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Gillespie M, Afolabi-Brown O, Machogu E, Willen S, Kopp BT. Updates in Pediatric Sickle Cell Lung Disease. Clin Chest Med 2024; 45:749-760. [PMID: 39069335 DOI: 10.1016/j.ccm.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Sickle cell lung disease presents a challenging care paradigm involving acute and chronic lower airway disease, sleep-disordered breathing, pulmonary vascular disease, and modification by environmental factors. Understanding the presentation, pathophysiology, and diagnostic approaches is essential for accurate identification and management. While significant progress has been made, there remains a need for research to develop effective treatments and interventions to decrease disease burden in these children. Additionally, the long-term impact of interventions on cardiopulmonary outcomes is unknown. Collaborative efforts among health care providers, researchers, advocacy groups, and policy makers are crucial to improving the lives of children with SCD.
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Affiliation(s)
- Michelle Gillespie
- Division of Pulmonary Medicine, The Ohio State University Wexner Medical Center, Nationwide Children's Hospital, 2050 Kenny Road, Suite 2200, Columbus, OH, USA
| | - Olufunke Afolabi-Brown
- Division of Pulmonary and Sleep Medicine, Children' Hospital of Philadelphia, 3500 Civic Center Boulevard, Philadelphia, PA, USA
| | - Evans Machogu
- Division of Pediatric Pulmonary, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital, ROC 4270 Indianapolis, IN 46202, USA
| | - Shaina Willen
- Division of Pulmonology, Department of Pediatrics, UC Davis Medical Center, 2516 Stockton Boulevard, Sacramento, CA, USA; Division of Hematology/Oncology, Department of Pediatrics, UC Davis Medical Center, 2516 Stockton Boulevard, Sacramento, CA, USA
| | - Benjamin T Kopp
- Division of Pulmonology, Asthma, Cystic Fibrosis, and Sleep, Emory Children's Center, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, Emory Children's Center, 2015 Uppergate Drive, Atlanta, GA 30322, USA.
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2
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Jacob SA, Talati R, Kanter J. The evolving treatment landscape for children with sickle cell disease. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:797-808. [PMID: 37858508 DOI: 10.1016/s2352-4642(23)00201-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 10/21/2023]
Abstract
Sickle cell disease is the most common inherited pathological haemoglobinopathy. Over the past 30 years, disease-related morbidity and mortality have improved in high-income countries due to advances in preventive care and treatments. Established disease-modifying therapies, such as hydroxyurea (hydrocarbamide), are continuing to have an important role in the treatment of sickle cell disease, and newer agents also show promise. In the past 5 years, the US Food and Drug Administration approved three additional sickle cell disease-modifying medications, and new gene therapies have been developed as an alternative curative treatment to haematopoietic stem-cell transplantation. In this Review, we discuss the current treatment landscape for paediatric sickle cell disease and emerging innovations in care. We also review the need for close, long-term management for children receiving newer therapies and the importance of ongoing investment in people with sickle cell disease in low-income and middle-income countries.
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Affiliation(s)
- Seethal A Jacob
- Division of Pediatric Hematology Oncology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Ravi Talati
- Division of Pediatric Hematology, Oncology & Blood/Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Julie Kanter
- Lifespan Comprehensive Sickle Cell Center, University of Alabama, Birmingham, AL, USA.
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Pugh C, Zeno RN, Stanek J, Gillespie M, Kopp BT, Creary SE. Description of a Colocated Comprehensive Care Model for People With Sickle Cell and Comorbid Pulmonary Disease. J Pediatr Hematol Oncol 2023; 45:e723-e727. [PMID: 36898038 DOI: 10.1097/mph.0000000000002655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/08/2022] [Indexed: 03/12/2023]
Abstract
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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Affiliation(s)
| | | | | | - Michelle Gillespie
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Benjamin T Kopp
- Center for Microbial Pathogenesis
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Susan E Creary
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute
- Division of Hematology/Oncology/BMT
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Hidden Comorbidities in Asthma: A Perspective for a Personalized Approach. J Clin Med 2023; 12:jcm12062294. [PMID: 36983294 PMCID: PMC10059265 DOI: 10.3390/jcm12062294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Bronchial asthma is the most frequent inflammatory non-communicable condition affecting the airways worldwide. It is commonly associated with concomitant conditions, which substantially contribute to its burden, whether they involve the lung or other districts. The present review aims at providing an overview of the recent acquisitions in terms of asthma concomitant systemic conditions, besides the commonly known respiratory comorbidities. The most recent research has highlighted a number of pathobiological interactions between asthma and other organs in the view of a shared immunological background underling different diseases. A bi-univocal relationship between asthma and common conditions, including cardiovascular, metabolic or neurodegenerative diseases, as well as rare disorders such as sickle cell disease, α1-Antitrypsin deficiency and immunologic conditions with hyper-eosinophilia, should be considered and explored, in terms of diagnostic work-up and long-term assessment of asthma patients. The relevance of that acquisition is of utmost importance in the management of asthma patients and paves the way to a new approach in the light of a personalized medicine perspective, besides targeted therapies.
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Desai AA, Machado RF, Cohen RT. The Cardiopulmonary Complications of Sickle Cell Disease. Hematol Oncol Clin North Am 2022; 36:1217-1237. [PMID: 36400540 PMCID: PMC10323820 DOI: 10.1016/j.hoc.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sickle cell disease (SCD) is a genetic hemoglobinopathy associated with extensive morbidity and early mortality. While there have been recent improvements in available disease-modifying therapies for SCD, cardiopulmonary complications remain a major risk factor for death in this population. We provide an overview of current knowledge regarding several of the major acute and chronic cardiopulmonary complications in SCD, including: acute chest syndrome, airway disease, lung function abnormalities, nocturnal hypoxemia and sleep disordered breathing, pulmonary vascular disease, and sickle cell cardiomyopathy.
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Affiliation(s)
- Ankit A Desai
- Department of Medicine, Indiana School of Medicine, Indianapolis, IN, USA; Indiana University, 950 W. Walnut Street R2 Building, Room 466, Indianapolis, IN 46202, USA
| | - Roberto F Machado
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Room C400, Walther Hall, R3 980 W. Walnut Street, Indianapolis, IN 46202, USA
| | - Robyn T Cohen
- Department of Pediatrics, Boston Medical Center/Boston University School of Medicine, 801 Albany Street 4th Floor, Boston, MA 02118, USA.
