Airway hyperresponsiveness in children with sickle cell anemia. Chest 2011 Mar;139(3):563-568
Date
08/21/2010Pubmed ID
20724735Pubmed Central ID
PMC3047289DOI
10.1378/chest.10-1243Scopus ID
2-s2.0-79952202822 (requires institutional sign-in at Scopus site) 77 CitationsAbstract
BACKGROUND: The high prevalence of airway hyperresponsiveness (AHR) among children with sickle cell anemia (SCA) remains unexplained.
METHODS: To determine the relationship between AHR, features of asthma, and clinical characteristics of SCA, we conducted a multicenter, prospective cohort study of children with SCA. Dose response slope (DRS) was calculated to describe methacholine responsiveness, because 30% of participants did not achieve a 20% decrease in FEV1 after inhalation of the highest methacholine concentration, 25 mg/mL. Multiple linear regression analysis was done to identify independent predictors of DRS.
RESULTS: Methacholine challenge was performed in 99 children with SCA aged 5.6 to 19.9 years (median, 12.8 years). Fifty-four (55%) children had a provocative concentration of methacholine producing a 20% decrease in FEV1<4 mg/mL. In a multivariate analysis, independent associations were found between increased methacholine responsiveness and age (P<.001), IgE (P=.009), and lactate dehydrogenase (LDH) levels (P=.005). There was no association between methacholine responsiveness and a parent report of a doctor diagnosis of asthma (P=.986). Other characteristics of asthma were not associated with methacholine responsiveness, including positive skin tests to aeroallergens, exhaled nitric oxide, peripheral blood eosinophil count, and pulmonary function measures indicating airflow obstruction.
CONCLUSIONS: In children with SCA, AHR to methacholine is prevalent. Younger age, serum IgE concentration, and LDH level, a marker of hemolysis, are associated with AHR. With the exception of serum IgE, no signs or symptoms of an allergic diathesis are associated with AHR. Although the relationship between methacholine responsiveness and LDH suggests that factors related to SCA may contribute to AHR, these results will need to be validated in future studies.
Author List
Field JJ, Stocks J, Kirkham FJ, Rosen CL, Dietzen DJ, Semon T, Kirkby J, Bates P, Seicean S, DeBaun MR, Redline S, Strunk RCAuthor
Joshua J. Field MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Administration, InhalationAdolescent
Age Factors
Anemia, Sickle Cell
Asthma
Bronchial Provocation Tests
Child
Child, Preschool
Cohort Studies
Female
Humans
Immunoglobulin E
L-Lactate Dehydrogenase
Linear Models
Lung
Male
Methacholine Chloride
Prevalence
Prospective Studies
Respiratory Function Tests
Risk Factors
Young Adult
