Significant bronchospasm during sickle cell painful crises is associated with a lower peripheral eosinophil count

Abstract

Bronchial hyperresponsiveness and/or bronchospasm are recognized complications of sickle cell disease. The aim of this study was to investigate the presence of bronchospasm during painful crises, using simple spirometry in patients with sickle cell disease. A prospective, non-randomized study was undertaken in patients with homozygous sickle cell disease, who presented with increasing pain. A painful crisis was defined as any increase in bodily pains necessitating hospital admission. A 15% increase in FEV(1) following salbutamol nebulization was considered significant. Thirty-nine patients took part in the study. Significant bronchodilator responses were demonstrable in 48.7% of patients during painful crises. Patients with such a response had a significantly lower peripheral blood eosinophil count (mean count 0.17 x 10(9)/L vs. 0.445 x 10(9)/L, P = 0.02, confidence interval for difference between groups, 0.0, 0.39). Furthermore, the magnitudes of the bronchodilator responses were related to the degree of lowering of peripheral blood eosinophil counts (r(s) = -0.344, P = 0.037). Significant bronchospasm is demonstrable in a sizeable proportion of patients presenting with painful sickle cell crises. There seems to be a negative correlation between the magnitude of bronchospasm and the peripheral blood eosinophil count. We postulate a possible role for pulmonary sequestration of eosinophils in the pathophysiology of bronchospasm in sickle cell disease patients.