Pain and acute chest syndrome (ACS) episodes are 2 of the most common causes of hospitalization in children with sickle cell anemia (SCA). However, very few potentially modifiable risk factors for either condition have been identified. In this prospective infant cohort study, we tested the hypothesis that asthma is associated with an increased incidence rate of pain and ACS episodes. An infant cohort was composed of 291 African American children with hemoglobin SS enrolled in the Cooperative Study for Sickle Cell Disease before age 6 months and followed beyond age 5 years. Asthma was defined by a physician diagnosis, an acute asthma event, or use of prescription asthma medications. The incidence rates of ACS and painful episodes were compared for children with and without asthma. A clinical diagnosis of asthma was made in 17% of the cohort. Asthma was associated with more frequent ACS episodes (0.39 vs 0.20 events per patient year, P < .001) and painful episodes (1.39 vs 0.47 events per patient year, P < .001). In conclusion, in children with SCA, asthma is associated with an increased incidence of sickle cell disease-related morbidity, including ACS and painful episodes. IntroductionPainful episodes and acute chest syndrome (ACS) are common complications of sickle cell anemia (SCA) and are the 2 leading causes of hospitalization among people with SCA. 1,2 ACS affects up to 50% of individuals with SCA and is the leading cause of premature death. [2][3][4] The pathogenesis of ACS is multifactorial and remains unclear. In a large prospective study, several etiologies were identified, but in approximately 50% of episodes, no cause was determined. 5 Known risk factors for the development of ACS include younger age, degree of anemia (higher steady-state hemoglobin level), lower hemoglobin F, and higher steady-state white blood cell count. 2,6 Asthma is a common chronic disease affecting approximately 15% to 20% of African American children. [7][8][9][10] Previous retrospective studies suggest a relationship between ACS and asthma among children with SCA. We previously reported a 4-fold higher risk of ACS among children with SCA and a prior doctor diagnosis of asthma within a cohort of children with SCA hospitalized for pain. 11 Knight-Madden et al 12 reported a 6-fold higher risk of recurrent ACS among children with SCA and a parental report of doctor-diagnosed asthma. Airway obstruction and airway lability have been previously described in patients with SCA, suggesting that asthma may contribute to the pulmonary complications of the disease. [13][14][15][16] These data suggest that in children with SCA, a diagnosis of asthma may be a risk factor for ACS. This study also seeks to determine whether asthma is also associated with painful episodes, a common complication in SCA that often precedes or occurs concurrently with ACS episodes.In a cohort of infants established and followed for 20 years by the Cooperative Study of Sickle Cell Disease (CSSCD), we tested the hypothesis that a concurrent diagnosis of asthma in p...

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Our objective was to determine if physician-diagnosed asthma increases the risk of acute chest syndrome (ACS) in children with sickle-cell disease (SCD) hospitalized for pain. Our study design was a retrospective case-control study of all SCD patients, aged 2-21 years, hospitalized for pain during the interval 1999-2000. Medical records of first admissions during the interval were reviewed to determine the presence of ACS during the admission. Cases were defined as patients with ACS, and controls were patients without ACS. Independently, medical records of admissions prior to the study interval were reviewed for evidence of physician-diagnosed asthma. Sixty-three cases with ACS and 76 controls without ACS were identified. No significant differences in gender, age, and hemoglobin phenotype were found. Patients with physician-diagnosed asthma were 4.0 times (95% CI, 1.7, 9.5) more likely to develop ACS during the admission than patients without asthma. Individuals with physician-diagnosed asthma had a longer hospitalization for ACS, i.e., 5.6 days vs. 2.6 days, respectively (P = 0.01). In conclusion, our preliminary data suggest that asthma in children with SCD admitted to the hospital for pain may be a risk factor for ACS and may increase the duration of hospitalization when compared to children with SCD and without asthma.

Compared with an arteriovenous fistula or graft, sustained use of tunnelled CVCs for vascular access is associated with higher risks of all-cause, cardiovascular and infection-related mortality.