Logical Approach to a Patient Presenting with Recurrent Wheezing

Year 2019, Volume: 11 Issue: 2, 118 - 127, 07.03.2019

Dr. Öğr. Üyesi Nurşen Ciğerci Günaydın

Abstract

Abstract

Recurrent wheezing is one of the most common respiratory problems of childhood. One third of the children has a wheezing atack in the first three years of life. Recurrent wheezing is usually related with recurrent upper respiratory tract infections in children. Wheezing has phenotypes which occures with different phatophysiologic mechanisms. These phenotypes can have different outcomes and triggers. As a result wheezing is a heterogen situation, in this age group. Wheezing doesn’t predict asthma everytime, it can be seen with a lot of respiratory problems. Making differential diagnosis for patients with recurrent wheezing and defining asthma risk factors is important for predicting the prognosis.  In this article a case with recurrent wheezing, differential diagnosis in wheezy infant, risk factors for asthma development, prognosis and treatment will be reviewed.

Keywords

Recurrentwheezing, children, Logical approach

Tekrarlayan Hışıltı Yakınması ile Başvuran Çocuğa Akılcı Yaklaşım

Abstract

Öz

Tekrarlayan hışıltı yakınması çocukluk çağının en sık karşılaşılan solunum problemlerinden biridir.  Hayatın ilk 3 yılında her üç çocuktan biri hışıltı atağı geçirmektedir. 5yaşından küçük çocuklarda sıklıkla tekrarlayan hışıltı görülür. Çocukluk çağında tekrarlayan hışıltı, sıklıkla tekrarlayan üst solunum yolu enfeksiyonu ile ilişkilidir. Hışıltının farklı patofizyolojik mekanizmalara bağlı gelişebilen, çeşitli tetikleyicilerle ve farklı klinik seyirleri olabilen fenotipleri bulunmaktadır. Dolayısıyla, bu yaş grubunda hışıltı, oldukça heterojen bir durumdur. Hışıltı her zaman astımı öngörmez; pek çok solunum yolu probleminde görülebilir. Tekrarlayan hışıltı yakınması olan hastalarda ayırıcı tanı yapılması ve astım gelişimi için risk faktörlerinin belirlenmesi prognozu öngörmek için oldukça önemlidir.  Bu makalede tekrarlayan hışıltı yakınması olan bir olguile hışıltılı çocukta ayırıcı tanısı, astım gelişimi için risk faktörleri, prognoz ve tedavi incelenecektir.