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Saxena S, Afolabi-Brown O, Ballester L, Schmucker N, Smith-Whitley K, Allen J, Bhandari A. Benefit of pulmonary subspecialty care for children with sickle cell disease and asthma. Pediatr Pulmonol 2022; 57:885-893. [PMID: 35068085 DOI: 10.1002/ppul.25845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/28/2021] [Accepted: 01/20/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Asthma is a recognized comorbidity in children with sickle cell disease (SCD). It increases the risk of acute chest syndrome (ACS), vaso-occlusive episodes, and early mortality. We aim to determine whether evaluation and management of children with SCD and asthma by a pulmonologist reduce rate of asthma exacerbation and ACS. METHODS The study included 192 patients with SCD (0-21 years) followed at Children's Hospital of Philadelphia Hematology between January 1, 2015, and December 31, 2018, with a diagnosis of asthma, wheeze, or cough. Patients were placed in two groups: those evaluated by a pulmonologist (SCD-A-P) and those not (SCD-A). Rates of emergency department (ED) visits and hospitalizations for asthma exacerbation and ACS were compared between groups and over time. RESULTS SCD-A-P patients (n = 70) were predominantly SCD type SS with lower hemoglobin and hematocrit compared to SCD-A patients (n = 122). SCD-A-P started with a higher average rate of hospital visits for asthma exacerbation and ACS per year (2.69 [1.02-4.37]) compared to SCD-A (0.43 [0.24-0.63]), (p < 0.001). For SCD-A-P patients with at least one hospital visit (n = 48), the average rate decreased from 3.93 (1.57-6.29) to 0.85 (0.48-1.23) following pulmonary consultation (p = 0.014) and was comparable to the SCD-A rate by study end. CONCLUSION SCD-A-P was mainly SCD type SS and had higher ED/hospitalization rates for asthma exacerbation and ACS compared to SCD-A, but the rates significantly decreased following pulmonology consultation. These findings support the pulmonologist's role in the multidisciplinary care of SCD patients and highlight the need for evidence-based asthma guidelines for children with SCD.
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Affiliation(s)
- Shikha Saxena
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Olufunke Afolabi-Brown
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lance Ballester
- Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nathaniel Schmucker
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kim Smith-Whitley
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julian Allen
- 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
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Klings ES, Steinberg MH. Acute chest syndrome of sickle cell disease: genetics, risk factors, prognosis and management. Expert Rev Hematol 2022; 15:117-125. [PMID: 35143368 DOI: 10.1080/17474086.2022.2041410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IntroductionSickle cell disease, one of the world's most prevalent Mendelian disorders, is a chronic hemolytic anemia punctuated by acute vasoocclusive events. Both hemolysis and vasoocclusion lead to irreversible organ damage and failure. Among the many sub-phenotypes of sickle cell disease is the acute chest syndrome (ACS) characterized by combinations of chest pain, cough, dyspnea, fever, abnormal lung exam, leukocytosis, hypoxia, and new radiographic opacities. ACS is a major cause of morbidity and mortality.Area coveredWe briefly review the diagnosis, epidemiology, etiology, and current treatments for ACS and focus on understanding and estimating the risks for developing this complication, how prognosis and outcomes might be improved and the genetic elements that might impact the risk of ACS.Expert opinionThe clinical heterogeneity of ACS has hindered our understanding of risk stratification. Lacking controlled clinical trials most treatment is based on expert opinion. Fetal hemoglobin levels and coexistent α thalassemia affect the incidence of ACS; other genetic associations are tenuous. Transfusions, whose use not innocuous, should be targeted to the severity and likelihood of ACS progression. Stable, non-hypoxic patients with favorable hematologic and radiographic findings usually do not need transfusion; severe progressive ACS is best managed with exchange transfusion.
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Affiliation(s)
- Elizabeth S Klings
- Sections of Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston University School of Medicine, Boston, USA
| | - Martin H Steinberg
- Hematology and Medical Oncology, Center of Excellence for Sickle Cell Disease, Boston University School of Medicine and Boston Medical Center, Boston, USA
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Angel A, Wandalsen GF, Solé D, Lanza FC, Cobra CL, Johnston C, Braga JAP. Asthma, allergic sensitization and lung function in sickle cell disease. Allergol Immunopathol (Madr) 2020; 48:450-457. [PMID: 32249096 DOI: 10.1016/j.aller.2019.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/30/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pulmonary disease is a frequent acute and chronic manifestation in sickle cell disease (SCD), presenting high morbidity and mortality. OBJECTIVES To identify the prevalence and association of asthma, allergic sensitization and altered pulmonary function in patients with SCD (SS and Sβo). METHODS A single-center, cross-sectional study was conducted, in which 70 patients with SCD and 44 controls, aged six to 18 years, responded to the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), complemented with an anamnesis regarding the associated clinical outcomes. All patients underwent immediate hypersensitivity skin tests with aeroallergens and a pulmonary function evaluation (spirometry). Regarding the statistical analysis, parametric and non-parametric methods were used, depending on the variables studied. Tests were considered significant when p<0.05. RESULTS There was no significant difference between the patients and controls regarding the prevalence of asthma and allergic sensitization (p>0.05). The number of occurrences of acute chest syndrome per patient per year was significantly higher for asthmatic patients than for non-asthmatic patients (p=0.04). Obstructive pulmonary function occurred in 30.9% of the patients and in 5.4% of the controls, and restrictive pulmonary function occurred in 5.5% of the patients and 5.4% of the controls. Asthma and wheezing in the last 12months had significant associations with obstructive pulmonary function (p=0.014 and p=0.027, respectively). CONCLUSIONS The occurrence of asthma, allergic sensitization and alteration in lung function in patients with SCD reinforces the importance of routine monitoring of these diagnoses, which allows for early treatment and prevention of the evolution of pulmonary disease in adulthood.
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Ballas SK, Dampier C. Risk factors associated with increased emergency department utilization in patients with sickle cell disease: a systematic literature review. Ann Hematol 2020; 99:2483-2495. [PMID: 32852615 DOI: 10.1007/s00277-020-04205-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Sickle cell disease (SCD), a genetic disorder affecting up to 100,000 patients in the USA, impacts multiple organ systems. The emergency department (ED) is frequently utilized by patients with SCD who have severe pain from vaso-occlusive crises. The goal of this systematic literature review is to identify predictors for ED use among patients with SCD in the USA, as high ED reliance is not ideal because of the potential for discontinuity of care as well as higher costs. PubMed and Embase were searched for articles containing the keywords "sickle cell disease" AND ("emergency" OR "acute care") AND ("utilization" OR "health care") published between 2000 and 26 September 2019. A total of 26 publications were identified meeting the following inclusion criteria: report of ED or acute care clinic use; report of health care utilization for SCD; and report of ED visits independent of hospital admission, ED revisits, inpatient care visits, and SCD care unit visits. Articles unavailable in English or those focused on populations outside the USA were excluded. Of the 26 articles included, 4 were prospective and the remainder were retrospective. Qualitative analysis of the articles revealed a higher rate of ED utilization among adults than children, patients with public insurance than private insurance, and patients with more comorbidities, complications, or pain. Age and pain levels were both commonly cited as predictors of ED utilization. Additional prospective and interventional studies are needed to further define predictors of ED utilization and to uncover treatments that decrease ED visits.
