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

Abstract

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.

Wheezing Is Common in Children With Sickle Cell Disease When Compared With Controls

“…However, what is not clear is whether wheezing is more common in children with SCD when compared to children without SCD. Determining whether children with SCD have an increased rate of wheezing is particularly important, because wheezing is the most common respiratory finding occurring in SCD 23 and is associated with a physician diagnosis of asthma that requires daily medication 23 .…”

The intersection between asthma and acute chest syndrome in children with sickle-cell anaemia

“…9,27,28 In many of these studies, the asthma diagnosis is made based on a parental report of a physician diagnosis of asthma, 29–31 a standard strategy for asthma epidemiology studies. Other definitions of asthma in children with sickle-cell disease include physician diagnosis of asthma and an episode of wheezing in the previous 12 months or receiving asthma medication, or both (table 2).…”

“…28 The model had a sensitivity of 100% when two or more features were present. When none of the features were present, model sensitivity was 0% at differentiation from children without asthma.…”

Obstructive Sleep Apnea and Sickle Cell Anemia

“…On the other hand, in this cohort, parent report of wheezing symptoms was a better predictor of a physician diagnosis of asthma than lung function testing. 60 In terms of data collection, tonsil size was not assessed, end-tidal carbon dioxide was not measured, and daytime behavioral problems were not evaluated, so the assessment of OSAS signs, symptoms, and consequences could have been more comprehensive. Finally, although validated in comparison with arterial saturation in patients with SCA, 61 simple pulse oximetry may underestimate oxygenation status because the dyshemoglobins are not measured.…”