Abstract
Asthma is a common comorbid factor in sickle cell disease (SCD). However, the incidence of asthma in SCD is much higher than expected compared to rates in the general population. Whether “asthma” in SCD is purely related to genetic and environmental factors or rather is the consequence of the underlying hemolytic and inflammatory state is a topic of recent debate. Regardless of the etiology, hypoxemia induced by bronchoconstriction and inflammation associated with asthma exacerbations will contribute to a cycle of sickling and subsequent complications of SCD. Recent studies confirm that asthma predisposes to complications of SCD such as pain crises, acute chest syndrome, and stroke and is associated with increased mortality. Early recognition and aggressive standard of care management of asthma may prevent serious pulmonary complications and reduce mortality. However, data regarding the management of asthma in SCD is very limited. Clinical trials are needed to evaluate the effectiveness of current asthma therapy in patients with SCD and coincident asthma, while mechanistic studies are needed to delineate the underlying pathophysiology.
Highlights
The association between sickle cell disease (SCD) and asthma has been described in numerous studies
The pathophysiology underlying the relationship between asthma and SCD has become a topic of interest, little is known
In California, asthma rates for African-American children are 20% [5], while a retrospective review of patients screened by pulmonary function testing at the Northern California Comprehensive Sickle Cell Center suggested the presence of obstructive disease in 58% of the 124 adults and children screened by standard pulmonary function testing (PFTs)
Summary
The association between sickle cell disease (SCD) and asthma has been described in numerous studies. An increased prevalence of asthma in patients with SCD has been documented as have increased morbidity and mortality amongst patients with coincident SCD and asthma. The pathophysiology underlying the relationship between asthma and SCD has become a topic of interest, little is known. Further insight will hopefully lead to targeted interventions that can help minimize the complications associated with coincident asthma and SCD. Asthma management based on the guidelines published by the National Institutes of Health (NIH) should be implemented to minimize morbidity and mortality for patients with SCD and asthma. Concerns regarding the use of typical treatments for asthma in patients with SCD have arisen, but the benefits of optimal asthma treatment outweigh the risks of possible side effects
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