Astımı Rahatsız Edici ve Riski Azaltıcı Güncel Tedavi

Özlem Cavkaytar

Astımı Rahatsız Edici ve Riski Azaltıcı Güncel Tedavi

Öz

Astım, çoğunlukla çocukluk döneminde ortaya çıkan, alevlenmelere ya da persistan semptomlara neden olan kompleks, kronik inflamatuar bir alt solunum yolu hastalığıdır. Son yıllarda astım tedavisinde “kontrol” kavramı ön plana çıkmıştır, bu kavram ile astımın hem farmakoterapi hem de diğer stratejik önlemlerin alınmasıyla tüm yönleriyle kontrol altına alınması hedeflenmektedir. Astımda farmakoterapi rahatlatıcı tedavi, kontrol edici tedavi ve ağır astımı olan hastalarda ek tedaviler olmak üzere üçe ayrılmaktadır. Kontrol edici astım tedavisi ile havayolundaki inflamasyonun azaltılması, semptomların kontrol altına alınması, gelecek için astım ilişkili atak riskinin ve rahatlatıcı ilaç kullanım oranlarının azaltılması hedeflenir. Günümüzde bir yandan ağır astım tedavisi için çok yönlü araştırılmalar yapılıp yeni ek tedaviler geliştirilirken, diğer yandan intermittan ya da hafif persistan astımı olan hastalar için gerektiğinde ya düzenli olarak kullanılacak farklı tedavi şekillerinin etkinliği ve güvenilirliği araştırılmaktadır. Astım hastalığında patofizyolojideki heterojeniteden dolayı gelecekte herbir basamaktaki tedavi yanıtını belirleyecek diğer klinik, laboratuvar ve genetik belirteçlerin keşfi yol gösterici olacaktır.

Anahtar Kelimeler

References

1. Drake SM, Simpson A, Fowler SJ. Asthma Diagnosis: The Changing Face of Guidelines. Pulm Ther 2019;5(2):103-115.
2. Dünya Sağlık Örgütü Verilerinden. (Güncelleme Kasım 2019). Erişim için: https://www.who.int/news-room/q-a-detail/ asthma. Son erişim: Şubat 2020.
3. Rehman N, Morais-Almeida M, Wu AC. Asthma Across Childhood: Improving Adherence to Asthma Management from Early Childhood to Adolescence. J Allergy Clin Immunol Pract 2020.
4. “Astımın Tedavisi ve Korunmasında Global Strateji”’den. (Güncelleme 2019) https://ginasthma.org/wp-content/uploads/
2019/06/GINA-2019-main-report-June-2019-wms.pdf. Son erişim: Şubat 2020.
5. Kalayci O, Abdelateef H, Pozo Beltran CF, El-Sayed ZA, Gomez RM, Hossny E, et al. Challenges and choices in the pharmacological
treatment of non-severe pediatric asthma: A commentary for the practicing physician. World Allergy Organ J2019;12(9):100054.
6. Busse WW, Pedersen S, Pauwels RA, Tan WC, Chen YZ, Lamm CJ, et al. The Inhaled Steroid Treatment As Regular Therapy

