intervention and targeted treatment [ 23 , 31 ]. Additionally, studies examining the utility of screening tools, such as the BCIS, in preschool-aged children with SCD highlight the importance of the early detection and management of asthma in vulnerable populations [ 32 ].…”

“…Among them, 249 had both SCD and ACS with asthma. Among these patients, 77 underwent spirometry during the study period [ 31 ]. Moreover, Sadreameli et al hypothesized that a screening program could help identify children with SCD who needed a referral to a pulmonary clinic for asthma management.…”

Defining global strategies to improve outcomes in sickle cell disease: a Lancet Haematology Commission

“…In the past 10 years, implemen tation science has evolved as a muchneeded set of tools to increase the uptake of evidencebased clinical guide lines. [326][327][328] The same approaches of identifying the evidencebased practice or learning objectives, assessing the organisation's culture or setting, and working through strategies to deliver the education or training are relevant to implementing curricula. 329,330 In implementation research, the REAIM is a framework commonly used in public health to reduce the gap between evidencebased practice and actual activities.…”