Keywords

Tekrarlayan hışıltı, çocuk, akılcı yaklaşım

References

• Kaynaklar 1.Martinez FD, Wright AL, Taussig LM, et al. Asthma andwheezing in the first six years of life. N Engl J Med 1995;332: 133–138. 2.Henderson J, Granell R, Heron J, Sherriff A, Simpson A,Woodcock AA, et al. Associations of wheezing phenotypesin the first six years of life with atopy, lung function andairway responsiveness in mid childhood. Thorax 2008;63:974-80. 3.Bisgaard H, Szefler S. Prevalence of asthma-like symptomsin young children. Pediatr Pulmonol 2007; 42:723-8. 4.Elphick HE, Sherlock P, Foxall G, Simpson EJ, Shiell NA,Primhak RA, et al. Survey of respiratory sounds in in-fants. Arch Dis Child 2001; 84:35–39 5.Lowe L, Murray CS, Martin L, et al. Reported versus con-firmed wheeze and lung function in early life. Arch DisChild 2004; 89:540–543. 6.2018 GINA Report, Global Strategy for Asthma Manage-ment and Prevention. Available at: http:/ www. ginasth-ma.com 7.Van Der Heijden HH, Brouwer ML, Hoekstra F, Van DerPol P, Merkus PJ. Reference values of exhaled nitric oxi-de in healthy children 1-5 years using off-line tidal breat-hing. Pediatr Pulmonol 2014; 49:291-5. 8.Singer F, Luchsinger I, Inci D, et al. Exhaled nitric oxidein symptomatic children at preschool age predicts laterasthma. Allergy 2013; 68:531-8. 9.Doherty G, Bush A. Diagnosing respiratory problems inyoung children. Practitioner 2007; 251:20, 2-5. 10.Pedersen S. Preschool asthma not so easy to diagnose.Prim Care Respir J 2007; 16:4-6. 11.National Heart, Lung, and Blood Institute. Expert panelreport 3. National asthma education and preventionprogram. Section 4, Managing Asthma Long Term inChildren 0–4 Years of Age and 5–11 Years of Age 2007:282-289. 12.Taussig LM, Wright AL, Holberg CJ, Halonen M, MorganWJ, Martinez FD. Tucson Children's Respiratory Study:1980 to present. J Allergy Clin Immunol. 2003;111:661-75. 13.Martinez FD. Recognizing early asthma. Allergy 1999;54:24-8. 14.Castro-Rodríguez JA, Holberg CJ, Wright AL, MartinezFD. A clinical index to define risk of asthma in youngchildren with recurrent wheezing. Am J Respir Crit CareMed 2000;162:1403-6. 15.Sears MR. Predicting asthma outcomes. J Allergy ClinImmunol 2015;136:829-837. 16.Papadopoulos NG, Arakawa H, Carlsen KH, et al. Inter-national consensus on (ICON) pediatric asthma. Allergy2012; 67: 976–97. 17.Nagel G, Buchele G, Weinmayr G, et al. Effect of breast-feeding on asthma, lung function and bronchial hyperre-activity in ISAAC Phase II.Eur Respir J 2009; 33:993-1002. 18.Guibas GV, Makris M, Papadopoulos NG. Acute asthmaexacerbations in childhood: risk factors, prevention andtreatment. Expert Rev Respir Med 2012: 6: 629–38. 19.Sigurs N, Gustafsson PM, Bjarnason R, Lundberg F,Schmidt S, Sigurbergsson F, Kjellman B. Severe respira-tory syncytial virus bronchiolitis in infancy and asthmaand allergy at age 13. Am J Respir Crit Care Med 2005;171:137-41. 20.Lemanske RF Jr, Jackson DJ, Gangnon RE, Evans MD, LiZ, Shult PA, Kirk CJ, et al. Rhinovirus illnesses duringinfancy predict subsequent childhood wheezing. J AllergyClin Immunol. 2005;116:571-7. 21.Holt PG, Strickland DH, Sly PD. Virus infection and al-lergy in the development of asthma: what is the connecti-on? Curr Opin Allergy Clin Immunol. 2012;12: 151-7. 22.Guxens M, Sonnenschein-van der Voort AM, Tiemeier H,Hofman A, Sunyer J, de Jongste JC, et al. Parentalpsychological distress during pregnancy and wheezing inpreschool children: the Generation R Study. J AllergyClin Immunol 2014; 133:59-67. 23.Landau LI. Tobacco smoke exposure and tracking of lungfunction into adult life. Paediatr Respir Rev. 2008;9:39-43. 24.Brand PL, Caudri D, Eber E, Gaillard EA, Garcia-Mar-cos L, Hedlin G, et al. Classification and pharmacologi-cal treatment of preschool wheezing: changes since 2008.Eur Respir J. 2014;43: 1172-7. 