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Feld L, Bhandari A, Allen J, Saxena S, Stefanovski D, Afolabi-Brown O. The impact of obstructive sleep apnea in children with sickle cell disease and asthma. Pediatr Pulmonol 2023; 58:3188-3194. [PMID: 37606223 DOI: 10.1002/ppul.26643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/13/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Asthma 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. METHODS We 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. RESULTS Fifty-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. DISCUSSION Overall, 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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Affiliation(s)
- Lance Feld
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anita Bhandari
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julian Allen
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shikha Saxena
- Division of Allergy, Immunology, and Pulmonary Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Darko Stefanovski
- Department of Clinical Studies New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Olufunke Afolabi-Brown
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Feld L, Fiorino EK, Aygun B, Appiah-Kubi A, Mitchell EC, Jackson S, Mehran R, Fishbein J, Santiago MT. NT-proBNP levels and cardiopulmonary function in children with sickle cell disease. Pediatr Pulmonol 2021; 56:495-501. [PMID: 33151019 DOI: 10.1002/ppul.25155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/20/2020] [Accepted: 10/30/2020] [Indexed: 02/01/2023]
Abstract
Patients with sickle cell disease (SCD) are living longer and subsequently more apt to develop cardiopulmonary dysfunction. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels have been used in adults with SCD to assess for pulmonary hypertension and mortality. While the incidence of PH is low in pediatrics, it is reasonable to presume that NT-proBNP levels can be used to assess risk for the development of cardiopulmonary morbidity. We hypothesized that NT-proBNP levels would be increased in patients with SCD compared to age-adjusted healthy children; additionally, these levels would be associated with labs indicative of hemolysis and would demonstrate evidence of obstructive lung disease and cardiac dysfunction. We retrospectively evaluated patients with SCD, 8-18 years old, at a large, tertiary care children's hospital. NT-proBNP levels were assessed in correlation with hemolytic lab work, spirometry, and echocardiographic data. The age group 8-14 years old, 75% of our cohort's population, had a median NT-proBNP of 70 pg/ml, greater than their age-adjusted counterparts (52 pg/ml). NT-proBNP levels were associated with an increased degree of hemolysis when compared with hemoglobin (Hb) (r = -0.43, p < .0001), reticulocyte count (r = .25, p = .01) and lactate dehydrogenase levels (r = .47, p < .0001). An inverse trend was found between NT-proBNP and spirometric data. Finally, a positive correlation was found between NT-proBNP and diastolic left ventricular size (r = .28, p = .047]. The correlations found suggest that NT-proBNP may be used prospectively to identify patients with SCD at increased risk for the development of cardiopulmonary dysfunction.
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Affiliation(s)
- Lance Feld
- Division of Pulmonary and Sleep Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth K Fiorino
- Division of Pulmonology, Allergy, and Immunology, Weill Cornell Medicine, New York, New York, USA
| | - Banu Aygun
- Department of Pediatric Hematology and Oncology, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Abena Appiah-Kubi
- Department of Pediatric Hematology and Oncology, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Elizabeth C Mitchell
- Department of Pediatric Cardiology, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Stacey Jackson
- Department of Pediatric Pulmonary Medicine and Cystic Fibrosis, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Roxana Mehran
- Department of Pediatric Pulmonary Medicine and Cystic Fibrosis, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Joanna Fishbein
- Center for Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Northwell Health, Northwell Health, New York, USA
| | - Maria T Santiago
- Department of Pediatric Pulmonary Medicine and Cystic Fibrosis, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York, USA
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Chen L, Gong J, Matta E, Morrone K, Manwani D, Rastogi D, De A. Pulmonary disease burden in Hispanic and non-Hispanic children with sickle cell disease. Pediatr Pulmonol 2020; 55:2064-2073. [PMID: 32484996 DOI: 10.1002/ppul.24883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 05/29/2020] [Indexed: 12/19/2022]
Abstract
RATIONALE Pulmonary complications are the leading cause of morbidity and mortality in sickle cell disease (SCD) patients. Research in SCD has predominantly been conducted on African-Americans, and the disease burden of SCD in other races and ethnicities, including Hispanic patients, is not well characterized. OBJECTIVE To compare pulmonary disease burden between Hispanic and non-Hispanic ethnic groups among children with SCD. METHODS In a retrospective chart review on 566 SCD patients followed at the Children's Hospital at Montefiore, NY, we compared the pulmonary disease burden and disease management in Hispanic patients to their non-Hispanic counterparts. We also compared the contribution of demographic and clinical variables to acute chest syndrome (ACS), vaso-occlusive crisis (VOC), and hospitalizations for SCD related complications between the two ethnic groups. RESULTS Hispanic patients had a greater proportion of ACS, and had lower forced expiratory volume (FEV1), forced vital capacity, and vital capacity, compared to non-Hispanics. Hispanic patients were more likely to be evaluated in pulmonary clinic and to be on inhaled corticosteroids, short-acting β agonizts, and leukotriene receptor antagonists. In addition, Hispanic children were more likely to be on hydroxyurea, and receive exchange transfusions. However, the association of asthma with the proportion of ACS did not differ between Hispanics and non-Hispanics. CONCLUSION Hispanic children with SCD had differences in their pulmonary function profile and received more pulmonary evaluations than non-Hispanic children.
