Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA.
Department of Pediatrics, University of Texas Health Science Center, Houston Medical School, Houston, TX, USA.
J Asthma. 2021 Jun;58(6):782-790. doi: 10.1080/02770903.2020.1729381. Epub 2020 Mar 12.
Asthma is a chronic airway disorder with variable/recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an inflammation. The expert panel report of the National Heart Lung and Blood Institute recommends asthma screening in sickle cell disease (SCD); however, specific approach is not mentioned. We hypothesize that the breathmobile case identification survey (BCIS) is a valid asthma screening tool in children with SCD. This prospective, single-center study enrolled 129 SCD patients aged 5 to 18 years from March 2016 to March 2018. All patients completed BCIS, spirometry, and fractional exhaled nitric oxide (FeNO). A single pulmonologist blinded to the BCIS results evaluated patients for asthma. Asthma prevalence was 41%. Male gender (60.4%; = 0.041), allergic rhinitis (86.8%; < 0.01), hydroxyurea usage (73.6%; < 0.01), and family history of asthma (34%; < 0.01) were higher but not self-reported parental asthma history, eczema, and tobacco smoke exposure in the asthma group compared to the nonasthma group. FEV ( = 0.003), FVC ( = 0.02), FEV/FVC ( = 0.053), and FEF% ( = 0.02) were lower in asthma. FeNO levels were comparable in both groups. The sensitivity, specificity, positive predictive value, and negative predictive value of the abbreviated BCIS were 67.3%, 90.8%, 83.3%, and 80.2% for asthma; and 82.1%, 90.8%, 76.7%, and 93.2% for persistent asthma, respectively. Persistent asthma patients had a trend of higher hydroxyurea use (82.8% vs. 58.3%; = 0.049) and tobacco smoke exposure (55.2% vs. 29.2%; = 0.057) compared to intermittent asthma. We have validated the BCIS to screen for asthma in SCD. Spirometry but not FeNO may support an asthma diagnosis.
哮喘是一种慢性气道疾病，具有可变/反复发作的症状、气流阻塞、支气管高反应性和炎症。美国国家心肺血液研究所的专家小组报告建议在镰状细胞病（SCD）中进行哮喘筛查；然而，并未提及具体方法。我们假设呼吸移动病例识别调查（BCIS）是 SCD 儿童中有效的哮喘筛查工具。这项前瞻性、单中心研究纳入了 2016 年 3 月至 2018 年 3 月期间年龄在 5 至 18 岁的 129 名 SCD 患者。所有患者均完成了 BCIS、肺量测定和呼出气一氧化氮分数（FeNO）检测。一位对 BCIS 结果不知情的单一肺病专家对患者进行了哮喘评估。哮喘患病率为 41%。与非哮喘组相比，男性（60.4%； = 0.041）、过敏性鼻炎（86.8%； < 0.01）、羟基脲使用（73.6%； < 0.01）和哮喘家族史（34%； < 0.01）更高，但哮喘组患者的父母哮喘史、湿疹和烟草烟雾暴露的自我报告率并未升高。哮喘组的 FEV（ = 0.003）、FVC（ = 0.02）、FEV/FVC（ = 0.053）和 FEF%（ = 0.02）较低。两组的 FeNO 水平无差异。简化版 BCIS 对哮喘的敏感性、特异性、阳性预测值和阴性预测值分别为 67.3%、90.8%、83.3%和 80.2%；对持续性哮喘的敏感性、特异性、阳性预测值和阴性预测值分别为 82.1%、90.8%、76.7%和 93.2%。与间歇性哮喘相比，持续性哮喘患者有使用羟基脲（82.8% vs. 58.3%； = 0.049）和接触烟草烟雾（55.2% vs. 29.2%； = 0.057）的趋势更高。我们已经验证了 BCIS 可用于筛查 SCD 中的哮喘。肺量测定而不是 FeNO 可能支持哮喘诊断。
