6. Did the study address a clearly focused
issue?
● P: Children with SCD
● E: Environmental tobacco smoke
● O: Pulmonary Sxs/ Function tests
● S: Cross sectional nested in a cohort
7. Was the cohort recruited in an acceptable
way?
● Children with SCD (4-20 yrs)
● Sleep and Asthma Cohort (SAC) study
● 3 pediatric hematology centers (2005-2010)
● Selection bias: Low
8. Was the exposure accurately measured to
minimize bias?
● E: Environmental tobacco smoke (ETS) exposure
● Childhood Asthma Management Program Smoke Exposure
Questionnaire.
● In-utero, infancy, preschool period, & current exposure.
● Classification bias (E) : moderate
9. Was the outcome accurately measured to
minimize bias?
● O: Pulmonary function
● Spirometry
● Detection bias: low
10. Have the authors identified important
confounding factors?
● HB level
● Physician Dx of asthma
● Skin test reactivity (atopy)
● Family income
● Education
11. Did they adjust for confounders in design/analysis?
● Design: None
● Analysis: Regression analyses
● Confounding bias: low
12. Was the follow-up of the subjects complete
and long enough?
● FU: 5 years
● Nested study No attrition
● Attrition bias: low
13. Is the study valid?
• Selection bias: Low
• Classification bias (E): moderate
• Detection bias: low
• Confounding bias: Low
• Attrition bias: low
20. Will the results help locally?
• My patient is a smoker with SCD
• Study is valid
• Association between respiratory Sx & smoking exposure
• Implications: limit smoking/ tobacco exposure
17 year old male known to have sickle cell disease presents to OPD complaining about chest pain and shortness of breath. While presenting the case, the resident informed the attending Dr that the patient started smoking recently. While discussing the symptoms with the patient, the attending Dr attributed his chest pain to his recent smoking habit because of his SCD. but the patient was not very convinced. This impelled me to search whether there is compelling data about this association.
My question is:
Where the Population is adolescents with sickle cell disease
Exposure is tobacco smoke
Outcome is development of acute chest syndrome
In order to appraise this paper i used the casp tool for prognosis
Exclusion criteria : children who had HbSC or HbSB+
Those with chronic lung disease (other than asthma) or structural heart disease. disease.
Those receiving long-term blood transfusions or long-term positive airway pressure
Participating in clinical trial for blood transfusions, oxygen, or hydroxyurea.
LIMITATION : The major limitations of this study were related to methods of ascertaining ETS exposure among participants. ETS questions were answered primarily by the participants’ mothers, which may underestimate the extent of current ETS exposure either because of reporting bias if it is perceived to be more socially acceptable to report previous ETS in a child’s home rather than current exposure or because of parental unawareness of their child’s exposures outside their own home. underreporting of current exposure
70t table 1
A total of 196 children aged 6 years with complete smoke exposure data performed spirometry
Data are presented as the unstandardized ( b ) estimate (95% CI) and P value
ETS during the infancy and preschool periods was associated with lower FEV 1 / FVC and forced expiratory flow, mid expiratory phase (FEF 25%-75% )/FVC ratios compared with unexposed children.These findings reflected relatively higher values of FVC and relatively lower values in FEF 25%-75% but no significant reduction in FEV 1 among those exposed
Current ETS exposure was also associated with a lower FEV 1 /FVC ratio and a higher FVC %
NO NEED FOR B , E , F
ETS at all time points was associated with an increased odds of having airway obstruction
maternal smoking during infancy and the preschool period were associated with having a positive bronchodilator response
Of 25 children with airway obstruction, 13 had a bronchodilator response of 12%.
A L7AL W B L7AL
Current ETS exposure was significantly associated with respiratory symptoms, including increased frequency of cough and wheeze with exercise. IUS and current ETS exposure were also associated with more frequent nighttime awakening because of cough and wheeze. ETS was not associated with daytime cough and wheeze unrelated to exercise
ZABETA HIGHLIGHT