in Early Asthma (START) study 5-year follow-up: effectiveness of early intervention with budesonide in mild persistent asthma. J Allergy Clin Immunol 2008;121(5):1167-1174.
7. O'Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW, Group SI. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med 2009;179(1):19-24.
8. Selroos O, Pietinalho A, Lofroos AB, Riska H. Effect of early vs late intervention with inhaled corticosteroids in asthma. Chest 1995;108(5):1228-1234.
9. El Baou C, Di Santostefano RL, Alfonso-Cristancho R, Suarez EA, Stempel D, Everard ML, et al. Effect of inhaled corticosteroid
particle size on asthma efficacy and safety outcomes: a systematic literature review and meta-analysis. BMC Pulm Med 2017;17(1):31.
10. Leach CL, Davidson PJ, Hasselquist BE, Boudreau RJ. Lung deposition of hydrofluoroalkane-134a beclomethasone
is greater than that of chlorofluorocarbon fluticasone and chlorofluorocarbon beclomethasone : a cross-over study in healthy volunteers. Chest 2002;122(2):510-516.
11. Lasserson TJ, Cates CK, Jones AB, Steele EH, White J. Fluticasone versus HFA-beclomethasone dipropionate for chronic
asthma in adults and children. Cochrane Database Syst Rev 2006(2):CD005309.
12. van Aalderen WM, Grigg J, Guilbert TW, Roche N, Israel E, Martin RJ, et al. Small-particle Inhaled Corticosteroid as Firstline
or Step-up Controller Therapy in Childhood Asthma. J Allergy Clin Immunol Pract 2015;3(5):721-731 e716.
13. Fitzpatrick AM, Jackson DJ, Mauger DT, Boehmer SJ, Phipatanakul W, Sheehan WJ, et al. Individualized therapy for persistent
asthma in young children. J Allergy Clin Immunol 2016;138(6):1608-1618 e1612.
14. Chauhan BF, Ducharme FM. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent
and/or chronic asthma in adults and children. Cochrane Database Syst Rev 2012(5):CD002314.
15. Szefler SJ, Phillips BR, Martinez FD, Chinchilli VM, Lemanske RF, Strunk RC, et al. Characterization of within-subject responses
to fluticasone and montelukast in childhood asthma. J Allergy Clin Immunol 2005;115(2):233-242.
16. Ducharme FM, Ni Chroinin M, Greenstone I, Lasserson TJ. Addition of long-acting beta2-agonists to inhaled corticosteroids
versus same dose inhaled corticosteroids for chronic asthma in adults and children. Cochrane Database Syst Rev 2010(5):CD005535.
17. Peters SP, Bleecker ER, Canonica GW, Park YB, Ramirez R, Hollis S, et al. Serious Asthma Events with Budesonide plus
Formoterol vs. Budesonide Alone. N Engl J Med 2016;375(9):850-860.
18. Stempel DA, Raphiou IH, Kral KM, Yeakey AM, Emmett AH, Prazma CM, et al. Serious Asthma Events with Fluticasone
plus Salmeterol versus Fluticasone Alone. N Engl J Med 2016;374(19):1822-1830.
19. Lemanske RF, Jr., Mauger DT, Sorkness CA, Jackson DJ, Boehmer SJ, Martinez FD, et al. Step-up therapy for children with
uncontrolled asthma receiving inhaled corticosteroids. N Engl J Med 2010;362(11):975-985.
20. Bisgaard H, Le Roux P, Bjamer D, Dymek A, Vermeulen JH, Hultquist C. Budesonide/formoterol maintenance plus reliever
therapy: a new strategy in pediatric asthma. Chest 2006;130(6):1733-1743.
21. Stempel DA, Szefler SJ, Pedersen S, Zeiger RS, Yeakey AM, Lee LA, et al. Safety of Adding Salmeterol to Fluticasone Propionate
in Children with Asthma. N Engl J Med 2016;375(9):840-849.
22. Vogelberg C, Engel M, Laki I, Bernstein JA, Schmidt O, El Azzi G, et al. Tiotropium add-on therapy improves lung function
in children with symptomatic moderate asthma. J Allergy Clin Immunol Pract 2018;6(6):2160-2162 e2169.
23. Hamelmann E, Bateman ED, Vogelberg C, Szefler SJ, Vandewalker M, Moroni-Zentgraf P, et al. Tiotropium add-on therapy
in adolescents with moderate asthma: A 1-year randomized controlled trial. J Allergy Clin Immunol 2016;138(2):441-450 e448.
24. Rodrigo GJ, Neffen H. Efficacy and safety of tiotropium in school- age children with moderate-to-severe symptomatic asthma: A systematic review. Pediatr Allergy Immunol 2017;28(6):573-578.
25. Sobieraj DM, Baker WL, Nguyen E, Weeda ER, Coleman CI, White CM, et al. Association of Inhaled Corticosteroids and
Long-Acting Muscarinic Antagonists With Asthma Control in Patients With Uncontrolled, Persistent Asthma: A Systematic Review and Meta-analysis. JAMA 2018;319(14):1473-1484.
