Yoğun Bakım Ünitesinde Akut Şiddetli Bronşiolit Nedeniyle Yatırılan İnfantların Tekrarlayan Hışıltı veya Astım Gelişimi Açısından Değerlendirilmesi

Year 2025, Volume: 19 Issue: 2, 71 - 75, 24.03.2025

Ahmet Selmanoğlu , Cankat Genis , Hatice Irmak Çelik , Serhan Özcan , Zeynep Sengul Emeksiz , Emine Dibek Mısırlıoğlu

https://doi.org/10.12956/tchd.1510781

Abstract

Amaç: Bronşiolit, çocuklar arasında en yaygın alt solunum yolu enfeksiyonu olarak öne çıkmaktadır. Hastaneye yatış gerektiren ağır bronşiolit, tüm infantların yaklaşık %2-3’ünü etkilemektedir. Bu çalışmanın amacı, ağır bronşiolit nedeniyle çocuk yoğun bakım ünitesinde (ÇYBÜ) takip edilmiş olan bireyleri astım gelişimi açısından değerlendirmektir.

Gereç ve Yöntemler: Ocak 2013 ile Aralık 2022 tarihleri arasında Ankara Bilkent Şehir Hastanesi ÇYBÜ’ye kabul edilen, ağır bronşiolit tanısı almış ve ek sistemik hastalığı olmayan hastalar çalışmaya dahil edilmiştir. Hastaların demografik ve klinik özellikleri, aldıkları yoğun bakım destek tedavileri, hastanede kalış süreleri, atopi durumları ve solunum yolundan izole edilen viral panel sonuçları değerlendirilmiştir. Hastaların mevcut klinik durumu, hastane kayıtları ve bakım verenler ile yapılan telefon görüşmelerinden elde edildi. Astım semptomlarının varlığı ve son 12 ay içinde tedavi kullanımı, GINA ve Uluslararası Çocukluk Çağı Astım ve Alerjileri Çalışması (ISAAC) anketine göre değerlendirildi.

Bulgular: Çalışma kriterlerini karşılayan 60 hastanın, yoğun bakımda yatışı yaş ortalaması 13.5 (±7.2) aydı. Çalışma sırasında çocukların ortalama yaşı 42.5 aydı.ekleyelim. Erkek cinsiyet daha baskındı (n=39, %65). Mevcut astım tedavisi alan hasta sayısı 33 (%55) olarak belirlendi. Mevcut durum sorgulandığında, son 12 ayda astım atağı geçirmiş olanların sayısı 25 (%41.6) olarak tespit edildi.

Sonuç: Bu çalışmada, şiddetli bronşiolit geçiren hastaların yarısından fazlasında astım geliştiği ve bazı hastaların alerji polikliniğine yönlendirilmediği görülmüştür. Ayrıca, bazı hastaların astım semptomları olmasına rağmen, bu semptomların astımdan kaynaklandığının farkında olmadıkları belirlenmiştir. Ağır bronşiolit tanısı ile ÇYBÜ’ye yatırılan hastaların, astım gelişimi açısından yakından izlenmesi ve taburculuk sırasında ailelerin bilgilendirilmesi gerektiğini öneriyoruz.

Keywords

astım, çocuk yoğun bakım, Ağır bronşiolit, Bebek

Ethical Statement

Etik kurul onayı alınmıştır

Supporting Institution

Yok

Thanks

Yok

Evaluation of Infants Hospitalized in Intensive Care Unit Due to Acute Severe Bronchiolitis in Terms of Recurrent Wheezing or Asthma Development

Abstract

Objective: Bronchiolitis stands out as the most prevalent lower respiratory tract infection among young children. Severe bronchiolitis, or bronchiolitis requiring admission to the hospital, affects 2-3% of all infants. The aim of this study was to evaluate individuals who were followed up in the pediatric intensive care unit (PICU) due to severe bronchiolitis in terms of asthma development.

Material and Methods: Patients who were admitted Ankara Bilkent City Hospital PICU between January 2013 and December 2022, who were diagnosed with severe bronchiolitis and who had no additional systemic disease were included in the study. Demographic and clinical characteristics of patients, intensive care support treatments, duration of hospital stays, atopic conditions, and respiratory viral panel cultures was documented. The current clinical condition of the patients was documented through hospital records and telephone interviews conducted with their caregivers. The existence of asthma symptoms and the utilization of treatments within the last 12 months were evaluated according to the guidelines of the Global Initiative for Asthma (GINA) and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire.

