Acute chest syndrome in sickle cell anaemia: higher serum levels of interleukin-8 and highly sensitive C-reactive proteins are associated with impaired lung function.

BACKGROUND: Sickle cell anaemia (SCA) is a chronic inflammatory disorder with multiple organ manifestations including acute and long-term pulmonary dysfunction. AIMS/OBJECTIVES: To assess lung function of children with SCA and determine the possible role of acute chest syndrome (ACS), serum inflammatory cytokines, highly sensitive C-reactive protein (hs-CRP), leucocytes and 25-hydroxyvitamin D on the development of impaired lung function. SUBJECTS AND METHODS: Lung function of 76 children with SCA was determined by spirometer and classified into normal or impaired. Sociodemographic, clinical, haematological, biochemical and immunological data of the two groups were compared by univariate and multivariate analyses. RESULTS: Fifty (65.8%) patients had impaired lung function, comprising of 30.3%, 3.9% and 31.6% with restrictive, obstructive and mixed disease patterns, respectively. Children with previous ACS were 3.6 times more likely to have impaired lung function than those without ACS (82.1% vs 56.3%, p = 0.02, OR 3.6, 95% CI 1.2-10.8). Interleukin (IL)-8 and hs-CRP were significantly higher in patients with impaired lung function (p = 0.02 and <0.001, respectively). Using logistic regression, previous ACS (OR 5.8, 95% CI 1.1-5.8, p = 0.03) and higher serum IL-8 levels (OR 3.0, 95% CI 1.0-8.0, p = 0.02) independently predicted the presence of abnormal lung function. CONCLUSIONS: Lung dysfunction, predominantly restrictive pattern, is common in SCA and is associated with previous ACS and alterations in immunological markers, especially serum IL-8 and hs-CRP. ABBREVIATIONS: ACS: acute chest syndrome; CBT: chronic blood transfusion; ELISA: enzyme-linked immunosorbent assay; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; HPLC: high-density liquid chromatography; hs-CRP: highly sensitive C-reactive proteins; HU: hydroxyurea; IL: Interleukin; PEFR: peak expiratory flow rate; SEM: standard error of the mean; TLC: total lung capacity; 25-OHD: 25-hydroxyvitamin D; VOC: vaso-occlusive crisis; WGH: Wesley Guild Hospital.

Epidemiology, triggers, and severity of childhood asthma in Ilesa, Nigeria: Implications for management and control.

BACKGROUND: Knowledge about childhood asthma in a locality will assist clinicians to adequately manage the condition. This study set out to report the epidemiology, triggers of exacerbation, comorbid conditions, and severity of childhood asthma at a tertiary health facility in Nigeria and the implication of these, in management and symptoms control. METHODS: Over a 15-month study period, children (aged <15 years) with physician-diagnosed asthma were consecutively recruited at the pediatric chest clinic of the hospital. Sociodemographic history, triggers, and comorbidities in the children were recorded. The severity and level of symptoms control were determined using Global Initiative for Asthma criteria. The children were examined and had lung function test. Appropriate descriptive and inferential statistics were used to analyze the data obtained. RESULTS: A total of 110 children were recruited for the study with an overall male preponderance 1.6:1, however, more adolescent females than males were observed. The ages of the children ranged from 10 months to 14 years with mean (standard deviation) of 6.4 (3.9) years. The median (interquartile range) age at diagnosis was 2.5 (1.5-6.0) years. The comorbidities were allergic rhinoconjunctivitis (45.5%), atopic dermatitis (10.9%), and overweight/obesity (7.3%). The recognizable triggers of exacerbations were respiratory tract infections (RTIs) seen more in preschool than school age children (χ2 = 6.225; P = 0.031), exercise, dust, and fumes. Mild intermittent asthma (82.7%) was the most common forms, 13 (25.0%) of the children who had Spirometry had obstructive ventilatory pattern and 17.3% had suboptimal asthma control. CONCLUSION: The majority of children with asthma at the Wesley Guild Hospital, Ilesa were school age children, however, 10% were <2 years and most asthmatics (72.7%) were diagnosed before age five. RTI is a major trigger of exacerbation and more than one-half had other allergic conditions which should be looked for and managed to ensure successful asthma management.

Prevalence and factors associated with exercise-induced bronchospasm among rural school children in Ilesa, Nigeria.

BACKGROUND: Exercise-induced bronchospasm (EIB) assessed using changes in peak expiratory flow rates (PEFRs) to free range exercise is a relatively cheap way of screening for asthma in resource-poor centres where children with asthma are often undiagnosed and poorly managed. This study sets out to determine the prevalence and factors associated with EIB among rural schoolchildren in Ilesa, Nigeria. SUBJECTS AND METHODS: Children aged 8-16 years from two middle schools in rural Ilesa were selected by multistage sampling. Their sociodemographic characteristics and personal/family history of asthma and allergies were obtained. The children had their PEFR measured before, 5, 10 and 15 min after 6-8 min of free running exercise to achieve 80% of their maximal pulse rate. EIB was defined as change in PEFR expressed as a percentage of the pre-exercise value ≥15%. The prevalence and factors associated with EIB were determined. RESULTS: The mean (standard deviation) age of the 250 study participants was 12.5 (1.5) years (M: F 0.9:1) None of the children had previously been diagnosed with asthma. The prevalence of EIB was 9.2%, 6.4% and 4.0% at 5, 10 and 15 min post-exercise, respectively. Household poultry birds, personal history of allergies, wheeze in the past 12 months and family history of asthma were associated with EIB (P < 0.05); only wheezing in the past 12 months independently predicted EIB (odds ratio = 6.343; 95% confidence interval = 2.040-8.798; P= 0.020). CONCLUSION: The prevalence of EIB among rural schoolchildren in Ilesa was 9.2%. EIB was associated with the history of allergies and wheeze and presence of household poultry birds. We recommend routine screening of these children for early diagnosis and good asthma symptom control.

Factors associated with childhood asthma control in a resource-poor center.

INTRODUCTION: Optimal asthma control is a major aim of childhood asthma management. This study aimed to determine factors associated with suboptimal asthma control at the pediatric chest clinic of a resource-poor center. METHODS: Over a 12-month study period, children aged 2-14 years with physician-diagnosed asthma attending the pediatric chest clinic of the Wesley Guild Hospital (WGH), Ilesa, Nigeria were consecutively recruited. Asthma control was assessed using childhood asthma control questionnaire. Partly and uncontrolled asthma was recorded as a suboptimal control. Relevant history and examinations findings were compared between children with good and suboptimal asthma control. Binary logistic regression analysis was used to determine the predictors of suboptimal asthma control. RESULTS: A total of 106 children participated in the study with male:female ratio of 1.5:1, and majority (83.0%) had mild intermittent asthma. Suboptimal asthma control was observed in 19 (17.9%) of the children. Household smoke exposure, low socioeconomic class, unknown triggers, concomitant allergic rhinoconjunctivitis, and poor parental asthma knowledge, were significantly associated with suboptimal control (P < 0.05). Low socioeconomic class (odds ratio [OR] =6.231; 95% confidence interval [CI] =1.022-8.496; P = 0.005) and poor parental asthma knowledge (OR = 7.607; 95% CI = 1.011-10.481; P = 0.007) independently predict suboptimal control. CONCLUSION: Approximately, one in five asthmatic children attending the WGH pediatric chest clinic who participated in the study had suboptimal asthma control during the study. More comprehensive parental/child asthma education and provision of affordable asthma care services may help improve asthma control among the children.