PREVALENCE AND FACTORS ASSOCIATED WITH ABNORMAL LUNG FUNCTION AMONG ADOLESCENTS AND ADULTS AGED 12 YEARS AND ABOVE WITH SICKLE CELL DISEASE IN EASTERN UGANDA
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Date
2026-09-10
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ABSTRACT
Background: Sickle Cell Disease (SCD) is the most prevalent genetic condition in the world caused by a mutation in the beta-globin gene. The lungs are among the progressively damaged organs by this condition. The majority of research conducted in Africa is restricted to younger individuals with SCD, and yet there is a downward trajectory in lung function with age. Due to advancements in care, many young people with SCD are living into adulthood, and therefore, it's critical to comprehend the anomalies in lung function that these individuals experience.
Aim: This study aimed to determine the prevalence, patterns, and factors associated with abnormal lung function among adolescents and adults aged 12 years and above with SCD in Eastern Uganda.
Methods: This was a hospital-based cross-sectional study conducted among 228 individuals with SCD aged ≥12 years attending the Sickle Cell Clinic (SCC) at Mbale Regional Referral Hospital (MRRH). The inclusion criteria were individuals with SCD aged 12 years and above who provided informed consent or assent, as appropriate. Exclusion criteria included those who were critically ill, had musculoskeletal disorders capable of influencing lung function, verified cases of pneumonia, pulmonary tuberculosis, or any other respiratory illness being treated or diagnosed at the time of enrollment. Lung function was assessed using spirometry. Sociodemographic and clinical data were collected using a pretested questionnaire. Data were analysed using R version 4.5.2. Descriptive statistics summarised participant characteristics and spirometric patterns. Prevalence was estimated with 95% confidence intervals, and logistic regression was used to identify factors associated with abnormal lung function. ORs, aORs, 95% confidence intervals, and p-values were reported; p < 0.05 was considered statistically significant.
Results
Of 228 enrolled participants, 218 with valid spirometry were analysed. The median age was 17 years (IQR 14–22), 53.2% were male, 70.6% had a history of recurrent acute chest syndrome, and 92.7% were receiving hydroxyurea therapy. The prevalence of abnormal lung function was 47.2% (103/218; 95% CI: 40.7–53.9%). Restrictive lung pattern was the most common abnormality (48.5%), followed by obstructive pattern with reversibility (26.2%).
In multivariable analysis, Haemoglobin levels showed the strongest association, with moderate anaemia (aOR 6.04, 95% CI 2.26 to 16.15, p < 0.001) and severe anaemia (aOR 13.99, 95% CI 4.98 to 39.28, p < 0.001) having higher odds than mild or normal haemoglobin. Each additional year of age was associated with 9% higher odds of abnormal lung function (aOR 1.09, 95% CI 1.02 to 1.17, p = 0.009; likelihood ratio test for age p = 0.007) and non-use of hydroxyurea (aOR: 3.54; 95% CI: 1.01–12.49; p = 0.049) were independently associated with abnormal lung function.
Conclusion
Adolescents and adults with SCD frequently have impaired lung function, with a restrictive spirometric pattern being the most common. Significant predictors included growing older, anaemia, and non-use of hydroxyurea. Pulmonary outcomes may be improved by routine lung function evaluation, proper management of anaemia, and optimisation of disease-modifying treatment.