26. Vrijlandt E, El Azzi G, Vandewalker M, Rupp N, Harper T, Graham L, et al. Safety and efficacy of tiotropium in children aged
1-5 years with persistent asthmatic symptoms: a randomised, double-blind, placebo-controlled trial. Lancet Respir Med 2018;6(2):127-137.
27. Kelly HW, Sternberg AL, Lescher R, Fuhlbrigge AL, Williams P, Zeiger RS, et al. Effect of inhaled glucocorticoids in childhood on adult height. N Engl J Med 2012;367(10):904-912.
28. Cavkaytar O, Arik Yilmaz E, Karaatmaca B, Buyuktiryaki B, Sackesen C, Sekerel BE, et al. Different Phenotypes of Non-
Steroidal Anti-Inflammatory Drug Hypersensitivity during Childhood. Int Arch Allergy Immunol 2015;167(3):211-221.
29. Farne HA, Wilson A, Powell C, Bax L, Milan SJ. Anti-IL5 therapies for asthma. Cochrane Database Syst Rev 2017;9:CD010834.
30. Rodrigo GJ, Neffen H. Systematic review on the use of omalizumab for the treatment of asthmatic children and adolescents. Pediatr Allergy Immunol 2015;26(6):551-556.
31. Castro M, Corren J, Pavord ID, Maspero J, Wenzel S, Rabe KF, et al. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma. N Engl J Med 2018;378(26):2486- 2496.
32. O'Byrne PM, FitzGerald JM, Bateman ED, Barnes PJ, Zhong N, Keen C, et al. Inhaled Combined Budesonide-Formoterol
as Needed in Mild Asthma. N Engl J Med 2018;378(20):1865-1876.
33. Bateman ED, Reddel HK, O'Byrne PM, Barnes PJ, Zhong N, Keen C, et al. As-Needed Budesonide-Formoterol versus Maintenance
Budesonide in Mild Asthma. N Engl J Med 2018;378(20):1877-1887.
34. Lazarinis N, Jorgensen L, Ekstrom T, Bjermer L, Dahlen B, Pullerits T, et al. Combination of budesonide/formoterol on
demand improves asthma control by reducing exercise-induced bronchoconstriction. Thorax 2014;69(2):130-136.
35. Cates CJ, Karner C. Combination formoterol and budesonide as maintenance and reliever therapy versus current best
practice (including inhaled steroid maintenance), for chronic asthma in adults and children. Cochrane Database Syst Rev 2013(4):CD007313.
36. Kew KM, Karner C, Mindus SM, Ferrara G. Combination formoterol and budesonide as maintenance and reliever therapy
versus combination inhaler maintenance for chronic asthma in adults and children. Cochrane Database Syst Rev 2013(12):CD009019.
37. Papi A, Corradi M, Pigeon-Francisco C, Baronio R, Siergiejko Z, Petruzzelli S, et al. Beclometasone-formoterol as maintenance
and reliever treatment in patients with asthma: a double- blind, randomised controlled trial. Lancet Respir Med 2013;1(1):23-31.
38. Patel M, Pilcher J, Pritchard A, Perrin K, Travers J, Shaw D, et al. Efficacy and safety of maintenance and reliever combination
budesonide-formoterol inhaler in patients with asthma at risk of severe exacerbations: a randomised controlled trial. Lancet Respir Med 2013;1(1):32-42.
39.Welsh EJ, Cates CJ. Formoterol versus short-acting beta-agonists as relief medication for adults and children with asthma. Cochrane Database Syst Rev 2010(9):CD008418.
40. Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med 2000;343(5):332-336.
41. Magee JS, Pittman LM, Jette-Kelly LA. Paradoxical Bronchoconstriction with Short-Acting Beta Agonist. Am J Case Rep 2018;19:1204-1207.
42. Martinez FD, Chinchilli VM, Morgan WJ, Boehmer SJ, Lemanske RF, Jr., Mauger DT, et al. Use of beclomethasone dipropionate
as rescue treatment for children with mild persistent asthma (TREXA): a randomised, double-blind, placebocontrolled trial. Lancet 2011;377(9766):650-657.
43. Hoch HE, Calatroni A, West JB, Liu AH, Gergen PJ, Gruchalla RS, et al. Can we predict fall asthma exacerbations? Validation
of the seasonal asthma exacerbation index. J Allergy Clin Immunol 2017;140(4):1130-1137 e1135.
44. Ducharme FM, Lemire C, Noya FJ, Davis GM, Alos N, Leblond H, et al. Preemptive use of high-dose fluticasone for virus-
induced wheezing in young children. N Engl J Med 2009;360(4):339-353.
45. Blais L, Kettani FZ, Forget A, Beauchesne MF, Lemiere C, Ducharme FM. Assessing adherence to inhaled corticosteroids in
asthma patients using an integrated measure based on primary and secondary adherence. Eur J Clin Pharmacol 2017;73(1):91-97.
46. Morton RW, Elphick HE, Rigby AS, Daw WJ, King DA, Smith LJ, et al. STAAR: a randomised controlled trial of electronic
adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma. Thorax 2017;72(4):347-354.

