title: Wheezing symptoms and parental asthma are associated with a physician diagnosis of asthma in children with sickle cell anemia.
abstract: OBJECTIVE
  To identify factors associated with asthma associated with increased sickle cell anemia (SCA).
  
  
  METHODS
  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.
authors.affiliation: Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO. Electronic address: strunk@kids.wustl.edu.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
authors.affiliation: Department of Pediatrics, Boston Medical Center/Boston University School of Medicine, Boston, MA.
authors.forename: Robyn T
authors.initials: RT
authors.lastname: Cohen
authors.affiliation: Brown School of Social Work, Washington University, St Louis, MO.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Cooper
authors.affiliation: Independent Statistician, Chicago, IL.
authors.forename: Mark
authors.initials: M
authors.lastname: Rodeghier
authors.affiliation: University College, London Institute of Child Health, London, United Kingdom.
authors.forename: Fenella J
authors.initials: FJ
authors.lastname: Kirkham
authors.affiliation: Department of Paediatrics, Imperial College and Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: John O
authors.initials: JO
authors.lastname: Warner
authors.affiliation: University College, London Institute of Child Health, London, United Kingdom.
authors.forename: Janet
authors.initials: J
authors.lastname: Stocks
authors.affiliation: University College, London Institute of Child Health, London, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Kirkby
authors.affiliation: Department of Paediatrics, Imperial College and Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Irene
authors.initials: I
authors.lastname: Roberts
authors.affiliation: Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospitals, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Rosen
authors.affiliation: Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospitals, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Craven
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Michael R
authors.initials: MR
authors.lastname: DeBaun
mesh_terms: D056586:Acute Chest Syndrome / Q000150:complications*; D000755:Anemia, Sickle Cell / Q000150:complications*; D001249:Asthma / Q000150:complications* / Q000175:diagnosis*; D002648:Child; D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010290:Parents; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000175:diagnosis*