Asthma in children with sickle cell disease and its association with acute chest syndrome.
BACKGROUND
Pulmonary complications are a major cause of morbidity and mortality in sickle cell disease (SCD). The relationship of asthma with SCD and acute chest syndrome (ACS) remains uncertain. A study was undertaken to test the hypotheses that asthma and bronchial hyperreactivity (BHR) are more common in children with SCD than in ethnic matched controls and that SCD children with atopic asthma are more likely to have recurrent episodes of ACS.


METHODS
A modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was administered and skin prick tests undertaken in 80 children with SCD and 80 ethnic matched controls aged 5-10 years. BHR was assessed by measurement of forced expiratory volume in 1 second before and after a bronchodilator (albuterol 200 mug) or an exercise challenge.


RESULTS
Asthma (48% v 22%, p = 0.002) and BHR (p = 0.02) but not atopy were more common in children with SCD than in controls. Atopy (66.6% v 29%, p = 0.007) and asthma (80% v 40%, p = 0.005), particularly atopic asthma (53% v 12%, p<0.001), were more common in children with SCD who had suffered recurrent episodes of ACS than in those who had suffered a single or no episode.


CONCLUSIONS
Asthma and BHR are more common in children with SCD than in ethnic matched controls, and atopic asthma appears to be associated with recurrent ACS. Early and effective anti-asthma therapy might reduce the pulmonary morbidity associated with SCD.
Knight-Madden
J M
JM
Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston 5, Jamaica. jennifer.knightmadden@uwimona.edu.jm
Forrester
T S
TS
Lewis
N A
NA
Greenough
A
A
D000208:Acute Disease; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000503:physiopathology; D001249:Asthma / Q000150:complications / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000503:physiopathology; D008297:Male; D013577:Syndrome; D014797:Vital Capacity / Q000502:physiology
J Clin Invest. 1982 Dec;70(6):1253-9
6294138
West Indian Med J. 1981 Jun;30(2):86-9
7257344
Int J Epidemiol. 1996 Jun;25(3):609-16
8671563
J Pediatr. 1997 Aug;131(2):278-83
9290616
J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):1-10
9893177
Pediatr Pulmonol. 1999 Sep;28(3):205-16
10495338
Am J Physiol. 1999 Oct;277(4 Pt 2):H1579-92
10516198
Am J Hematol. 1983 Aug;15(1):1-13
6881134
Clin Haematol. 1985 Feb;14(1):129-40
2985310
Ann Allergy. 1988 Aug;61(2):129-32
3400898
N Engl J Med. 1989 Feb 2;320(5):271-7
2911321
Thorax. 1993 Sep;48(9):873-6
8236066
Blood. 1994 Jul 15;84(2):643-9
7517723
Ann Clin Biochem. 1994 May;31 ( Pt 3):296-7
8067674
West Indian Med J. 1995 Mar;44(1):16-9
7793107
Blood. 1995 Jul 15;86(2):776-83
7606007
Blood. 1996 Mar 15;87(6):2573-8
8630425
Am J Respir Crit Care Med. 2000 Jan;161(1):309-29
10619836
Chest. 2000 May;117(5):1386-92
10807826
N Engl J Med. 2000 Jun 22;342(25):1855-65
10861320
Acta Haematol. 2000;103(4):197-202
11014893
J Pediatr. 2001 Feb;138(2):188-92
11174615
Thorax. 2002 Aug;57(8):742-8
12149539
ANZ J Surg. 2003 Apr;73(4):189-93
12662224
Thorax. 2004 Jan;59(1):67-70
14694252
J R Soc Med. 2004 Jan;97(1):49-50
14702376
Clin Infect Dis. 2004 Aug 15;39(4):488-96
15356811
Clin Infect Dis. 2004 Aug 15;39(4):561-5
15356822
Ann Allergy. 1972 Nov;30(11):623-6
5080738
Q J Med. 1975 Apr;44(174):325-47
1101285
East Afr Med J. 1979 Apr;56(4):163-5
487982
East Afr Med J. 1982 Jul;59(7):481-6
7160326