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- 1. Case • OPD: 17 y.o. boy • SCD • Respiratory symptoms • Tobacco smoking
- 2. PECO In adolescents with SCD (P) does smoking (E) increase risk of ACS (O)? Q: Harm S: Case control/Cohort
- 6. 1.Is of the study valid?
- 7. Did the study address a clearly focused issue? ● P: children with sickle cell anemia ● E: Environmental tobacco smoke ● O: obstructive lung disease and pulmonary symptoms ● S: Cross sectional/ Prospective cohort
- 8. Was the cohort recruited in an acceptable way? ● Data collected as part of the Sleep and Asthma Cohort (SAC) study. SAC is a prospective, observational cohort study of children aged 4 to 20 years with sickle cell confirmed by hb electrophoresis ● Participants were enrolled at three pediatric hematology centers between 2005 and 2010 without regard to severity of disease ● Sample size: 245
- 9. Was the exposure accurately measured to minimize bias? ● E: Parents were asked eight questions about past and present in- home environmental tobacco smoke (ETS) exposure using the Childhood Asthma Management Program Smoke Exposure Questionnaire. ● Questions focused on in utero smoke exposure, ETS exposure in infancy (until the child’s second birthday), ETS during the preschool period (age 2 years until starting first grade), and current exposure. Any ETS was defined as a positive response to any of the questions about ETS exposure at any time point. Classification bias : moderate
- 10. Was the outcome accurately measured to minimize bias? ● O: Spirometry was performed by SAC-certified pulmonary function technicians with a pneumotachograph-type spirometer interfaced with a personal computer system ● American Thoracic Society standards for the performance of spirometry were adapted for children. ● Appropriate prediction equations for FEV 1 and FVC were used, taking into account height, age, sex, and ethnicity. ● Detection bias: low
- 11. Have the authors identified important confounding factors? ● Confounders identified : - Age - Height - Sex - Ethnicity ● For IUS : patterns of airway growth are strongly influenced by genetic factors ● Healthy smoker effect
- 12. Did they adjust for confounders in design/analysis? ● Adjustment for confounding variables : ● Design: Appropriate prediction equations for FEV 1 and FVC were used, taking into account height, age, sex, and ethnicity. ● Analysis: Lower airway obstruction was defined as an FEV 1 /FVC below the lower 95% CI adjusted for age, sex, race, and height
- 13. Was the follow-up of the subjects complete and long enough? ● FU: 5 years ( 2005-2010 ) (as part of the cohort study from which the data for this study was obtained ) ● No mention for loss to follow up in the cohort study ● 97% participation : of the 252 children enrolled in the SAC, 245 (97%) had documented information about ETS exposure from the baseline questionnaire ● Attrition bias: moderate
- 14. Is the study valid? • Selection bias: Low • Classification bias (E): moderate • Detection bias: low • Confounding bias: Low • Attrition bias: moderate
Editor's Notes
- 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 3mel animation lal q wel s
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- In order to appraise this paper i used the casp tool for prognosis Combine hayed ma3 abla
- 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 Max nb of bullets 3 to 5 , with no sentences or paragraphs
- Healthy smoker effect : parents of children with milder disease tended to continue to smoke, whereas those of the sickest children did not. Confouders : above ets and respiratory symptoms
- Confounding bias: low
- Fu was 5 years from 2005 till 2010. for the cohort study named sleep and asthma cohort study for sickle cell disease children , no follow up after that was done for the study . Instead quinonimine was used to ask questions not initially covered by the cohort study that included environmental smoke exposure. Institutional approval was obtained from all participating sites in the SAC study