Okul çağındaki astımlı olguların çocukluk çağı astım kontrol testi ile değerlendirilmesi

Year 2017, Volume: 15 Issue: 3, 11 - 16, 01.12.2017

Başak Ceylan Demirbaş Şükrü Çekiç Yakup Canıtez Nihat Sapan

Abstract

GİRİŞ ve
AMAÇ: Astım çocukluk çağında en sık görülen kronik hastalıktır. Mevsimsel
değişikliklerin, astım atak sayıları ve hastalığın kontrol altında olma
durumunu etkilediği bilinmektedir. BU çalışmada astım tanılı 6-11 yaş
arasındaki olguların çocukluk çağı astım kontrol testi (Ç-AKT) ile
değerlendirilmesi ve astım kontrolünü etkileyen faktörlerin belirlenmesi
amaçlanmıştır.

YÖNTEM ve GEREÇLER: Çalışmaya astım tanısıyla takipli 6-11 yaş arası 103 olgu
alındı. Olgulardan Çocukluk Çağı Astım Kontrol Testi (Ç-AKT) ve tarafımızca
hastaların değerlendirilmesi için düzenlenen astımlı anketini doldurmaları
istendi. 

BULGULAR: Çocukluk çağı astım kontrol testi (Ç-AKT) sonucuna göre olguların
%47,5’inin (n=49) kontrol altında olduğu saptandı. Kontrol altında olan grupta
yıllık atak sayısı (medyan=2/yıl, minimum=0/yıl, maksimum=10/yıl) kontrol
altında olmayan gruba göre ( medyan=3,5/yıl, minimum=0/yıl, maksimum=10/yıl)
anlamlı olarak azdı (p=0,005). Kontrol altında olan olguların %14,3’ünün (n=7),
kontrol altında olmayan olguların %38,9’unun (n=21) ailesinde egzama öyküsü
olduğu tespit edildi (p=0,005). Hastaneye başvuru oranları kontrol altında olan
olgularda: Eylül ayında %30,6 (n=15), Ekim ayında %32,7 (n=16), Kasım ayında
%30,6 (n=15) ve Aralık ayında %6,10 (n=3); kontrol altında olmayan olgularda
Eylül ayında %5,6 (n=3), Ekim ayında %25,9 (n=14), Kasım ayında %33,3 (n=18) ve
Aralık ayında %35,2 (n=19) olarak saptandı. Aralık ayında kontrol altında
olmayan olguların, kontrol altında olan olgulara göre daha sık başvurduğu
tespit edildi (p=0,001).

TARTIŞMA ve SONUÇ: Astım kontrol testleri hastaların takiplerinde hekimlere
yardımcı olan pratik bir uygulamadır. Çalışma sonucunda astımlı hastaların
önemli bir kısmının kontrol altında olmadığı görüldü. Astımlı olgularda Aralık
ayında yakınmalarda görülen artışın bölgesel iklim değişiklikleri ve çevresel
faktörlere bağlı olabileceği düşünüldü. 

Evaluation
of school age asthmatic cases with childhood asthma control test

INTRODUCTION:
Asthma is the most common chronic disease in children. It is known that
seasonal changes affect the number of asthma attacks and the condition of the
disease under control as well. We evaluated children aged 6-11 years of age who
had been diagnosed with asthma using the childhood asthma control test (C-ACT)
to determine the factors affecting the control of asthma.

METHODS: One hundred and three follow-up cases diagnosed with asthma between
the ages of 6–11 were included. All cases were asked to fill in the C-ACT and
the asthmatic questionnaire that we had prepared to evaluate the patients.

RESULTS: It was determined that the 47.5% of the cases (n=49) were under
control according to the results of the C-ACT. The number of annual attacks in
the group under control (median=2/year, minimum=0/year,maximum=10/year) was
significantly less than for the uncontrolled cases (median=3.5/year,
minimum=0/year, maximum=10/year) (p=0.005). We determined that 14.3% (n=7) of
the families of the group under control and 38.9% (n=21) of the families of the
uncontrolled cases had a history of eczema (p=0.005). The hospital admission
rates of the group under control were found to be 30.6% (n=15) in September,
32.7% (n=16) in October, 30.6% (n=15) in November, and 6.10% (n=3) in December,
and the rates for the uncontrolled cases were 5.6% (n=3) in September, 25.9%
(n=14) in October, 33.3% (n=18) in November, and 35.2% (n=19) in December. We
detected that the uncontrolled cases were admitted more frequently than the
ones under control in December (p=0.001).

