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Defınıtıon and Management of Asthma in Children

Year 2018, Volume: 10 Issue: 2, 27 - 32, 06.03.2018

Abstract

Abstract

Asthma, is the most common chronic childhood disorder, characterized by airwayinflammation and airflow limitation triggered by various stimuli, marked by recurrentcough, wheezing, shortness of breath and chest tightness. Allergen sensitization is the most important factor responsible in development of asthma. Besides, genetic and on going epigenetic influences, respiratory infections, air pollution and smoking affect the development and course and exacerbations of asthma. Despite difficulties in childhood, it is possible to establish asthma diagnosis with a detailed disease history and physical examination, with clinical follow-up, evaluation of treatment responsiveness and by relevant diagnostic methods. Identification of asthma phenotypes facilitates asthma follow-up and treatment plans. The main goal of treatment is to maintain symptomcontrol, to prevent exacerbations and avoid deterioration of quality of life. In addition to the treatment steps recommended in guidelines, it is possible to improve disease control by increasing patient education, by creating written action plans, by avoiding modifiable risk factors andcomorbidities, as well as by promoting physical activity,weight restriction and by overviewing inhaler techniques.

References

  • Kaynaklar 1.2018 GINA Report [Available from: http://ginasthma.org /2018-gina-report-global-strategy-for-asthma-management-and-pre-vention/. 2.Bahceciler NN, Ozdemir C, Kucukosmanoglu E, Arikan C, OverU, Karavelioglu S, et al. Association between previous entero-biasis and current wheezing: evaluation of 1018 children. Al-lergy Asthma Proc. 2007;28(2):174-82. 3.Ones U, Akcay A, Tamay Z, Guler N, Zencir M. Rising trend ofasthma prevalence among Turkish schoolchildren (ISAACphases I and III). Allergy. 2006;61(12):1448-53. 4.Ones U, Sapan N, Somer A, Disci R, Salman N, Guler N, et al.Prevalence of childhood asthma in Istanbul, Turkey. Allergy.1997;52(5):570-5. 5.Sennhauser FH, Braun-Fahrlander C, Wildhaber JH. The bur-den of asthma in children: a European perspective. Paediatr Res-pir Rev. 2005;6(1):2-7. 6.Dogruel D, Bingol G, Altintas DU, Seydaoglu G, Erkan A, Yil-maz M. The Trend of Change of Allergic Diseases over the Ye-ars: Three Repeated Surveys from 1994 to 2014. Int Arch Al-lergy Immunol. 2017;173(3):178-82. 7.Türk Toraks Derneği Astım tanı ve tedavi rehberi [Availablefrom: http://www.toraks.org.tr/uploadFiles/book/file/1082017TTD-Astim-Tani-ve-Tedavi-Rehberi-2016.pdf. 8.Holgate ST. Genetic and environmental interaction in allergyand asthma. J Allergy Clin Immunol. 1999;104(6):1139-46. 9.Del Giacco SR, Bakirtas A, Bel E, Custovic A, Diamant Z, Ha-melmann E, et al. Allergy in severe asthma. Allergy.2017;72(2):207-20. 10.D'Amato G, Liccardi G, D'Amato M, Holgate S. Environmen-tal risk factors and allergic bronchial asthma. Clin Exp Allergy.2005;35(9):1113-24. 11.Ober C. Perspectives on the past decade of asthma genetics. JAllergy Clin Immunol. 2005;116(2):274-8. 12.Akdis M, Verhagen J, Taylor A, Karamloo F, Karagiannidis C,Crameri R, et al. Immune responses in healthy and allergic in-dividuals are characterized by a fine balance between allergen-specific T regulatory 1 and T helper 2 cells. J Exp Med.2004;199(11):1567-75. 13.Oettgen HC. Fifty years later: Emerging functions of IgE an-tibodies in host defense, immune regulation, and allergic disea-ses. J Allergy Clin Immunol. 