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Affiliation(s)
- Samir K Ballas
- Cardeza Foundation for Hematologic Research, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1020 Locust Street Suite 394, Philadelphia, PA, 19107, USA.
| | - Carlton Dampier
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Emory Healthcare, Atlanta, GA, USA.,AFLAC Cancer and Blood Disorders Center, Atlanta, GA, USA
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10
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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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Abstract
PURPOSE OF REVIEW Asthma is common in children with sickle cell disease (SCD) and appears to be associated with increased morbidity. Providers caring for children with SCD have struggled with the question of whether asthma exists as a true comorbidity or whether certain aspects of the chronic inflammatory disease gives children with SCD an asthma-like phenotype. RECENT FINDINGS Clinical signs and symptoms seen in children with asthma in the general population, such as wheezing, airway hyperresponsiveness, atopy, elevated leukotrienes, and abnormal lung function are seen in children with SCD both with and without a diagnosis of asthma. SUMMARY Current evidence highlights that the presence of lung disease in children with SCD has significant implications irrespective of the underlying cause, including asthma. Further research should focus on well tolerated and effective interventions to prevent disease-related complications for children with pulmonary complications of SCD.
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12
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Jiang C, Gavitt TD, Szczepanek SM. House Dust Mite-Induced Allergic Lung Inflammation Is Not Exacerbated in Sickle Cell Disease Mice. Int Arch Allergy Immunol 2019; 179:192-200. [PMID: 30999298 DOI: 10.1159/000499043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 02/14/2019] [Indexed: 11/19/2022] Open
Abstract
AIM Asthma appears to be a common comorbid condition in children with sickle cell disease (SCD), and such individuals may be at a higher risk for increased morbidity and mortality. However, several reports have indicated that asthma severity is not particularly high in those with SCD, and airway hyperreactivity and wheeze may be independently associated with SCD. In SCD mice, exacerbated allergic airway disease (AAD) has been observed in response to the model antigen ovalbumin (OVA). We sought to determine if allergic lung inflammation is also exacerbated in SCD mice when they are exposed to the human allergen, house dust mite (HDM). METHODS AND RESULTS Eosinophil counts in bronchoalveolar lavage fluid were determined by cytocentrifugation and increased in both wild-type (WT) and SCD mice after acute exposure to a high dose (25 µg) of HDM, which then decreased in chronically exposed mice. WT mice exposed to a low dose of HDM (1 µg) followed the same pattern of eosinophil flux, but SCD mice did not induce much eosinophilia after acute exposure to HDM. As was observed in previous studies, lung lesions similarly increased in severity in both WT and SCD mice after acute exposure to HDM, which remained elevated after chronic exposure. Furthermore, serum HDM-specific IgE titers similarly increased and selected serum cytokines were similar in both WT and SCD mice. CONCLUSION These results contrast with previous reports of exacerbated AAD in SCD mice exposed to OVA and support the alternative hypothesis that asthmatic responses are normal in those with SCD.
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Affiliation(s)
- Chenyang Jiang
- Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, Connecticut, USA
| | - Tyler D Gavitt
- Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, Connecticut, USA
| | - Steven M Szczepanek
- Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, Connecticut, USA,
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13
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Lunt A, Sturrock SS, Greenough A. Asthma and the outcome of sickle cell disease. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1547964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Alan Lunt
- Department of Child Health, King’s College Hospital NHS Foundation Trust, London, UK
| | - Sarah S. Sturrock
- Department of Child Health, King’s College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Department of Child Health, King’s College Hospital NHS Foundation Trust, London, UK
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14
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Country of Birth and Variations in Asthma and Wheezing Prevalence, and Emergency Department Utilization in Children: A NHANES Study. J Immigr Minor Health 2018; 19:1290-1295. [PMID: 27393335 DOI: 10.1007/s10903-016-0459-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Asthma prevalence and asthma-related healthcare utilization differ across racial/ethnic groups and geographical areas. This study builds on previous research to examine the relationship between country of birth and asthma prevalence and healthcare utilization using a national data set. The National Health and Nutrition Examination Survey (NHANES) Demographic and Questionnaire Files from 2007 to 2012 were used for this study. We used SPSS complex sampling design to estimate the association between country of birth and asthma prevalence, wheezing and emergency department (ED) use. The sample size was 8272 children and adolescents between the ages of 5 and 19 years old. US-born children had more reported episodes of wheezing (p = 0.024) 95 % CI 1.06; 2.54. There was no association between country of birth and asthma and ED use. US-born children and adolescents compared to foreign-born children and adolescents are more likely to have episodes of wheezing.
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15
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Abstract
Sickle cell disease (SCD) is a group of inherited disorders caused by mutations in HBB, which encodes haemoglobin subunit β. The incidence is estimated to be between 300,000 and 400,000 neonates globally each year, the majority in sub-Saharan Africa. Haemoglobin molecules that include mutant sickle β-globin subunits can polymerize; erythrocytes that contain mostly haemoglobin polymers assume a sickled form and are prone to haemolysis. Other pathophysiological mechanisms that contribute to the SCD phenotype are vaso-occlusion and activation of the immune system. SCD is characterized by a remarkable phenotypic complexity. Common acute complications are acute pain events, acute chest syndrome and stroke; chronic complications (including chronic kidney disease) can damage all organs. Hydroxycarbamide, blood transfusions and haematopoietic stem cell transplantation can reduce the severity of the disease. Early diagnosis is crucial to improve survival, and universal newborn screening programmes have been implemented in some countries but are challenging in low-income, high-burden settings.
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16
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Raghunathan VM, Whitesell PL, Lim SH. Sleep-disordered breathing in patients with sickle cell disease. Ann Hematol 2017; 97:755-762. [PMID: 29214337 DOI: 10.1007/s00277-017-3199-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/29/2017] [Indexed: 01/18/2023]
Abstract
Sickle cell disease is one of the most common hereditary hemoglobinopathies worldwide, and its vaso-occlusive and hemolytic crises cause considerable patient morbidity. A growing body of evidence has shown that sleep-disordered breathing, and in particular, obstructive sleep apnea, occurs at high frequency in the sickle cell population, and that there is significant overlap in the underlying pathophysiology of these two conditions. Through a variety of mechanisms including nocturnal hypoxemia and increased oxidative stress, production of pro-inflammatory cytokines, and endothelial dysfunction, sickle cell anemia and sleep-disordered breathing potentiate each other's clinical effects and end-organ complications. Here, we will review the shared pathophysiologic mechanisms of these conditions and discuss their clinical sequelae. We will also examine the results of studies that have been carried out with clinical intervention of nocturnal hypoxemia in patients with sickle cell disease in the attempts to overcome the complications of the disease. Finally, we will propose the areas of investigation that merit further investigations in future in patients with sickle cell disease and sleep-disordered breathing.
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Affiliation(s)
- Vikram M Raghunathan
- Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Peter L Whitesell
- Department of Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Seah H Lim
- Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA. .,Rhode Island Hospital, Room 140, APC Building593 Eddy Street, Providence, RI, 02903, USA.
