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

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 alternati...

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Bibliographic Details
Published in:Blood cells, molecules, & diseases molecules, & diseases, 2018-07, Vol.71, p.55-62
Main Authors: Leonard, Alexis, Godiwala, Nihal, Herrera, Nicole, McCarter, Robert, Sharron, Matthew, Meier, Emily Riehm
Format: Article
Language:English
Subjects:
Acute chest syndrome
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
Asthma
Child
Child, Preschool
Cohort Studies
Female
Humans
Inhaled corticosteroids
Male
Morbidity
Pediatric
Severity of Illness Index
Sickle cell disease
Time-to-Treatment
Treatment Outcome
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Summary: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.
ISSN:1079-9796
1096-0961
DOI:10.1016/j.bcmd.2018.03.001