2016;137(6):1631-45. 14.Platts-Mills TAE, Schuyler AJ, Erwin EA, Commins SP, Wood-folk JA. IgE in the diagnosis and treatment of allergic disease.J Allergy Clin Immunol. 2016;137(6):1662-70. 15.Ferstl R, Frei R, Barcik W, Schiavi E, Wanke K, Ziegler M, etal. Histamine receptor 2 modifies iNKT cell activity within theinflamed lung. Allergy. 2017;72(12):1925-35. 16.Stone KD, Prussin C, Metcalfe DD. IgE, mast cells, basophils,and eosinophils. J Allergy Clin Immunol. 2010;125(2 Suppl2):S73-80. 17.Akdis M, Aab A, Altunbulakli C, Azkur K, Costa RA, Crameri R,et al. Interleukins (from IL-1 to IL-38), interferons, transforminggrowth factor beta, and TNF-alpha: Receptors, functions, and ro-les in diseases. J Allergy Clin Immunol. 2016;138(4):984-1010. 18.Wills-Karp M, Luyimbazi J, Xu X, Schofield B, Neben TY, KarpCL, et al. Interleukin-13: central mediator of allergic asthma.Science. 1998;282(5397):2258-61. 19.Ozdemir C, Kucuksezer UC, Akdis M, Akdis CA. Specific im-munotherapy and turning off the T cell: how does it work? AnnAllergy Asthma Immunol. 2011;107(5):381-92. 20.Sharma N, Akkoyunlu M, Rabin RL. Macrophages-common culp-rit in obesity and asthma. Allergy. 2017. 21.Dupont C, Armant DR, Brenner CA. Epigenetics: definition, mec-hanisms and clinical perspective. Semin Reprod Med.2009;27(5):351-7. 22.Harb H, Renz H. Update on epigenetics in allergic disease. JAllergy Clin Immunol. 2015;135(1):15-24. 23.Saxon A, Diaz-Sanchez D. Diesel exhaust as a model xenobio-tic in allergic inflammation. Immunopharmacology.2000;48(3):325-7. 24.Ozdemir C, Kucuksezer UC, Akdis M, Akdis CA. Mechanismsof Aeroallergen Immunotherapy: Subcutaneous Immunotherapyand Sublingual Immunotherapy. Immunol Allergy Clin North Am.2016;36(1):71-86. 25.Palomares O, Akdis M, Martin-Fontecha M, Akdis CA. Mecha-nisms of immune regulation in allergic diseases: the role of re-gulatory T and B cells. Immunol Rev. 2017;278(1):219-36. 26.Sugita K, Steer CA, Martinez-Gonzalez I, Altunbulakli C, Mo-rita H, Castro-Giner F, et al. Type 2 innate lymphoid cells dis-rupt bronchial epithelial barrier integrity by targeting tight junc-tions through IL-13 in asthmatic patients. J Allergy Clin Immu-nol. 2018;141(1):300-10 e11. 27.Illi S, von Mutius E, Lau S, Nickel R, Gruber C, Niggemann B,et al. The natural course of atopic dermatitis from birth to age7 years and the association with asthma. J Allergy Clin Immu-nol. 2004;113(5):925-31. 28.Huang CC, Chiang TL, Chen PC, Lin SJ, Wen HJ, Guo YL. Riskfactors for asthma occurrence in children with early-onset ato-pic dermatitis: An 8-year follow-up study. Pediatr Allergy Im-munol. 2018;29(2):159-65. 29.Ozdemir C. Allerjik yürüyüş. Turkiye Klinikleri J Pediatr Sci.2014;10(2):58-62. 30.Stridsman C, Backman H, Eklund BM, Ronmark E, Hedman L.Adolescent girls with asthma have worse asthma control and he-alth-related quality of life than boys-A population based study.Pediatr Pulmonol. 2017;52(7):866-72. 31.Ekstrom S, Hallberg J, Kull I, Protudjer JLP, Thunqvist P, Bot-tai M, et al. Body mass index status and peripheral airway obs-truction in school-age children: a population-based cohort study.Thorax. 2018. 32.Muc M, Mota-Pinto A, Padez C. Association between obesityand asthma - epidemiology, pathophysiology and clinical pro-file. Nutr Res Rev. 2016;29(2):194-201. 33.Sigurs N, Bjarnason R, Sigurbergsson F, Kjellman B. Respira-tory syncytial virus bronchiolitis in infancy is an important riskfactor for asthma and allergy at age 7. Am J Respir Crit CareMed. 