Recommended asthma evaluation in children and adults with sickle cell disease.
| A. Clinical Assessment . | |||
|---|---|---|---|
| Test . | Frequency . | Rationale . | References . |
| Review of systems for atopy, asthma | Annually, starting at one year of age If history is positive, refer to a pulmonologist | Individuals with asthma and SCD are at increased risk of vaso-occlusive episodes, acute chest syndrome and death | 7–12 |
| Assessment of lung function by spirometry and lung volumes by plethysmography | For children, starting at 6 years of age: every 5 years in children with no asthma or ACS episodes and every 2–3 years in children with asthma or ACS | Children with SCD may have obstructive defects that predispose to increased SCD morbidity | 57,64 |
| For adults, at least once and every 2–3 years if abnormal If there is evidence of obstruction or restriction, refer to pulmonologist | Adults with SCD have a high incidence of restrictive defects | 58 | |
| B. Treatment | |||
| Therapy | Frequency | Rationale | References |
| Treatment of individuals with SCD and asthma per NHLBI guidelines | Indefinitely | Treatment of persistent asthma with daily inhaled corticosteroids is effective in reducing asthma hospitalizations and symptom days | NHLBI guidelines 2007 |
| Appointment with pulmonologist | At least annually for individuals with SCD and mild asthma At least every 6 months for individuals with SCD and moderate to severe asthma | Individuals with asthma and SCD are at increased risk of vaso-occlusive episodes, acute chest syndrome and death | 7–12 |
| A. Clinical Assessment . | |||
|---|---|---|---|
| Test . | Frequency . | Rationale . | References . |
| Review of systems for atopy, asthma | Annually, starting at one year of age If history is positive, refer to a pulmonologist | Individuals with asthma and SCD are at increased risk of vaso-occlusive episodes, acute chest syndrome and death | 7–12 |
| Assessment of lung function by spirometry and lung volumes by plethysmography | For children, starting at 6 years of age: every 5 years in children with no asthma or ACS episodes and every 2–3 years in children with asthma or ACS | Children with SCD may have obstructive defects that predispose to increased SCD morbidity | 57,64 |
| For adults, at least once and every 2–3 years if abnormal If there is evidence of obstruction or restriction, refer to pulmonologist | Adults with SCD have a high incidence of restrictive defects | 58 | |
| B. Treatment | |||
| Therapy | Frequency | Rationale | References |
| Treatment of individuals with SCD and asthma per NHLBI guidelines | Indefinitely | Treatment of persistent asthma with daily inhaled corticosteroids is effective in reducing asthma hospitalizations and symptom days | NHLBI guidelines 2007 |
| Appointment with pulmonologist | At least annually for individuals with SCD and mild asthma At least every 6 months for individuals with SCD and moderate to severe asthma | Individuals with asthma and SCD are at increased risk of vaso-occlusive episodes, acute chest syndrome and death | 7–12 |