http://orcid.org/0000-0003-0075-3304
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Abstract
Background: Asthma is a chronic airway disorder with variable/recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an inflammation. The expert panel report of the National Heart Lung and Blood Institute recommends asthma screening in sickle cell disease (SCD); however, specific approach is not mentioned. We hypothesize that the breathmobile case identification survey (BCIS) is a valid asthma screening tool in children with SCD.
Methods: This prospective, single-center study enrolled 129 SCD patients aged 5 to 18 years from March 2016 to March 2018. All patients completed BCIS, spirometry, and fractional exhaled nitric oxide (FeNO). A single pulmonologist blinded to the BCIS results evaluated patients for asthma.
Results: Asthma prevalence was 41%. Male gender (60.4%; p = 0.041), allergic rhinitis (86.8%; p < 0.01), hydroxyurea usage (73.6%; p < 0.01), and family history of asthma (34%; p < 0.01) were higher but not self-reported parental asthma history, eczema, and tobacco smoke exposure in the asthma group compared to the nonasthma group. FEV1 (p = 0.003), FVC (p = 0.02), FEV1/FVC (p = 0.053), and FEF25–75% (p = 0.02) were lower in asthma. FeNO levels were comparable in both groups. The sensitivity, specificity, positive predictive value, and negative predictive value of the abbreviated BCIS were 67.3%, 90.8%, 83.3%, and 80.2% for asthma; and 82.1%, 90.8%, 76.7%, and 93.2% for persistent asthma, respectively. Persistent asthma patients had a trend of higher hydroxyurea use (82.8% vs. 58.3%; p = 0.049) and tobacco smoke exposure (55.2% vs. 29.2%; p = 0.057) compared to intermittent asthma.
Conclusion: We have validated the BCIS to screen for asthma in SCD. Spirometry but not FeNO may support an asthma diagnosis.
Additional information
Notes on contributors
Ashwin P. Patel
AY, RM, DB, TN, and JS conceptualized the study. AY, RM, JS, TG, and CJ interpreted the pulmonary function tests. AY, AP, TG, and SK collected/compiled the data. AP and SK performed the statistical analysis. AY, AP, SK, DB, TN, and KW prepared the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Soornela Krupani
AY, RM, DB, TN, and JS conceptualized the study. AY, RM, JS, TG, and CJ interpreted the pulmonary function tests. AY, AP, TG, and SK collected/compiled the data. AP and SK performed the statistical analysis. AY, AP, SK, DB, TN, and KW prepared the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
James M. Stark
AY, RM, DB, TN, and JS conceptualized the study. AY, RM, JS, TG, and CJ interpreted the pulmonary function tests. AY, AP, TG, and SK collected/compiled the data. AP and SK performed the statistical analysis. AY, AP, SK, DB, TN, and KW prepared the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Ricardo A. Mosquera
AY, RM, DB, TN, and JS conceptualized the study. AY, RM, JS, TG, and CJ interpreted the pulmonary function tests. AY, AP, TG, and SK collected/compiled the data. AP and SK performed the statistical analysis. AY, AP, SK, DB, TN, and KW prepared the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Dorothy Kim Waller
AY, RM, DB, TN, and JS conceptualized the study. AY, RM, JS, TG, and CJ interpreted the pulmonary function tests. AY, AP, TG, and SK collected/compiled the data. AP and SK performed the statistical analysis. AY, AP, SK, DB, TN, and KW prepared the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Traci Gonzales
AY, RM, DB, TN, and JS conceptualized the study. AY, RM, JS, TG, and CJ interpreted the pulmonary function tests. AY, AP, TG, and SK collected/compiled the data. AP and SK performed the statistical analysis. AY, AP, SK, DB, TN, and KW prepared the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Deborah L. Brown
AY, RM, DB, TN, and JS conceptualized the study. AY, RM, JS, TG, and CJ interpreted the pulmonary function tests. AY, AP, TG, and SK collected/compiled the data. AP and SK performed the statistical analysis. AY, AP, SK, DB, TN, and KW prepared the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Trinh T. Nguyen
AY, RM, DB, TN, and JS conceptualized the study. AY, RM, JS, TG, and CJ interpreted the pulmonary function tests. AY, AP, TG, and SK collected/compiled the data. AP and SK performed the statistical analysis. AY, AP, SK, DB, TN, and KW prepared the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Cindy K. Jon
AY, RM, DB, TN, and JS conceptualized the study. AY, RM, JS, TG, and CJ interpreted the pulmonary function tests. AY, AP, TG, and SK collected/compiled the data. AP and SK performed the statistical analysis. AY, AP, SK, DB, TN, and KW prepared the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Aravind Yadav
AY, RM, DB, TN, and JS conceptualized the study. AY, RM, JS, TG, and CJ interpreted the pulmonary function tests. AY, AP, TG, and SK collected/compiled the data. AP and SK performed the statistical analysis. AY, AP, SK, DB, TN, and KW prepared the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.