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Affiliation(s)
- Laura Chen
- Division of Pediatric Respiratory and Sleep Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Jacqueline Gong
- College of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Esther Matta
- Division of Pediatric Respiratory and Sleep Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Kerry Morrone
- Division of Hematology and Oncology, Children's Hospital at Montefiore, Bronx, New York
| | - Deepa Manwani
- Division of Hematology and Oncology, Children's Hospital at Montefiore, Bronx, New York
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC
| | - Aliva De
- Division of Pediatric Pulmonology, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
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Cieri-Hutcherson NE, Hutcherson TC, Conway-Habes EE, Burns BN, White NA. Systematic Review of l-glutamine for Prevention of Vaso-occlusive Pain Crisis in Patients with Sickle Cell Disease. Pharmacotherapy 2019; 39:1095-1104. [PMID: 31505045 DOI: 10.1002/phar.2329] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
l-glutamine was approved by the U.S. Food and Drug Administration (FDA) for sickle cell disease (SCD) in 2017. A vaso-occlusive crisis (VOC) occurs in persons with SCD and is associated with acute pain episodes. This systematic review summarizes the evidence for l-glutamine in the prevention of VOC and associated pain in patients with SCD. Medline, Embase, and International Pharmaceutical Abstracts were searched for records reporting on l-glutamine use in persons with SCD. Eligibility criteria identified primary reports of investigations conducted in humans who were administered l-glutamine, reported on outcomes related to VOC or associated pain, published in English, and were available as full text. All relevant efficacy, safety, participant demographic data, and study method characteristics were extracted and documented. Risk-of-bias assessments were conducted using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool and the revised Cochrane risk-of-bias tool for randomized studies. Three studies assessing the effect of exogenous l-glutamine administration in patients with SCD met eligibility criteria: one prospective nonrandomized controlled study and two prospective randomized controlled trials. Rate of VOC and related hospitalizations were reduced in patients receiving l-glutamine, although some conflicting results were noted between studies. l-glutamine was generally well tolerated. Limitations of one or more of the eligible studies included small sample size, nonblinding, and study groups that differed at baseline. l-glutamine has limited high-quality evidence supporting its use. Although l-glutamine is FDA approved for the prevention of frequent episodes of VOC pain, only one randomized controlled trial has strong evidence to support this indication. Based on the results of a systematic review, l-glutamine may be considered for patients unable to receive hydroxyurea or in addition to hydroxyurea for reduction in VOC and associated pain.
