Çocuklarda akut astım atağı tedavisinde sistemik ve yüksek doz inhale kortikosteroidlerin erken ve geç dönem etkinliğinin karşılaştırılması

Abstract

Amaç: Bu çalışmada akut astım atağı ile başvuran ço­cuklarda sistemik steroidler ile yüksek doz inhale steroid­lerin etkinliğinin karşılaştırılması amaçlandı. Gereç ve yöntem: Akut astım atağı ile gelen çocuklar randomize olarak iki gruba ayrıldı. Hastalara 1 mg/kg oral yoldan metilprednisolon (Sistemik Steroid Grubu, Grup 1, n=27) veya bir kez 4000 μg inhale flutikazon (İnhale Steroid Grubu, Grup 2, n=35) verildi. Tedaviyi izleyen bi­rer saat aralıklarla dört saat boyunca astım skoru, birinci saniyede üflenen zorlu ekspiratuar hacim (FEV1) ve zirve ekspiratuar akım (PEF) değerleri ölçüldü. Birincil sonuç hastaneye yatış oranı, ikincil sonuçlar ise astım skoru, FEV1 ve PEF sonuçları ve oksijen saturasyonu ile değer­lendirildi. Bulgular: Hastaların geliş anı ile tedavinin dördüncü saati ve hastaların rahat olduğu dönemde PEF değerleri Grup 1\'de sırasıyla, 173, 223, 220 L/dk (p

Keywords

• Astım, astım atağı, inhale flutikazon, sistemik kortikosteroid

The comparison of early and late effectiveness of systemic and high dose inhaled glucocorticoids in the management of acute asthma attacks in children

Abstract

Objective: In this study it was aimed to compare effec­tiveness of systemic steroids and inhaled corticosteroids in children who applied with acute asthmatic attack. Materials and methods: Children with acute asthmatic at­tack were randomly allocated to two groups; 1 mg/kg per oral methylprednisolone was given to Group 1 (Systemic steroid group, n=27), and 4000 μg inhaled fluticasone to Group 2 (Inhaled steroid group, n=35). Following treat­ment patients were evaluated for four hours, at one-hour intervals by asthma score, forced expiratory volume in first-second (FEV1) and peak expiratory flow (PEF). Pri­mary outcome of this study was the rate of hospital admis­sions and secondary outcome were asthma score, FEV1, PEF and oxygen saturation. Results: Significant improvements were obtained in mea­sured parameters in both Group 1 and Group 2. Values of measured parameters at hospital admission, 4th hour of treatment and while patients were in comfort were as fol­low: PEF values (Group 1: 173, 223, 220 L/min, p

Keywords

• Asthma, asthma exacerbation, inhaled flutica­sone, systemic corticosteroid

References

1. Pauwels RA, Pedersen S, Buse WW. Early intervention with budesonide in mild persistent asthma: a randomised, dou- ble-blind trial. Lancet 2003;361:1071-6.
2. Szefler S, Weiss S. Long-term effects of budesonide or nedo- cromil in children with asthma. The Childhood Asthma Management Program Research Group. N Engl J Med 2000;343:1054-63.
3. Strunk RC. Defining asthma in the preschool-aged child. Pe- diatr 2002;109:357-61.
4. National Asthma Education and Prevention Program. Ex- pert panel report II: Guidelines for the diagnosis and man- agement of asthma. Bethesda, MD: National Institutes of Health, 1997.
5. British Thoracic Society. The British guidelines on asthma management: 1995 review and position statement; British Thoracic Society. Thorax 1997;52:1-21.
6. Beveridge RC, Grunfeld AF, Hodder RV. Guidelines for the emergency management of asthma in adults. Can Med As- soc J 1996;155:25-37.
7. Global Initiative For Asthma (GINA) web site [homepage on the internet] http://www.ginasthma.com/.
8. Barnes PJ, Pedersen S, Busse WW. Efficacy and safety of in- haled corticosteroids. New developments. Am J Respir Crit Care Med 1998;157:1-53.

9. Edmonds ML, Camargo CA Jr, Pollack CV Jr, Rowe BH. Early use of inhaled corticosteroids in the emergency de- partment treatment of acute asthma. The Cochrane Library 2000;4:22-9.
10. Rodrigo G, Rodrigo C. Inhaled flunisolide for acute severe asthma. Am J Respir Crit Care Med 1998;157:698-703.
11. Rodrigo GJ, Rodrigo C. Triple inhaled drug protocol for the treatment of acute severe asthma. Chest 2003;123:1908-15.
12. Lee-Wong M, Dayrit FM, Kohli AR. Comparison of high- dose inhaled flunisolide to systemic corticosteroids in se- vere adult asthma. Chest 2002;122:1208-13.
13. Guttman A, Afilalo M, Colacone A. The effects of combined intravenous and inhaled steroids (beclomethasone dipropi- onate) for the emergency treatment of acute asthma. The Asthma ED Study Group. Acad Emerg Med 1997;4:100-6.
14. Levy ML, Stevenson C, Maslen T. Comparison of short courses of oral prednisolone and fluticasone propionate in the treatment of adults with acute exacerbations of asthma in primary care. Thorax 1996;51:1087-92.
15. McFadden ER Jr. Inhaled glucocorticoids and acute asth- ma: therapeutic breakthrough or nonspecific effect? Am J Respir Crit Care Med 1998;157:677-8.
16. Rodrigo GJ. Comparison of inhaled fluticasone with intra- venous hydrocortisone in the treatment of adult acute asth- ma. Am J Respir Crit Care Med 2005;171:1231-6.
17. Scarfone RJ, Fuchs SM, Nager AL, Shane SA. Con- trolled trial of oral prednisone in the emergency depart- ment treatment of children with acute asthma. Pediatrics 1993;92:513-8.
18. Harris JB, Weinberger MM, Nassif E, Smith G, Milavetz G, Stillerman A. Early intervention with short courses of prednisone to prevent progression of asthma in ambulatory patients incompletely responsive to bronchodilators. J Pe- diatr 1987;110:627-33.
19. Brunette MG, Lands L, Thibodeau LP. Childhood asth- ma: prevention of attacks with short-term corticosteroid treatment of upper respiratory tract infection. Pediatrics 1988;81:624-9.
20. Shapiro GG, Furukawa CT, Pierson WE, Gardinier R, Bierman CW. Double-blind evaluation of methylpredniso- lone versus placebo for acute asthma episodes. Pediatrics 1983;71:510-4.
21. Schuh S, Reisman J, Alshehri M, Dupuis A, Corey M, Ar- seneault R, Alothman G, Tennis O, Canny G. A comparison of inhaled fluticasone and oral prednisone for children with severe acute asthma. N Engl J Med 20007;343:689-94.
22. Devidayal, S Singhi, L Kumar, M Jayshree. Efficacy of neb- ulized budesonide compared to oral prednisolone in acute bronchial asthma. Acta Pediatr 1999;88:835-40.
23. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT. Asthma Control Test: reliability, validity, and responsive- ness in patients not previously followed by asthma special- ists. J Allergy Clin Immunol 2006;117:549-56.