Pulmonary function in children and adolescents with sickle cell disease: have we paid proper attention to this problem?

Pulmonary Function Test Abnormalities in Children with Sickle Cell Anemia: A Cross-Sectional Study from a Tertiary Care Centre in Odisha, India

BACKGROUND

This cross-sectional study analyzed the pulmonary function in children with sickle cell disease (SCD), assessing the pulmonary abnormalities and comparing these with a control group of children with other forms of anemia.

MATERIALS AND METHODOLOGY

This study was conducted from July 2022 to June 2024 at Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, and included 126 children (63 with SCD, 63 with other forms of anemia) aged between six to 18 years. Anthropometric data, clinical history, and laboratory parameters were collected, and pulmonary function tests (PFTs) were performed using spirometry to evaluate forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).

RESULTS

Children with SCD had lower height and weight than those in the control group, with height differences reaching statistical significance. Hemoglobin levels were higher in SCD cases than those in the control group, despite both groups exhibiting anemia. The PFTs revealed lower mean FVC and FEV1 in SCD patients, with a predominant restrictive pattern observed in 40 children with SCD (63.4%) compared to 25 children (39.6%) in controls. Only 17 children with SCD (29.6%) showed normal PFT results. Among risk factors, older age, history of vaso-occlusive crises, acute chest syndrome, and blood transfusions were linked to restrictive abnormalities, though not statistically significant. Children on hydroxyurea showed a trend toward restrictive PFT patterns.

CONCLUSION

The study underscores the high prevalence of restrictive lung function abnormalities in children with SCD, highlighting the importance of regular pulmonary monitoring and early intervention to address pulmonary complications. Further research is warranted to explore the impact of hydroxyurea and the cumulative effect of vaso-occlusive events on lung function in SCD.

Role of fractional exhaled nitric oxide in patients with sickle cell disease

INTRODUCTION

Patients with sickle cell disease exhibit different patterns in pulmonary function tests. In particular, there is little evidence on the fractional exhaled nitric oxide (FeNO) test, and its value ranges and its interpretation in these patients have been under debate in recent years.

METHODS

We conduced a cross-sectional, observational and descriptive study between November 2021 and January 2023 including patients aged 6-18 years with sickle cell disease able to perform the FeNO test. We applied the GLI-2012 reference values and the ERS/ATS standards. We defined statistical significance as P < 0.05.

RESULTS

The sample included 43 patients with a median age of 12 years (IQR, 10-15). We did not find an association between significantly elevated FeNO (≥25 ppb) and the diagnosis of asthma (P = 0.37), an obstructive pattern in spirometry (P = 0.67), a positive bronchodilator test (P = 0.53), clinical bronchial hyperreactivity in the context of cold or flu-like symptoms (P = 0.48), cough with exercise (P = 0.42) or nocturnal cough (P = 1.0), but found an association with peripheral eosinophilia (P < 0.01).

CONCLUSIONS

We found no association between FeNO values and the classic features of asthma (clinical or spirometric) in patients with sickle cell disease. Therefore, airway inflammation mechanisms are probably different in these patients.

Prevalence, patterns, and factors associated with abnormal lung function among children with sickle cell disease in Uganda: a cross-sectional study

BACKGROUND

Pulmonary complications are common among children with sickle cell disease (SCD). However, there is little literature on associated lung function abnormalities in Uganda. We aimed to determine the prevalence, patterns, and factors associated with abnormal lung function among children with SCD in a tertiary care hospital in Uganda.

METHOD

A cross-sectional study was conducted among children aged 6 to 18 years at the SCD clinic (SCC) of Mulago National Super-Specialized Hospital between January 2020 and April 2021. Data on sociodemographic and clinical characteristics was collected using a standardized questionnaire. Laboratory investigations, including a complete blood count and serum lactate dehydrogenase (LDH), were done. Spirometry was performed following the ATS/ERS standards. Multivariable modified Poisson regression analysis was performed to determine factors associated with abnormal lung function.

RESULTS

A total of 332 participants were enrolled. The mean age was 11.7 ± 3.4 years, and 184 (55.4%) were female. Overall, 126 (37.9%) participants had abnormal lung function: 67/126 (53.2%) restrictive, 57/126 (45.2%) obstructive, and 2/126 (1.6%) mixed-ventilatory patterns. Factors associated with abnormal lung function were; serum LDH level > 600UL (aIRR: 1.89 95% CI: 1.2 - 7.4, p = 0.049), a history of acute chest syndrome (aIRR: 1.55, 95% CI: 1.06-2.25, p = 0.024), wasting (aIRR: 1.33, 95%CI: 1.02 - 1.72, p = 0.032), and use of charcoal for household cooking (aIRR: 1.49, 95% CI: 1.03-2.15, p = 0.035).

