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. 2005 Mar;60(3):206–210. doi: 10.1136/thx.2004.029165

Asthma in children with sickle cell disease and its association with acute chest syndrome

J Knight-Madden 1, T Forrester 1, N Lewis 1, A Greenough 1
PMCID: PMC1747351  PMID: 15741436

Abstract

Background: Pulmonary complications are a major cause of morbidity and mortality in sickle cell disease (SCD). The relationship of asthma with SCD and acute chest syndrome (ACS) remains uncertain. A study was undertaken to test the hypotheses that asthma and bronchial hyperreactivity (BHR) are more common in children with SCD than in ethnic matched controls and that SCD children with atopic asthma are more likely to have recurrent episodes of ACS.

Methods: A modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was administered and skin prick tests undertaken in 80 children with SCD and 80 ethnic matched controls aged 5–10 years. BHR was assessed by measurement of forced expiratory volume in 1 second before and after a bronchodilator (albuterol 200 µg) or an exercise challenge.

Results: Asthma (48% v 22%, p = 0.002) and BHR (p = 0.02) but not atopy were more common in children with SCD than in controls. Atopy (66.6% v 29%, p = 0.007) and asthma (80% v 40%, p = 0.005), particularly atopic asthma (53% v 12%, p<0.001), were more common in children with SCD who had suffered recurrent episodes of ACS than in those who had suffered a single or no episode.

Conclusions: Asthma and BHR are more common in children with SCD than in ethnic matched controls, and atopic asthma appears to be associated with recurrent ACS. Early and effective anti-asthma therapy might reduce the pulmonary morbidity associated with SCD.