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Bendiak GN, Mateos-Corral D, Sallam A, Atenafu EG, Kirby M, Odame I, Bikangaga P, Subbarao P, Grasemann H. Association of wheeze with lung function decline in children with sickle cell disease. Eur Respir J 2017; 50:50/5/1602433. [PMID: 29191949 DOI: 10.1183/13993003.02433-2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/07/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Glenda N Bendiak
- Section of Respiratory Medicine, Dept of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada
| | - Dimas Mateos-Corral
- Division of Pediatric Respiratory Medicine, Dept of Pediatrics, IWK Health Centre, Halifax, NS, Canada
| | - Anwar Sallam
- Division of Respiratory Medicine, Dept of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Biostatistics Dept, University Health Network, Toronto, ON, Canada
| | - Melanie Kirby
- Division of Hematology and Oncology, Dept of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Isaac Odame
- Division of Hematology and Oncology, Dept of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Bikangaga
- Division of Respiratory Medicine, Dept of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Dept of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Program in Physiology and Experimental Medicine, SickKids Research Institute, The Hospital for Sick Children, and University of Toronto, Toronto, ON, Canada
| | - Hartmut Grasemann
- Division of Respiratory Medicine, Dept of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada .,Program in Physiology and Experimental Medicine, SickKids Research Institute, The Hospital for Sick Children, and University of Toronto, Toronto, ON, Canada
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18
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Glassberg J, Minnitti C, Cromwell C, Cytryn L, Kraus T, Skloot GS, Connor JT, Rahman AH, Meurer WJ. Inhaled steroids reduce pain and sVCAM levels in individuals with sickle cell disease: A triple-blind, randomized trial. Am J Hematol 2017; 92:622-631. [PMID: 28370266 DOI: 10.1002/ajh.24742] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 12/31/2022]
Abstract
Clinical and preclinical data demonstrate that altered pulmonary physiology (including increased inflammation, increased blood flow, airway resistance, and hyper-reactivity) is an intrinsic component of Sickle Cell Disease (SCD) and may contribute to excess SCD morbidity and mortality. Inhaled corticosteroids (ICS), a safe and effective therapy for pulmonary inflammation in asthma, may ameliorate the altered pulmonary physiologic milieu in SCD. With this single-center, longitudinal, randomized, triple-blind, placebo controlled trial we studied the efficacy and feasibility of ICS in 54 nonasthmatic individuals with SCD. Participants received once daily mometasone furoate 220 mcg dry powder inhalation or placebo for 16 weeks. The primary outcome was feasibility (the number who complete the trial divided by the total number enrolled) with prespecified efficacy outcomes including daily pain score over time (patient reported) and change in soluble vascular cell adhesion molecule (sVCAM) levels between entry and 8-weeks. For the primary outcome of feasibility, the result was 96% (52 of 54, 95% CI 87%-99%) for the intent-to-treat analysis and 83% (45 of 54, 95% CI 71%-91%) for the per-protocol analysis. The adjusted treatment effect of mometasone was a reduction in daily pain score of 1.42 points (95%CI 0.61-2.21, P = 0.001). Mometasone was associated with a reduction in sVCAM levels of 526.94 ng/mL more than placebo (95% CI 50.66-1003.23, P = 0.03). These results support further study of ICS in SCD including multicenter trials and longer durations of treatment. www.clinicaltrials.gov (NCT02061202).
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Affiliation(s)
- Jeffrey Glassberg
- Department of Emergency Medicine; Icahn School of Medicine at Mount Sinai; New York
| | | | - Caroline Cromwell
- Department of Hematology and Oncology; Icahn School of Medicine at Mount Sinai Beth Israel; New York
| | - Lawrence Cytryn
- Department of Hematology and Oncology; Icahn School of Medicine at Mount Sinai Beth Israel; New York
| | - Thomas Kraus
- Center for Therapeutic Antibody Development, Icahn School of Medicine at Mount Sinai; New York
| | - Gwen S. Skloot
- Department of Pulmonary, Critical Care and Sleep Medicine; Icahn School of Medicine at Mount Sinai; New York
| | | | - Adeeb H. Rahman
- Department of Genetics and Genomic Sciences; Icahn School of Medicine at Mount Sinai; New York
| | - William J. Meurer
- Departments of Emergency Medicine and Neurology; University of Michigan; Ann Arbor Michigan
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19
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Sickle Cell Disease. Respir Med 2017. [DOI: 10.1007/978-3-319-43447-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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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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21
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Musa BM, Galadanci NA, Rodeghier M, Debaun MR. Higher prevalence of wheezing and lower FEV1 and FVC percent predicted in adults with sickle cell anaemia: A cross-sectional study. Respirology 2016; 22:284-288. [PMID: 27653959 DOI: 10.1111/resp.12895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/16/2016] [Accepted: 07/10/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Respiratory symptoms including wheezing are common in adults with sickle cell anaemia (SCA), even in the absence of asthma. However, the prevalence of spirometry changes and respiratory symptoms in adults with SCA is unknown. METHODS Using a cross-sectional study design, we tested the hypothesis that adults with SCA (cases) would have higher rates of lower airway obstruction and wheezing than those without SCA (controls) using the American Thoracic Society Division of Lung Diseases' questionnaire. Patients were adults with SCA aged between 18 and 65 years. Controls were consecutive unselected individuals without SCA who presented to an outpatient general medicine clinic. RESULTS We enrolled 150 adults with SCA and 287 consecutive controls without SCA. The median age was 23.0 and 27.0 years for adults with and without SCA, respectively. Cases were more likely to report cough without a cold (35.0% vs 18.6%, P < 0.001), lower forced expiratory volume in 1 s (FEV1 ) % predicted (70.1% vs 82.1%, P = 0.001) and lower forced vital capacity (FVC) % predicted (67.4% vs 74.9%, P = 0.001) than controls. In the multivariable model, wheezing was significantly associated with SCA status (OR = 1.69, 95% CI = 1.08-2.65, P = 0.024). Similarly, FEV1 % predicted was significantly associated with SCA status and wheezing (P = 0.001 for both). CONCLUSION Adults with SCA experience a higher rate of wheezing and impaired respiratory functions compared with controls from the same region.
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Affiliation(s)
- Baba M Musa
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Najibah A Galadanci
- Department of Haematology and Blood Transfusion, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Michael R Debaun
- Department of Pediatrics and Vanderbilt and Meharry Sickle Cell Disease Center of Excellence, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Vanderbilt and Meharry Sickle Cell Disease Center of Excellence, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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22
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Abstract
Acute chest syndrome is a frequent cause of acute lung disease in children with sickle-cell disease. Asthma is common in children with sickle-cell disease and is associated with increased incidence of vaso-occlusive pain events, acute chest syndrome episodes, and earlier death. Risk factors for asthma exacerbation and an acute chest syndrome episode are similar, and both can present with shortness of breath, chest pain, cough, and wheezing. Despite overlapping risk factors and symptoms, an acute exacerbation of asthma or an episode of acute chest syndrome are two distinct entities that need disease-specific management strategies. Although understanding has increased about asthma as a comorbidity in sickle-cell disease and its effects on morbidity, substantial gaps remain in knowledge about best management.
