Early initiation of inhaled corticosteroids does not decrease acute chest syndrome morbidity in pediatric patients with sickle cell disease

Alexis Leonard; Nihal Godiwala; Nicole Herrera; Robert McCarter; Matthew Sharron; Emily Riehm Meier

doi:10.1016/j.bcmd.2018.03.001

Early initiation of inhaled corticosteroids does not decrease acute chest syndrome morbidity in pediatric patients with sickle cell disease

Blood Cells Mol Dis. 2018 Jul:71:55-62. doi: 10.1016/j.bcmd.2018.03.001. Epub 2018 Mar 7.

Authors

Alexis Leonard¹, Nihal Godiwala², Nicole Herrera³, Robert McCarter⁴, Matthew Sharron⁵, Emily Riehm Meier⁶

Affiliations

¹ Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, D.C. 20010, United States.
² Division of Critical Care Medicine, Children's National Medical Center, Washington, D.C. 20010, United States.
³ Division of Biostatistics and Study Methodology, Children's National Medical Center, Washington, D.C. 20010, United States.
⁴ Division of Biostatistics and Study Methodology, Children's National Medical Center, Washington, D.C. 20010, United States; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C. 20037, United States.
⁵ Division of Critical Care Medicine, Children's National Medical Center, Washington, D.C. 20010, United States; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C. 20037, United States.
⁶ Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, D.C. 20010, United States; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C. 20037, United States. Electronic address: emeier@IHTC.org.

PMID: 29550053
DOI: 10.1016/j.bcmd.2018.03.001

Abstract

Acute chest syndrome (ACS) is a leading cause of mortality in patients with sickle cell disease (SCD). Systemic corticosteroids decrease ACS severity, but the risk of readmission for vaso-occlusive crises (VOC) has limited their use. The efficacy of inhaled corticosteroids (ICS) as a safer alternative is currently unknown. An observational, historic cohort study compared patients with SCD with ACS who received ICS at admission (ICS) to those who did not (non-ICS). Outcome measures included rates of transfusion, oxygen requirement, BiPAP initiation, PICU transfer, intubation, readmission, hospital cost, and length of stay. One hundred twenty patients with SCD (55 non-ICS, 65 ICS) were included. A significantly higher proportion of the non-ICS group had bilateral infiltrates, but fewer had asthma. More children in the ICS group had BiPAP initiated, however transfer to the PICU, intubation, transfusion rates, oxygen requirement, hospital cost, length of stay, and readmission rates did not differ between groups. Regression analysis did not reveal any differences in outcomes, nor were outcomes changed when patients were separated based on the presence or absence of asthma. In this observational cohort study, ICS did not demonstrate a significant reduction in ACS morbidity, though ICS use should be studied in a prospective manner.

Keywords: Acute chest syndrome; Asthma; Inhaled corticosteroids; Pediatric; Sickle cell disease.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Acute Chest Syndrome / diagnosis*
Acute Chest Syndrome / epidemiology
Acute Chest Syndrome / etiology*
Administration, Inhalation
Adolescent
Adrenal Cortex Hormones / administration & dosage
Adrenal Cortex Hormones / therapeutic use*
Age Factors
Anemia, Sickle Cell / complications*
Anemia, Sickle Cell / drug therapy*
Anemia, Sickle Cell / epidemiology
Child
Child, Preschool
Cohort Studies
Female
Humans
Male
Morbidity
Severity of Illness Index
Time-to-Treatment
Treatment Outcome

Substances

Adrenal Cortex Hormones

Grants and funding

UL1 TR001876/TR/NCATS NIH HHS/United States