Results: The mean age of the 60 patients admitted to the intensive care unit who met the study criteria was 13.5±7.2 months. The mean age of the children at the time of the study was 42.5 months. Male gender was more predominant (n=39, 65%). The mean number of days that respiratory support was received in intensive care was 4.9 (±3.5) days and the mean number of days of systemic steroid therapy was 3.8 (±1.7) days. In the viral respiratory tract, Respiratory Syncytial Virus (RSV) was isolated at the highest frequency in 27 patients, accounting for 45%, followed by rhinovirus (n=6, 10%) and Bocavirus (n=5, 8.3%). The number of patients receiving current asthma treatment was (n=33, 55%). Upon assessing the current status, it was found that there had been 25 (41.6%) patients with asthma attacks over the past 12 months.

Conclusion: This study revealed that over half of the patients who experienced severe bronchiolitis subsequently developed asthma, with some not being referred to an allergy clinic. Furthermore, it was observed that certain patients, despite presenting with asthma symptoms, were unaware that these symptoms were attributable to asthma. We recommend that patients admitted to the PICU with a diagnosis of severe bronchiolitis be closely monitored for the potential development of asthma and that families be thoroughly informed at the time of discharge.

Keywords

infants, pediatric intensive care, severe bronchiolitis, asthma, wheezing

References

• Hasegawa K, Mansbach JM, Camargo Jr CA. Infectious pathogens and bronchiolitis outcomes. Expert review of anti-infective therapy. 2014;1:817-28.
• Altman MC, Beigelman A, Ciaccio C, Gern JE, Heymann PW, Jackson DJ, et al. Evolving concepts in how viruses impact asthma: A Work Group Report of the Microbes in Allergy Committee of the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 2020;145:1332-44.
• Guitart C, Alejandre C, Torrús I, Balaguer M, Esteban E, Cambra F, et al. Impact of a modification of the clinical practice guide of the American Academy of Pediatrics in the management of severe acute bronchiolitis in a pediatric intensive care unit. Med Intensiva (Engl Ed) 2021;45:289-97.
• Dumas O, Erkkola R, Bergroth E, Hasegawa K, Mansbach JM, Piedra PA, et al. Severe bronchiolitis profiles and risk of asthma development in Finnish children. J Allergy Clin Immunol 2022;149:1281-5. e1.
• Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2023. Available from: www.ginasthma.org. 2023.
• Akcakaya N, Kulak K, Hassanzadeh A, Camcioğlu Y, Cokuğraş H. Prevalence of bronchial asthma and allergic rhinitis in Istanbul school children. European journal of epidemiology. 2000;16:693-9.
• Yalcin E, Karadag B, Uzuner N. Türk Toraks Derneği Akut Bronşiolit Tanı ve Tedavi Uzlaşı Raporu 2009. Turk Thorac J 2009;10:1-7.
• Ones U, Akcay A, Tamay Z, Guler N, Zencir M. Rising trend of asthma prevalence among Turkish schoolchildren (ISAAC phases I and III). Allergy 2006;61:1448-53.
• Oneş U, Sapan N, Somer A, Dişçi R, Salman N, Güler N, et al. Prevalence of childhood asthma in Istanbul, Turkey. Allergy 1997;52:570-5.
• Feldman AS, He Y, Moore ML, Hershenson MB, Hartert TV. Toward primary prevention of asthma. Reviewing the evidence for early-life respiratory viral infections as modifiable risk factors to prevent childhood asthma. Am J Respir Crit Care Med 2015;191:34-44.
• Jackson DJ, Gern JE, Lemanske Jr RF. Lessons learned from birth cohort studies conducted in diverse environments. J Allergy Clin Immunol 2017;139:379-86.
• Hasegawa K, Tsugawa Y, Brown DF, Mansbach JM, Camargo Jr CA. Trends in bronchiolitis hospitalizations in the United States, 2000–2009. Pediatrics 2013;132:28-36.
• Bacharier LB, Cohen R, Schweiger T, Yin-DeClue H, Christie C, Zheng J, et al. Determinants of asthma after severe respiratory syncytial virus bronchiolitis. J Allergy Clin Immunol 2012;130:91-100. e3.
• Midulla F, Nicolai A, Ferrara M, Gentile F, Pierangeli A, Bonci E, et al. Recurrent wheezing 36 months after bronchiolitis is associated with rhinovirus infections and blood eosinophilia. Acta paediatri 2014;103:1094-9.
• Topal E, Kaplan F, Türker K, Kutlutürk K, Bağ Gözükara H. The Prevalence of Allergic Diseases and Associated Risk Factors in the 6-7 Age Children Who are Living in Malatya, Turkey. Turkey. Asthma Allergy Immunology 2017;15:129-34.
