Astımlı Çocuklarda Lökotrien Reseptör Antagonisti ile İnhale Kortikosteroid Etkinliğinin Karşılaştırılması

Yıl 2018, , 24 - 28, 01.04.2018

Özlem Bostan Gayret Sedat Öktem Ayşe Gülnur Tokuç

https://doi.org/10.5222/j.child.2018.30974

Öz

Amaç: Çocukluk çağı astım tedavisinde lökotrien antagonisti ile inhale kortikosteroidler kullanılmaktadır. Çalışma, astım tanısı almış çocuklarda lökotrien reseptör antagonisti ile inhale kortikosteroid tedavisinin etkinliğini karşılaştırmak için yapılmıştır. Gereç ve Yöntem: Çalışmaya 6-14 yaş grubunda astım tanısı alan 62 hasta dâhil edildi. Hastalar ardışık iki gruba ayrılarak birinci gruba montelukast gece yatmadan önce 5 mg, ikinci gruba inhale kortikosteroid budesonide 400 mcg/gün 2 doza bölünerek verildi. Hastalar 6 ay süreyle takip edildi. Değerlendirmede FEV1’deki değişiklikler birincil hedef alındı. Ayrıca tedavi öncesi ve sonrası günlük kısa etkili β2 agonist kullanımı, gece uyanma, acile başvuru, okula devamsızlık değerleri ile karşılaştırıldı. Bulgular: Tedavi sonrasında, tedavi öncesine göre her iki grupta; FEV1 ortalamasında, kısa etkili β2 agonist kullanımı, gece uyanma, acile başvuru ve okula devamsızlık açısından ileri düzeyde düzelme görüldü p=0,001 . Ancak, iki grup arasında istatistiki fark saptanmadı.Sonuç: Astımlı çocuklarda tek başına monlelukast tedavisi; kolay uygulanabilir, güvenilir ve inhale kortikosteroidler kadar etkili bir seçenek olarak saptanmıştır

Anahtar Kelimeler

Astım, montelukast, inhale kortikosteroid

The Comparison of the Effectiveness of Leukotriene Receptor Antagonists and Inhaled Corticosteroids in Children with Asthma

Öz

This study was conducted to compare the effectiveness of the leukotriene receptor antagonist and inhaled corticosteroid treatment in children diagnosed with asthma. Material and Methods: Sixty - two patients diagnosed with asthma in the age group of 6-14 years were included in the study. Patients were consecutively divided into 2 groups, and the first group was given 5 mg of montelukast before sleep and the second group received 400 mcg/day of inhaled corticosteroid budesonide in two doses. The patients were followed up for 6 months. Primary target were changes in the FEV1. Furthermore, daily short-acting β2 agonist use, night awakenings, admission to the emergency department, absenteeism at school were compared before and after the treatment. Results: Significant improvement was observed in both groups during postoperative period when compared to the pre-treatment period in terms of the mean FEV1, shortacting β2 agonist use, night awakenings, admission to the emergency department, and absenteeism at school p=0,001 . However, no statistical difference was determined between two groups.Conclusion: It was determined that montelukast therapy alone in children with asthma is an easy-to-administer and safe option, which is as effective as inhaled corticosteroids