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Affiliation(s)
- Nicole E Cieri-Hutcherson
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Science, University at Buffalo, Buffalo, New York
| | - Timothy C Hutcherson
- Department of Pharmacy Practice, D'Youville College School of Pharmacy, Drug Information Center, Buffalo, New York
| | - Erin E Conway-Habes
- Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, Buffalo, New York
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Ruhl AP, Sadreameli SC, Allen JL, Bennett DP, Campbell AD, Coates TD, Diallo DA, Field JJ, Fiorino EK, Gladwin MT, Glassberg JA, Gordeuk VR, Graham LM, Greenough A, Howard J, Kato GJ, Knight-Madden J, Kopp BT, Koumbourlis AC, Lanzkron SM, Liem RI, Machado RF, Mehari A, Morris CR, Ogunlesi FO, Rosen CL, Smith-Whitley K, Tauber D, Terry N, Thein SL, Vichinsky E, Weir NA, Cohen RT. Identifying Clinical and Research Priorities in Sickle Cell Lung Disease. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2019; 16:e17-e32. [PMID: 31469310 PMCID: PMC6812163 DOI: 10.1513/annalsats.201906-433st] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Pulmonary complications of sickle cell disease (SCD) are diverse and encompass acute and chronic disease. The understanding of the natural history of pulmonary complications of SCD is limited, no specific therapies exist, and these complications are a primary cause of morbidity and mortality.Methods: We gathered a multidisciplinary group of pediatric and adult hematologists, pulmonologists, and emergency medicine physicians with expertise in SCD-related lung disease along with an SCD patient advocate for an American Thoracic Society-sponsored workshop to review the literature and identify key unanswered clinical and research questions. Participants were divided into four subcommittees on the basis of expertise: 1) acute chest syndrome, 2) lower airways disease and pulmonary function, 3) sleep-disordered breathing and hypoxia, and 4) pulmonary vascular complications of SCD. Before the workshop, a comprehensive literature review of each subtopic was conducted. Clinically important questions were developed after literature review and were finalized by group discussion and consensus.Results: Current knowledge is based on small, predominantly observational studies, few multicenter longitudinal studies, and even fewer high-quality interventional trials specifically targeting the pulmonary complications of SCD. Each subcommittee identified the three or four most important unanswered questions in their topic area for researchers to direct the next steps of clinical investigation.Conclusions: Important and clinically relevant questions regarding sickle cell lung disease remain unanswered. High-quality, multicenter, longitudinal studies and randomized clinical trials designed and implemented by teams of multidisciplinary clinician-investigators are needed to improve the care of individuals with SCD.
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Marinho CDL, Maioli MCP, do Amaral JLM, Lopes AJ, de Melo PL. Respiratory resistance and reactance in adults with sickle cell anemia: Part 2-Fractional-order modeling and a clinical decision support system for the diagnosis of respiratory disorders. PLoS One 2019; 14:e0213257. [PMID: 30845242 PMCID: PMC6405112 DOI: 10.1371/journal.pone.0213257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 02/19/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A better understanding of sickle cell anemia (SCA) and improvements in drug therapy and health policy have contributed to the emergence of a large population of adults living with this disease. The mechanisms by which SCA produces adverse effects on the respiratory system of these patients are largely unknown. Fractional-order (FrOr) models have a high potential to improve pulmonary clinical science and could be useful for diagnostic purposes, offering accurate models with an improved ability to mimic nature. Part 2 of this two-part study examines the changes in respiratory mechanics in patients with SCA using the new perspective of the FrOr models. These results are compared with those obtained in traditional forced oscillation (FOT) parameters, investigated in Part 1 of the present study, complementing this first analysis. METHODOLOGY/PRINCIPAL FINDINGS The data consisted of three categories of subjects: controls (n = 23), patients with a normal spirometric exam (n = 21) and those presenting restriction (n = 24). The diagnostic accuracy was evaluated by investigating the area under the receiver operating characteristic curve (AUC). Initially, it was observed that biomechanical changes in SCA included increased values of fractional inertance, as well as damping and hysteresivity (p<0.001). The correlation analysis showed that FrOr parameters are associated with functional exercise capacity (R = -0.57), pulmonary diffusion (R = -0.71), respiratory muscle performance (R = 0.50), pulmonary flows (R = -0.62) and airway obstruction (R = 0.60). Fractional-order modeling showed high diagnostic accuracy in the detection of early respiratory abnormalities (AUC = 0.93), outperforming spirometry (p<0.03) and standard FOT analysis (p<0.01) used in Part 1 of this study. A combination of machine learning methods with fractional-order modeling further improved diagnostic accuracy (AUC = 0.97). CONCLUSIONS FrOr modeling improved our knowledge about the biomechanical abnormalities in adults with SCA. Changes in FrOr parameters are associated with functional exercise capacity decline, abnormal pulmonary mechanics and diffusion. FrOr modeling outperformed spirometric and traditional forced oscillation analyses, showing a high diagnostic accuracy in the diagnosis of early respiratory abnormalities that was further improved by an automatic clinical decision support system. This finding suggested the potential utility of this combination to help identify early respiratory changes in patients with SCA.