Details

Primary Language

Turkish

Subjects

Internal Diseases

Journal Section

Review

Authors

Özlem Cavkaytar ^* This is me
Türkiye

Publication Date

April 1, 2020

Submission Date

February 19, 2020

Acceptance Date

March 16, 2020

Published in Issue

Year 2020 Volume: 12 Number: 2

IZ

https://izlik.org/JA37TT83SB

Cite

RIS / Bibtex

APA

Cavkaytar, Ö. (2020). Astımı Rahatsız Edici ve Riski Azaltıcı Güncel Tedavi. Klinik Tıp Pediatri Dergisi, 12(2), 57-65. https://izlik.org/JA37TT83SB

AMA

1.Cavkaytar Ö. Astımı Rahatsız Edici ve Riski Azaltıcı Güncel Tedavi. Pediatri. 2020;12(2):57-65. https://izlik.org/JA37TT83SB

Chicago

Cavkaytar, Özlem. 2020. “Astımı Rahatsız Edici Ve Riski Azaltıcı Güncel Tedavi”. Klinik Tıp Pediatri Dergisi 12 (2): 57-65. https://izlik.org/JA37TT83SB.

EndNote

Cavkaytar Ö (April 1, 2020) Astımı Rahatsız Edici ve Riski Azaltıcı Güncel Tedavi. Klinik Tıp Pediatri Dergisi 12 2 57–65.

IEEE

[1]Ö. Cavkaytar, “Astımı Rahatsız Edici ve Riski Azaltıcı Güncel Tedavi”, Pediatri, vol. 12, no. 2, pp. 57–65, Apr. 2020, [Online]. Available: https://izlik.org/JA37TT83SB

ISNAD

Cavkaytar, Özlem. “Astımı Rahatsız Edici Ve Riski Azaltıcı Güncel Tedavi”. Klinik Tıp Pediatri Dergisi 12/2 (April 1, 2020): 57-65. https://izlik.org/JA37TT83SB.

JAMA

1.Cavkaytar Ö. Astımı Rahatsız Edici ve Riski Azaltıcı Güncel Tedavi. Pediatri. 2020;12:57–65.

MLA

Cavkaytar, Özlem. “Astımı Rahatsız Edici Ve Riski Azaltıcı Güncel Tedavi”. Klinik Tıp Pediatri Dergisi, vol. 12, no. 2, Apr. 2020, pp. 57-65, https://izlik.org/JA37TT83SB.

Vancouver

1.Özlem Cavkaytar. Astımı Rahatsız Edici ve Riski Azaltıcı Güncel Tedavi. Pediatri [Internet]. 2020 Apr. 1;12(2):57-65. Available from: https://izlik.org/JA37TT83SB