Spirometry use in patients with sickle cell disease with and without asthma and acute chest syndrome: A multicenter study

A de‐identified data repository of electronic medical record data, i2b2 (Informatics for Integrating Biology and the Bedside), including four geographically diverse academic medical centers, was queried to determine the use of diagnostic spirometry testing in African American children and young adults 5‐34 years of age with sickle cell disease (SCD) with or without a documented history of asthma and/or acute chest syndrome (ACS). A total of 2749 patients were identified with SCD, of these 577 had asthma and 409 had ACS. Cross‐referencing the CPT code for diagnostic spirometry showed that for patients identified as having SCD, a history of ACS, and a diagnosis of asthma, only 31% across all four centers had spirometry. Having an asthma diagnosis was associated with ACS. Among SCD patients with asthma, the proportion with ACS for the four centers was 47%, 75%, 38%, and 36% respectively. The bivariate association between asthma and ACS for each Center was significant for each (P < .001). To summarize, only one third of patients with co‐morbid SCD, ACS, and asthma received the spirometry procedure as recommended in evidence‐based guidelines, suggesting limited testing for changes in pulmonary function. Future studies to determine barriers and facilitators to implementation of pulmonary testing in SCD are warranted.