CONCLUSION

More than one-third of children with SCD in Uganda have lung function abnormalities. Strategies to improve nutrition, reduce exposure to charcoal smoke, and monitoring serum LDH levels may be important in preventing or managing abnormal lung function in this population. The identification of reversible and irreversible airway obstruction in children with sickle cell disease also highlights the need for targeted interventions to address these specific patterns of abnormal lung function.

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

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.

Functional capacity and quality of life in children and adolescents with sickle cell anemia

OBJECTIVE

To evaluate the functional and exercise capacity, lung function, quality of life of children and adolescents with sickle cell anemia (SCA HbSS) and to test the reproducibility of functional capacity tests in this population.

METHOD

Cross-sectional study with volunteers with SCA Hb-SS (SCAG), aged 6-18 years matched in age and gender to the control group (CG) with healthy individuals. Spirometry, 5-repetition sit-to-stand test (5STS-test), modified shuttle test (MST), and Pediatric Quality of Life Questionnaire (PedsQL) were performed. The reproducibility of 5STS-test and MST was evaluated: RESULTS: Forty eight volunteers of SCAG and 48 of CG were evaluated. Lung function of SCAG (FVC: 92 ± 15% pred.; FEV₁ /FVC: 84 ± 8% pred.) was worse than the CG (104 ± 15% pred.; FEV₁ /FVC: 90 ± 6% pred.) p < 0.05. SCAG had worse functional capacity registered by distance walked: 576 m (515-672 m) and 5STS-test: 8 s (7.4-8.9 s) compared with the CG who showed distance walked: 1010 m (887-1219 m) and 5STS-test: 7 s (7.0-8.1 s), p < 0.001. SCAG had worse quality of life compared to CG, p < 0.05. The reproducibility of MST (ICC 0.99 (0.98-0.99 IC-95%)) and 5STS-test (ICC 0.80 (0.69-0.88) was considered good, p < 0.001.

CONCLUSION

Children and adolescents with sickle cell anemia presented worse capacity to walk or run, and to perform sit-to-stand test when compared with their control peers. Additionally, they have poorer quality of life. The MST and 5STS-test showed good reproducibility to be applied in pediatric individuals with SCA.

Exercise Capacity and Biomarkers Among Children and Adolescents With Sickle Cell Disease

BACKGROUND

Sickle cell disease is the most common genetic hemoglobinopathy globally and systemically affects body functioning, decreasing exercise capacity.

OBJECTIVE

To assess exercise capacity through the 6-minute walk test (6MWT) and biomarkers in children and adolescents with sickle cell disease.

MATERIALS AND METHODS

Cross-sectional study involving 20 children and adolescents from Brazil. Demographic and socioeconomic data were obtained. Baseline measurements included biomarkers (red blood cells, hemoglobin, hematocrit, white blood cells, platelets, reticulocytes, lactate dehydrogenase, creatine phosphokinase, C-reactive protein, interleukin 6, and fetal hemoglobin). The following data were obtained before, during, and after the 6MWT: heart rate, blood pressure, and peripheral oxygen saturation.

RESULTS

Eighteen children and adolescents ages 5-14 years old were analyzed, 61.1% boys, 100% black or brown, and 61.1% in primary education, with low household income. The average distance walked in 6MWT was 463.8 (137.7) m, significantly less than the predicted value (P < .001). The distance of 6MWT was associated positively with age (P = .042) and inversely with reticulocyte count (P = .42) and interleukin 6 (P = .00). Age modified the effect of interleukin 6 in younger children (P = .038).

CONCLUSION

Our findings suggest increased baseline levels of biomarkers of hemolysis and inflammation impact on 6MWT performance.

Surfactant protein D as a marker for pulmonary complications in pediatric patients with sickle cell disease: Relation to lung function tests

BACKGROUND

Surfactant protein D (SP-D) is considered a candidate biomarker for lung integrity and for disease progression.

AIM

We determined the level of SP-D in children and adolescents with SCD and assessed its possible relation to pulmonary complications and lung function.

METHODS

Serum SP-D levels were assessed in 50 SCD patients compared with 30 healthy controls. High-resolution computerized tomography (HRCT) of the chest was done. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁ ), FEV₁ /FVC% and forced expiratory flow rate during 25-75% of expiration (FEF25-75%) were determined.

RESULTS

SP-D was significantly higher in SCD patients than controls, particularly patients with sickle cell anemia than those with sickle β-thalassemia. SP-D levels were significantly associated with increasing severity of interstitial lung disease. The highest SP-D levels were observed among patients with restrictive lung disease followed by mixed type then obstructive lung disease. SP-D was positively correlated to HbS and serum ferritin while negatively correlated to duration of hydroxyurea treatment and parameters of pulmonary functions. ROC curve analysis revealed that SP-D cutoff value 720 ng/mL could significantly detect the presence of abnormal pulmonary function among SCD patients with 82% sensitivity and 88% specificity. Logistic regression analysis showed that SP-D is an independent factor related to abnormal pulmonary function in SCD.

CONCLUSIONS

SP-D may be a promising biomarker for screening of SCD patients for risk of later pulmonary complications.