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Selected References

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  1. Adewuyi J. O., Bandele E. O. Haemoglobin electrophoretic patterns and A B O blood groups in bronchial asthma. East Afr Med J. 1982 Jul;59(7):481–486. [PubMed] [Google Scholar]
  2. Balfour-Lynn I. M., Elborn J. S. "CF asthma": what is it and what do we do about it? Thorax. 2002 Aug;57(8):742–748. doi: 10.1136/thorax.57.8.742. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brouwer Richard, Kiroff George K. Improvement of respiratory symptoms following laparoscopic Nissen fundoplication. ANZ J Surg. 2003 Apr;73(4):189–193. doi: 10.1046/j.1445-1433.2002.02568.x. [DOI] [PubMed] [Google Scholar]
  4. Burrows B., Martinez F. D., Halonen M., Barbee R. A., Cline M. G. Association of asthma with serum IgE levels and skin-test reactivity to allergens. N Engl J Med. 1989 Feb 2;320(5):271–277. doi: 10.1056/NEJM198902023200502. [DOI] [PubMed] [Google Scholar]
  5. Caplin I., Haynes J. T., Lloyd F. Incidence and significance of sickle cell trait in asthma. Ann Allergy. 1972 Nov;30(11):623–626. [PubMed] [Google Scholar]
  6. Castro O., Brambilla D. J., Thorington B., Reindorf C. A., Scott R. B., Gillette P., Vera J. C., Levy P. S. The acute chest syndrome in sickle cell disease: incidence and risk factors. The Cooperative Study of Sickle Cell Disease. Blood. 1994 Jul 15;84(2):643–649. [PubMed] [Google Scholar]
  7. Crapo R. O., Casaburi R., Coates A. L., Enright P. L., Hankinson J. L., Irvin C. G., MacIntyre N. R., McKay R. T., Wanger J. S., Anderson S. D. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000 Jan;161(1):309–329. doi: 10.1164/ajrccm.161.1.ats11-99. [DOI] [PubMed] [Google Scholar]
  8. Gill F. M., Sleeper L. A., Weiner S. J., Brown A. K., Bellevue R., Grover R., Pegelow C. H., Vichinsky E. Clinical events in the first decade in a cohort of infants with sickle cell disease. Cooperative Study of Sickle Cell Disease. Blood. 1995 Jul 15;86(2):776–783. [PubMed] [Google Scholar]
  9. Gordin Fred M., Cohn David L., Matts John P., Chaisson Richard E., O'Brien Richard J., Terry Beirn Community Programs for Clinical Research on AIDS. Adult AIDS Clinical Trials Group. Centers for Disease Control and Prevention Hepatotoxicity of rifampin and pyrazinamide in the treatment of latent tuberculosis infection in HIV-infected persons: is it different than in HIV-uninfected persons? Clin Infect Dis. 2004 Jul 30;39(4):561–565. doi: 10.1086/422724. [DOI] [PubMed] [Google Scholar]
  10. Hammerman S. I., Klings E. S., Hendra K. P., Upchurch G. R., Jr, Rishikof D. C., Loscalzo J., Farber H. W. Endothelial cell nitric oxide production in acute chest syndrome. Am J Physiol. 1999 Oct;277(4 Pt 2):H1579–H1592. doi: 10.1152/ajpheart.1999.277.4.H1579. [DOI] [PubMed] [Google Scholar]
  11. Hebbel R. P. Auto-oxidation and a membrane-associated 'Fenton reagent': a possible explanation for development of membrane lesions in sickle erythrocytes. Clin Haematol. 1985 Feb;14(1):129–140. [PubMed] [Google Scholar]
  12. Hebbel R. P., Eaton J. W., Balasingam M., Steinberg M. H. Spontaneous oxygen radical generation by sickle erythrocytes. J Clin Invest. 1982 Dec;70(6):1253–1259. doi: 10.1172/JCI110724. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Jenkins M. A., Clarke J. R., Carlin J. B., Robertson C. F., Hopper J. L., Dalton M. F., Holst D. P., Choi K., Giles G. G. Validation of questionnaire and bronchial hyperresponsiveness against respiratory physician assessment in the diagnosis of asthma. Int J Epidemiol. 1996 Jun;25(3):609–616. doi: 10.1093/ije/25.3.609. [DOI] [PubMed] [Google Scholar]
  14. Knight J., Murphy T. M., Browning I. The lung in sickle cell disease. Pediatr Pulmonol. 1999 Sep;28(3):205–216. doi: 10.1002/(sici)1099-0496(199909)28:3<205::aid-ppul8>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  15. Koumbourlis A. C., Zar H. J., Hurlet-Jensen A., Goldberg M. R. Prevalence and reversibility of lower airway obstruction in children with sickle cell disease. J Pediatr. 2001 Feb;138(2):188–192. doi: 10.1067/mpd.2001.111824. [DOI] [PubMed] [Google Scholar]
  16. Lachant N. A., Davidson W. D., Tanaka K. R. Impaired pentose phosphate shunt function in sickle cell disease: a potential mechanism for increased Heinz body formation and membrane lipid peroxidation. Am J Hematol. 1983 Aug;15(1):1–13. doi: 10.1002/ajh.2830150102. [DOI] [PubMed] [Google Scholar]
  17. Laszlo G. European standards for lung function testing: 1993 update. Thorax. 1993 Sep;48(9):873–876. doi: 10.1136/thx.48.9.873. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Lawrence A. W., Segree W. The prevalence of allergic disease in Jamaican adolescents. West Indian Med J. 1981 Jun;30(2):86–89. [PubMed] [Google Scholar]
  19. Leong M. A., Dampier C., Varlotta L., Allen J. L. Airway hyperreactivity in children with sickle cell disease. J Pediatr. 1997 Aug;131(2):278–283. doi: 10.1016/s0022-3476(97)70166-5. [DOI] [PubMed] [Google Scholar]
  20. Maitre B., Habibi A., Roudot-Thoraval F., Bachir D., Belghiti D. D., Galacteros F., Godeau B. Acute chest syndrome in adults with sickle cell disease. Chest. 2000 May;117(5):1386–1392. doi: 10.1378/chest.117.5.1386. [DOI] [PubMed] [Google Scholar]
  21. Martin Justin. Gastro-oesophageal reflux. J R Soc Med. 2004 Jan;97(1):49–50. doi: 10.1258/jrsm.97.1.49-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Nichols D. J., Longsworth F. G. Prevalence of exercise-induced asthma in schoolchildren in Kingston, St. Andrew and St. Catherine, Jamaica. West Indian Med J. 1995 Mar;44(1):16–19. [PubMed] [Google Scholar]
  23. Onadeko B. O. Haemoglobin genotypes and bronchial asthma. East Afr Med J. 1979 Apr;56(4):163–165. [PubMed] [Google Scholar]
  24. Peat J. K., Li J. Reversing the trend: reducing the prevalence of asthma. J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):1–10. doi: 10.1016/s0091-6749(99)70517-8. [DOI] [PubMed] [Google Scholar]
  25. Raghupathy R., Haider M. Z., Azizieh F., Abdelsalam R., D'Souza T. M., Adekile A. D. Th1 and Th2 cytokine profiles in sickle cell disease. Acta Haematol. 2000;103(4):197–202. doi: 10.1159/000041049. [DOI] [PubMed] [Google Scholar]
  26. Savoy L. B., Lim J. D., Sarnaik S. A., Jones D. C. Prevalence of atopy in a sickle-cell anemia population. Ann Allergy. 1988 Aug;61(2):129–132. [PubMed] [Google Scholar]
  27. Styles L. A., Schalkwijk C. G., Aarsman A. J., Vichinsky E. P., Lubin B. H., Kuypers F. A. Phospholipase A2 levels in acute chest syndrome of sickle cell disease. Blood. 1996 Mar 15;87(6):2573–2578. [PubMed] [Google Scholar]
  28. Sylvester K. P., Patey R. A., Milligan P., Dick M., Rafferty G. F., Rees D., Thein S. L., Greenough A. Pulmonary function abnormalities in children with sickle cell disease. Thorax. 2004 Jan;59(1):67–70. [PMC free article] [PubMed] [Google Scholar]
  29. Vichinsky E. P., Neumayr L. D., Earles A. N., Williams R., Lennette E. T., Dean D., Nickerson B., Orringer E., McKie V., Bellevue R. Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group. N Engl J Med. 2000 Jun 22;342(25):1855–1865. doi: 10.1056/NEJM200006223422502. [DOI] [PubMed] [Google Scholar]
  30. Warrell D. A., Fawcett I. W., Harrison B. D., Agamah A. J., Ibu J. O., Pope H. M., Maberly D. J. Bronchial asthma in the Nigerian savanna region. A clinical and laboratory study of 106 patients with a review of the literature on asthma in the tropics. Q J Med. 1975 Apr;44(174):325–347. [PubMed] [Google Scholar]
  31. al-Ali A. K. Erythrocyte reduced glutathione level in sickle cell anaemia and glucose-6-phosphate dehydrogenase deficient Saudi subjects. Ann Clin Biochem. 1994 May;31(Pt 3):296–297. doi: 10.1177/000456329403100316. [DOI] [PubMed] [Google Scholar]
  32. van Hest Rob, Baars Hennie, Kik Sandra, van Gerven Paul, Trompenaars Marie-Christine, Kalisvaart Nico, Keizer Sytze, Borgdorff Martien, Mensen Marlies, Cobelens Frank. Hepatotoxicity of rifampin-pyrazinamide and isoniazid preventive therapy and tuberculosis treatment. Clin Infect Dis. 2004 Jul 30;39(4):488–496. doi: 10.1086/422645. [DOI] [PubMed] [Google Scholar]

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