***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Allogeneic marrow transplantation can cure sickle cell disease ; however , HLA-matched donors are difficult to find , and the toxicities of myeloablative conditioning are prohibitive for most adults with this disease . We developed a nonmyeloablative bone marrow transplantation platform using related , including HLA-haploidentical , donors for patients with sickle cell disease . The regimen consisted of antithymocyte globulin , fludarabine , cyclophosphamide , and total body irradiation , and graft-versus-host disease prophylaxis with posttransplantation high-dose cyclophosphamide , mycophenolate mofetil , and tacrolimus or sirolimus . After screening 19 patients , we transplanted 17 , 14 from HLA-haploidentical and 3 from HLA-matched related donors . Eleven patients engrafted durably . With a median follow-up of 711 days ( minimal follow up 224 days ) , 10 patients are asymptomatic , and 6 patients are off immunosupression . Only 1 patient developed skin-only acute graft-versus-host disease that resolved without any therapy ; no mortality was seen . Nonmyeloablative conditioning with posttransplantation high-dose cyclophosphamide exp and s the donor pool , making marrow transplantation feasible for most patients with sickle cell disease , and is associated with a low risk of complications , even with haploidentical related donors . Graft failure , 43 % in haploidentical pairs , remains a major obstacle but may be acceptable in a fraction of patients if the majority can be cured without serious toxicities BACKGROUND The use of inhaled glucocorticoids for persistent asthma causes a temporary reduction in growth velocity in prepubertal children . The result ing decrease in attained height 1 to 4 years after the initiation of inhaled glucocorticoids is thought not to decrease attained adult height . METHODS We measured adult height  in 943 of 1041 participants ( 90.6 % ) in the Childhood Asthma Management Program ; adult height was determined at a mean ( ±SD ) age of 24.9±2.7 years . Starting at the age of 5 to 13 years , the participants had been r and omly assigned to receive 400 μg of budesonide , 16 mg of nedocromil , or placebo daily for 4 to 6 years . We calculated differences in adult height for each active treatment group , as compared with placebo , using multiple linear regression with adjustment for demographic characteristics , asthma features , and height at trial entry . RESULTS Mean adult height was 1.2 cm lower ( 95 % confidence interval [ CI ] , -1.9 to -0.5 ) in the budesonide group than in the placebo group ( P=0.001 ) and was 0.2 cm lower ( 95 % CI , -0.9 to 0.5 ) in the nedocromil group than in the placebo group ( P=0.61 ) . A larger daily dose of inhaled glucocorticoid in the first 2 years was associated with a lower adult height ( -0.1 cm for each microgram per kilogram of body weight ) ( P=0.007 ) . The reduction in adult height in the budesonide group as compared with the placebo group was similar to that seen after 2 years of treatment ( -1.3 cm ; 95 % CI , -1.7 to -0.9 ) . During the first 2 years , decreased growth velocity in the budesonide group occurred primarily in prepubertal participants . CONCLUSIONS The initial decrease in attained height associated with the use of inhaled glucocorticoids in prepubertal children persisted as a reduction in adult height , although the decrease was not progressive or cumulative . ( Funded by the National Heart , Lung , and Blood Institute and the National Center for Research Re sources ; CAMP Clinical Trials.gov number , NCT00000575 . ) IMPORTANCE Myeloablative allogeneic hematopoietic stem cell transplantation ( HSCT ) is curative for children with severe sickle cell disease , but toxicity may be prohibitive for adults . Nonmyeloablative transplantation has been attempted with degrees of preparative regimen intensity , but graft rejection and graft-vs-host disease remain significant . OBJECTIVE To determine the efficacy , safety , and outcome on end-organ function with this low-intensity regimen for sickle cell phenotype with or without thalassemia . DESIGN , SETTING , AND PARTICIPANTS From July 16 , 2004 , to October 25 , 2013 , 30 patients aged 16 - 65 years with severe disease enrolled in this nonmyeloablative transplant study , consisting of alemtuzumab ( 1 mg/kg in divided doses ) , total-body irradiation ( 300 cGy ) , sirolimus , and infusion of unmanipulated filgrastim mobilized peripheral blood stem cells ( 5.5 - 31.7 × 10(6 ) cells/kg ) from human leukocyte antigen-matched siblings . MAIN OUTCOMES AND MEASURES The primary end point was treatment success at 1 year after the transplant , defined as a full donor-type hemoglobin for patients with sickle cell disease and transfusion independence for patients with thalassemia . The secondary end points were the level of donor leukocyte chimerism ; incidence of acute and chronic graft-vs-host disease ; and sickle cell-thalassemia disease-free survival , immunologic recovery , and changes in organ function , assessed by annual brain imaging , pulmonary function , echocardiographic image , and laboratory testing . RESULTS Twenty-nine patients survived a median 3.4 years ( range , 1 - 8.6 ) , with no nonrelapse mortality . One patient died from intracranial bleeding after relapse . As of October 25 , 2013 , 26 patients ( 87 % ) had long-term stable donor engraftment without acute or chronic