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Affiliation(s)
- Michael R DeBaun
- Department of Pediatrics and Medicine, Division of Hematology/Oncology, Nashville, TN, USA; Vanderbilt-Meharry Sickle Cell Center for Excellence, 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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23
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Meurer WJ, Connor JT, Glassberg J. Simulation of various randomization strategies for a clinical trial in sickle cell disease. ACTA ACUST UNITED AC 2016; 21:241-7. [PMID: 26868369 DOI: 10.1080/10245332.2015.1101966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To use numerical simulation to evaluate various randomization strategies for a clinical trial in sickle cell disease (SCD). METHODS The Inhaled Mometasone to Promote Reduction in Vaso-occlusive Events trial* is a randomized, controlled, feasibility study of inhaled mometasone for individuals with SCD who do not have asthma. The target sample size is 45 patients and one goal is to limit imbalance with respect to two important covariates (1) hydroxyurea use and (2) historical emergency department (ED) utilization. We compared three methods of patient allocation (simple randomization, block randomization, and biased-coin adaptive randomization) using numerical simulation (10 000 trials). The primary outcome measure was the proportion of simulated trials with numerically apparent differences in the two covariates: hydroxyurea use (binary) and ED utilization (three-level ordinal). RESULTS Overall, only 1.6% of simulated trials had any covariate comparison with P < 0.3 across groups for simple randomization, and 0% for both the block and adaptive randomization. In trials where the total sample size was 45 patients, the block randomization strategy achieved the greatest balance because participants were deterministically assigned to the treatment arm that balanced covariates. The adaptive strategy achieved similar results without deterministic treatment assignments even when trials included only 45 patients. DISCUSSION Adaptive clinical trial designs have potential to mitigate some of the challenges that have hampered SCD trials. In small exploratory trials, even non-statistically significant differences in important covariates can threaten interpretability and external validity. CONCLUSION Adaptive randomization performed similarly to block randomization and offers advantages including better allocation concealment and less ability for investigators to predict the next assignment.
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Affiliation(s)
- William J Meurer
- a Departments of Emergency Medicine and Neurology , University of Michigan , Ann Arbor , MI , USA
| | - Jason T Connor
- b Berry Consultants , Austin , TX , USA.,c University of Central Florida College of Medicine , Orlando , FL , USA
| | - Jeffrey Glassberg
- d Departments of Emergency Medicine, Hematology and Medical Oncology , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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24
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Mehari A, Klings ES. Chronic Pulmonary Complications of Sickle Cell Disease. Chest 2016; 149:1313-24. [PMID: 26836905 DOI: 10.1016/j.chest.2015.11.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 10/19/2015] [Accepted: 11/14/2015] [Indexed: 01/31/2023] Open
Abstract
Sickle cell disease (SCD), the most common genetic hemolytic anemia worldwide, affects 250,000 births annually. In the United States, SCD affects approximately 100,000 individuals, most of African descent. Hemoglobin S (HbS) results from a glutamate-to-valine mutation of the sixth codon of the β-hemoglobin allele; the homozygous genotype (HbSS) is associated with the most prevalent and severe form of the disease. Other SCD genotypes include HbSC, composed of one HbS allele and one HbC (glutamate-to-lysine mutation) allele; and HbS-β-thalassemia(0) or HbS-β-thalassemia(+), composed of one HbS allele and one β-thalassemia allele with absent or reduced β-chain production, respectively. Despite advances in care, median survival remains in the fifth decade, due in large part to chronic complications of the disease. Chronic pulmonary complications in SCD are major contributors to this early mortality. Although our understanding of these conditions has improved much over the past 10 to 15 years, there remains no specific treatment for pulmonary complications of SCD. It is unclear whether conventional treatment regimens directed at non-SCD populations have equivalent efficacy in patients with SCD. This represents a critical research need. In this review, the authors review the state-of-the-art understanding of the following pulmonary complications of SCD: (1) pulmonary hypertension; (2) venous thromboembolic disease; (3) sleep-disordered breathing; (4) asthma and recurrent wheezing; and (5) pulmonary function abnormalities. This review highlights the advances as well as the knowledge gaps in this field to update clinicians and other health care providers and to garner research interest from the medical community.
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Affiliation(s)
- Alem Mehari
- Department of Pulmonary Diseases, Howard University College of Medicine, Washington, DC
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25
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Eiymo Mwa Mpollo MS, Brandt EB, Shanmukhappa SK, Arumugam PI, Tiwari S, Loberg A, Pillis D, Rizvi T, Lindsey M, Jonck B, Carmeliet P, Kalra VK, Le Cras TD, Ratner N, Wills-Karp M, Hershey GKK, Malik P. Placenta growth factor augments airway hyperresponsiveness via leukotrienes and IL-13. J Clin Invest 2015; 126:571-84. [PMID: 26690703 DOI: 10.1172/jci77250] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/12/2015] [Indexed: 12/25/2022] Open
Abstract
Airway hyperresponsiveness (AHR) affects 55%-77% of children with sickle cell disease (SCD) and occurs even in the absence of asthma. While asthma increases SCD morbidity and mortality, the mechanisms underlying the high AHR prevalence in a hemoglobinopathy remain unknown. We hypothesized that placenta growth factor (PlGF), an erythroblast-secreted factor that is elevated in SCD, mediates AHR. In allergen-exposed mice, loss of Plgf dampened AHR, reduced inflammation and eosinophilia, and decreased expression of the Th2 cytokine IL-13 and the leukotriene-synthesizing enzymes 5-lipoxygenase and leukotriene-C4-synthase. Plgf-/- mice treated with leukotrienes phenocopied the WT response to allergen exposure; conversely, anti-PlGF Ab administration in WT animals blunted the AHR. Notably, Th2-mediated STAT6 activation further increased PlGF expression from lung epithelium, eosinophils, and macrophages, creating a PlGF/leukotriene/Th2-response positive feedback loop. Similarly, we found that the Th2 response in asthma patients is associated with increased expression of PlGF and its downstream genes in respiratory epithelial cells. In an SCD mouse model, we observed increased AHR and higher leukotriene levels that were abrogated by anti-PlGF Ab or the 5-lipoxygenase inhibitor zileuton. Overall, our findings indicate that PlGF exacerbates AHR and uniquely links the leukotriene and Th2 pathways in asthma. These data also suggest that zileuton and anti-PlGF Ab could be promising therapies to reduce pulmonary morbidity in SCD.
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26
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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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27
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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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28
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Tewari S, Brousse V, Piel FB, Menzel S, Rees DC. Environmental determinants of severity in sickle cell disease. Haematologica 2015; 100:1108-16. [PMID: 26341524 PMCID: PMC4800688 DOI: 10.3324/haematol.2014.120030] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/05/2015] [Indexed: 12/13/2022] Open
Abstract
Sickle cell disease causes acute and chronic illness, and median life expectancy is reduced by at least 30 years in all countries, with greater reductions in low-income countries. There is a wide spectrum of severity, with some patients having no symptoms and others suffering frequent, life-changing complications. Much of this variability is unexplained, despite increasingly sophisticated genetic studies. Environmental factors, including climate, air quality, socio-economics, exercise and infection, are likely to be important, as demonstrated by the stark differences in outcomes between patients in Africa and USA/Europe. The effects of weather vary with geography, although most studies show that exposure to cold or wind increases hospital attendance with acute pain. Most of the different air pollutants are closely intercorrelated, and increasing overall levels seem to correlate with increased hospital attendance, although higher concentrations of atmospheric carbon monoxide may offer some benefit for patients with sickle cell disease. Exercise causes some adverse physiological changes, although this may be off-set by improvements in cardiovascular health. Most sickle cell disease patients live in low-income countries and socioeconomic factors are undoubtedly important, but little studied beyond documenting that sickle cell disease is associated with decreases in some measures of social status. Infections cause many of the differences in outcomes seen across the world, but again these effects are relatively poorly understood. All the above factors are likely to account for much of the pathology and variability of sickle cell disease, and large prospective studies are needed to understand these effects better.
