Wheeze predicts sickle cell disease crisis

By Lynda Williams, Senior medwireNews Reporter

Wheezing is a significant indicator for morbidity in patients with sickle cell disease (SCD), US researchers believe.

Emergency department (ED) records for 262 SCD patients demonstrate a significant increase in the risk for acute chest syndrome among patients with at least one recorded episode of wheeze but no asthma compared with those without a history of wheeze (relative risk [RR]=2.58), after adjusting for confounding factors such as hemoglobin level and phenotype.

Wheezing independent of asthma was also associated with a significantly increased risk for ED visits for pain (RR=2.18) compared with no wheeze.

"Prospective trials are necessary to determine if control of wheezing reduces the frequency of pain or acute chest syndrome in individuals with SCD," say Jeffrey Glassberg (Mount Sinai School of Medicine, New York, USA) and co-workers.

Of note, just 53.1% of patients with a history of wheezing also had a diagnosis of asthma. Although SCD patients with asthma were significantly more likely than those without to attend the ED with pain (RR=1.44), these patients had no increased risk for acute chest syndrome.

"This is consistent with prior reports that not all wheezing in SCD patients is due to asthma, and that an asthma-like syndrome may be a pulmonary manifestation of SCD," the researchers observe.

The team suggests that criteria used to diagnose and initiate treatment for asthma in the general population may not identify all SCD patients who might benefit from long-term asthma medication.

"We hypothesize that control of wheezing with inhaled corticosteroid or cysteinyl leucotriene receptor antagonist taken routinely, together with a beta-2 agonist for acute symptoms, could prevent vaso-occlusive complications of SCD," they write in the British Journal of Haematology.

The study reviewed data for 49 patients with and 213 patients without wheeze attending a SCD clinic at Mount Sinai Hospital in New York, USA. The patients were aged between 6 months and 67 years old.

Their records were examined for ED attendance between 2007 and 2011. On average, patients with wheeze and with asthma attended the ED at a rate of 2.5 and 2.8 visits per year, respectively, versus 1.1 visits per year for those with neither condition.

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