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scientific articles

Wheezing symptoms and parental asthma are associated with a physician diagnosis of asthma in children with sickle cell anemia

key information

source: The Journal of Pediatrics

year: 2014

authors: Strunk RC, Cohen RT, Cooper BP, Rodeghier M, Kirkham FJ, Warner JO, Stocks J, Kirkby J, Roberts I, Rosen CL, Craven DI, DeBaun MR

summary/abstract:

OBJECTIVE:
To identify factors associated with asthma associated with increased sickle cell anemia (SCA).

STUDY DESIGN:
Children with SCA (N = 187; mean age 9.6 years, 48% male) were classified as having “asthma” based on parent report of physician diagnosis plus prescription of asthma medication (n = 53) or “no asthma” based on the absence of these features (n = 134). Pain and acute chest syndrome (ACS) events were collected prospectively.

RESULTS:
Multiple variable logistic regression model identified 3 factors associated with asthma: parent with asthma (P = .006), wheezing causing shortness of breath (P = .001), and wheezing after exercise (P < .001). When ≥2 features were present, model sensitivity was 100%. When none of the features were present, model sensitivity was 0%. When only 1 feature was present, model sensitivity was also 0%, and presence of ≥2 of positive allergy skin tests, airway obstruction on spirometry, and bronchodilator responsiveness did not improve clinical utility. ACS incident rates were significantly higher in individuals with asthma than in those without asthma (incident rate ratio 2.21, CI 1.31-3.76), but pain rates were not (incident rate ratio 1.28, CI 0.78-2.10).

CONCLUSIONS:
For children with SCA, having a parent with asthma and specific wheezing symptoms are the best features to distinguish those with and without parent report of a physician diagnosis of asthma and to identify those at higher risk for ACS events. The value of treatment for asthma in the prevention of SCA morbidity needs to be studied.

organisation: Washington University School of Medicine; Boston Medical Center/Boston University School of Medicine; Brown School of Social Work, Washington University; Independent Statistician, Chicago; London Institute of Child Health; Imperial College and Imperial College Healthcare NHS Trust, London; Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospitals, University Hospitals Case Medical Center, Cleveland; Vanderbilt University School of Medicine, Nashville

DOI: 10.1016/j.jpeds.2013.11.034

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