A physicians survey assessing management of pulmonary airway involvement in sickle cell disease

Sabhyata Agrawal, William B. Burton, Deepa Manwani, Deepa Rastogi, Aliva De

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Airway involvement in patients with sickle cell disease (SCD) involves recurrent episodes of acute chest syndrome (ACS), co-existent asthma, lower airway obstruction (LAO), or airway hyper-responsiveness/ bronchodilator response (AHR/BDR). With increased recognition that sickle cell (SC) airway inflammation may be distinct from asthma, our aim was to study regional and individual practices among pediatric pulmonologists and elucidate the patient characteristics that determine the diagnosis of asthma or SC airway inflammation. Methods: A cross-sectional web-based survey including 6 case scenarios on diagnosis and management of pulmonary manifestations of pediatric SC airway disease was conducted. The case scenarios, combined different risk factors for airway inflammation: history of recurrent ACS, atopy, family history of asthma, LAO, or AHR/BDR, with possible responses including − diagnosis of asthma, SC airway inflammation, both or neither. Results: Of the 130 responses, 83 were complete. “Asthma” was diagnosed when LAO (OR, 7.96 [4.28, 14.79]; p < 0.001), family history of asthma (OR 18.88 [5.87, 60.7]; p < 0.001), and atopy (OR 3.19 [1.74, 5.8]; p < 0.001) were present. “SC airway inflammation” was diagnosed when ACS (OR 3.95 [2.08, 7.51]; p < 0.001), and restrictive pattern on PFT (OR 3.75 [2.3, 6.09]; p < 0.001) were present in the scenarios. Regardless of the diagnosis, there was a high likelihood of initiating or stepping up inhaled corticosteroid as compared to prescribing montelukast. Conclusion: There is variability in the diagnosis and management of SC airway inflammation among pediatric pulmonologists. This study highlights the need for consensus guidelines to improve management of SC airway inflammation.

Original languageEnglish (US)
Pages (from-to)993-1001
Number of pages9
JournalPediatric pulmonology
Volume54
Issue number7
DOIs
StatePublished - Jul 2019

Keywords

  • airway
  • asthma
  • inflammation
  • pulmonary
  • sickle cell disease
  • survey

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

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