2000;161(5):1501-7. 34.Tormanen S, Lauhkonen E, Riikonen R, Koponen P, Huhtala H, Hel-minen M, et al. Risk factors for asthma after infant bronchiolitis. Al-lergy. 2017. 35.Garcia-Garcia ML, Calvo C, Casas I, Bracamonte T, Rellan A, Go-zalo F, et al. Human metapneumovirus bronchiolitis in infancy is animportant risk factor for asthma at age 5. Pediatr Pulmonol.2007;42(5):458-64. 36.Lambert KA, Prendergast LA, Dharmage SC, Tang M, O'Sullivan M,Tran T, et al. The role of human rhinovirus (HRV) species on asth-ma exacerbation severity in children and adolescents. J Asthma.2017:1-7. 37.Vanker A, Gie RP, Zar HJ. The association between environmentaltobacco smoke exposure and childhood respiratory disease: a revi-ew. Expert Rev Respir Med. 2017;11(8):661-73. 38.Holgate ST, Arshad HS, Roberts GC, Howarth PH, Thurner P, Da-vies DE. A new look at the pathogenesis of asthma. Clin Sci (Lond).2009;118(7):439-50. 39.Pollock J, Shi L, Gimbel RW. Outdoor Environment and PediatricAsthma: An Update on the Evidence from North America. Can Res-pir J. 2017;2017:8921917. 40.Karakoc-Aydiner E, Ozdemir C. Ev içi ve ev dışı hava kirliliğinin as-tım üzerine etkileri. Clinic Pediatri. 2011;6(6):26-30. 41.Gaffin JM, Hauptman M, Petty CR, Sheehan WJ, Lai PS, WolfsonJM, et al. Nitrogen dioxide exposure in school classrooms of inner-city children with asthma. J Allergy Clin Immunol. 2017. 42.Balte P, Karmaus W, Roberts G, Kurukulaaratchy R, Mitchell F, Ars-had H. Relationship between birth weight, maternal smoking duringpregnancy and childhood and adolescent lung function: A path analy-sis. Respir Med. 2016;121:13-20. 43.Lodge CJ, Braback L, Lowe AJ, Dharmage SC, Olsson D, ForsbergB. Grandmaternal smoking increases asthma risk in grandchildren:A nationwide Swedish cohort. Clin Exp Allergy. 2018;48(2):167-74. 44.Tay TR, Hew M. Comorbid "treatable traits" in difficult asthma: Cur-rent evidence and clinical evaluation. Allergy. 2017. 45.Bousquet J, Schunemann HJ, Samolinski B, Demoly P, Baena-Cag-nani CE, Bachert C, et al. Allergic Rhinitis and its Impact on Asth-ma (ARIA): achievements in 10 years and future needs. J Allergy ClinImmunol. 2012;130(5):1049-62. 46.Katon W, Lozano P, Russo J, McCauley E, Richardson L, Bush T.The prevalence of DSM-IV anxiety and depressive disorders in yo-uth with asthma compared with controls. J Adolesc Health.2007;41(5):455-63. 47.Berry A, Busse WW. Biomarkers in asthmatic patients: Has theirtime come to direct treatment? J Allergy Clin Immunol.2016;137(5):1317-24. 48.Agache I, Akdis C, Jutel M, Virchow JC. Untangling asthma phenoty-pes and endotypes. Allergy. 2012;67(7):835-46. 49.Ozdemir C, Akdis M, Akdis CA. Precision medicine in allergic di-sorders. . Curr Treat Opt Allergy. 2017;4(3):283-5. 50.Moore WC, Meyers DA, Wenzel SE, Teague WG, Li H, Li X, et al.Identification of asthma phenotypes using cluster analysis in the Se-vere Asthma Research Program. Am J Respir Crit Care Med.2010;181(4):315-23. 51.Ozdemir C, Yazi D, Gocmen I, Yesil O, Aydogan M, Semic-Jusufa-gic A, et al. Efficacy of long-term sublingual immunotherapy as anadjunct to pharmacotherapy in house dust mite-allergic children withasthma. Pediatr Allergy Immunol. 2007;18(6):508-15. 52.Normansell R, Kew KM, Bridgman AL. Sublingual immunotherapyfor asthma. Cochrane Database Syst Rev. 2015(8):CD011293. 53.Ozdemir C. Monoclonal antibodies in allergy; updated applicationsand promising trials. Recent Pat Inflamm Allergy Drug Discov.2015;9(1):54-65.