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Affiliation(s)
- Sanjay Tewari
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
| | - Valentine Brousse
- Reference Centre for Sickle Cell Disease, Pediatric Department, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris; Université Paris Descartes, France
| | | | - Stephan Menzel
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
| | - David C Rees
- Department of Molecular Haematology, King's College London School of Medicine, King's College Hospital, London, England
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29
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Glassberg J, Simon J, Patel N, Jeong JM, McNamee JJ, Yu G. Derivation and preliminary validation of a risk score to predict 30-day ED revisits for sickle cell pain. Am J Emerg Med 2015; 33:1396-401. [PMID: 26283616 DOI: 10.1016/j.ajem.2015.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Emergency department (ED) revisits and 30-day readmissions have been proposed as markers for quality of ED care for sickle cell disease (SCD). OBJECTIVE To create a scoring system that quantifies the risk of 30-day revisit after ED discharge for SCD vaso-occlusive pain METHODS This was a dual-center retrospective derivation and validation cohort study. The derivation was performed at an academic, tertiary care center and the validation at an urban community hospital. The primary outcome was revisit to the ED within 30 days after an ED discharge for SCD pain. Recursive partitioning was used to derive a scoring system to predict 30-day revisits. RESULTS Of a total of 1456 ED visits for SCD pain, there were 680 ED discharges (admission rate of 53%) in 193 unique individuals included in the derivation cohort. There were 240 (35.3%) 30-day revisits. Of a total of 126 ED visits for SCD, there were 79 ED discharges in 41 unique individuals in the validation cohort. The final risk score included 4 variables: (1) age, (2) insurance status, (3) triage pain score, and (4) amount of opioids administered during the ED visit. Possible scores range from 0 to 6. The areas under the receiver operating characteristic curves were 0.746 (95% confidence interval, 0.71-0.78-derivation cohort) and 0.753 (95% confidence interval, 0.65-0.86-validation cohort). A cutoff of 4 or greater identified 60% of 30-day ED revisits in the derivation cohort and 80% of revisits in the validation cohort. CONCLUSIONS A risk score can identify ED visits for SCD pain with high risk of 30-day revisit.
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MESH Headings
- Adolescent
- Adult
- Age Distribution
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Anemia, Sickle Cell/complications
- Anemia, Sickle Cell/economics
- Anemia, Sickle Cell/therapy
- Emergency Service, Hospital/economics
- Emergency Service, Hospital/standards
- Emergency Service, Hospital/statistics & numerical data
- Female
- Hospitals, Community
- Hospitals, Urban
- Humans
- Insurance Coverage
- Insurance, Health/classification
- Insurance, Health/statistics & numerical data
- Male
- Medical Records/statistics & numerical data
- Multicenter Studies as Topic
- New Jersey
- New York City
- Pain/drug therapy
- Pain/etiology
- Pain Measurement
- Patient Discharge/standards
- Patient Discharge/statistics & numerical data
- Patient Readmission/standards
- Patient Readmission/statistics & numerical data
- Propensity Score
- Retrospective Studies
- Risk Assessment/methods
- Socioeconomic Factors
- Young Adult
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Affiliation(s)
- Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai New York, NY.
| | - Jena Simon
- Department of Nursing, Icahn School of Medicine at Mount Sinai New York, NY.
| | - Nilesh Patel
- Department of Emergency Medicine, St Joseph's Regional Medical Center, Paterson, NJ.
| | - Jordan M Jeong
- Department of Emergency Medicine, St Joseph's Regional Medical Center, Paterson, NJ.
| | - Justin J McNamee
- Department of Emergency Medicine, St Joseph's Regional Medical Center, Paterson, NJ.
| | - Gary Yu
- NYU College of Nursing, New York, NY.
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30
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Diep RT, Busani S, Simon J, Punzalan A, Skloot GS, Glassberg JA. Cough and wheeze events are temporally associated with increased pain in individuals with sickle cell disease without asthma. Br J Haematol 2015; 170:732-4. [PMID: 25753135 DOI: 10.1111/bjh.13325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Robert T Diep
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jena Simon
- Department of Nursing, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexa Punzalan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gwen S Skloot
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Gileles-Hillel A, Kheirandish-Gozal L, Gozal D. Hemoglobinopathies and sleep--The road less traveled. Sleep Med Rev 2015; 24:57-70. [PMID: 25679069 DOI: 10.1016/j.smrv.2015.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/05/2015] [Accepted: 01/06/2015] [Indexed: 01/11/2023]
Abstract
Sickle cell disease and thalassemia are common hereditary blood disorders associated with increased systemic inflammation, tissue hypoxia, endothelial dysfunction and end-organ damage, the latter accounting for the substantial morbidity and abbreviated lifespan associated with these conditions. Sleep perturbations in general, and sleep-disordered breathing in particular are also highly prevalent conditions and the mechanisms underlying their widespread end-organ morbidities markedly and intriguingly overlap with the very same pathways implicated in the hemoglobinopathies. However, little attention has been given to date to the potential contributing role of sleep disorders to sickle cell disease manifestations. Here, we comprehensively review the pathophysiological mechanisms and clinical manifestations linking disturbed sleep and hemoglobinopathies, with special emphasis on sickle cell disease. In addition to a broad summary of the available evidence, we identify many of the research gaps that require attention and future investigation, and provide the scientific contextual setting that should enable opportunities to investigate the intertwined pathophysiological mechanisms and clinical outcomes of sleep disorders and hemoglobinopathies.
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Affiliation(s)
- Alex Gileles-Hillel
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Leila Kheirandish-Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.
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Matthie N, Brewer CA, Moura VL, Jenerette CM. Breathing Exercises for Inpatients with Sickle Cell Disease. MEDSURG NURSING : OFFICIAL JOURNAL OF THE ACADEMY OF MEDICAL-SURGICAL NURSES 2015; 24:35-38. [PMID: 26306354 PMCID: PMC5363956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sickle cell disease (SCD) is a painful condition wherein breathing often is compromised. This pilot study supports the premise that individuals with SCD are willing to learn breathing exercises. Medical-surgical nurses should encourage breathing exercises for managing pain and preventing complications.
