Wheezing Symptoms and Parental Asthma Are Associated with a Physician Diagnosis of Asthma in Children with Sickle Cell Anemia

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• 作者：Robert C. Strunk ; MD¹ ; ^{strunk@kids.wustl.edu" class="auth_mail} ; Robyn T. Cohen ; MD ; MPH² ; Benjamin P. Cooper ; MA³ ; Mark Rodeghier ; PhD⁴ ; Fenella J. Kirkham ; MD⁵ ; John O. Warner ; MD⁶ ; Janet Stocks ; PhD⁵ ; Jane Kirkby ; PhD⁵ ; Irene Roberts ; MD⁶ ; Carol L. Rosen ; MD⁷ ; Daniel I. Craven ; MD⁷ ; Michael R. DeBaun ; MD⁸ ; on behalf of the Sleep Asthma Cohort Investigative Team &lowast
• 关键词：ACS ; Acute chest syndrome ; FEV1 ; Forced expiratory volume in 1 second ; FVC ; Forced vital capacity ; IRR ; Incident rate ratio ; LLN ; Lower limit of normal ; NHLBI ; National Heart ; Lung ; and Blood Institute ; SCA ; Sickle cell anemia ; WBC ; White blood cell
• 刊名：The Journal of Pediatrics
• 出版年：April, 2014
• 年：2014
• 卷：164
• 期：4
• 页码：821-826.e1
• 全文大小：320 K

文摘

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Objective

To identify factors associated with asthma associated with increased sickle cell anemia (SCA).

Study design

Children with SCA (N聽=聽187; mean age 9.6聽years, 48% male) were classified as having 鈥渁sthma鈥?based on parent report of physician diagnosis plus prescription of asthma medication (n聽=聽53) or 鈥渘o asthma鈥?based on the absence of these features (n聽=聽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聽=聽.006), wheezing causing shortness of breath (P聽=聽.001), and wheezing after exercise (P聽<聽.001). When 鈮? 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 鈮? 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.