Inhaled bronchodilators for acute chest syndrome in people with sickle cell disease

Knight‐Madden, Jennifer; Hambleton, Ian

doi:10.1002/14651858.cd003733.pub4

Cited by 16 publications

(10 citation statements)

References 24 publications

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“…The high variability we found in the use of bronchodilators for ACS likely reflects the dearth of published evidence regarding their efficacy in the SCD population 18 as well as conflicting expert recommendations. Some authors suggest using bronchodilators only in patients with a known history of asthma or as a trial in those who are wheezing on physical examination, 20 while others recommend that AHR should be assumed to be present in all patients and bronchodilators should be used universally.…”

Section: Discussionmentioning

confidence: 96%

“…Our results show that bronchodilator use is associated with a modest increase in length of hospital stay for patients admitted with ACS. It is possible that the adverse effects of bronchodilators such as tachycardia, anxiety, and hyperactivity 18 may be contributing to a longer length of stay. In subgroup analysis, we found that length of stay was increased with bronchodilator use among subjects who did not have a co-diagnosis of asthma; however, in subjects with a co-diagnosis of asthma, bronchodilator use was associated with a decreased length of stay.…”

Section: Discussionmentioning

confidence: 99%

“…A recent Cochrane review found no randomized controlled trials evaluating bronchodilators for ACS. 18…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Bronchodilator Use for Acute Chest Syndrome Among Large Pediatric Hospitals in North America

Kopel

Klings

Monuteaux

et al. 2018

Clin Pediatr (Phila)

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The utility of bronchodilators to treat acute chest syndrome (ACS) in patients with sickle cell disease is unknown. Our objectives were to examine the variability in bronchodilator use for ACS among pediatric hospitals contributing to a large database and to examine the relationship between bronchodilator use and length of stay (LOS) and mortality. Between 2005 and 2011, bronchodilators were used during 6812/11 328 hospitalizations (60.1%) and use varied from 0.0% to 97.0% (median = 46.0%, interquartile range = 37.0% to 74.0%). Median LOS was 4 days, and interquartile range was 2 to 6 days. Bronchodilator use was associated with a 13.2% increase in LOS (95% confidence interval = 9.2% to 17.3%, P < .001). However, in the subgroup with asthma, bronchodilator use was associated with a 17.9% decrease in LOS (95% confidence interval = 1.7% to 31.4%, P = .03). There is wide variability in bronchodilator use for ACS, and it has variable association with LOS, depending on comorbid asthma. Prospective trials are needed to evaluate bronchodilators for ACS.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Bronchodilator Use for Acute Chest Syndrome Among Large Pediatric Hospitals in North America

Kopel

Klings

Monuteaux

et al. 2018

Clin Pediatr (Phila)

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“…Cochrane reviews by Knight-Madden and colleagues have not identified a single article regarding albuterol and SCD. 58,59 …”

Section: Management Of Wheezing In Scd: Chronic Wheezementioning

confidence: 99%

Wheezing in children with sickle cell disease

Glassberg

Strunk

DeBaun

2014

Current Opinion in Pediatrics

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Purpose of review The purpose of this article is to provide a comprehensive review of wheezing in sickle cell disease (SCD) including epidemiology, pathophysiology, associations between wheezing and SCD morbidity and finally the clinical approach to evaluation and management of individuals with SCD who wheeze. Recent findings Wheezing is common in SCD and in some individuals represents an intrinsic component of SCD related lung disease rather than asthma. Emerging data suggest that regardless of the etiology, individuals with SCD and with recurrent wheezing are at increased risk for subsequent morbidity and premature mortality. We believe Individuals that acutely wheeze and have respiratory symptoms should be managed with a beta agonist and short term treatment of oral steroids, typically less than 3 days to attenuate rebound vaso-occlusive disease. For those that wheeze and have a history or examination associated with atopy, we consider asthma treatment and monitoring per NHLBI asthma guidelines. Summary Wheezing in SCD should be treated aggressively in both the acute setting and with controller medications. Prospective SCD-specific clinical trials will be necessary to address whether anti-inflammatory asthma therapies (leukotriene antagonists, inhaled corticosteroids) can safely mitigate the sequelae of wheezing in SCD.

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“…Long term, patients may be placed on an inhaled corticosteroid or leukotriene receptor antagonist 11,12,20,29 . The physiologic benefit of albuterol has been demonstrated in the literature, as patients with SCD have higher rates of asthma, airway hyperreactivity, and bronchodilator responsiveness 8,2,16,30 . Inhaled corticosteroids are another mainstay of asthma treatment, and otherwise healthy children with asthma are more likely to have a controller prescription after pediatric pulmonary consultation 22 , but not many studies have been performed in the SCD population.…”

Section: Discussionmentioning

confidence: 99%

Benefit of Pulmonary Subspecialty Care for Children with Sickle Cell Disease and Asthma

Saxena

Afolabi‐Brown

Ballester

et al. 2021

Preprint

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Objective: Asthma is a recognized comorbidity in children with sickle cell disease (SCD). It increases risk of acute chest syndrome (ACS), vaso-occlusive episodes, and early mortality. We aim to determine whether evaluation and management of children with sickle cell disease (SCD) and asthma by a pulmonologist reduces rate of asthma exacerbation and ACS. Methods: The study included 192 patients with SCD (0-21 years) followed at Children’s Hospital of Philadelphia Hematology between 01/01/2015 and 12/31/2018 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 before/after initial pulmonology visit. Results: SCD-A-P (n=70) had lower baseline pulmonary function, hemoglobin, and hematocrit compared to SCD-A (n=122). SCD-A-P had a higher average rate of hospital visits for asthma exacerbation and ACS per year compared to SCD-A: 0.84 [0.56-1.12] versus 0.31 [0.18-0.43], (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] before initial pulmonary visit to 0.85 [0.48-1.23] after the visit (p=0.014). Conclusion: SCD-A-P had more severe baseline disease and higher rates of ED visits and hospitalizations 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. Further studies are needed to help establish evidence-based asthma guidelines for children with SCD.

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Inhaled bronchodilators for acute chest syndrome in people with sickle cell disease

Cited by 16 publications

References 24 publications

Bronchodilator Use for Acute Chest Syndrome Among Large Pediatric Hospitals in North America

Bronchodilator Use for Acute Chest Syndrome Among Large Pediatric Hospitals in North America

Wheezing in children with sickle cell disease

Benefit of Pulmonary Subspecialty Care for Children with Sickle Cell Disease and Asthma

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