Asthma in sickle cell disease as a risk factor for acute chest syndrome in pediatric patients

OBJECTIVES: Asthma and sickle cell disease (SCD) are major Public Health concerns. Previous studies demonstrated that asthma among children with SCD may increase the risk of developing acute chest syndrome (ACS). These respiratory complications may increase emergency department (ED) utilization, increase health care costs, and reduce life span among persons with SCD. The purpose of this study is to determine whether children with SCD and asthma have significantly more ED visits and if they are at higher risk of developing ACS compared to children with SCD who do not have asthma. METHODS: We used MarketScan® Multi-State Medicaid Databases from Thompson Reuters (Ann Arbor, Michigan) for the years 2001-2005. These are proprietary datasets covering eight unidentified states. We used International Classification of Disease, 9th Division, Clinical Modifications (ICD-9-CM) codes to identify SCD, asthma and ACS. RESULTS: In 2005, 2428 children with SCD enrolled in Medicaid. Among those, 369 (15.2%) patients had asthma. The mean number of ED visits was significantly higher among children with both SCD and asthma compared to children with SCD without asthma (p<0.05). Children with SCD and asthma were also more likely to have at least one episode of ACS than children with SCD without asthma (28.2% vs. 7.8%, respectively). CONCLUSIONS: Among children with SCD who are enrolled in Medicaid, asthma is a common comorbidity, which is associated with high incidence of ACS. Asthma should be aggressively managed among SCD patients, which could result in reduced costs related to ED utilization and reduce pulmonary complications that progress into adulthood lung disease.