graft-vs-host disease . The mean donor T-cell level was 48 % ( 95 % CI , 34%-62 % ) ; the myeloid chimerism levels , 86 % ( 95 % CI , 70%-100 % ) . Fifteen engrafted patients discontinued immunosuppression medication with continued stable donor chimerism and no graft-vs-host disease . The normalized hemoglobin and resolution of hemolysis among engrafted patients were accompanied by stabilization in brain imaging , a reduction of echocardiographic estimates of pulmonary pressure , and allowed for phlebotomy to reduce hepatic iron . The mean annual hospitalization rate was 3.23 ( 95 % CI , 1.83 - 4.63 ) the year before , 0.63 ( 95 % CI , 0.26 - 1.01 ) the first year after , 0.19 ( 95 % CI , 0 - 0.45 ) the second year after , and 0.11 ( 95 % CI , 0.04 - 0.19 ) the third year after transplant . For patients taking long-term narcotics , the mean use per week was 639 mg ( 95 % CI , 220 - 1058 ) of intravenous morphine-equivalent dose the week of their transplants and 140 mg ( 95 % CI , 56 - 225 ) 6 months after transplant . There were 38 serious adverse events : pain and related management , infections , abdominal events , and sirolimus related toxic effects . CONCLUSIONS AND RELEVANCE Among 30 patients with sickle cell phenotype with or without thalassemia who underwent nonmyeloablative allogeneic HSCT , the rate of stable mixed-donor chimerism was high and allowed for complete replacement with circulating donor red blood cells among engrafted participants . Further accrual and follow-up are required to assess longer-term clinical outcomes , adverse events , and transplant tolerance . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00061568 Prior studies of asthma in children with sickle cell disease ( SCD ) were based on reports of a doctor‐diagnosis of asthma with limited description of asthma features . Doctor‐diagnoses of asthma may represent asthma or wheezing unrelated to asthma . Objectives of this study were to determine if asthma characteristics are present in adults with a doctor‐diagnosis of asthma and /or wheezing , and to examine the relationship between doctor‐diagnosis of asthma , wheezing and SCD morbidity . This was an observational cohort study of 114 adults with SCD who completed respiratory symptom question naires and had serum IgE measurements . A subset of 79 participants completed pulmonary function testing .  Survival analysis was based on a mean prospect i ve follow‐up of 28 months and data were censored at the time of death or loss to follow‐up . Adults reporting a doctor‐diagnosis of asthma ( N = 34 ) were more likely to have features of asthma including wheeze , eczema , family history of asthma , and an elevated IgE level ( all P < 0.05 ) . However , there was no difference in pain or ACS rate , lung function , or risk of death between adults with and without a doctor‐diagnosis of asthma . In contrast , adults who reported recurrent , severe episodes of wheezing ( N = 34 ) , regardless of asthma , had twice the rates of pain and ACS , decreased lung function and increased risk of death compared with adults without recurrent , severe wheezing . Asthma features were not associated with recurrent , severe wheezing . Our data suggest that wheezing in SCD may occur independently of asthma and is a marker of disease severity . Am . J. Hematol . 2011 . © 2011 Wiley‐Liss , Pain and acute chest syndrome ( ACS ) episodes are 2 of the most common causes of hospitalization in children with sickle cell anemia ( SCA ) . However , very few potentially modifiable risk factors for either condition have been identified . In this prospect i ve infant cohort study , we tested the hypothesis that asthma is associated with an increased incidence rate of pain and ACS episodes . An infant cohort was composed of 291 African American children with hemoglobin SS enrolled in the Cooperative Study for Sickle Cell Disease before age 6 months and followed beyond age 5 years . Asthma was defined by a physician diagnosis , an acute asthma event , or use of prescription asthma medications . The incidence rates of ACS and painful episodes were compared for children with and without asthma . A clinical diagnosis of asthma was made in 17 % of the cohort . Asthma was associated with more frequent ACS episodes ( 0.39 vs 0.20 events per patient year , P < .001 ) and painful episodes ( 1.39 vs 0.47 events per patient year , P < .001 ) . In conclusion , in children with SCA , asthma is associated with an increased incidence of sickle cell disease-related morbidity , including ACS and painful episodes An analysis of a prospect i ve cohort of individuals with sickle cell anemia ( SCA ) , enrolled from birth through adulthood , was conducted to determine if asthma is a risk factor for death in SCA . All-cause mortality was determined for participants after adjusting for known risk factors for death in SCA . The study included 1,963 individuals who were followed for 18,495 patient-years . After controlling for established risk factors , individuals with SCA and asthma had a more than two-fold higher risk of mortality ( hazard ratio 2.36 , 95 % CI 1.21 to 4.62 , p=0.01 ) . To summarize , asthma is a risk factor for death in SCA 
    Output:
    
The presence of asthma or asthma symptom(recurrentwheezing ) , significantly increases the risk ofSCD-relatedmorbidity4 and mortality.5 - 7However , the guideline doesnotprovide anyapproach to screen and treat asthma orasthma-like symptoms .