Çocuklarda Astım’ın Tanımı ve Yönetimi

Year 2018, Volume: 10 Issue: 2, 27 - 32, 06.03.2018

Abstract

Öz

Astım, tekrarlayan öksürük, hışıltı, nefes darlığı ve göğüste sıkışma hissi ataklarıyla seyreden alt hava yollarında çeşitli uyaranların etkisiyle gelişen havayolu inflamasyonuyla ve hava akımı kısıtlanmasıyla karakterize çocukluk çağının en sık görülen kronik rahatsızlığıdır. Alerjen duyarlılığı astım gelişiminde en önemli etkendir. Alerjenlerin yanı sıra genetik ve süregelen epigenetik etki, solunum yolu enfeksiyonları, çevresel hava kirliliği, sigara dumanı gibi faktörler astımın gelişimini ve seyrini etkilemekte, atakları alevlendirmektedir. Çocukluk çağında astım tanısı, zorluklarıyla beraber, özellikle iyi bir anamnez ve fizik muayeneyle, klinik takip, tedavi yanıtı ve tanısal testlerinin değerlendirilmesiyle konulur. Astım fenotiplerinin tanımlanması, astımın takip ve tedavi planlamalarının şekillendirilmesinde yol göstericidir. Semptomların kontrolü ve kontrolün devamının sağlanması, atakların önüne geçilmesi, yaşam kalitesinin bozulmasının engellenmesi çocukluk çağı astımında tedavinin ana hedefidir. Günümüzde tedavi kılavuzlarında önerilen tedavi basamaklarına ek olarak hasta eğitimi, yazılı eylemplanlarının oluşturulması, değiştirilebilir risk faktörlerinin ve komorbiditelerin önüne geçilmesi, fiziksel aktivite, kilo kısıtlanması ve ilaç kullanım tekniklerinin kontrol edilmesi ayrıca önem taşımaktadır.