DISCUSSION AND CONCLUSION: C-ACT is a practical application that helps
physicians with the follow-up of patients. We have determined in our study that
a significant percentage of the asthmatics are uncontrolled cases. We estimated
that the increase of complaints in December in patients with asthma may be
related to regional climatic changes as well as environmental conditions.

Keywords

Astım, okul çağı, astım kontrol testi

References

• 1.Global Initiative For Asthma (GINA) web site [homepage on the internet] available at:http://www.ginasthma.org/ , September 2016.
• 2.Braman SS. The global burden of asthma. Chest 2006;130:4S-12S.
• 3.Akinbami LJ, Schoendorf KC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics 2002; 110: 315- 22.
• 4.Cohen HA, Blau H, Hoshen M, Batat E, Bralicer RD. Seasonality of asthma: a restrospective population study. Pediatrics 2014; 133: 923-32.
• 5.Özçeker D, Oral Cebeci S, Güler N. Çocuklarda astım atak tedavisi: rehberlerle pratik yaklaşım. İst Tıp Fak Derg 2015;78:1:13-22.
• 6.Liu AH, Zeiger R, Sorkness C, et al. Development and cross-sectional validation of the Childhood Asthma Control Test. J Allergy Clin Immunol 2007;119:817-25.
• 7.Türk toraks derneği astım tanı ve tedavi rehberi. www.toraks.org.tr Eylül 2016.
• 8.Visitsunthorn N, Lilitwat W, Jirapongsananuruk O, Vichyanond P. Factors affecting readmission for acute asthmatic attacks in children. Asian Pac J Allergy Immunol 2013; 31:138-41.
• 9.Cates CJ, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database of Systematic Reviews 2013, 2: CD000364.
• 10.Friedman BC, Goldman RD. Influenza vaccination for children with asthma. Can Fam Physician 2010;56:1137-9.
• 11.Kaya A, Altınel N, Karakaya G, Çetinkaya F. Knowledge and attitudes among patients with asthma and parents and physicians towards influenza vaccination. Allergol Immunopathol (Madr) 2017 ; 45:240-3. 12.Moonie S, Sterling DA, Fıggs LW, Castro M. The relationship between school absence, academic performance, and asthma status. Journal of school health 2008;78:140-8.
• 13.Xiang L, Zhao J, Zheng Y, Liu H, Hong J, Bao Y, et al. Uncontrolled asthma and its risk factors in Chinese children: A cross-sectional observational study. J Asthma 2016;53:699-706.
• 14.Garcia E, Aristizabal G, Vasquez C, Rodriguez-Martinez CE, Sarmiento OL, Satizabal CL. Prevalence of and factors associated with current asthma symptoms in school children aged 6 - 7 and 13 - 14 yr old in Bogotá, Colombia. Pediatr Allergy Immunol 2008;19: 307 -14.
• 15.Öneş Ü, Sapan N, Somer A, Dişçi R, Salman N, Güler N, et al. Prevalence of childhood asthma in İstanbul, Turkey. Allergy 1997; 52: 570-5.
• 16.Talay F, Kurt B, Tug T, Yilmaz F, Goksugur N. Prevalence and risk factors of asthma and allergic diseases among schoolchildren in Bolu, Turkey. Acta Paediatr 2008;97: 459 - 62.
• 17.Gold LS, Smith N, Allen-Ramey FC, Nathan RA, Sullivan SD. Associations of patient outcomes with level of asthma control. Ann Allergy Asthma Immunol. 2012;109:260-5.
• 18.Costa E, Bregman M, Araujo DV, Costa CH, Rufino R. Asthma and the socio-economic reality in Brazil. World Allergy Organ J. 2013; 20.
• 19.Gong T, Lundholm C, Rejnö G, Mood C, Långström N, Almqvist C. Parental Socioeconomic status, childhood asthma and medication use--a population-based study. PLoS One. 2014;9(9):e106579.
