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Benefit of Pulmonary Subspecialty Care for Children with Sickle Cell Disease and Asthma
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  • Shikha Saxena,
  • Olufunke Afolabi-Brown,
  • Lance Ballester,
  • Nathaniel Schmucker,
  • Kim Smith-Whitley,
  • Julian Allen,
  • Anita Bhandari
Shikha Saxena
Monroe Carell Junior Children's Hospital at Vanderbilt
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Olufunke Afolabi-Brown
The Children's Hospital of Philadelphia
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Lance Ballester
The Children's Hospital of Philadelphia
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Nathaniel Schmucker
The Children's Hospital of Philadelphia
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Kim Smith-Whitley
The Children's Hospital of Philadelphia
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Julian Allen
The Children's Hospital of Philadelphia
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Anita Bhandari
The Children's Hospital of Philadelphia
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Abstract

Objective: Asthma is a recognized comorbidity in children with sickle cell disease (SCD). It increases risk of acute chest syndrome (ACS), vaso-occlusive episodes, and early mortality. We aim to determine whether evaluation and management of children with sickle cell disease (SCD) and asthma by a pulmonologist reduces rate of asthma exacerbation and ACS. Methods: The study included 192 patients with SCD (0-21 years) followed at Children’s Hospital of Philadelphia Hematology between 01/01/2015 and 12/31/2018 with a diagnosis of asthma, wheeze, or cough. Patients were placed in two groups: those evaluated by a pulmonologist (SCD-A-P) and those not (SCD-A). Rates of emergency department (ED) visits and hospitalizations for asthma exacerbation and ACS were compared between groups and before/after initial pulmonology visit. Results: SCD-A-P (n=70) had lower baseline pulmonary function, hemoglobin, and hematocrit compared to SCD-A (n=122). SCD-A-P had a higher average rate of hospital visits for asthma exacerbation and ACS per year compared to SCD-A: 0.84 [0.56-1.12] versus 0.31 [0.18-0.43], (p<0.001). For SCD-A-P patients with at least one hospital visit (n=48), the average rate decreased from 3.93 [1.57-6.29] before initial pulmonary visit to 0.85 [0.48-1.23] after the visit (p=0.014). Conclusion: SCD-A-P had more severe baseline disease and higher rates of ED visits and hospitalizations for asthma exacerbation and ACS compared to SCD-A, but the rates significantly decreased following pulmonology consultation. These findings support the pulmonologist’s role in the multidisciplinary care of SCD patients. Further studies are needed to help establish evidence-based asthma guidelines for children with SCD.

Peer review status:IN REVISION

28 May 2021Submitted to Pediatric Pulmonology
28 May 2021Assigned to Editor
28 May 2021Submission Checks Completed
29 May 2021Reviewer(s) Assigned
13 Jun 2021Review(s) Completed, Editorial Evaluation Pending
14 Jun 2021Editorial Decision: Revise Major