Tekrarlayan Hışıltılı Çocuklarda Etiyolojik Değerlendirme

Year 2015, Volume: 9 Issue: 2, 96 - 103, 01.06.2015

Mehmet Kılıç Erdal Taşkın

Abstract

Amaç: 1 ay ila 3 yaş arasında olup, en az üç kez hışıltı atağı geçirmiş olan çocuklarda etiyolojinin ortaya konması ve ek olarak atopinin eşlik ettiği çoklu-tetiklenen hışıltısı olan çocuklar ile viral (epizodik) hışıltısı olan çocukların birbiriyle karşılaştırılması amaçlanmıştır.Gereç ve Yöntemler: Çalışmaya en az üç hışıltı atağı geçirmiş olan toplam 261 çocuk alındı. Etiyolojiyi aydınlatmak üzere, ayrıntılı öykü ve fizik muayenenin yanı sıra, tam kan sayımı, periferik kanda eozinofil sayısı, serum immünglobulin düzeyleri, ter testi, PPD, akciğer grafisi, gastroösefageal reflü sintigrafisi, allerjen spesifik IgE, deri ‘prick’ testi sonuçları hastaların dosyalarından retrospektif olarak kaydedildi.Bulgular: 142 olgu (% 54.4) viral hışıltı atağı, 54 olgu (% 20.7) atopinin eşlik ettiği çoklu-tetiklenen hışıltı atağı, 12 olgu (% 4.6) gastroösefageal reflü, 9 olgu (% 3.4) yabancı cisim aspirasyonu, 8 olgu (%3.1) kistik fibrozis ve 6 olgu (%2.3) bronkopulmoner displazi tanısı aldı. Viral hışıltılı çocuklarda ilk atak yaşının atopinin eşlik ettiği çoklu-tetiklenen hışıltısı olanlara göre daha düşük olduğu belirlendi (p=0.0001). Ayrıca, atopinin eşlik ettiği çoklu-tetiklenen hışıltısı olan gruptaki çocuklar, viral hışıltılı gruptaki çocuklar ile karşılaştırıldığında annede astım, ailede atopi ve çocukta atopik dermatit öyküsü sıklığı anlamlı derecede yüksek bulundu (sırasıyla p=0.01, p=0.0001 ve p=0.0001).Sonuç: Hayatın ilk üç yılında tekrarlayan hışıltısı olan çocuklarda etiyolojiyi ortaya çıkarmanın, erken tedavi ve prognoz açısından oldukça önemli olduğu düşünülmektedir.

Keywords

Atopi çocuk, Etiyoloji, Hışıltılı çocuk, Viral enfeksiyon

Etiological Evaluation of Recurrent Wheezing in Children

Abstract

Objective: The aim of the study was to investigate wheezing etiology in children aged between 1 month to 3 years who had suffered at least three wheezing episodes and additionally to compare children suffering from multiple-trigger wheeze accompanied with atopy with children who had viral (episodic) wheeze. Material and Methods: This study included 261 patients who had a history of at least three wheezing episodes. In addition to a detailed history and physical examination, the complete blood count, blood eosinophils, serum immunoglobulin levels, sweat chloride test, PPD skin testing, lung X-ray, scintigraphy for gastroesophageal reflux, allergen spesific IgE, and allergen skin prick test results were recorded from the hospital files of the patients retrospectively to clarify the etiology of the wheezing episodes.Results: We diagnosed 142 patients (54.4%) with viral wheeze, 54 patients (20.7%) with multiple-trigger wheeze accompanied by atopy, 12 patients (4.6%) with gastroesophageal reflux disease, 9 patients (3.4%) with foreign body aspiration, 8 patients (3.1%) with cystic fibrosis, and 6 patients (2.3%) with bronchopulmonary dysplasia. The age of children with viral wheeze at the first episode was younger than those of children with multiple-trigger wheeze accompanied by atopy (p=0.0001). In addition, the rate of maternal asthma, family history of atopy, and atopic dermatitis history in the child were found to be significantly higher in children with multiple-trigger wheeze accompanied by atopy in comparison to children with viral wheeze (p=0.01, p=0.0001, and p=0.0001 respectively).conclusion: We believe that it is very important to explore the etiology of wheezing episodes in children in the first three years of life for early treatment and prognosis

Keywords

Atopic child, Etiology, Wheezing infant, Viral infection

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