References

  • Kaynaklar 1.2018 GINA Report [Available from: http://ginasthma.org /2018-gina-report-global-strategy-for-asthma-management-and-pre-vention/. 2.Bahceciler NN, Ozdemir C, Kucukosmanoglu E, Arikan C, OverU, Karavelioglu S, et al. Association between previous entero-biasis and current wheezing: evaluation of 1018 children. Al-lergy Asthma Proc. 2007;28(2):174-82. 3.Ones U, Akcay A, Tamay Z, Guler N, Zencir M. Rising trend ofasthma prevalence among Turkish schoolchildren (ISAACphases I and III). Allergy. 2006;61(12):1448-53. 4.Ones U, Sapan N, Somer A, Disci R, Salman N, Guler N, et al.Prevalence of childhood asthma in Istanbul, Turkey. Allergy.1997;52(5):570-5. 5.Sennhauser FH, Braun-Fahrlander C, Wildhaber JH. The bur-den of asthma in children: a European perspective. Paediatr Res-pir Rev. 2005;6(1):2-7. 6.Dogruel D, Bingol G, Altintas DU, Seydaoglu G, Erkan A, Yil-maz M. The Trend of Change of Allergic Diseases over the Ye-ars: Three Repeated Surveys from 1994 to 2014. Int Arch Al-lergy Immunol. 2017;173(3):178-82. 7.Türk Toraks Derneği Astım tanı ve tedavi rehberi [Availablefrom: http://www.toraks.org.tr/uploadFiles/book/file/1082017TTD-Astim-Tani-ve-Tedavi-Rehberi-2016.pdf. 8.Holgate ST. Genetic and environmental interaction in allergyand asthma. J Allergy Clin Immunol. 1999;104(6):1139-46. 9.Del Giacco SR, Bakirtas A, Bel E, Custovic A, Diamant Z, Ha-melmann E, et al. Allergy in severe asthma. Allergy.2017;72(2):207-20. 10.D'Amato G, Liccardi G, D'Amato M, Holgate S. Environmen-tal risk factors and allergic bronchial asthma. Clin Exp Allergy.2005;35(9):1113-24. 11.Ober C. Perspectives on the past decade of asthma genetics. JAllergy Clin Immunol. 2005;116(2):274-8. 12.Akdis M, Verhagen J, Taylor A, Karamloo F, Karagiannidis C,Crameri R, et al. Immune responses in healthy and allergic in-dividuals are characterized by a fine balance between allergen-specific T regulatory 1 and T helper 2 cells. J Exp Med.2004;199(11):1567-75. 13.Oettgen HC. Fifty years later: Emerging functions of IgE an-tibodies in host defense, immune regulation, and allergic disea-ses. J Allergy Clin Immunol. 2016;137(6):1631-45. 14.Platts-Mills TAE, Schuyler AJ, Erwin EA, Commins SP, Wood-folk JA. IgE in the diagnosis and treatment of allergic disease.J Allergy Clin Immunol. 2016;137(6):1662-70. 15.Ferstl R, Frei R, Barcik W, Schiavi E, Wanke K, Ziegler M, etal. Histamine receptor 2 modifies iNKT cell activity within theinflamed lung. Allergy. 2017;72(12):1925-35. 16.Stone KD, Prussin C, Metcalfe DD. IgE, mast cells, basophils,and eosinophils. J Allergy Clin Immunol. 2010;125(2 Suppl2):S73-80. 17.Akdis M, Aab A, Altunbulakli C, Azkur K, Costa RA, Crameri R,et al. Interleukins (from IL-1 to IL-38), interferons, transforminggrowth factor beta, and TNF-alpha: Receptors, functions, and ro-les in diseases. J Allergy Clin Immunol. 2016;138(4):984-1010. 18.Wills-Karp M, Luyimbazi J, Xu X, Schofield B, Neben TY, KarpCL, et al. Interleukin-13: central mediator of allergic asthma.Science. 1998;282(5397):2258-61. 19.Ozdemir C, Kucuksezer UC, Akdis M, Akdis CA. Specific im-munotherapy and turning off the T cell: how does it work? AnnAllergy Asthma Immunol. 2011;107(5):381-92. 20.Sharma N, Akkoyunlu M, Rabin RL. Macrophages-common culp-rit in obesity and asthma. Allergy. 2017. 21.Dupont C, Armant DR, Brenner CA. Epigenetics: definition, mec-hanisms and clinical perspective. Semin Reprod Med.2009;27(5):351-7. 22.Harb H, Renz H. Update on epigenetics in allergic disease. JAllergy Clin Immunol. 2015;135(1):15-24. 23.Saxon A, Diaz-Sanchez D. Diesel exhaust as a model xenobio-tic in allergic inflammation. Immunopharmacology.2000;48(3):325-7. 24.Ozdemir C, Kucuksezer UC, Akdis M, Akdis CA. Mechanismsof Aeroallergen Immunotherapy: Subcutaneous Immunotherapyand Sublingual Immunotherapy. Immunol Allergy Clin North Am.2016;36(1):71-86. 25.Palomares O, Akdis M, Martin-Fontecha M, Akdis CA. Mecha-nisms of immune regulation in allergic diseases: the role of re-gulatory T and B cells. Immunol Rev. 2017;278(1):219-36. 26.Sugita K, Steer CA, Martinez-Gonzalez I, Altunbulakli C, Mo-rita H, Castro-Giner F, et al. Type 2 innate lymphoid cells dis-rupt bronchial epithelial barrier integrity by targeting tight junc-tions through IL-13 in asthmatic patients. J Allergy Clin Immu-nol. 2018;141(1):300-10 e11. 27.Illi S, von Mutius E, Lau S, Nickel R, Gruber C, Niggemann B,et al. The natural course of atopic dermatitis from birth to age7 years and the association with asthma. J Allergy Clin Immu-nol. 2004;113(5):925-31. 