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J Pediatr. 2014 Apr;164(4):821-826.e1. doi: 10.1016/j.jpeds.2013.11.034. Epub 2013 Dec 31.

Wheezing symptoms and parental asthma are associated with a physician diagnosis of asthma in children with sickle cell anemia.

Author information

1
Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO. Electronic address: strunk@kids.wustl.edu.
2
Department of Pediatrics, Boston Medical Center/Boston University School of Medicine, Boston, MA.
3
Brown School of Social Work, Washington University, St Louis, MO.
4
Independent Statistician, Chicago, IL.
5
University College, London Institute of Child Health, London, United Kingdom.
6
Department of Paediatrics, Imperial College and Imperial College Healthcare NHS Trust, London, United Kingdom.
7
Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospitals, University Hospitals Case Medical Center, Cleveland, OH.
8
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.

Abstract

OBJECTIVE:

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

STUDY DESIGN:

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.

PMID:
24388323
PMCID:
PMC3962704
DOI:
10.1016/j.jpeds.2013.11.034
[Indexed for MEDLINE]
Free PMC Article

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