Astım Atak Tedavisi

Yıl 2017, Cilt: 9 Sayı: 2, 24 - 31, 15.03.2017

Prof. Dr. Nermin Güler

Öz

Öz

Astım; çocukluk çağının en sık kronik hastalığıdır. Günümüzde halen astım has-talığını 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 sebebidir. Aynı zamanda çocukların okul kaybına, ailelerde endişeye ve tedavi masraflarında artışa neden olmaktadır. Atakta olan her hastanın öncelikle kısa öyküsü alınarak, muayenesi yapılmalı veatak 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 belirlenirkenhastanın yaşı göz önünde bulundurulmalıdır.

Anahtar Kelimeler

astım atağı, akut astım, tedavi

Management of Asthma Exacerbation

Öz

Abstract

Asthma is the most prevalent chronic disease in childhood. With our current treatment options asthma is not a curable disease, so it is not avoidable for asthma patients to seek medical care for exacerbations. Asthma exacerbation is a major cau-se for patients to visit emergency services and may even cause hospitalization. Increased treatmentcost, anxiety among parents and missed school days for children is other adverse events that are caused by asthma exacerbations. Quick anamnesis, physical examination and evaluation of frequency of exacerbations followed by quick ini-tiation 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, this changes controlling-therapy as well as exacerbation-therapy approach for these patients. While determining the treatment choice patient’s age isan important variable.