28.Huang CC, Chiang TL, Chen PC, Lin SJ, Wen HJ, Guo YL. Riskfactors for asthma occurrence in children with early-onset ato-pic dermatitis: An 8-year follow-up study. Pediatr Allergy Im-munol. 2018;29(2):159-65. 29.Ozdemir C. Allerjik yürüyüş. Turkiye Klinikleri J Pediatr Sci.2014;10(2):58-62. 30.Stridsman C, Backman H, Eklund BM, Ronmark E, Hedman L.Adolescent girls with asthma have worse asthma control and he-alth-related quality of life than boys-A population based study.Pediatr Pulmonol. 2017;52(7):866-72. 31.Ekstrom S, Hallberg J, Kull I, Protudjer JLP, Thunqvist P, Bot-tai M, et al. Body mass index status and peripheral airway obs-truction in school-age children: a population-based cohort study.Thorax. 2018. 32.Muc M, Mota-Pinto A, Padez C. Association between obesityand asthma - epidemiology, pathophysiology and clinical pro-file. Nutr Res Rev. 2016;29(2):194-201. 33.Sigurs N, Bjarnason R, Sigurbergsson F, Kjellman B. Respira-tory syncytial virus bronchiolitis in infancy is an important riskfactor for asthma and allergy at age 7. Am J Respir Crit CareMed. 2000;161(5):1501-7. 34.Tormanen S, Lauhkonen E, Riikonen R, Koponen P, Huhtala H, Hel-minen M, et al. Risk factors for asthma after infant bronchiolitis. Al-lergy. 2017. 35.Garcia-Garcia ML, Calvo C, Casas I, Bracamonte T, Rellan A, Go-zalo F, et al. Human metapneumovirus bronchiolitis in infancy is animportant risk factor for asthma at age 5. Pediatr Pulmonol.2007;42(5):458-64. 36.Lambert KA, Prendergast LA, Dharmage SC, Tang M, O'Sullivan M,Tran T, et al. The role of human rhinovirus (HRV) species on asth-ma exacerbation severity in children and adolescents. J Asthma.2017:1-7. 37.Vanker A, Gie RP, Zar HJ. The association between environmentaltobacco smoke exposure and childhood respiratory disease: a revi-ew. Expert Rev Respir Med. 2017;11(8):661-73. 38.Holgate ST, Arshad HS, Roberts GC, Howarth PH, Thurner P, Da-vies DE. A new look at the pathogenesis of asthma. Clin Sci (Lond).2009;118(7):439-50. 39.Pollock J, Shi L, Gimbel RW. Outdoor Environment and PediatricAsthma: An Update on the Evidence from North America. Can Res-pir J. 2017;2017:8921917. 40.Karakoc-Aydiner E, Ozdemir C. Ev içi ve ev dışı hava kirliliğinin as-tım üzerine etkileri. Clinic Pediatri. 2011;6(6):26-30. 41.Gaffin JM, Hauptman M, Petty CR, Sheehan WJ, Lai PS, WolfsonJM, et al. Nitrogen dioxide exposure in school classrooms of inner-city children with asthma. J Allergy Clin Immunol. 2017. 42.Balte P, Karmaus W, Roberts G, Kurukulaaratchy R, Mitchell F, Ars-had H. Relationship between birth weight, maternal smoking duringpregnancy and childhood and adolescent lung function: A path analy-sis. Respir Med. 2016;121:13-20. 43.Lodge CJ, Braback L, Lowe AJ, Dharmage SC, Olsson D, ForsbergB. Grandmaternal smoking increases asthma risk in grandchildren:A nationwide Swedish cohort. Clin Exp Allergy. 2018;48(2):167-74. 44.Tay TR, Hew M. Comorbid "treatable traits" in difficult asthma: Cur-rent evidence and clinical evaluation. Allergy. 2017. 45.Bousquet J, Schunemann HJ, Samolinski B, Demoly P, Baena-Cag-nani CE, Bachert C, et al. Allergic Rhinitis and its Impact on Asth-ma (ARIA): achievements in 10 years and future needs. J Allergy ClinImmunol. 2012;130(5):1049-62. 46.Katon W, Lozano P, Russo J, McCauley E, Richardson L, Bush T.The prevalence of DSM-IV anxiety and depressive disorders in yo-uth with asthma compared with controls. J Adolesc Health.2007;41(5):455-63. 47.Berry A, Busse WW. Biomarkers in asthmatic patients: Has theirtime come to direct treatment? J Allergy Clin Immunol.2016;137(5):1317-24. 48.Agache I, Akdis C, Jutel M, Virchow JC. Untangling asthma phenoty-pes and endotypes. Allergy. 2012;67(7):835-46. 49.Ozdemir C, Akdis M, Akdis CA. Precision medicine in allergic di-sorders. . Curr Treat Opt Allergy. 2017;4(3):283-5. 50.Moore WC, Meyers DA, Wenzel SE, Teague WG, Li H, Li X, et al.Identification of asthma phenotypes using cluster analysis in the Se-vere Asthma Research Program. Am J Respir Crit Care Med.2010;181(4):315-23. 51.Ozdemir C, Yazi D, Gocmen I, Yesil O, Aydogan M, Semic-Jusufa-gic A, et al. Efficacy of long-term sublingual immunotherapy as anadjunct to pharmacotherapy in house dust mite-allergic children withasthma. Pediatr Allergy Immunol. 2007;18(6):508-15. 52.Normansell R, Kew KM, Bridgman AL. Sublingual immunotherapyfor asthma. Cochrane Database Syst Rev. 2015(8):CD011293. 53.Ozdemir C. Monoclonal antibodies in allergy; updated applicationsand promising trials. Recent Pat Inflamm Allergy Drug Discov.2015;9(1):54-65.
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Details

