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Screening for asthma in preschool children with sickle cell disease
Kok Hoe Chan1, James M Stark2, Ricardo A Mosquera2
1Division of Hematology/Oncology, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA.
Insights
The Breathmobile Case Identification Survey (BCIS) effectively screens preschool children with sickle cell disease (SCD) for asthma. This study found a low asthma prevalence in young SCD patients, highlighting BCIS
Area of Science:
- Pediatric Pulmonology
- Hematology
- Allergy and Immunology
Background:
- Asthma diagnosis in preschool children with sickle cell disease (SCD) is challenging due to poorly defined symptoms.
- The Breathmobile Case Identification Survey (BCIS) shows promise as a screening tool for asthma in older children with SCD.
Purpose of the Study:
- To validate the BCIS as an effective asthma screening tool for preschool-aged children diagnosed with SCD.
- To assess asthma prevalence and identify associated risk factors in young children with SCD.
Main Methods:
- A prospective, single-center study involved 50 children aged 2-5 years with SCD.
- The BCIS was administered to all participants.
- A pulmonologist, blinded to BCIS results, evaluated patients for asthma, collecting demographic, clinical, and laboratory data.
Main Results:
- Asthma prevalence was 6% (3/50), lower than atopic dermatitis (20%) and allergic rhinitis (32%).
- The BCIS demonstrated high sensitivity (100%), specificity (85%), positive predictive value (30%), and negative predictive value (100%).
- All children diagnosed with asthma also had a history of acute chest syndrome (ACS), viral respiratory infections requiring hospitalization, and the HbSS subtype.
Conclusions:
- The BCIS is a validated and effective tool for screening asthma in preschool children with SCD.
- Asthma prevalence is low in this young SCD population.
- The absence of typical ACS risk factors may be attributed to early hydroxyurea treatment.
Background:
Asthma in preschool children is poorly defined, proving to be a challenge for early detection. The Breathmobile Case Identification Survey (BCIS) has been shown to be a feasible screening tool in older SCD children and could be effective in younger children. We attempted to validate the BCIS as an asthma screening tool in preschool children with SCD.
Methods:
This is a prospective, single-center study of 50 children aged 2-5 years with SCD. BCIS was administered to all patients and a pulmonologist blinded to the results evaluated patients for asthma. Demographic, clinical, and laboratory data were obtained to assess risk factors for asthma and acute chest syndrome in this population.
Results:
Asthma prevalence (n = 3/50; 6%) was lower than atopic dermatitis (20%) and allergic rhinitis (32%). Sensitivity (100%), specificity (85%), positive predictive value (30%), and negative predictive value (100%) of the BCIS were high. Clinical demographics, atopic dermatitis, allergic rhinitis, asthma, viral respiratory infection, hematology parameters, sickle hemoglobin subtype, tobacco smoke exposure, and hydroxyurea were not different between patients with or without history of ACS, although eosinophil was significantly lower in the ACS group (p = 0.0093). All those with asthma had ACS, known viral respiratory infection resulting in hospitalization (3 RSV and 1 influenza), and HbSS (homozygous Hemoglobin SS) subtype.
Conclusion:
The BCIS is an effective asthma screening tool in preschool children with SCD. Asthma prevalence in young children with SCD is low. Previously known ACS risk factors were not seen, possibly from the beneficial effects of early life initiation of hydroxyurea.
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