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Determinants of clinical severity in children with sickle cell disease and confirmed asthma
Gabriel Bafunyembaka1,2, Mathieu Nacher3, Ariel Makembi4
1Department of Pediatrics, Centre Hospitalier de l'Ouest Guyanais (CHOG), Franck Joly Hospital, Saint-Laurent-du-Maroni, French Guiana, France.
Insights
In children with sickle cell disease and asthma, over a third experience severe clinical outcomes. This study found no independent predictors of severity, highlighting the need for better risk stratification.
Area of Science:
- Pediatric Hematology
- Pulmonology
- Infectious Diseases
Background:
- Asthma is a common comorbidity in pediatric sickle cell disease (SCD).
- SCD with asthma increases the risk of acute complications like vaso-occlusive crises and acute chest syndrome.
- Factors influencing clinical severity in this co-occurrence are poorly understood, especially in tropical regions.
Purpose of the Study:
- To identify factors associated with clinical severity in children with SCD and confirmed asthma.
- To characterize the determinants of severe disease in this vulnerable pediatric population.
Main Methods:
- An observational study was conducted in French Guiana.
- Included were children with SCD and confirmed asthma.
- Clinical severity was defined by ≥2 hospitalizations for vaso-occlusive crises and/or acute chest syndrome in 12 months.
- Univariate and multivariate logistic regression analyses identified associated factors.
Main Results:
- 138 children with SCD and asthma were analyzed; 73.9% had severe disease.
- No independent predictors of clinical severity were found in multivariate analysis.
- Trends suggested increased severity risk in rural areas and a protective effect of Strongyloides stercoralis infection.
- Allergic sensitization was not associated with severity.
Conclusions:
- Over one-third of children with SCD and asthma experience severe clinical disease.
- No independent predictors of severity were identified in this cohort.
- Findings suggest a need for stratified approaches to manage sickle cell-associated asthma and prevent complications.
Background:
Asthma is a frequent comorbidity in children with sickle cell disease and has been associated with an increased risk of acute complications, particularly vaso-occlusive crises and acute chest syndrome. However, determinants of clinical severity among children with sickle cell disease and confirmed asthma remain poorly characterized, especially in tropical settings. This study aimed to identify factors associated with clinical severity in this population.
Methods:
We conducted an observational study among children with sickle cell disease followed in French Guiana. The analysis was restricted to children with confirmed asthma. Clinical severity was defined as the occurrence of at least two hospitalizations during the 12 months preceding evaluation for vaso-occlusive crises and/or acute chest syndrome. Factors associated with severity were assessed using univariate and multivariate logistic regression analyses.
Results:
A total of 138 children with sickle cell disease and confirmed asthma were included, of whom 102 (73.9%) presented a severe clinical form. In multivariate analysis, no variable was independently associated with clinical severity. However, a trend toward an increased risk of severe disease was observed among children living in rural areas (adjusted OR = 1.94; 95% CI: 0.77-4.86), while a trend toward a protective effect was observed for Strongyloides stercoralis infection (adjusted OR = 0.18; 95% CI: 0.02-1.51). Allergic sensitization, although frequent (64.5%), was not associated with clinical severity after adjustment (adjusted OR = 0.66; 95% CI: 0.31-1.44).
Conclusion:
Among children with sickle cell disease and confirmed asthma, more than one third experience severe clinical disease. No independent predictors of severity were identified. Observed trends should be interpreted cautiously and considered exploratory. These findings support a stratified approach to sickle cell-associated asthma to identify high-risk children and prevent avoidable acute complications.
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