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Article Open Access

Patients with sickle cell disease and asthma have a higher risk for acute chest syndrome: A systematic review and meta‑analysis of observational studies

  • Authors:
    • Konstantinos Dodos
    • Tsampika-Vasileia Kalamara
    • Demetrios A. Spandidos
    • Alexandru Corlateanu
    • Vasiliki Epameinondas Georgakopoulou
  • View Affiliations / Copyright

    Affiliations: Laboratory of Physiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece, Laboratory of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece, Department of Pulmonology and Allergology, State University of Medicine and Pharmacy ‘Nicolae Testemitanu’, Chisinau MD‑2004, Republic of Moldova, Department of Pathophysiology, Laiko General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
    Copyright: © Dodos et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 35
    |
    Published online on: November 28, 2025
       https://doi.org/10.3892/etm.2025.13030
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Abstract

Sickle cell disease (SCD) is a hereditary hematologic disorder characterized by abnormal hemoglobin polymerization, leading to vaso‑occlusion, hemolysis and multi‑organ complications. Acute chest syndrome (ACS) is a severe pulmonary complication and a leading cause of morbidity and mortality in patients with SCD. Asthma, a prevalent comorbidity in SCD, has been implicated in worsening disease outcomes, including increased ACS risk. This systematic review and meta‑analysis aimed to evaluate the association between asthma and ACS in patients with SCD by synthesizing data from observational studies. A comprehensive search of the PubMed, Cochrane Library and Scopus databases, as well as gray literature, identified 13 eligible studies, 12 of which were included in the quantitative synthesis. The meta‑analysis demonstrated that patients with SCD and asthma had a significantly higher risk of ACS (risk ratio=2.27, 95% confidence interval: 1.61‑3.20, P=0.0003) compared to patients with SCD without asthma, with substantial heterogeneity observed (I²=74%). The underlying mechanisms linking asthma and ACS may include chronic airway inflammation, increased susceptibility to infections, oxidative stress and endothelial dysfunction. Despite variations in study design and population characteristics, the findings underscore the need for vigilant asthma management in patients with SCD to mitigate ACS risk. Further research is required to elucidate the pathophysiological interactions and develop targeted interventions to improve patient outcomes.
View Figures

Figure 1

Flowchart of the study selection
process.

Figure 2

Forest plot for the association
between asthma and acute chest syndrome in patients with sickle
cell disease. CI, confidence interval; RR, risk ratio; SCD, sickle
cell disease; ACS, acute chest syndrome.

Figure 3

Mechanisms linking asthma in patients
with SCD with ACS. ACS, acute chest syndrome; SCD, sickle cell
disease; IL-3, interleukin-3; TNF-α, tumor necrosis factor α; NO,
nitric oxide.
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Copy and paste a formatted citation
Spandidos Publications style
Dodos K, Kalamara T, Spandidos DA, Corlateanu A and Georgakopoulou VE: Patients with sickle cell disease and asthma have a higher risk for acute chest syndrome: A systematic review and meta‑analysis of observational studies. Exp Ther Med 31: 35, 2026.
APA
Dodos, K., Kalamara, T., Spandidos, D.A., Corlateanu, A., & Georgakopoulou, V.E. (2026). Patients with sickle cell disease and asthma have a higher risk for acute chest syndrome: A systematic review and meta‑analysis of observational studies. Experimental and Therapeutic Medicine, 31, 35. https://doi.org/10.3892/etm.2025.13030
MLA
Dodos, K., Kalamara, T., Spandidos, D. A., Corlateanu, A., Georgakopoulou, V. E."Patients with sickle cell disease and asthma have a higher risk for acute chest syndrome: A systematic review and meta‑analysis of observational studies". Experimental and Therapeutic Medicine 31.2 (2026): 35.
Chicago
Dodos, K., Kalamara, T., Spandidos, D. A., Corlateanu, A., Georgakopoulou, V. E."Patients with sickle cell disease and asthma have a higher risk for acute chest syndrome: A systematic review and meta‑analysis of observational studies". Experimental and Therapeutic Medicine 31, no. 2 (2026): 35. https://doi.org/10.3892/etm.2025.13030
Copy and paste a formatted citation
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Spandidos Publications style
Dodos K, Kalamara T, Spandidos DA, Corlateanu A and Georgakopoulou VE: Patients with sickle cell disease and asthma have a higher risk for acute chest syndrome: A systematic review and meta‑analysis of observational studies. Exp Ther Med 31: 35, 2026.
APA
Dodos, K., Kalamara, T., Spandidos, D.A., Corlateanu, A., & Georgakopoulou, V.E. (2026). Patients with sickle cell disease and asthma have a higher risk for acute chest syndrome: A systematic review and meta‑analysis of observational studies. Experimental and Therapeutic Medicine, 31, 35. https://doi.org/10.3892/etm.2025.13030
MLA
Dodos, K., Kalamara, T., Spandidos, D. A., Corlateanu, A., Georgakopoulou, V. E."Patients with sickle cell disease and asthma have a higher risk for acute chest syndrome: A systematic review and meta‑analysis of observational studies". Experimental and Therapeutic Medicine 31.2 (2026): 35.
Chicago
Dodos, K., Kalamara, T., Spandidos, D. A., Corlateanu, A., Georgakopoulou, V. E."Patients with sickle cell disease and asthma have a higher risk for acute chest syndrome: A systematic review and meta‑analysis of observational studies". Experimental and Therapeutic Medicine 31, no. 2 (2026): 35. https://doi.org/10.3892/etm.2025.13030
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