• Ece A, Ceylan A, Saraçlar Y, Saka G, Gürkan F, Haspolat K. Prevalence of asthma and other allergic disorders among schoolchildren in Diyarbakir, Turkey. Turk J Pediatr 2001;43:286-92.
• Cetemen A and Yenigün A. Prevalences of asthma and allergic diseases in primary school children in Aydin. Asthma Allergy Immunology 2012;10;84-92.
• Çelik V, Tanriverdi̇ H, Kiliç F, Tutal T. Prevalence of Asthma and Allergic Diseases Among Children in Adıyaman, Türkiye: a Cross-sectional Study. Journal of Child 2023;23:77-82.
• Kalyoncu A, Selcuk Z, Karakoca Y, Emri A, Cöplü L, Şahin A, et al. Prevalence of childhood asthma and allergic diseases in Ankara, Turkey. Allergy 1994;49:485-8.
• Pate CA, Zahran HS, Qin X, Johnson C, Hummelman E, Malilay J. Asthma surveillance—United States, 2006–2018. MMWR Surveillance Summaries 2021;70:1-32.
• Fu L-S, Tsai M-C. Asthma exacerbation in children: a practical review. Pediatri Neonatol 2014;55:83-91.
• Rabe K, Vermeire P, Soriano J, Maier W. Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study. Eur Respir J 2000;16:802-7.
• Engelkes M, Janssens H, de Ridder M, Sturkenboom M, de Jongste J, Verhamme K. Real life data on incidence and risk factors of severe asthma exacerbations in children in primary care. Respir med 2016;119:48-54.
• de Sonnaville ES, Knoester H, Terheggen-Lagro SW, Kӧnigs M, Oosterlaan J, van Woensel JB. Long-term pulmonary outcomes in children mechanically ventilated for severe bronchiolitis. Pediatric Critical Care Medicine 2022;23:801.
• Carroll KN, Wu P, Gebretsadik T, Griffin MR, Dupont WD, Mitchel EF, et al. The severity-dependent relationship of infant bronchiolitis on the risk and morbidity of early childhood asthma. J Allergy Clin Immunol 2009;123:1055-61. e1.
• Pelletier JH, Au AK, Fuhrman D, Clark RS, Horvat C. Trends in bronchiolitis ICU admissions and ventilation practices: 2010–2019. Pediatrics 2021;147:e2020039115.
• Hasegawa K, Pate BM, Mansbach JM, Macias CG, Fisher ES, Piedra PA, et al. Risk factors for requiring intensive care among children admitted to ward with bronchiolitis. Acad pediatr 2015;15:77-81.
• Hall CB, Weinberg GA, Blumkin AK, Edwards KM, Staat MA, Schultz AF, et al. Respiratory syncytial virus–associated hospitalizations among children less than 24 months of age. Pediatrics. 2013;132:e341-8.
• Jartti T, Lehtinen P, Vuorinen T, Ruuskanen O. Bronchiolitis: age and previous wheezing episodes are linked to viral etiology and atopic characteristics. Pediatr Infec Dis J 2009;28:311-7.
• Nascimento MS, de Souza AV, de Souza Ferreira AV, Rodrigues JC, Abramovici S, da Silva Filho LVF. High rate of viral identification and coinfections in infants with acute bronchiolitis. Clinics. 2010;65:1133-7.
• Øymar K, Skjerven HO, Mikalsen IB. Acute bronchiolitis in infants, a review. Scandinavian journal of trauma, resuscitation and emergency medicine. 2014;22:1-10.
• Ghazaly M, Nadel S. Characteristics of children admitted to intensive care with acute bronchiolitis. Eur J Pediatr 2018;177:913-20.
• Ruotsalainen M, Hyvärinen MK, Piippo‐Savolainen E, Korppi M. Adolescent asthma after rhinovirus and respiratory syncytial virus bronchiolitis. Pediatr Pulmonol 2013;48:633-9.
• Henderson J, Hilliard TN, Sherriff A, Stalker D, Shammari NA, Thomas HM, et al. Hospitalization for RSV bronchiolitis before 12 months of age and subsequent asthma, atopy and wheeze: a longitudinal birth cohort study. Pediatr Allergy Immunol 2005;16:386-92.
• Uršič T, Steyer A, Kopriva S, Kalan G, Krivec U, Petrovec M. Human bocavirus as the cause of a life-threatening infection. J Clin Microbiol 2011;49:1179-81.
• Edner N, Castillo-Rodas P, Falk L, Hedman K, Söderlund-Venermo M, Allander T. Life-threatening respiratory tract disease with human bocavirus-1 infection in a 4-year-old child. J Clin Microbiol 2012;50:531-2.
• Jula A, Waris M, Kantola K, Peltola V, Söderlund-Venermo M, Hedman K, et al. Primary and secondary human bocavirus 1 infections in a family, Finland. Emerg Infect Dis 2013;19:1328-31.
• Del Rosal T, García-García M, Calvo C, Gozalo F, Pozo F, Casas I. Recurrent wheezing and asthma after bocavirus bronchiolitis. Allergol Immunopathol 2016;44:410-4.