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Affiliation(s)
- Cirlene de Lima Marinho
- Biomedical Instrumentation Laboratory—Institute of Biology and Faculty of Engineering, and BioVasc Research Laboratory—Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Jorge Luis Machado do Amaral
- Department of Electronics and Telecommunications Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- School of Medical Sciences, Pulmonary Function Testing Laboratory, Rio de Janeiro/RJ, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Centre, Rio de Janeiro, Brazil
| | - Pedro Lopes de Melo
- Biomedical Instrumentation Laboratory—Institute of Biology and Faculty of Engineering, and BioVasc Research Laboratory—Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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8
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McLaren A, Klingel M, Behera S, Odame I, Kirby-Allen M, Grasemann H. Effect of Hydroxyurea Therapy on Pulmonary Function in Children with Sickle Cell Anemia. Am J Respir Crit Care Med 2017; 195:689-691. [PMID: 28248149 DOI: 10.1164/rccm.201606-1119le] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Anya McLaren
- 1 Hospital for Sick Children Toronto, Ontario, Canada and.,2 University of Toronto Toronto, Ontario, Canada
| | - Michelle Klingel
- 1 Hospital for Sick Children Toronto, Ontario, Canada and.,2 University of Toronto Toronto, Ontario, Canada
| | - Suman Behera
- 1 Hospital for Sick Children Toronto, Ontario, Canada and.,2 University of Toronto Toronto, Ontario, Canada
| | - Isaac Odame
- 1 Hospital for Sick Children Toronto, Ontario, Canada and.,2 University of Toronto Toronto, Ontario, Canada
| | - Melanie Kirby-Allen
- 1 Hospital for Sick Children Toronto, Ontario, Canada and.,2 University of Toronto Toronto, Ontario, Canada
| | - Hartmut Grasemann
- 1 Hospital for Sick Children Toronto, Ontario, Canada and.,2 University of Toronto Toronto, Ontario, Canada
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Marinho CDL, Maioli MCP, do Amaral JLM, Lopes AJ, de Melo PL. Respiratory resistance and reactance in adults with sickle cell anemia: Correlation with functional exercise capacity and diagnostic use. PLoS One 2017; 12:e0187833. [PMID: 29220407 PMCID: PMC5722327 DOI: 10.1371/journal.pone.0187833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/26/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The improvement in sickle cell anemia (SCA) care resulted in the emergence of a large population of adults living with this disease. The mechanisms of lung injury in this new population are largely unknown. The forced oscillation technique (FOT) represents the current state-of-the-art in the assessment of lung function. The present work uses the FOT to improve our knowledge about the respiratory abnormalities in SCA, evaluates the associations of FOT with the functional exercise capacity and investigates the early detection of respiratory abnormalities. METHODOLOGY/PRINCIPAL FINDINGS Spirometric classification of restrictive abnormalities resulted in three categories: controls (n = 23), patients with a normal exam (n = 21) and presenting pulmonary restriction (n = 24). FOT analysis showed that, besides restrictive changes (reduced compliance; p<0.001), there is also an increase in respiratory resistance (p<0.001) and ventilation heterogeneity (p<0.01). FOT parameters are associated with functional exercise capacity (R = -0.38), pulmonary diffusion (R = 0.66), respiratory muscle performance (R = 0.41), pulmonary volumes (R = 0.56) and airway obstruction (R = 0.54). The diagnostic accuracy was evaluated by investigating the area under the receiver operating characteristic curve (AUC). A combination of FOT and machine learning (ML) classifiers showed adequate diagnostic accuracy in the detection of early respiratory abnormalities (AUC = 0.82). CONCLUSIONS In this study, the use of FOT showed that adults with SCA develop a mixed pattern of respiratory disease. Changes in FOT parameters are associated with functional exercise capacity decline, abnormal pulmonary mechanics and diffusion. FOT associated with ML methods accurately diagnosed early respiratory abnormalities. This suggested the potential utility of the FOT and ML clinical decision support systems in the identification of respiratory abnormalities in patients with SCA.
