Çocuklarda Astım Atak Tedavisi

Öz

Astım, çocukluk çağının en sık kronik hastalığıdır. Günümüzde hâlen astım hastalığını ortadan kaldıracak bir tedavi olmaması nedeni ile astım hastalarının atak yakınmaları ile karşımıza çıkmaları kaçınılmazdır. Astım atakları acil servis başvuruları ve hastane yatışlarının önemli bir nedenidir. Aynı zamanda çocukların okul kaybına, ailelerde endişeye ve tedavi masraflarında artışa neden olmaktadır. Atakta olan her hastanın öncelikle kısa öyküsü alınarak, muayenesi yapılmalı ve atak şiddeti belirlenmelidir. Ardından hızlıca hastanın tedavisine başlanmalıdır. Beş yaş altında ve üstünde olan çocukların anatomik ve fizyolojik özellikleri birbirinden oldukça farklı olduğundan hem kronik astım tedavisi hem de atak sırasında yapılması gerekenler bazı farklılıklar göstermektedir. Tedavi planı belirlenirken hastanın yaşı göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Astım,atak,çocuk

Management of Asthma Exacerbation in Children

Öz

Asthma is the most frequently seen chronic disease in childhood. With our current treatment options asthma is not a curable disease, so it is not inevitable for asthma patients to seek medical care for exacerbations. Asthmatic exacerbation is a major cause for patients to visit emergency services and may even cause hospitalization. Increased treatment-cost, anxiety among parents and missed school days for children are other adverse events that are caused by asthma exacerbations. Quick anamnesis, physical examination and evaluation of frequency of exacerbations followed by early initiation of the therapy, is the simple algorithm for approaching asthma exacerbations. Children who are older than 5 years differ both anatomically and physiologically from younger ones, so the procedures which should be performed during both the treatment of asthma, and demonstrate differences this changes controlling-therapy as well as exacerbation-therapy approach for these patients. While determining the treatment plan patient’s age should be taken into consideration.

Anahtar Kelimeler

• Asthma,children,exacerbation

Kaynakça

1. Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, et al. An official American Thoracic Society/European Respiratory Society state- ment: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practi- ce. Am J Respir Crit Care Med 2009;180:59-99.
2. https://doi.org/10.1164/rccm.200801-060ST
3. Guidelines for the Diagnosis and Management of Asthma (Expert Panel Report 3) National Heart, Lung, and Blood Institute-2007.
4. Papadopoulos NG, Arakawa H, Carlsen KH, Custovic A, Gern J, Lemanske R, et al. International consensus on (ICON) pediatric asthma. Allergy 2012; 67:976-97.
5. https://doi.org/10.1111/j.1398-9995.2012.02865.x
6. Hançerli-Törün S, Özçeker D, Uysalol m, Tamay Z, Şık G, Somer A, et al. Predictive factor for first whee- zing episode. Turk J Pediatr 2015;57(4):367-73.
7. Global Initiative for Asthma (GINA) Program 2016. www.ginaasthma.org
8. Brunette mG1, Lands L, Thibodeau LP. Childhood asthma: prevention of attacks with short-term corticos- teroid treatment of upper respiratory tract infection. Pediatrics 1988;81:624-9.