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The proportion of potentially preventable emergency department visits by patients with sickle cell disease. J Pediatr Hematol Oncol 2015; 37:48-53. [PMID: 24517964 DOI: 10.1097/mph.0000000000000124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emergency department (ED) visits by children with sickle cell disease (SCD) are often classified as urgent based on resource utilization. This classification may not accurately reflect the potentially preventable nature of SCD visits. We sought to determine the proportion of SCD crisis-related pediatric ED visits that are possibly preventable. PROCEDURE We reviewed 2 years of ED visits with a diagnosis of SCD with crisis at a hospital with an established sickle cell program. Criteria for preventable visits were predefined by pediatric hematologists. Non-pain-related chief complaints requiring emergent evaluation or painful episodes preceded by 2 opioid doses were considered not preventable; others were potentially preventable. RESULTS The study included 603 visits by 187 patients; 33% were potentially preventable. Overall, 29% of visits were emergent based on non-pain-related emergent complaints. Of the remaining pain-related visits, 26% were preceded by 2 or more doses of opioids at home. Visits by children with asthma were 0.58 times as likely to be preventable, due to more non-pain-related emergent chief complaints (32%) and more children (36%) taking 2 or more opioid doses. CONCLUSIONS Approximately two thirds of SCD crisis-related pediatric ED visits are not immediately preventable; that percentage is higher in children with asthma.
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Abstract
In children with sickle cell disease (SCD), wheezing may occur in the absence of asthma. However, the prevalence of wheezing in children with SCD when compared with children without SCD (controls) in the same setting is unknown. Using a case-control study design, we tested the hypothesis that children with SCD would have a higher rate of wheezing than those without SCD. We enrolled 163 children with SCD (cases) and 96 children without SCD (controls) from a community hospital in Nigeria. Parent reports of respiratory symptoms were identified based on responses to questions taken from the American Thoracic Society Division of Lung Diseases' Questionnaire. The median age was 8.5 years for children with SCD and 7.7 years for controls. Cases were more likely than controls to report wheezing both with colds (17.3% vs. 2.1%, P<0.01) and without colds (4.9% vs. 0%, P=0.03). Cases had 9.8 times greater odds of wheezing (95% confidence interval, 2.3-42.2). In the multivariable model, the only variable associated with wheezing was SCD status (odds ratio=18.7, 95% confidence interval, 2.5-142; P=0.005). Children with SCD experience a significantly higher rate of wheezing when compared with children of similar age without SCD.
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DeBaun MR, Rodeghier M, Cohen R, Kirkham FJ, Rosen CL, Roberts I, Cooper B, Stocks J, Wilkey O, Inusa B, Warner JO, Strunk RC. Factors predicting future ACS episodes in children with sickle cell anemia. Am J Hematol 2014; 89:E212-7. [PMID: 25088663 DOI: 10.1002/ajh.23819] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 07/31/2014] [Indexed: 01/07/2023]
Abstract
While a doctor-diagnosis of asthma is associated with an increased risk of pain and acute chest syndrome (ACS) in children with sickle cell anemia (SCA), little is known about the relationship between specific asthma characteristics and clinical factors and future morbidity in children with SCA. We evaluated the relationship between (i) asthma risk factors at the time of a clinical visit (respiratory symptoms, maternal history of asthma, allergy skin tests, spirometry results) and (ii) the known risk factor of ACS early in life, on prospective pain and ACS episodes in a cohort of 159 children with SCA followed from birth to a median of 14.7 years. An ACS episode prior to 4 years of age, (incidence rate ratio [IRR] = 2.84; P < 0.001], female gender (IRR = 1.80; P = 0.009), and wheezing causing shortness of breath (IRR = 1.68; P = 0.042) were associated with future ACS rates. We subsequently added spirometry results (obstruction defined as FEV1 /FVC less than the lower limits of normal; and bronchodilator response, FEV1 ≥ 12%) and prick skin test responses to the model. Only ≥ 2 positive skin tests had a significant effect (IRR 1.87; P = 0.01). Thus, early in life ACS events, wheezing causing shortness of breath, and ≥ 2 positive skin tests predict future ACS events.
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Affiliation(s)
- Michael R. DeBaun
- Department of Pediatrics; Vanderbilt University School of Medicine; Nashville Tennessee
| | | | - Robyn Cohen
- Department of Pediatrics; Boston Medical Center/Boston University School of Medicine; Boston Massachusetts
| | - Fenella J. Kirkham
- Department of Paediatrics; Imperial College and the Biomedical Centre of Imperial College Healthcare NHS Trust; London United Kingdom
| | - Carol L. Rosen
- Department of Pediatrics; Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospitals, University Hospitals Case Medical Center; Cleveland Ohio
| | - Irene Roberts
- Department of Paediatrics; Imperial College and the Biomedical Centre of Imperial College Healthcare NHS Trust; London United Kingdom
| | - Ben Cooper
- Brown School of Social Work, Washington University; St. Louis Missouri
| | - Janet Stocks
- University College London Institute of Child Health; London United Kingdom
| | - Olu Wilkey
- Department of Paediatrics; North Middlesex Hospital NHS Trust; London United Kingdom
| | - Baba Inusa
- Department of Paediatrics; Evelina Children's Hospital, Guy's and St. Thomas' National Health Service Foundation Trust; London United Kingdom
| | - John O. Warner
- Department of Paediatrics; Imperial College and the Biomedical Centre of Imperial College Healthcare NHS Trust; London United Kingdom
| | - Robert C. Strunk
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics; Washington University School of Medicine; St. Louis Missouri
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Rosen CL, Debaun MR, Strunk RC, Redline S, Seicean S, Craven DI, Gavlak JC, Wilkey O, Inusa B, Roberts I, Goodpaster RL, Malow B, Rodeghier M, Kirkham FJ. Obstructive sleep apnea and sickle cell anemia. Pediatrics 2014; 134:273-81. [PMID: 25022740 PMCID: PMC4187233 DOI: 10.1542/peds.2013-4223] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To ascertain the prevalence of and risk factors for obstructive sleep apnea syndrome (OSAS) in children with sickle cell anemia (SCA). METHODS Cross-sectional baseline data were analyzed from the Sleep and Asthma Cohort Study, a multicenter prospective study designed to evaluate the contribution of sleep and breathing abnormalities to SCA-related morbidity in children ages 4 to 18 years, unselected for OSAS symptoms or asthma. Multivariable logistic regression assessed the relationships between OSAS status on the basis of overnight in-laboratory polysomnography and putative risk factors obtained from questionnaires and direct measurements. RESULTS Participants included 243 children with a median age of 10 years; 50% were boys, 99% were of African heritage, and 95% were homozygous for β(S) hemoglobin. OSAS, defined by obstructive apnea hypopnea indices, was present in 100 (41%) or 25 (10%) children at cutpoints of ≥1 or ≥5, respectively. In univariate analyses, OSAS was associated with higher levels of habitual snoring, lower waking pulse oxygen saturation (Spo2), reduced lung function, less caretaker education, and non-preterm birth. Lower sleep-related Spo2 metrics were also associated with higher obstructive apnea hypopnea indices. In multivariable analyses, habitual snoring and lower waking Spo2 remained risk factors for OSAS in children with SCA. CONCLUSIONS The prevalence of OSAS in children with SCA is higher than in the general pediatric population. Habitual snoring and lower waking Spo2 values, data easily obtained in routine care, were the strongest OSAS risk factors. Because OSAS is a treatable condition with adverse health outcomes, greater efforts are needed to screen, diagnose, and treat OSAS in this high-risk, vulnerable population.
