not-yet-known not-yet-known not-yet-known unknown Objective: To investigate use of asthma controller medications and their effect on lung function in pediatric patients with SCD. Methods: Retrospective study in pediatric patients of African American ethnicity with SCD treated at PCH between 2014-2021. Associations of asthma controller medications with changes in lung symptoms (cough, wheeze, chest pain, shortness of breath with exercise, sleep disturbance), Acute Chest Syndrome (ACS), and percent predicted spirometry (FEV 1, FVC, FEV 1/FVC, FEF 25%-75%)) were examined (Fisher exact, Wilcoxon rank sum) separately in SCD patients with and without asthma. Results: Of the total 98 SCD patients, 28 (29%) had an asthma diagnosis. Asthma controller medications were prescribed to 20 (71% of 28) with asthma and 37 (53% of 70) without asthma. Patients with vs without asthma were more likely to receive combined medications (55% vs 8.1%), but less ICS alone (35% vs 48 %) or LTRA alone (10% vs 43%) (p<0.0003). Medication use vs non-use improved cough (38% vs 9%, P=0.006) and shortness of breath with exercise (32% vs 12%, P=0.03) in SCD patients without asthma, but these were non-significant in asthmatics. Medications also improved the mean percent change in both non-asthmatics FEV 1 (10.2 vs -3.2; P<0.0001), FVC (8.8 vs -0.7; P=0.002), and FEF 25%-75%, (17.6 vs -9.7; P=0.0005), and asthmatics FEV 1 (16.4 vs -5.2; P=0.001), FVC (13.7 vs -3.8; P=0.0009), and FEF 25%-75%, (26.1 vs -5.0; P=0.02). Conclusion: These findings, demonstrating improved lung function with asthma controller medications in pediatric patients with SCD, irrespective of an asthma diagnosis, holds great promise for this undertreated population.

Background: Despite numerous prior interventions to reduce unnecessary visits to the emergency department (ED), overutilization and overreliance on EDs continue to negatively impact quality of care and cost. Objective: Motivated by finding solutions to ED overuse, we evaluated the effect of COVID19 on pediatric ED utilization, specifically focusing on patients with pulmonary diagnoses. Methods: A retrospective study was conducted to review visits to the pediatric ED at Phoenix Children’s Hospital. The baseline pre-COVID19 period ranged from 01/01/2016 to 03/14/2019. Post-COVID19 data were collected from 03/15/2020 to 07/31/2020. Study subjects included all patients between 0-18 years of age. Data was collected biweekly for the number of ED visits, admission to hospital from ED, presenting diagnosis and pulmonary consults. Results: The average number of biweekly ED visits decreased significantly from 3437 during baseline to 2061 post-COVID19, while the percent of hospital admissions increased from 0.14% to 0.18% (p< 0.01). A significant decrease was also observed in the biweekly average number of pulmonology consults (527 to 250), and the percent of pulmonology consults (0.15% to 0.11%), presenting diagnosis of asthma (130 to 59), tracheostomy (7 to 6), cystic fibrosis (7 to 5), cough/wheeze (66 to 41) and bronchiolitis/upper and lower respiratory tract infections (300 to 126). No changes were detected in chronic respiratory failure, respiratory distress or hypoxemia. Conclusion: Many factors including telehealth, improved infection control measures, social responsibility, and fear of getting sick may have played a role in the reduction in our ED visits during the COVID pandemic.