Submitted January 30, 2006
Accepted April 17, 2006
Asthma is associated with acute chest syndrome and pain in
children with sickle cell anemia
Jessica H Boyd, Eric A Macklin, Robert C Strunk, and Michael R DeBaun*
Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
New England Research Institutes, Watertown, MA, USA
* Corresponding author; email: debaun_m{at}kids.wustl.edu.
Pain and acute chest syndrome (ACS) episodes are two of
the most common causes of hospitalization in children
with sickle cell anemia (SCA). However, very few
potentially modifiable risks factors for either
condition have been identified. In this prospective
infant cohort study, we tested the hypothesis that
asthma is associated with an increased incidence rate of
pain and ACS episodes. An infant cohort was comprised
of 291 African-American children with hemoglobin SS
enrolled in the Cooperative Study for Sickle Cell
Disease (CSSCD) before age six months and followed
beyond age five-years. Asthma was defined by a
physician diagnosis, an acute asthma event, or use of
prescription asthma medications. The incidence rates of
ACS episodes and painful events were compared for
children with and without asthma. A clinical diagnosis
of asthma was made in 17% of the cohort. Asthma was
associated with more frequent ACS episodes (0.39 v. 0.20
events per patient-year, p<0.001) and painful episodes
(1.39 v. 0.47 events per patient-year, p<0.001). In
conclusion, in children with SCA, asthma is associated
with an increased incidence of sickle cell disease-
related morbidity, including ACS and painful episodes.
