SCD and asthma comorbidity: the potential role of adverse childhood experiences

Asthma is strongly associated with poor health amongst individuals with SCD. Adverse Childhood Experiences (ACEs) are traumatic experiences occurring before 18 years of age. ACEs occur at the individual and familial (original ACEs) levels and expand to the community level (additional ACEs). Chronic exposure to ACEs leads to toxic stress, inflammation, and risk for chronic illnesses, including asthma. This study examined the relationship between ACEs and asthma among children and adolescents with SCD.

Employing a cross-sectional study design, 75 children/adolescents with SCD were screened for ACEs. Prevalence ratios and logistic regressions were used to test the association and independent relationship between ACEs and asthma.

Fifty-nine (78%) participants reported exposure to at least 1 ACE. Adolescents exposed to ≥2 original- or ≥4 expanded ACEs (original + additional) were 1.15 times as likely to have asthma compared to those with no/low ACEs (95% CI: 1.03, 1.28, P = .01; 1.07, 1.24, P ≤ .001). Through logistic regression analyses, covarying age, sex, SCD genotype, income, and disease-modifying therapy, original (OR 1.52, 95% CI: 1.031, 2.242), additional (2.43, 95% CI: 1.335, 4.421), and expanded ACEs (1.529, 95% CI: 1.149, 2.036) were all shown to be independently associated with asthma.

The findings from this research support our hypothesis that children/adolescents with SCD exposed to a higher number of ACEs have a higher prevalence of asthma compared to low-exposed subjects. This study lays the foundation for future longitudinal and interventional studies aimed to improve SCD-asthma outcomes through ACE-protective mechanisms.