title: Factors predicting future ACS episodes in children with sickle cell anemia.
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.
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Michael R
authors.initials: MR
authors.lastname: DeBaun
authors.forename: Mark
authors.initials: M
authors.lastname: Rodeghier
authors.forename: Robyn
authors.initials: R
authors.lastname: Cohen
authors.forename: Fenella J
authors.initials: FJ
authors.lastname: Kirkham
authors.forename: Carol L
authors.initials: CL
authors.lastname: Rosen
authors.forename: Irene
authors.initials: I
authors.lastname: Roberts
authors.forename: Ben
authors.initials: B
authors.lastname: Cooper
authors.forename: Janet
authors.initials: J
authors.lastname: Stocks
authors.forename: Olu
authors.initials: O
authors.lastname: Wilkey
authors.forename: Baba
authors.initials: B
authors.lastname: Inusa
authors.forename: John O
authors.initials: JO
authors.lastname: Warner
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
mesh_terms: D056586:Acute Chest Syndrome / Q000453:epidemiology / Q000209:etiology*; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications*; D001249:Asthma / Q000150:complications* / Q000453:epidemiology; D001993:Bronchodilator Agents; D002648:Child; D002675:Child, Preschool; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000150:complications / Q000235:genetics; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012135:Respiratory Sounds; D012307:Risk Factors; D012805:Sickle Cell Trait / Q000150:complications; D012882:Skin Tests; D013147:Spirometry; D017086:beta-Thalassemia / Q000150:complications / Q000235:genetics
chemical_list: D001993:Bronchodilator Agents
references.citation: Chest. 2011 Mar;139(3):563-568
references.pmid: 20724735
references.citation: J Pediatr. 2001 Feb;138(2):188-92
references.pmid: 11174615
references.citation: Blood. 2007 Jan 1;109(1):40-5
references.pmid: 16940426
references.citation: PLoS One. 2013 Apr 24;8(4):e62398
references.pmid: 23638066
references.citation: Pediatr Pulmonol. 2007 Mar;42(3):272-6
references.pmid: 17262858
references.citation: Am J Respir Crit Care Med. 2005 Jan 15;171(2):137-41
references.pmid: 15516534
references.citation: Pediatr Pulmonol. 2007 Dec;42(12):1187-92
references.pmid: 17960821
references.citation: J Allergy Clin Immunol. 1999 Oct;104(4 Pt 1):775-85
references.pmid: 10518821
references.citation: J Allergy Clin Immunol. 2002 Sep;110(3):395-403
references.pmid: 12209085
references.citation: J Allergy Clin Immunol. 2005 Sep;116(3):571-7
references.pmid: 16159626
references.citation: Eur Respir J. 2012 Dec;40(6):1324-43
references.pmid: 22743675
references.citation: Blood. 1997 Mar 1;89(5):1787-92
references.pmid: 9057664
references.citation: Blood. 2006 Nov 1;108(9):2923-7
references.pmid: 16690969
references.citation: Expert Rev Respir Med. 2011 Oct;5(5):635-45
references.pmid: 21955234
references.citation: Pediatr Pulmonol. 1989;7(3):153-8
references.pmid: 2797929
references.citation: Pediatrics. 2003 Aug;112(2):e85-92
references.pmid: 12897312
references.citation: Hematology Am Soc Hematol Educ Program. 2009;:45-53
references.pmid: 20008181
references.citation: J Pediatr. 2014 Apr;164(4):821-826.e1
references.pmid: 24388323
references.citation: Am J Respir Cell Mol Biol. 2012 Mar;46(3):389-96
references.pmid: 22033263
references.citation: J Allergy Clin Immunol. 2011 Jun;127(6):1440-6
references.pmid: 21388662
references.citation: Eur Respir J. 2005 Aug;26(2):319-38
references.pmid: 16055882
references.citation: Immunol Allergy Clin North Am. 2010 Nov;30(4):513-22, vi
references.pmid: 21029935
references.citation: Lancet. 1999 Aug 14;354(9178):541-5
references.pmid: 10470697
references.citation: Am J Hematol. 2011 Sep;86(9):756-61
references.pmid: 21809369
references.citation: Control Clin Trials. 1987 Dec;8(4 Suppl):131S-140S
references.pmid: 3440386
references.citation: Am Rev Respir Dis. 1978 Dec;118(6 Pt 2):1-120
references.pmid: 742764
references.citation: Am J Respir Crit Care Med. 2008 Oct 1;178(7):667-72
references.pmid: 18565953
references.citation: Haematologica. 2008 Dec;93(12):1917-8
references.pmid: 18815195
references.citation: Thorax. 2005 Mar;60(3):206-10
references.pmid: 15741436
references.citation: Br Med J (Clin Res Ed). 1987 Oct 31;295(6606):1114-5
references.pmid: 3120905
references.citation: Br J Haematol. 2012 Nov;159(4):472-9
references.pmid: 22966893