Anahtar Kelimeler

Asthma attack, acute asthma, therapy

Kaynakça

• Kaynaklar 1.http://www.cdc.gov/nchs/FASTATS/asthma.htm [accessed09.03.09]. 2.Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA,Busse WW, at al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exa-cerbations: standardizing endpoints for clinical asthma tri-als and clinical practice. Am J Respir Crit Care Med.2009;180:59-99. 3.Guidelines for the Diagnosis and Management of Asthma (Ex-pert Panel Report 3) National Heart, Lung,and Blood Insti-tute-2007. 4.Papadopoulos NG, Arakawa H, Carlsen KH, Custovic A, GernJ, Lemanske R, at al. International consensus on (ICON) pe-diatric asthma. Allergy. 2012; 67:976-97. 5.Hançerli-Törün S, Özçeker D, Uysalol M, Tamay Z, Şık G, So-mer A, et al. Predictive factor for first wheezing episode. TurkJ Pediatr. 2015 Jul-Aug;57(4):367-73. 6.Global Initiative for Asthma (GINA) Program 2016. www.gi-naasthma.org 7.Brunette MG1, Lands L, Thibodeau LP. Childhood asthma: pre-vention of attacks with short-term corticosteroid treatment ofupper respiratory tract infection. Pediatrics. 1988;81:624-9. 8.Fox GF1, Marsh MJ, Milner AD.Treatment of recurrent acu-te wheezing episodes in infancy with oral salbutamol and pred-nisolone. Eur J Pediatr.1996;155:512-6. 9.Grant CC1, Duggan AK, DeAngelis C. Independent parental ad-ministration of prednisone in acute asthma: a double-blind, pla-cebo-controlled, crossover study. Pediatrics. 1995;96:224-9. 10.Oommen A, Lambert PC, Grigg J. Efficacy of a short cour-se of parent-initiated oral prednisolone for viral wheeze inchildren aged 1-5 years: randomised controlled trial. Lancet.2003;362:1433-8. 11.Vuillermin P, South M, Robertson C. Parent-initiated oral cor-ticosteroid therapy for intermittent wheezing illnesses in child-ren. Cochrane Database Syst Rev. 2006;19:CD005311. 12.Bisgaard H, Hermansen MN, Loland L, Halkjaer LB, Buch-vald F. Intermittent inhaled corticosteroids in infants with epi-sodic wheezing. N Engl J Med. 2006 11;354:1998-2005. 13.Connett G, Lenney W. Prevention of viral induced asthma attacksusing inhaled budesonide. Arch Dis Child. 1993;68:85-7. 14.Ducharme FM1, Lemire C, Noya FJ, Davis GM, Alos N, Leb-lond H, et all. Preemptive use of high-dose fluticasone for vi-rus-induced wheezing in young children. N Engl J Med.2009;360:339-53. 15.Zeiger RS, Mauger D, Bacharier LB, Guilbert TW, MartinezFD, Lemanske RF, at al. Daily or intermittent budesonide inpreschool children with recurrent wheezing. N Engl J Med.2011;365:1990-2001. 16.Chen AH, Zeng GQ, Chen RC, Zhan JY, Sun LH, Huang SK,at al. Effects of nebulized high-dose budesonide on modera-te-to-severe acute exacerbation of asthma in children: a ran-domized, double-blind, placebo-controlled study. Respirology.2013;18:47-52. 17.Brooks LJ, Cloutier MM, Afshani E. Significance of roentge-nographic abnormalities in children hospitalized for asthma.Chest. 1982; 82:315-8. 18.Qureshi F. Management of children with acute asthma in theemergency department. Pediatr 19.Castro-Rodriguez JA, Rodrigo GJ. Beta-agonists through me-tered-dose inhaler with valved holding chamber versus nebu-lizer for acute exacerbation of wheezing or asthma in child-ren under 5 years of age: a systematic review with meta-analy-sis. J Pediatr. 2004;145:172-7. 20.Deerojanawong J, Manuyakorn W, Prapphal N, Harnrutha-korn C, Sritippayawan S, Samransamruajkit R. Randomizedcontrolled trial of salbutamol aerosol therapy via metered doseinhaler-spacer vs. jet nebulizer in young children with whee-zing. Pediatr Pulmonol. 2005;39:466-72. 21.Griffiths B, Ducharme FM. Combined inhaled anticholiner-gics and short-acting beta2-agonists for initial treatment ofacute asthma in children. Cochrane Database Syst Rev.2013;8:CD000060. 22.Rowe BH, Bretzlaff J, Bourdon C, Bota G, Blitz S, CamargoCA. Magnesium sulfate for treating exacerbations of acute asth-ma in the emergency department. Cochrane Database Syst Rev.2000;CD001490. 23.Bousquet J. Primum non nocere. Prim Care Respir J.2005;14:122-3. 24.Torres S, Sticco N, Bosch JJ, Iolster T, Siaba A, Rocca Riva-rola M, Schnitzler E. Effectiveness of magnesium sulfate asinitial treatment of acute severe asthma in children, conduc-ted in a tertiary-level university hospital: a randomized, con-trolled trial. Arch Argent Pediatr. 2012;110(4):291-6. 25.Powell C, Dwan K, Milan SJ, Beasley R, Hughes R, Knopp-Sihota JA, Rowe BH. Inhaled magnesium sulfate in the treat-ment of acute asthma. Cochrane Database Syst Rev.2012;12:CD003898. 26.Dobashi K, Akiyama K, Usami A, Yokozeki H, Ikezawa Z, Tsu-rikisawa N, at al. Japanese Guideline for Occupational Aller-gic Diseases 2014. Allergol Int. 2014 ;63:421-42. 27.Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers)versus nebulisers for beta-agonist treatment of acute asthma.Cochrane Database Syst Rev 2013. 28.Rodrigo GJ, Rodrigo C. Continuous vs intermittent beta-ago-nists in the treatment of acute adult asthma: a systematic re-view with meta-analysis. Chest 2002; 122: 160-5. 29.Camargo CA, Jr., Spooner CH, Rowe BH. Continuous versusintermittent 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 ofintravenous beta (2)-agonist to inhaled beta(2)-agonists foracute asthma. Cochrane Database Syst Rev 2012; 12:CD010179. 30.Travers AH, Milan SJ, Jones AP, Camargo CA, Rowe BH. Ad-dition of intravenous beta(29-agonist to inhaled beta(2)-ago-nist for acute asthma. Cochrane Database Syst Rev2012;12:CD010179 31.Beckhaus AA, Riutort MC, Castro-Rodriguez JA. Inhaled ver-sus systemic corticosteroids for acute asthma in children. Asystematic review. Pediatr Pulmonol. 2014;49:326-34. 32.Rodrigo GJ, Castro-Rodriguez JA. Anticholinergics in the tre-atment of children and adults with acute asthma: a systema-tic review with meta-analysis. Thorax 2005;60:740-6. 33.Vezina K, Chauhan BF, Ducharme FM. Inhaled anticholiner-gics and short-acting beta(2)-agonists versus shortacting beta2-agonists alone for children with acute asthma in hospital. Coch-rane Database Syst Rev 2014;7:Cd010283. 34.Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW.Early emergency department treatment of acute asthma withsystemic corticosteroids. Cochrane Database Syst Rev.2001;CD002178. 35.Cheuk DK, Chau TC, Lee SL. A meta-analysis on intraveno-us magnesium sulphate for treating acute asthma. Arch DisChild 2005;90:74–7. 36.Mitra AAD, Bassler D, Watts K, Lasserson TJ, Ducharme FM.Intravenous aminophylline for acute severe asthma in child-ren over two years receiving inhaled bronchodilators. Coch-rane Database Syst Rev. 2005;18:CD001276. 37.Jat KR, Chawla D. Ketamine for management of acute exa-cerbations of asthma in children. Cochrane Database Syst Rev.2012;11:CD009293. 38.Joseph KS, Blais L, Ernst P, Suissa S. Increased morbidity andmortality related to asthma among asthmatic patients who usemajor tranquillisers. BMJ 1996;312:79-82. 39.FitzGerald JM, Macklem P. Fatal asthma. Annu Rev Med1996;47:161-8.