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Affiliation(s)
- Cirlene de Lima Marinho
- Biomedical Instrumentation Laboratory—Institute of Biology and Faculty of Engineering, and BioVasc Research Laboratory—Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro—Brazil
| | | | - Jorge Luis Machado do Amaral
- Department of Electronics and Telecommunications Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- School of Medical Sciences, Pulmonary Function Testing Laboratory, Rio de Janeiro/RJ, State University of Rio de Janeiro, Rio de Janeiro–Brazil
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Centre, Rio de Janeiro, Brazil
| | - Pedro Lopes de Melo
- Biomedical Instrumentation Laboratory—Institute of Biology and Faculty of Engineering, and BioVasc Research Laboratory—Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro—Brazil
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Bundy DG, Richardson TE, Hall M, Raphael JL, Brousseau DC, Arnold SD, Kalpatthi RV, Ellison AM, Oyeku SO, Shah SS. Association of Guideline-Adherent Antibiotic Treatment With Readmission of Children With Sickle Cell Disease Hospitalized With Acute Chest Syndrome. JAMA Pediatr 2017; 171:1090-1099. [PMID: 28892533 PMCID: PMC5710371 DOI: 10.1001/jamapediatrics.2017.2526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
IMPORTANCE Acute chest syndrome (ACS) is a common, serious complication of sickle cell disease (SCD) and a leading cause of hospitalization and death in both children and adults with SCD. Little is known about the effectiveness of guideline-recommended antibiotic regimens for the care of children hospitalized with ACS. OBJECTIVES To use a large, national database to describe patterns of antibiotic use for children with SCD hospitalized for ACS and to determine whether receipt of guideline-adherent antibiotics was associated with lower readmission rates. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study including 14 480 hospitalizations in 7178 children (age 0-22 years) with a discharge diagnosis of SCD and either ACS or pneumonia. Information was obtained from 41 children's hospitals submitting data to the Pediatric Health Information System from January 1, 2010, to December 31, 2016. EXPOSURES National Heart, Lung, and Blood Institute guideline-adherent (macrolide with parenteral cephalosporin) vs non-guideline-adherent antibiotic regimens. MAIN OUTCOMES AND MEASURES Acute chest syndrome-related and all-cause 7- and 30-day readmissions. RESULTS Of the 14 480 hospitalizations, 6562 (45.3%) were in girls; median (interquartile range) age was 9 (4-14) years. Guideline-adherent antibiotics were provided in 10 654 of 14 480 hospitalizations for ACS (73.6%). Hospitalizations were most likely to include guideline-adherent antibiotics for children aged 5 to 9 years (3230 of 4047 [79.8%]) and declined to the lowest level for children 19 to 22 years (697 of 1088 [64.1%]). Between-hospital variation in antibiotic regimens was wide, with use of guideline-adherent antibiotics ranging from 24% to 90%. Children treated with guideline-adherent antibiotics had lower 30-day ACS-related (odds ratio [OR], 0.71; 95% CI, 0.50-1.00) and all-cause (OR, 0.50; 95% CI, 0.39-0.64) readmission rates vs children who received other regimens (cephalosporin and macrolide vs neither drug class). CONCLUSIONS AND RELEVANCE Current approaches to antibiotic treatment in children with ACS vary widely, but guideline-adherent therapy appears to result in fewer readmissions compared with non-guideline-adherent therapy. Efforts to increase the dissemination and implementation of SCD treatment guidelines are warranted as is comparative effectiveness research to strengthen the underlying evidence base.
