Asthma management in sickle cell disease

SCD and asthma comorbidity: the potential role of adverse childhood experiences

Objectives

Asthma is strongly associated with poor health amongst individuals with SCD. Adverse Childhood Experiences (ACEs) are traumatic experiences occurring before 18 years of age. ACEs occur at the individual and familial (original ACEs) levels and expand to the community level (additional ACEs). Chronic exposure to ACEs leads to toxic stress, inflammation, and risk for chronic illnesses, including asthma. This study examined the relationship between ACEs and asthma among children and adolescents with SCD.

Methods

Employing a cross-sectional study design, 75 children/adolescents with SCD were screened for ACEs. Prevalence ratios and logistic regressions were used to test the association and independent relationship between ACEs and asthma.

Results

Fifty-nine (78%) participants reported exposure to at least 1 ACE. Adolescents exposed to ≥2 original- or ≥4 expanded ACEs (original + additional) were 1.15 times as likely to have asthma compared to those with no/low ACEs (95% CI: 1.03, 1.28, P = .01; 1.07, 1.24, P ≤ .001). Through logistic regression analyses, covarying age, sex, SCD genotype, income, and disease-modifying therapy, original (OR 1.52, 95% CI: 1.031, 2.242), additional (2.43, 95% CI: 1.335, 4.421), and expanded ACEs (1.529, 95% CI: 1.149, 2.036) were all shown to be independently associated with asthma.

Conclusion

The findings from this research support our hypothesis that children/adolescents with SCD exposed to a higher number of ACEs have a higher prevalence of asthma compared to low-exposed subjects. This study lays the foundation for future longitudinal and interventional studies aimed to improve SCD-asthma outcomes through ACE-protective mechanisms.

The impact of obstructive sleep apnea in children with sickle cell disease and asthma

INTRODUCTION

Asthma and obstructive sleep apnea (OSA) are chronic diseases that disproportionately affect children with sickle cell disease (SCD). The literature describes the negative impact that both conditions have on children with SCD separately; however, the effect of OSA on asthmatic children with OSA is less specific. We hypothesized that the presence of OSA in children with SCD and asthma is associated with specific hematologic markers, worse clinical outcomes, and greater healthcare utilization.

METHODS

We retrospectively evaluated children with both SCD and asthma who underwent polysomnography (PSG). We assessed their demographic information, PSG data, hematologic indices, and healthcare utilization based on the concurrent presence of OSA.

RESULTS

Fifty-nine percent of the cohort had OSA with a lower oxygen saturation (SpO2 ) nadir (87% vs. 93%, p < 0.001) and a lower median daytime SpO2 (96.5% vs. 98.5%, p < 0.05); those with OSA were more likely to have the hemoglobin SS genotype (86% vs. 46.5%, p = 0.03). Additionally, those with OSA had a higher mean corpuscular volume (87 vs. 77.2 fL, p = 0.03) and reticulocyte count (10.1% vs. 5.5%, p < 0.01). There was no difference in asthma severity or healthcare utilization between those with OSA and those without OSA.

DISCUSSION

Overall, children with SCD and asthma might be at increased risk for developing OSA, and screening for sleep-disordered breathing should be incorporated as part of their routine care.

Asthma, allergic sensitization and lung function in sickle cell disease

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 Sβ^o).

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.

Convergence of Inflammatory Pathways in Allergic Asthma and Sickle Cell Disease

The underlying pathologies of sickle cell disease and asthma share many characteristics in terms of respiratory inflammation. The principal mechanisms of pulmonary inflammation are largely distinct, but activation of common pathways downstream of the initial inflammatory triggers may lead to exacerbation of both disease states. The altered inflammatory landscape of these respiratory pathologies can differentially impact respiratory pathogen susceptibility in patients with sickle cell disease and asthma. How these two distinct diseases behave in a comorbid setting can further exacerbate pulmonary complications associated with both disease states and impact susceptibility to respiratory infection. This review will provide a concise overview of how asthma distinctly affects individuals with sickle cell disease and how pulmonary physiology and inflammation are impacted during comorbidity.

Summer Camps for Children with Sickle Cell Disease

Background

Children with sickle cell disease (SCD) face unique problems that attendance at a camp with their peers is well suited to address. However, because the staff members at ordinary summer camps are not accustomed to accommodating children with chronic diseases, the potential for significant health consequences exists.

Methods

We searched the literature in PubMed and CINAHL using the keywords summer camp, camp, sickle, and anemia to identify the unique characteristics of camps for children with SCD and the recommendations for care and/or lessons learned.

Results

Published data are limited. Accommodations to avoid triggering sickle vaso-occlusive pain have been developed empirically and extrapolated from other settings. Camp experiences provide peer learning opportunities, positive role models, and a safe area to explore personal growth. The supportive atmosphere of the camp and escape from social stigma are welcome changes from the daily routine. Camp experiences can help with education on self-care and the transition from adolescent to adult healthcare.

Conclusion

Camp offers unique opportunities for care coordination. Camps for children with SCD provide a setting for dissemination of best practices for the disease. Community-based organizations should partner in recruiting young adults with SCD as counselors. Educational material now available could be modified for use in the camp setting. All stakeholders in the care of children with SCD should work in unison to ensure these children enjoy the benefits of summer camp.