The Impact of Cigarette Smoking and Vaping on Acute Chest Syndrome in Adolescents and Young Adults with Sickle Cell Disease

Sickle Cell Disease (SCD) is a hereditary blood disorder that distorts the shape of red blood cells, increasing the risk of blocked blood vessels and damage to organs. Sickled red blood cells may lead to acute chest syndrome (ACS), which presents with the detection of a lung abnormality during chest imaging accompanied by fever or respiratory symptoms. ACS is a leading cause of premature death in youth with SCD, accounting for one-quarter of SCD-related deaths. For many years, tobacco smoke exposure has been suspected to worsen the frequency or severity of ACS. However, much of the earlier evidence combined children, adolescents, and adults together and relied on self-reported smoking habits. Biomarkers of smoke exposure are now available and e-cigarette use (vaping) has become widespread. The transition period to adulthood is marked by increasing autonomy, experimentation with nicotine products, and peak SCD complications. Therefore, a review of literature discussing the effects of cigarette smoking and vaping in adolescents and young adults with SCD was conducted. Publications were systematically reviewed for the impact of combustible cigarette smoke, second-hand smoke, or vaping in SCD patients ≤24 years old. Across these studies, any tobacco smoke exposure was associated with an increase in ACS- and SCD-related hospitalizations, ACS frequency, ER visits, and overall mortality. This review demonstrates the increased risk for ACS and poor outcomes in the younger SCD population who are at higher risk for experimentation with cigarette smoking and vaping and highlights critical research gaps needed to inform targeted prevention, counseling, and policy interventions.