Saxena Shikha, Afolabi-Brown Olufunke, Ballester Lance, Schmucker Nathaniel, Smith-Whitley Kim, Allen Julian, Bhandari Anita
Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Pediatr Pulmonol. 2022 Apr;57(4):885-893. doi: 10.1002/ppul.25845. Epub 2022 Feb 4.
Asthma is a recognized comorbidity in children with sickle cell disease (SCD). It increases the risk of acute chest syndrome (ACS), vaso-occlusive episodes, and early mortality. We aim to determine whether evaluation and management of children with SCD and asthma by a pulmonologist reduce rate of asthma exacerbation and ACS.
The study included 192 patients with SCD (0-21 years) followed at Children's Hospital of Philadelphia Hematology between January 1, 2015, and December 31, 2018, with a diagnosis of asthma, wheeze, or cough. Patients were placed in two groups: those evaluated by a pulmonologist (SCD-A-P) and those not (SCD-A). Rates of emergency department (ED) visits and hospitalizations for asthma exacerbation and ACS were compared between groups and over time.
SCD-A-P patients (n = 70) were predominantly SCD type SS with lower hemoglobin and hematocrit compared to SCD-A patients (n = 122). SCD-A-P started with a higher average rate of hospital visits for asthma exacerbation and ACS per year (2.69 [1.02-4.37]) compared to SCD-A (0.43 [0.24-0.63]), (p < 0.001). For SCD-A-P patients with at least one hospital visit (n = 48), the average rate decreased from 3.93 (1.57-6.29) to 0.85 (0.48-1.23) following pulmonary consultation (p = 0.014) and was comparable to the SCD-A rate by study end.
SCD-A-P was mainly SCD type SS and had higher ED/hospitalization rates for asthma exacerbation and ACS compared to SCD-A, but the rates significantly decreased following pulmonology consultation. These findings support the pulmonologist's role in the multidisciplinary care of SCD patients and highlight the need for evidence-based asthma guidelines for children with SCD.
哮喘是镰状细胞病（SCD）患儿中一种公认的合并症。它会增加急性胸部综合征（ACS）、血管闭塞性发作和早期死亡的风险。我们旨在确定由肺科医生对患有SCD和哮喘的儿童进行评估和管理是否能降低哮喘加重和ACS的发生率。
该研究纳入了192例2015年1月1日至2018年12月31日期间在费城儿童医院血液科就诊的0至21岁SCD患者，这些患者被诊断为哮喘、喘息或咳嗽。患者被分为两组：由肺科医生评估的患者（SCD - A - P）和未由肺科医生评估的患者（SCD - A）。比较两组之间以及不同时间内哮喘加重和ACS的急诊就诊率和住院率。
与SCD - A组患者（n = 122）相比，SCD - A - P组患者（n = 70）主要为SS型SCD，血红蛋白和血细胞比容较低。与SCD - A组（0.43 [0.24 - 0.63]）相比，SCD - A - P组每年因哮喘加重和ACS的平均住院就诊率开始时较高（2.69 [1.02 - 4.37]），（p < 0.001）。对于至少有一次住院就诊的SCD - A - P组患者（n = 48），在接受肺部会诊后，平均住院就诊率从3.93（1.57 - 6.29）降至0.85（0.48 - 1.23）（p = 0.014），到研究结束时与SCD - A组的发生率相当。
SCD - A - P组主要为SS型SCD，与SCD - A组相比，其因哮喘加重和ACS的急诊/住院率更高，但在接受肺科会诊后，这些发生率显著下降。这些发现支持了肺科医生在SCD患者多学科护理中的作用，并强调了为SCD患儿制定循证哮喘指南的必要性。
