Early Initiation of Inhaled Corticosteroids Does Not Decrease Acute Chest Syndrome Morbidity in Pediatric Patients with Sickle Cell Disease

Acute chest syndrome (ACS) is the leading cause of mortality in patients with sickle cell disease (SCD). Because the etiology of ACS is multifactorial, treatment approaches include broad spectrum antibiotics, intravenous fluids to prevent sickling, encouragement of ambulation, and incentive spirometry. Inflammation, airway hyper-reactivity, and ventilation/perfusion mismatch are also important in ACS etiology, but inhaled corticosteroids (ICS) are not universally initiated and efficacy still needs to be demonstrated in the treatment of ACS. Systemic corticosteroids have previously been investigated as part of the treatment for ACS. In these studies, patients who received systemic steroids had shorter hospital stays, but they were more likely to be readmitted with sickle cell painful vaso-occlusive crises (VOC). ICS may be a safe alternative to systemic steroids in patients with ACS. The current study aims to investigate the utility of initiating ICS at the time of hospital admission in reducing ACS morbidity (defined here as transfer to the pediatric intensive care unit (PICU), the need for BiPAP, intubation or pRBC transfusion) or hospital costs in SCD patients who were admitted to the hospital with VOC or ACS.