Primary Language Turkish
Journal Section makale
Authors

Prof. Dr. Cevdet Özdemir

Publication Date March 6, 2018
Published in Issue Year 2018 Volume: 10 Issue: 2

Cite

APA Özdemir, P. D. C. (2018). Çocuklarda Astım’ın Tanımı ve Yönetimi. Klinik Tıp Pediatri Dergisi, 10(2), 27-32.
AMA Özdemir PDC. Çocuklarda Astım’ın Tanımı ve Yönetimi. Pediatri. March 2018;10(2):27-32.
Chicago Özdemir, Prof. Dr. Cevdet. “Çocuklarda Astım’ın Tanımı Ve Yönetimi”. Klinik Tıp Pediatri Dergisi 10, no. 2 (March 2018): 27-32.
EndNote Özdemir PDC (March 1, 2018) Çocuklarda Astım’ın Tanımı ve Yönetimi. Klinik Tıp Pediatri Dergisi 10 2 27–32.
IEEE P. D. C. Özdemir, “Çocuklarda Astım’ın Tanımı ve Yönetimi”, Pediatri, vol. 10, no. 2, pp. 27–32, 2018.
ISNAD Özdemir, Prof. Dr. Cevdet. “Çocuklarda Astım’ın Tanımı Ve Yönetimi”. Klinik Tıp Pediatri Dergisi 10/2 (March 2018), 27-32.
JAMA Özdemir PDC. Çocuklarda Astım’ın Tanımı ve Yönetimi. Pediatri. 2018;10:27–32.
MLA Özdemir, Prof. Dr. Cevdet. “Çocuklarda Astım’ın Tanımı Ve Yönetimi”. Klinik Tıp Pediatri Dergisi, vol. 10, no. 2, 2018, pp. 27-32.
Vancouver Özdemir PDC. Çocuklarda Astım’ın Tanımı ve Yönetimi. Pediatri. 2018;10(2):27-32.