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Affiliation(s)
- Carol L. Rosen
- Department of Pediatrics and Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michael R. Debaun
- Vanderbilt University School of Medicine and Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Robert C. Strunk
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sinziana Seicean
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel I. Craven
- Department of Pediatrics and Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Johanna C.D. Gavlak
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London, United Kingdom
| | - Olu Wilkey
- North Middlesex Hospital National Health Service Trust, London, United Kingdom
| | - Baba Inusa
- Evelina Children’s Hospital, Guy’s and St Thomas Hospital, London, United Kingdom
| | - Irene Roberts
- Department of Paediatrics, Imperial College and Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - R. Lucas Goodpaster
- Vanderbilt University School of Medicine and Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Beth Malow
- Vanderbilt University School of Medicine and Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | | | - Fenella J. Kirkham
- University College London Institute of Child Health, London, United Kingdom
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Abnormal pulmonary function and associated risk factors in children and adolescents with sickle cell anemia. J Pediatr Hematol Oncol 2014; 36:185-9. [PMID: 24309610 PMCID: PMC4681275 DOI: 10.1097/mph.0000000000000011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Obstructive and restrictive pulmonary changes develop in children with sickle cell disease, but reports conflict as to the type of change that predominates. We prospectively performed spirometry, plethysmography, and lung diffusing capacity in 146 children aged 7 to 20 years with hemoglobin SS or Sβ(0)-thalassemia. Nineteen percent of the patients had obstructive physiology as defined according to guidelines of the American Thoracic Society. In addition, 9% had restrictive physiology and 11% had abnormal but not categorized physiology. Increasing age, patient-reported or family-reported history of asthma or wheezing, and higher lactate dehydrogenase concentration were independent predictors of obstruction as reflected in lower forced expiratory volume in the first second/forced vital capacity. In conclusion, abnormal pulmonary function, most often obstructive, is common in children with hemoglobin SS and Sβ(0)-thalassemia. Full pulmonary function testing should be performed in children with hemoglobin SS or Sβ(0)-thalassemia, especially with history of asthma or wheezing and accentuated elevations in hemolytic markers.
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Wheezing symptoms and parental asthma are associated with a physician diagnosis of asthma in children with sickle cell anemia. J Pediatr 2014; 164:821-826.e1. [PMID: 24388323 PMCID: PMC3962704 DOI: 10.1016/j.jpeds.2013.11.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/20/2013] [Accepted: 11/14/2013] [Indexed: 02/02/2023]
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 physician 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 3 factors associated with asthma: parent with asthma (P = .006), wheezing causing shortness of breath (P = .001), and wheezing after exercise (P < .001). When ≥2 features were present, model sensitivity was 100%. When none of the features were present, model sensitivity was 0%. When only 1 feature was present, model sensitivity was also 0%, and presence of ≥2 of 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 in those without asthma (incident rate ratio 2.21, CI 1.31-3.76), but pain rates were not (incident rate ratio 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 physician diagnosis of asthma and to identify those at higher risk for ACS events. The value of treatment for asthma in the prevention of SCA morbidity needs to be studied.
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Abstract
Acute pulmonary problems in sickle cell disease (SCD) patients, in particular acute chest syndrome (ACS), cause significant mortality and morbidity. It is important to differentiate ACS from pneumonia to avoid inappropriate or inadequate treatment. Asthma may increase the risk of ACS and co-morbid asthma and SCD are associated with worse patient outcomes and, in preclinical models, more severe inflammation. Recurrent wheezing, however, can occur in the absence of a diagnosis of asthma; it is likely due to SCD related inflammation and additional therapies than those that treat asthma may be required. Further research is merited to clarify these issues.
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Affiliation(s)
- Jennifer Knight-Madden
- Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston 7, Jamaica, W.I..
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, The MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College, London, UK
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Abstract
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 cause, individuals with SCD and with recurrent wheezing are at increased risk for subsequent morbidity and premature mortality. We believe individuals who 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 who wheeze and have a history or examination associated with atopy, we consider asthma treatment and monitoring per National Heart, Lung and Blood Institute asthma guidelines. SUMMARY Wheezing in SCD should be treated aggressively both in 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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Affiliation(s)
- Jeffrey A Glassberg
- aEmergency Medicine, Hematology and Medical Oncology, Mount Sinai School of Medicine, New York bWashington University School of Medicine in St Louis, St Louis, Missouri cVanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Monroe Carell Jr Children's Hospital, Vanderbilt, Nashville, Tennessee, USA
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Gomez E, Morris CR. Asthma management in sickle cell disease. BIOMED RESEARCH INTERNATIONAL 2013; 2013:604140. [PMID: 24324967 PMCID: PMC3842053 DOI: 10.1155/2013/604140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 09/05/2013] [Accepted: 09/13/2013] [Indexed: 01/19/2023]
Abstract
Asthma is a common comorbid factor in sickle cell disease (SCD). However, the incidence of asthma in SCD is much higher than expected compared to rates in the general population. Whether "asthma" in SCD is purely related to genetic and environmental factors or rather is the consequence of the underlying hemolytic and inflammatory state is a topic of recent debate. Regardless of the etiology, hypoxemia induced by bronchoconstriction and inflammation associated with asthma exacerbations will contribute to a cycle of sickling and subsequent complications of SCD. Recent studies confirm that asthma predisposes to complications of SCD such as pain crises, acute chest syndrome, and stroke and is associated with increased mortality. Early recognition and aggressive standard of care management of asthma may prevent serious pulmonary complications and reduce mortality. However, data regarding the management of asthma in SCD is very limited. Clinical trials are needed to evaluate the effectiveness of current asthma therapy in patients with SCD and coincident asthma, while mechanistic studies are needed to delineate the underlying pathophysiology.
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Affiliation(s)
- Esteban Gomez
- Department of Hematology-Oncology, Children's Hospital & Research Center Oakland, Oakland, CA 94609, USA
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, 1645 Tullie Circle, NE, Atlanta, GA 30329, USA
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Dhakal B, Giese K, Santo-Thomas L, Field JJ. Death during an asthma exacerbation in an adult with sickle cell disease: an autopsy case study. Am J Hematol 2013; 88:824. [PMID: 23720156 DOI: 10.1002/ajh.23492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 05/14/2013] [Accepted: 05/17/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Binod Dhakal
- Department of Medicine; Medical College of Wisconsin; Milwaukee; Wisconsin
| | - Kristinza Giese
- Fond du Lac County Medical Examiner's Office; Fond du Lac; Wisconsin
| | - Linus Santo-Thomas
- Department of Medicine; Medical College of Wisconsin; Milwaukee; Wisconsin
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