25.Stein RT, Martinez FD. Asthma phenotypes in childhood:lessons from an epidemiological approach. Paediatr Res-pir Rev 2004; 5:155-61. 26.Spycher BD, Silverman M, Brooke AM, Minder CE, Ku-ehni CE. Distinguishing phenotypes of childhood wheezeand cough using latent class analysis. Eur Respir J 2008;31: 974-81 27.Speer CP, Silverman M. Issues relating to children bornprematurely. Eur Respir J 1998; 27:13–16. 28.Ball TM, Castro-Rodriguez JA, Griffith KA, Holberg CJ,Martinez FD, Wright AL. Siblings, day-care attendance,and the risk of asthma and wheezing during childhood. NEngl J Med 2000; 343:538–543. 29.Stein RT, Sherrill D, Morgan WJ, et al. Respiratorysyncytial virus in early life and risk of wheeze and al-lergy by age 13 years. Lancet. 1999; 354:541–545. 30.Guilbert TW, L.R., Jackson DJ. Diagnosis of Asthma inInfants and Children: Adkinson NF, Bochner BS, BurksAW et al, Middleton’s allergy: principles and practice2013: 861-875. 31.Martinez FD.Development of wheezing disorders and asth-ma in preschool children. Pediatrics 2002; 109:362-7. 32.Savenije OE, Granell R, Caudri D, Koppelman GH, SmitHA, Wijga A, et al. Comparison of childhood wheezingphenotypes in 2 birth cohorts: ALSPAC and PIAMA. J Al-lergy Clin Immunol. 2011; 127:1505-12. 33.Granell R, Henderson AJ, Sterne JA.Associations ofwheezing phenotypes with late asthma outcomes in theAvon Longitudinal Study of Parents and Children: A po-pulation-based birth cohort. J Allergy Clin Immunol2016; 138:1060-1070. 34.Brand PL, Baraldi E, Bisgaard H, et al. Definition, as-sessment and treatment of wheezing disorders in prescho-ol children: an evidence-based approach. Eur Respir J2008; 32: 1096–1110. 35.Schultz A, Devadason SG, Savenije OE, Sly PD, Le SouëfPN, Brand PL. The transient value of classifying presc-hool wheeze into episodic viral wheeze and multiple trig-ger wheeze. Acta Paediatr 2010; 99:56-60. 36.Ducharme FM, Tse SM, Chauhan B.Diagnosis, manage-ment, and prognosis of preschool wheeze. Lancet. 2014;383:1593-604. 37.Tai A, Tran H, Roberts M, Clarke N, Gibson AM, VidmarS, et al. Outcomes of childhood asthma to the age of 50years. J Allergy Clin Immunol 2014;133:1572-8. 38.Castro-Rodriguez JA, Rodrigo GJ. Beta-agonists throughmetered-dose inhaler with valved holding chamber ver-sus nebulizer for acute exacerbation of wheezing or asth-ma in children under 5 years of age: a systematic reviewwith meta-analysis. J Pediatr. 2004;145:172-7. 39.Deerojanawong J, Manuyakorn W, Prapphal N, Harnrut-hakorn C, Sritippayawan S, Samransamruajkit R. Rando-mized controlled trial of salbutamol aerosol therapy viametered dose inhaler-spacer, jet nebulizer in young child-ren with wheezing. Pediatr Pulmonol 2005;39:466-72. 40.Pedersen SE, Hurd SS, Lemanske RF, Becker A, Zar HJ,Sly PD et al. Global Initiative for Asthma. Global stra-tegy for the diagnosis and management of asthma inchildren 5 years and younger. Pediatr Pulmonol. 2011;46: 1-17. 41.Bisgaard H, Nielsen KG.Bronchoprotection with a leukot-riene receptor antagonist in asthmatic preschool child-ren. Am J Respir Crit Care Med 2000;162:187-90. 42.Knorr B, Franchi LM, Bisgaard H, et al. Montelukast, aleukotriene receptor antagonist, for the treatment of per-sistent asthma in children aged 2 to 5 years. Pediatrics2001;108 :48. 43.Brodlie M, Gupta A, Rodriguez-Martinez CE, Castro-Rodriguez JA, Ducharme FM, McKean MC. Leukotrienereceptor antagonists as maintenance and intermittenttherapy for episodic viral wheeze in children. CochraneDatabase Syst Rev 2015;19:10. 44.Fitzpatrick AM, Jackson DJ, Mauger DT, Boehmer SJ,Phipatanakul W, Sheehan WJ et al. Individualized the-rapy for persistent asthma in young children. J AllergyClin Immunol 2016;138:1608-1618.