Significant bronchospasm during sickle cell painful crises is associated with a lower peripheral eosinophil count.

Background: Bronchial hyperresponsiveness and/or bronchospasm are recognized complications of sickle cell disease.

Objective: The aim of this study was to investigate the presence of bronchospasm during painful crises, using simple spirometry in patients with sickle cell disease.

Methods: A prospective, non-randomized study was undertaken in patients with homozygous sickle cell disease, who presented with increasing pain. A painful crisis was defined as any increase in bodily pains necessitating hospital admission. A 15% increase in FEV(1) following salbutamol nebulization was considered significant.

Results: Thirty-nine patients took part in the study. Significant bronchodilator responses were demonstrable in 48.7% of patients during painful crises. Patients with such a response had a significantly lower peripheral blood eosinophil count (mean count 0.17 x 10(9)/L vs. 0.445 x 10(9)/L, P = 0.02, confidence interval for difference between groups, 0.0, 0.39). Furthermore, the magnitudes of the bronchodilator responses were related to the degree of lowering of peripheral blood eosinophil counts (r(s) = -0.344, P = 0.037).

Conclusion: Significant bronchospasm is demonstrable in a sizeable proportion of patients presenting with painful sickle cell crises. There seems to be a negative correlation between the magnitude of bronchospasm and the peripheral blood eosinophil count. We postulate a possible role for pulmonary sequestration of eosinophils in the pathophysiology of bronchospasm in sickle cell disease patients.