9. Fox GF1, marsh mJ, milner AD. Treatment of recur- rent acute wheezing episodes in infancy with oral sal- butamol and prednisolone. Eur J Pediatr 1996;155: 512-6.
10. https://doi.org/10.1007/BF01955192
11. Grant CC1, Duggan AK, DeAngelis C. Independent parental administration of prednisone in acute asthma: a double-blind, placebo-controlled, crossover study. Pediatrics 1995;96:224-9.
12. Oommen A, Lambert PC, Grigg J. Efficacy of a short course of parent-initiated oral prednisolone for viral wheeze in children aged 1-5 years: randomised control- led trial. Lancet 2003;362:1433-8.
13. https://doi.org/10.1016/S0140-6736(03)14685-5
14. Vuillermin P, South m, Robertson C. Parent-initiated oral corticosteroid therapy for intermittent wheezing illnesses in children. Cochrane Database Syst Rev 2006;19:CD005311.
15. https://doi.org/10.1002/14651858.cd005311.pub2
16. Bisgaard H, Hermansen mN, Loland L, Halkjaer LB, Buchvald F. Intermittent inhaled corticosteroids in infants with episodic wheezing. N Engl J Med 2006 11;354:1998-2005.
17. https://doi.org/10.1056/NEJMoa054692
18. Connett G, Lenney W. Prevention of viral induced asthma attacks using inhaled budesonide. Arch Dis Child 1993;68:85-7.
19. https://doi.org/10.1136/adc.68.1.85
20. Ducharme Fm1, Lemire C, Noya FJ, Davis Gm, Alos N, Leblond H, et al. Preemptive use of high-dose fluticasone for virus-induced wheezing in young child- ren. N Engl J Med 2009;360:339-53.
21. https://doi.org/10.1056/NEJMoa0808907
22. Zeiger RS, mauger D, Bacharier LB, Guilbert TW, martinez FD, Lemanske RF, et al. Daily or intermit- tent budesonide in preschool children with recurrent wheezing. N Engl J Med 2011;365:1990-2001.
23. https://doi.org/10.1056/NEJMoa1104647
24. Chen AH, Zeng GQ, Chen RC, Zhan Jy, Sun LH, Huang SK, et al. Effects of nebulized high-dose bude- sonide on moderate-to-severe acute exacerbation of asthma in children: a randomized, double-blind, placebo-controlled study. Respirology 2013;18:47-52.
25. https://doi.org/10.1111/resp.12168
26. Brooks LJ, Cloutier mm, Afshani E. Significance of roentgenographic abnormalities in children hospitali- zed for asthma. Chest 1982;82:315-8.
27. https://doi.org/10.1378/chest.82.3.315
28. Qureshi F. Management of children with acute asthma in the emergency department. Pediatr Emerg Care 1999;15:206-14.
29. Castro-Rodriguez JA, Rodrigo GJ. Beta-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: a systematic review with meta-analysis. J Pediatr 2004;145:172-7.
30. https://doi.org/10.1016/j.jpeds.2004.04.007
31. Deerojanawong J, manuyakorn W, Prapphal N, Harnruthakorn Samransamruajkit R. Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler- spacer vs. jet nebulizer in young children with whee- zing. Pediatr Pulmonol 2005;39:466-72. S
32. https://doi.org/10.1002/ppul.20204
33. Griffiths B, Ducharme Fm. Combined inhaled antic- holinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Cochrane Database Syst Rev 2013;8:CD000060.
34. https://doi.org/10.1002/14651858.cd000060.pub2
35. Rowe BH, Bretzlaff J, Bourdon C, Bota G, Blitz S, Camargo CA. Magnesium sulfate for treating exacer- bations of acute asthma in the emergency department. Cochrane Database Syst Rev 2000;CD001490.
36. https://doi.org/10.1002/14651858.cd001490
37. Bousquet J. Primum non nocere. Prim Care Respir J 2005;14:122-3.
38. https://doi.org/10.1016/j.pcrj.2005.03.006
39. Torres S, Sticco N, Bosch JJ, Iolster T, Siaba A, Rocca Rivarola m, Schnitzler E. Effectiveness of magnesium sulfate as initial treatment of acute severe asthma in children, conducted in a tertiary-level univer- sity hospital: a randomized, controlled trial. Arch Argent Pediatr 2012;110(4):291-6.
40. Powell C, Dwan K, milan SJ, Beasley R, Hughes R, Knopp-Sihota JA, Rowe BH. Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev 2012;12:CD003898.
41. https://doi.org/10.1002/14651858.cd003898.pub5
42. Dobashi K, Akiyama K, Usami A, yokozeki H, Ikezawa Z, Tsurikisawa N, et al. Japanese Guideline for occupational allergic diseases 2014. Allergol Int 2014;63:421-42.
43. https://doi.org/10.2332/allergolint.14-RAI-0771
44. Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev 2013.
45. https://doi.org/10.1002/14651858.CD000052.pub3
46. Rodrigo GJ, Rodrigo C. Continuous vs intermittent beta-agonists in the treatment of acute adult asthma: a systematic review with meta-analysis. Chest 2002; 122:160-5.
47. https://doi.org/10.1378/chest.122.1.160
48. Camargo CA, Jr, Spooner CH, Rowe BH. Continuous versus intermittent beta-agonists in the treatment of acute asthma. Cochrane Database Syst Rev 2003:CD001115. Travers AH, Milan SJ, Jones AP, Camargo CA, Jr., Rowe BH. Addition of intravenous beta (2)-agonist to inhaled beta(2)-agonists for acute asthma. Cochrane Database Syst Rev 2012;12: CD010179.
49. Travers AH, milan SJ, Jones AP, Camargo CA, Rowe BH. Addition of intravenous beta(29-agonist to inhaled beta(2)-agonist for acute asthma. Cochrane Database Syst Rev 2012;12:CD010179
50. Beckhaus AA, Riutort mC, Castro-Rodriguez JA. Inhaled versus systemic corticosteroids for acute ast- hma in children. A systematic review. Pediatr Pulmonol 2014;49:326-34.
51. https://doi.org/10.1002/ppul.22846
52. Vezina K, Chauhan BF, Ducharme Fm. Inhaled anticholinergics and short-acting beta(2)-agonists ver- sus shortacting beta2-agonists alone for children with acute asthma in hospital. Cochrane Database Syst Rev 2014;7:Cd010283.
53. Rowe BH, Spooner C, Ducharme Fm, Bretzlaff JA, Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev 2001;CD002178.
54. https://doi.org/10.1002/14651858.cd002178
55. Cheuk DK, Chau TC, Lee SL. A meta-analysis on intravenous magnesium sulphate for treating acute ast- hma. Arch Dis Child 2005;90:74-7.
56. https://doi.org/10.1136/adc.2004.050005
57. mitra AAD, Bassler D, Watts K, Lasserson TJ, Ducharme Fm. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. Cochrane Database Syst Rev. 2005;18:CD001276.
58. https://doi.org/10.1002/14651858.cd001276.pub2
59. Jat KR, Chawla D. Ketamine for management of acute exacerbations of asthma in children. Cochrane Database Syst Rev 2012;11:CD009293.
60. https://doi.org/10.1002/14651858.cd009293.pub2
61. Joseph KS, Blais L, Ernst P, Suissa S. Increased mor- bidity and mortality related to asthma among asthmatic patients who use major tranquillisers. BMJ 1996; 312:79-82.
62. https://doi.org/10.1136/bmj.312.7023.79
63. FitzGerald Jm, macklem P. Fatal asthma. Annu Rev Med 1996;47:161-8.
64. https://doi.org/10.1146/annurev.med.47.1.161