ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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The Association Between BMI and Airways Resistance in Children with Sickle Cell Disease: A Longitudinal Study
Session Title
TP71 - TP071 SICKLE CELL DISEASE
Abstract
A3292 - The Association Between BMI and Airways Resistance in Children with Sickle Cell Disease: A Longitudinal Study
Author Block: P. Mondal1, A. S. Khokhar2, D. Snyder2, C. Joseph3, L. Su2, L. Mazur2; 1Peds Pulmonary, Penn State College of Medicine, Hershey, PA, United States, 2Penn State College of Medicine, Hershey, PA, United States, 3Pediatrics, Penn State College of Medicine, Hershey, PA, United States.
Rationale:Respiratory physiology is altered in obesity as the lung compliance and strength of the respiratory pump decline. Airway resistance is also increased in obesity due to elevated transmural pressure across the chest wall and enlarged neck circumference. Obesity and its complications have recently become increasingly prevalent in Sickle Cell Disease (SCD) population. Although obesity is unusual in children with SCD (C-SCD), a trend in the association between body mass index (BMI) and airway resistance is still possible in this cohort. With this background, we hypothesize that BMI influences airway resistance in C-SCD.
Methods: We used Impulse oscillometry (IOS) to measure upper (R20) and total (R5) airway resistance as well as airway reactance (X5 and resonant frequency). Resonant frequency (FRES) is known to be positively associate airway resistance, thus included in study analyses. We identified 51 C-SCD (168 IOS measurements) and 35 age/race matched asthmatic children as 'Control' through a retrospective chart review. All the study participants performed IOS. The correlation between BMI and IOS estimates was analyzed using a linear mixed-effect model (adjusted with gender/asthma in C-SCD and with gender for Controls).
Results: Male: female participants ratio was ≃ 1:1 in both the groups. HbSS was the predominant SCD genotype followed by HbSC. C-SCD had significantly lower BMI (mean±SD) compared to the control group (18.17±4.60 vs. 24.47±9.62, p<0.001*). Linear mixed model analyses demonstrated that BMI had significant association with R5(%pred) (beta=2.48, 95%CI:1.46- 3.51, p-value<0.001) and R20(%pred) (beta=2.26, 95%CI:1.49-3.02, p-value<0.001*) in C-SCD. BMI was also significantly correlated with X5 (beta=-9.35, 95%CI:-3.20 to -15.50, p-value=0.004*) and FRES(%pred) (beta=2.36,95%CI:1.13-3.58, p-value<0.001*) respectively, in the case group. In control children, BMI was not associated with R5(%pred), R20(%pred) and X5(%pred) (p-values of 0.14, 0.18 and 0.17, respectively) and BMI had negative correlation with FRES(%pred) (r=-0.34, p-value=0.047*). R5(%pred) and FRES(%pred) demonstrated strong correlation in both case (r=0.75, p-value<0.001*) and controls (r=0.70, p-value<0.001*), justifying the inclusion of FRES.
Conclusion: Our study demonstrated that BMI significantly correlates with airway resistance and reactance in C-SCD. Association between FRES and BMI further established BMI's influence on airway resistance since FRES is known to relate to airway resistance. The respiratory system may be more influenced by BMI changes in C-SCD than controls, as pulmonary mechanics are affected in SCD by various conditions, including chronic inflammation, asthma, and increased pulmonary circulation. IOS is known to be a sensitive tool to measure pulmonary mechanics in C-SCD, as reemphasized by our study.
Author Block: P. Mondal1, A. S. Khokhar2, D. Snyder2, C. Joseph3, L. Su2, L. Mazur2; 1Peds Pulmonary, Penn State College of Medicine, Hershey, PA, United States, 2Penn State College of Medicine, Hershey, PA, United States, 3Pediatrics, Penn State College of Medicine, Hershey, PA, United States.
Rationale:Respiratory physiology is altered in obesity as the lung compliance and strength of the respiratory pump decline. Airway resistance is also increased in obesity due to elevated transmural pressure across the chest wall and enlarged neck circumference. Obesity and its complications have recently become increasingly prevalent in Sickle Cell Disease (SCD) population. Although obesity is unusual in children with SCD (C-SCD), a trend in the association between body mass index (BMI) and airway resistance is still possible in this cohort. With this background, we hypothesize that BMI influences airway resistance in C-SCD.
Methods: We used Impulse oscillometry (IOS) to measure upper (R20) and total (R5) airway resistance as well as airway reactance (X5 and resonant frequency). Resonant frequency (FRES) is known to be positively associate airway resistance, thus included in study analyses. We identified 51 C-SCD (168 IOS measurements) and 35 age/race matched asthmatic children as 'Control' through a retrospective chart review. All the study participants performed IOS. The correlation between BMI and IOS estimates was analyzed using a linear mixed-effect model (adjusted with gender/asthma in C-SCD and with gender for Controls).
Results: Male: female participants ratio was ≃ 1:1 in both the groups. HbSS was the predominant SCD genotype followed by HbSC. C-SCD had significantly lower BMI (mean±SD) compared to the control group (18.17±4.60 vs. 24.47±9.62, p<0.001*). Linear mixed model analyses demonstrated that BMI had significant association with R5(%pred) (beta=2.48, 95%CI:1.46- 3.51, p-value<0.001) and R20(%pred) (beta=2.26, 95%CI:1.49-3.02, p-value<0.001*) in C-SCD. BMI was also significantly correlated with X5 (beta=-9.35, 95%CI:-3.20 to -15.50, p-value=0.004*) and FRES(%pred) (beta=2.36,95%CI:1.13-3.58, p-value<0.001*) respectively, in the case group. In control children, BMI was not associated with R5(%pred), R20(%pred) and X5(%pred) (p-values of 0.14, 0.18 and 0.17, respectively) and BMI had negative correlation with FRES(%pred) (r=-0.34, p-value=0.047*). R5(%pred) and FRES(%pred) demonstrated strong correlation in both case (r=0.75, p-value<0.001*) and controls (r=0.70, p-value<0.001*), justifying the inclusion of FRES.
Conclusion: Our study demonstrated that BMI significantly correlates with airway resistance and reactance in C-SCD. Association between FRES and BMI further established BMI's influence on airway resistance since FRES is known to relate to airway resistance. The respiratory system may be more influenced by BMI changes in C-SCD than controls, as pulmonary mechanics are affected in SCD by various conditions, including chronic inflammation, asthma, and increased pulmonary circulation. IOS is known to be a sensitive tool to measure pulmonary mechanics in C-SCD, as reemphasized by our study.