Anahtar Kelimeler

asthma, montelukast, inhaled steroid

Kaynakça

• Masoli M, Fabian D, Holt S, Beasley R, Global Initiative for Asthma P. The global burden of asthma: executive summary of the GINA dissemination com- mittee report. Allergy 2004;59:469-78.
• https://doi.org/10.1111/j.1398-9995.2004.00526.x
• Özdemir C, Bahçeciler NN, Barlan IB. Çocukluk çağında acil serviste akut astım atağı ve tedavisi. Güncel Pediatri 2006;4:109-13.
• Drazen JM, Silverman EK, Lee TH. Heterogeneity of therapeutic responses in asthma. Br Med Bull. 2000;56:1054-70.
• https://doi.org/10.1258/0007142001903535
• Malmstrom K, Rodriguez-Gomez G, Guerra J, et al. Oral montelukast, inhaled beclomethasone, and place- bo for chronic asthma. A randomized, controlled trial. Montelukast / Beclomethasone study group. Ann Intern Med. 1999;130:487-95.
• https://doi.org/10.7326/0003-4819-130-6-199903160- 00005
• Hay DWP. Pharmacology of leukotriene receptor anta- gonits. More than inhibitors of bronchoconstriction. Chest. 1997;111:35-45.
• https://doi.org/10.1378/chest.111.2_Supplement.35S
• Claesson HE, Dahlen SE. Asthma and leukotrienes: antileukotrienes as novel anti-asthmatic drugs. J Intern Med. 1999;245:205-27.
• https://doi.org/10.1046/j.1365-2796.1999.00418.x
• Şekerel BE, Kalaycı Ö. Çocukluk çağında kronik astma tedavisi. In: Kalyoncu A.F, editör. Bronş Astması ve Allerji Hastalıkları, 1. Baskı. Ankara: Güneş Kitabevi, 1999:42-55.
• The Childhood Asthma Management Program Research Group. Long term effects of budesonide or nedocromil in children with asthma. N Engl J Med. 2000;343:1054- 63.
• https://doi.org/10.1056/NEJM200010123431501
• Busse WW, McGill KA, Horwitz RJ. Leukotriene path- way inhibitors in asthma and chronic obstructive pul- monary disease. Clin Exp Allergy. 1999;29:110-5.
• Amin N. Childhood asthma: management and preven- tion. In: Dozor AJ, editor. Primary Pediatric Pulmonology. New York: Futura Publishing Company, 2001;8:137-62.
• GINA Guideline 2018.
• Anandan C, Nurmatov U, van Schayck OC, Sheikh A. Is the prevalence of asthma declining? Systematic revi- ew of epidemiological studies. Allergy. 2010;65:152- 67.
• https://doi.org/10.1111/j.1398-9995.2009.02244.x
• Knoor B, Franchi L, Bisgaard M, et al. Montelukast, a leukotriene receptor antagonist, for the treatment per- sistent asthma in children aged 2 to 5 years. Pediatrics. 2001;180:48.
• https://doi.org/10.1542/peds.108.3.e48
• Von Mutius E. The burden of childhood asthma. Arch Dis Child. 2000;82:112-5.
• https://doi.org/10.1136/adc.82.suppl_2.ii2
• Akinbami LJ, Moorman JE, Liu X. Asthma prevalence,health care use, and mortality: United States, 2005-2009. Natl Health Stat Report. 2011;12:1- 14.
• Henderson WR Jr. Role of leukotrienes in asthma. Ann Allergy. 1994;72:272-8.
• Knorr B, Matz J, Berstein JA, et al. Montelukast for choronic asthma in 6-to14-year-old children: a rando- mized, double-blind trial. Pediatric Montelukast Study Group. JAMA 1998;279:1181-7.
• https://doi.org/10.1001/jama.279.15.1181
• Karaman O, Sunneli L, Uzuner N, et al. Evaluation of montelukast in 8 to 14 year old children with mild per- sistent asthma and compared with inhaled corticostero- ids. Allergol Immunopathol. (Madr) 2004;32:21-7.
• https://doi.org/10.1157/13057766
• Reiss TF, Chervinsky P, Dockhorn RJ, Shingo S, Seidenberg B, Edwards TB. Montelukast, a once-daily leukotriene receptor antagonist, in the treatment of chronic asthma: a multicenter, randomized, double- blind trial. Montelukast Clinical Research Study Group. Arch Intern Med. 1998;158:1213-20.
• https://doi.org/10.1001/archinte.158.11.1213
• Jung A, Kalicki B, Zuber J, Dadas E, Straz-Zebrowska E. Spirometry evaluation of montelukast treatment in children with bronchial asthma. Pol Merkur Lekarski 2002;12:92-4.
• Jarvis B, Markham A. Montelukast: a review of its therapeutic potential in persistent asthma. A review of its therapeutic potential in persistent asthma. Drugs 2000;59:891-928.
• https://doi.org/10.2165/00003495-200059040-00015
• Muijsers RB, Noble S. Montelukast: a review of its therapeutic potential in asthma in children 2 to 14 years of age. Paediatr Drugs 2002;4:123-39.
• https://doi.org/10.2165/00128072-200204020-00005
• Willams B, Noonan G, Reiss F, et al. Long-term asthma control with oral montelukast and inhaled beclometha- sone for adults and children 6 years and older. Clinical and Experimental Allergy 2001;31:845-54.
• https://doi.org/10.1046/j.1365-2222.2001.01085.x