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Affiliation(s)
- David G Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston
| | - Troy E Richardson
- Department of Research and Statistics, Children's Hospital Association, Lenexa, Kansas
| | - Matthew Hall
- Department of Research and Statistics, Children's Hospital Association, Lenexa, Kansas
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Staci D Arnold
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Ram V Kalpatthi
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine
| | - Angela M Ellison
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Suzette O Oyeku
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Section editor
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11
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Vascular Permeability Drives Susceptibility to Influenza Infection in a Murine Model of Sickle Cell Disease. Sci Rep 2017; 7:43308. [PMID: 28256526 PMCID: PMC5335717 DOI: 10.1038/srep43308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 01/25/2017] [Indexed: 01/01/2023] Open
Abstract
Sickle cell disease (SCD) is a major global health concern. Patients with SCD experience disproportionately greater morbidity and mortality in response to influenza infection than do others. Viral infection is one contributing factor for the development of Acute Chest Syndrome (ACS), a major cause of morbidity and mortality in SCD patients. We determined whether the heightened sensitivity to influenza infection could be reproduced in the two different SCD murine models to ascertain the underlying mechanisms of increased disease severity. In agreement with clinical observations, we found that both genetic and bone marrow-transplanted SCD mice had greater mortality in response to influenza infection than did wild-type animals. Despite similar initial viral titers and inflammatory responses between wild-type and SCD animals during infection, SCD mice continued to deteriorate and failed to resolve the infection, resulting in increased mortality. Histopathology of the lung tissues revealed extensive pulmonary edema and vascular damage following infection, a finding confirmed by heightened vascular permeability following virus challenge. These findings implicate the development of exacerbated pulmonary permeability following influenza challenge as the primary factor underlying heightened mortality. These studies highlight the need to focus on prevention and control strategies against influenza infection in the SCD population.
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12
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Cohen RT, Rodeghier M, Kirkham FJ, Rosen CL, Kirkby J, DeBaun MR, Strunk RC. Exhaled nitric oxide: Not associated with asthma, symptoms, or spirometry in children with sickle cell anemia. J Allergy Clin Immunol 2016; 138:1338-1343.e4. [PMID: 27521278 PMCID: PMC5330622 DOI: 10.1016/j.jaci.2016.06.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/25/2016] [Accepted: 06/13/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND The significance of fractional exhaled nitric oxide (Feno) levels in children with sickle cell anemia (SCA) is unclear, but increased levels can be associated with features of asthma and thus increased morbidity. OBJECTIVES We sought to determine factors associated with Feno and whether Feno levels are associated with increased rates of acute chest syndrome (ACS) and pain. METHODS All participants had SCA, were part of the prospective observational Sleep and Asthma Cohort study, and had the following assessments: Feno levels, spirometry, blood samples analyzed for hemoglobin, white blood cell counts, eosinophil counts and total serum IgE levels, questionnaires about child medical and family history, and review of medical records. RESULTS The analytic sample included 131 children with SCA (median age, 11.2 years; age range, 6-18 years) followed for a mean of 16.2 years, including a mean of 5.1 years after baseline Feno data measurements. In multivariable analyses higher Feno levels were associated with ln(IgE) levels (P < .001) and the highest quartile of peripheral eosinophil counts (P = .03) but not wheezing symptoms, baseline spirometric indices, or response to bronchodilator. Multivariable analyses identified that the incident rate of ACS was associated with ln(Feno) levels (P = .03), as well as male sex (P = .025), wheezing causing shortness of breath (P = .002), and ACS at less than 4 years of age (P < .001). Feno levels were not associated with future pain episodes. CONCLUSIONS Steady-state Feno levels were not associated with an asthma diagnosis, wheezing symptoms, lung function measures, or prior sickle cell morbidity but were associated with markers of atopy and increased risk of future ACS events.
