Providing hematology and pulmonary preventive care at a multidisciplinary sickle cell disease (SCD)-pulmonary clinic may reduce pulmonary complications such as acute chest syndrome, asthma, and vaso-occlusive episodes in children with SCD and improve health and acute care utilization, according to an article published in Blood Advances.

For the purpose of this study, researchers reviewed the medical charts of 119 patients with SCD and pulmonary disease from 2014 to 2020. To assess the effectiveness of a multidisciplinary approach, the selected participants were followed at Nationwide Children’s Hospital in Columbus, Ohio, for at least 2 years before and after the evaluation conducted at the multidisciplinary SCD-pulmonary clinic.

The study authors collected data on acute care outcomes, pulmonary function, polysomnography, echocardiography, laboratory tests, and prescribed medications using the Wilcoxon signed ranked and McNemar’s tests.

According to the results, the median number of acute care visits for acute chest syndrome and asthma was significantly reduced during the 2 years after the initial SCD-pulmonary clinic evaluation compared to the 2 years prior.

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Asthma and allergic rhinitis were diagnosed more often in the post-SCD-pulmonary clinic period, and hydroxyurea and inhaled corticosteroids were more frequently prescribed.

In addition, the median number of prescribed systemic corticosteroids decreased in the 2 years following SCD-pulmonary clinic evaluation. Lactate dehydrogenase levels and white blood cell counts were also significantly reduced. 

“Studies have demonstrated that people with SCD and their families often have healthcare access barriers,” Zeno and colleagues noted. “The combined SCD-pulmonary clinic at Nationwide Children’s Hospital was established with the intent of easing healthcare access barriers by allowing children with SCD to be seen for their underlying pulmonary complications at the same time they were receiving their hematology care.”

There are several factors that contribute to morbidity and mortality in people with SCD, with acute and chronic pulmonary conditions being the most common. For example, coexisting asthma is likely to increase all-cause morbidity due to vaso-occlusive pain episodes, stroke, acute chest syndrome, and the need for blood transfusions.

Reference

Zeno RN, Stanek J, Pugh C, Gillespie ML, Kopp BT, Creary SE. Outcomes before and after providing interdisciplinary hematology and pulmonary care for children with sickle cell diseaseBlood Adv. Published online December 28, 2022. doi:10.1182/bloodadvances.2022009079