• 20.Choi WJ, Um IY, Hong S, Yum HY, Kim H, Kwon H. Association between Household Income and Asthma Symptoms among Elementary School Children in Seoul. Environ Health Toxicol. 2012;27:e2012020.
• 21.Cope SF, Ungar WJ, Glazier RH. Socioeconomic factors and asthma control in children. Pediatr Pulmonol. 2008;43:745-52.
• 22.Dales RE, Choi B, Chen Y, Tang M. Influence of family income on hospital visits for asthma among Canadian school children. Thorax. 2002;57(6):513-7.
• 23.Papwijitsil R, Pacharn P, Areegarnlert N, Veskitkul J, Visitsunthorn N, Vichyanond P, et al. Risk factors associated with poor controlled pediatric asthma in a university hospital. Asian Pac J Allergy Immunol 2013;31:253-7.
• 24.Karadeniz P, Özdoğan Ş, Ayyıldız-Emecen D, Öncül Ü. Asthma control test and pediatric asthma quality of life questionnaire association in children with poor asthma control. Turk J Pediatr. 2016;58:464-72.
• 25.http://www.tuik.gov.tr/PreTablo.do?alt_id=1013
• 26.Tariq SM, Matthews SM, Hakim EA, Stevens M, Arshad SH, Hide DW. The prevalence of and risk factors for atopy in early childhood: a whole population birth cohort study. J Allergy Clin Immunol 1998;101:587-93.
• 27.Bornehag CG, Sundell J, Hagerhed L, Janson S. Pet-keeping in early childhood and airway, nose and skin symptoms later in life. Allergy 2003;58:939-44.
• 28.Bener A, Mobayed H, Sattar HA, Al-Mohammed AA, Ibrahimi AS, Sabbah A. Pet ownership: its effect on allergy and respiratory symptoms. Eur Ann Allergy Clin Immunol 2004;36: 306 –10.
• 29.Toskala E, Kennedy DW. Asthma risk factors. Int Forum Allergy Rhinol 2015;5:11-6. Rosenstreich DL, Eggleston P, Kattan M, Baker D, Slavin RG, Gergen P, et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med 1997;336:1356-63.
• 30.Uzel A, Capan N, Canbakan S, Yurdakul AS, Dursun B. Evaluation of the relationship between cockroach sensitivity and house-dust-mite sensitivity in Turkish asthmatic patients. Respir Med 2005;99:1032-7.
• 31.Huss K, Adkinson NF Jr, Eggleston PA, Dawson C, Van Natta ML, Hamilton RG. House dust mite and cockroach exposure are strong risk factors for positive allergy skin test responses in the Childhood Asthma Management Program. J Allergy Clin Immunol 2001;107:48-54.
• 32.Do DC, Zhao Y, Gao P. Cockroach Allergen Exposure and Risk of Asthma. Allergy 2016;71:463-74.
• 33.O'Connor GT, Lynch SV, Bloomberg GR, Kattan M, Wood RA, Gergen PJ, et al. Early-life home environment and risk of asthma among inner-city children. J Allergy Clin Immunol 2017;12:31204-6.
• 34.Lynch SV, Wood RA, Boushey H, Bacharier LB, Bloomberg GR, Kattan M, et al. Effects of early-life exposure to allergens and bacteria on recurrent wheeze and atopy in urban children. J Allergy Clin Immunol 2014;134:593-601.
• 35.Tomac N, Demirel F, Acun C, Ayoglu F. Prevalence and risk factors for childhood asthma in Zonguldak, Turkey. Allergy Asthma Proc 2005;26:397-402.
• 36.Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six yesrs of life. N Engl J Med 1995;332:133 - 8.
• 37.Dales RE, Schweitzer I, Toogood JH, Drouin M, Yang W, Dolovich J, et al. Respiratory infections and the autumn increase in asthma morbidity. Eur Respir J 1996;9:72-7.
• 38.Bayrakdar F, Altaş AB, Korukluoğlu G. Solunum Yolu Virüslerinin 2009-2012 Yılları Arasında Ülkemizdeki Mevsimsel Dağılımı. Türk Mikrobiyol Cem Derg 2013;43:56-66.