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Affiliation(s)
- Robyn T. Cohen
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | | | - Fenella J. Kirkham
- Neurosciences Unit, University College London, Institute of Child Health, London, United Kingdom
| | - Carol L. Rosen
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jane Kirkby
- Portex Respiratory Unit, University College London, Institute of Child Health, London, UK
| | - Michael R. DeBaun
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Robert C. Strunk
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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13
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Cohen RT, Klings ES, Strunk RC. Sickle cell disease: wheeze or asthma? Asthma Res Pract 2015; 1:14. [PMID: 27965767 PMCID: PMC5142438 DOI: 10.1186/s40733-015-0014-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/26/2015] [Indexed: 01/31/2023] Open
Abstract
Sickle cell disease (SCD) is the most common life-limiting genetic disease among African Americans, affecting more than 100,000 people in the United States. Respiratory disorders in patients with sickle cell disease have been associated with increased morbidity and mortality. Associations between asthma and pain, acute chest syndrome (ACS), and even death have long been reported. More recently wheezing, even in the absence of an asthma diagnosis, has gained attention as a possible marker of SCD severity. Several challenges exist with regards to making the diagnosis of asthma in patients with SCD, including the high prevalence of wheezing, evidence of airway obstruction on pulmonary function testing, and/or airway hyperresponsiveness among patients with SCD. These features often occur in isolation, in the absence of other clinical criteria necessary for an asthma diagnosis. In this review we will summarize: 1) Our current understanding of the epidemiology of asthma, wheezing, airway obstruction, and airway responsiveness among patients with SCD; 2) The evidence supporting associations with SCD morbidity; 3) Our understanding of the pathophysiology of airway inflammation in SCD; 4) Current approaches to diagnosis and management of asthma in SCD; and 5) Future directions.
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Affiliation(s)
- Robyn T Cohen
- Division of Pediatric Pulmonary and Allergy, Department of Pediatrics, Boston University School of Medicine, 850 Harrison Avenue, Boston, MA 02118 USA
| | - Elizabeth S Klings
- Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118 USA
| | - Robert C Strunk
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO USA
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14
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Yadav A, Corrales-Medina FF, Stark JM, Hashmi SS, Carroll MP, Smith KG, Meulmester KM, Brown DL, Jon C, Mosquera RA. Application of an Asthma Screening Questionnaire in Children with Sickle Cell Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015; 28:177-182. [PMID: 26421214 DOI: 10.1089/ped.2015.0515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: Asthma in sickle cell disease (SCD) patients is associated with elevated morbidity and mortality. Early detection and initiation of treatment may therefore lead to improved outcome. Utility of an asthma screening questionnaire to identify obstructive airway disease and physician diagnosed asthma in children with SCD at an outpatient setting as an effective, easy-to-administer screening tool has not previously been evaluated in this population. Methods: A previously validated asthma screening questionnaire and spirometry were prospectively administered to 41 SCD children at a routine clinic visit. Results: Prevalence of obstructive airway was 51.2% (n = 21) and physician diagnosis of asthma 33.3% (n = 13). Sensitivity (40%) and specificity (75%) of the questionnaire was poor in detecting obstructive airway disease, but sensitivity (77%), specificity (100%), positive predictive value (100%), and negative predictive value (90%) were high in detecting physician diagnosis of asthma. Conclusion: An asthma screening questionnaire could be a useful tool in identifying at-risk SCD children who may benefit from further management.
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Affiliation(s)
- Aravind Yadav
- Department of Pediatrics, University of Texas Health Science Center , Houston Medical School, Houston, Texas
| | - Fernando F Corrales-Medina
- Department of Pediatrics, University of Texas Health Science Center , Houston Medical School, Houston, Texas. ; Division of Pediatrics Hematology-Oncology, Department of Pediatrics, University of Miami-Miller School of Medicine , Miami, FL
| | - James M Stark
- Department of Pediatrics, University of Texas Health Science Center , Houston Medical School, Houston, Texas
| | - S Shahrukh Hashmi
- Department of Pediatrics, University of Texas Health Science Center , Houston Medical School, Houston, Texas
| | - Mary P Carroll
- Department of Pediatrics, University of Texas Health Science Center , Houston Medical School, Houston, Texas
| | - Keely G Smith
- Department of Pediatrics, University of Texas Health Science Center , Houston Medical School, Houston, Texas
| | - Kristen M Meulmester
- Department of Pediatrics, University of Texas Health Science Center , Houston Medical School, Houston, Texas
| | - Deborah L Brown
- Department of Pediatrics, University of Texas Health Science Center , Houston Medical School, Houston, Texas
| | - Cindy Jon
- Department of Pediatrics, University of Texas Health Science Center , Houston Medical School, Houston, Texas
| | - Ricardo A Mosquera
- Department of Pediatrics, University of Texas Health Science Center , Houston Medical School, Houston, Texas
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15
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Affiliation(s)
- Valentine Brousse
- Department of Pediatrics, Reference Centre for Sickle Cell Disease, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
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