Letters Painful sickle cell episodes

NICE guidance ignored incentive spirometry

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e5370 (Published 21 August 2012) Cite this as: BMJ 2012;345:e5370
  1. Amit Patel, specialist registrar in haematology and intensive care medicine1
  1. 1Imperial College London; Imperial College Healthcare NHS Trust, MRC Clinical Sciences Centre, Hammersmith Hospital, London W12 0NN, UK
  1. amit.patel{at}imperial.ac.uk

It is disappointing that the National Institute for Health and Clinical Excellence guidance on managing an acute painful sickle cell episode in hospital did not advocate incentive spirometry as an effective, simple, and cheap (about £14 (€18; $22)) non-pharmacological intervention,1 2 given that up to 54% of inpatients currently receive it as standard care.3 It involves awake patients taking 10 maximal inspirations every two hours.

Randomised data in patients presenting with chest or back pain show an absolute risk reduction of 36.8% (95% confidence interval 12.5% to 61.2%) for pulmonary complications (associated with the development of acute chest syndrome) and reduced hospital admission.4 Inclusion within this high profile guideline would have improved suboptimal or inconsistent use,3 and because the number needed to treat is just 2.7 (1.6 to 8.0) would have immediately benefited patients and budgets.


Cite this as: BMJ 2012;345:e5370


  • Competing interests: None declared.


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