Araştırma Makalesi
BibTex RIS Kaynak Göster

Orta-Ağır Akut Astım Atağı ile Başvuran 6-16 Yaş arası Çocuklarda Montelukastın Etkinliğinin Belirlenmesi

Yıl 2017, Cilt: 39 Sayı: 3, 1 - 8, 12.10.2017
https://doi.org/10.20515/otd.323970

Öz

Öz: Bu çalışmanın amacı 
orta veya ağır şiddette astım atağı ile 
başvuran 6-16 yaşlar arasındaki 
hastalardaki solunum parametrelerine (retraksiyon, astım atak skoru,
pozitif ekspirasyon akış hızı, dispne parametreleri, oskültasyon bulguları)
montelukastın etkisini araştırmaktır. Çalışmamıza orta ve ağır şiddette akut
astım atağı ile başvuran 30 astımlı çocuk dahil edildi. Çalışma; randomize,
çift kör, plasebo kontrollü, paralel bir incelemedir. Tüm hastalara başlangıç
tedavisi olarak  nebulize salbutamol All
patients were given nebulized salbutamol (0.15 mg/kg), ipratropium bromid (250
mcg/doz), oral metilprednizolon (1 mg/kg) ve oksijen verildi. Bu tedavilere ek
olarak Grup I’deki hastalara  5 mg
plasebo, Grup II’dekilere montelukast 5 mg oral olarak verildi. Ardından her
iki gruba da  20 dakika aralarla 2 kez
daha 0,15 mg/kg nebulize salbutamol ile 250 mcg/doz nebulize ipratropium bromür
verildi. Hastalar 0., 20., 40., 60., 90., 120., 180. ve 240. dakikalarda
respiratuar parametrelerle tedavi etkinliği açısından tekrar
değerlendirildi.  Çalışmaya dahil edilen
çocukların yaşları 6,5 ile 16 arasında değişmekte ve ortanca yaş 9, erkek kız
oranı eşitti. Grup I’de hastaların median yaşı 9,5 yaş, erkek kız oranı 0.87
idi. Grup II’de hastaların median yaşı 9 yaş, erkek kız oranı 1.14 idi. Tedavi
öncesi gruplar arasında çalışma parametreleri arasında anlamlı fark bulunmadı
(p > 0.05). Bununla birlikte grup-II’deki ortalama solunum
parametrelerindeki düzelme oranı grup-I’e göre daha yüksek bulundu. Grup
II’deki hastaların astım atak skorlarındaki düzelme tüm dakikalarda diğer gruba
göre daha yüksekken, aradaki fark istatistiksel olarak anlamlı değildi  (p > 0.05). Montelukastın 6-16 yaş arası
orta veya ağır şiddette  astım atağı ile
başvuran çocuklarda kullanımında PEFR’de ve astım atak skorlarının düzelmesinde
etkili olduğu saptanmıştır.         

Kaynakça

  • 1. E.R. McFadden,Jr. Acute Severe Asthma. Am J Respir Crit Care Med 2003, 168: 740-759
  • 2. Reiss TF, Sorkness CA, Stricker W. Effects of montelukast, a potent cysteinyl leıkotriene receptor antogonist, on bronchodilation in asthmatic subjects treated with and without inhaled corticosteroids. Thorax 1997; 52: 45-48.
  • 3. National Heart, Lung and Blood Institute, World Health Organisation. Global Initiative for Asthma. management and prevention. 2009 Update. 2009; NIH Publication No 02-3659 National Institutes of Health; 2009. Publication No. 02-3659:http://ginasthma.com/GuidelinesResources?11=2 12=0 (Assess date: 3 May 2010)
  • 4. Williams SG, Schmidt DK, Redd SC, Storms W. Key clinical activities for quality asthma care. Recommendations of the National Asthma Education and Prevention Program. MMWR Recomm Rep. 2003 Mar 28;52(RR-6):1-8.
  • 5. Pişgin Volkan B. Hafif persistan ve orta persistan astımlı çocuklarda montelukast ile zafirlukastın etkinliğinin karşılaştırılması. İstanbul 2008 Uzmanlık tezi
  • 6. Salvi SS, Krishna MT, Sampson AP. The anti inflammotory effects of leukotriene modifiying drugs and their use in asthma. Chest 2001; 119:1533-1546.
  • 7. Knoor B, Franchi L, Bisgaard M, et al. Montelukast, a leukotriene receptor antagonist, for the treatment persistent asthma in children aged 2 to 5 years. Pediatrics 2001; 180: 48.
  • 8. Kay AB, Bousquet J, Holt PG, Kaplan AP. Allergy and Allergic Diseases. Currie GP, Lipworth BJ. Antileukotrien agents. 2nd edition, Volume-1, Wiley-Blackwell publishing, 2008, 694-714
  • 9. Castro Rodriguez JA, Holberg CJ, Wright AL, Martinez FD. A Clinical index to define risk of asthma in young children with recurrent wheezing .Am J Respir Crit Care Med 2000; 162: 1403-1406
  • 10. Skoner D. Montelukast in 2- to 5- Year- Old Children With Asthma. Pediatric Pulmonology (Suppl) 2001; 21: 46-48 11. Ramsay CF, Pearson D, Mildenhall S, Wilson AM. Oral montelukast in acute asthma exacerbations: a randomised, double-blind, placebo-controlled trial. Thorax 2010; 18. [Epub ahead of print].
  • 12. Camargo CA Jr, Gurner DM, Smithline HA, Chapela R, Fabbri LM, Green SA, Malice MP, Legrand C, Dass SB, Knorr BA, Reiss TF. A randomized placebo-controlled study of intravenous montelukast for the treatment of acute asthma. J Allergy Clin Immunol 2010; 125(2): 374-380.
  • 13. Çilli A, Kara A, Ozdemir T, Oğüş C, Gülkesen KH. Effects of oral montelukast on airway function in acute asthma. Respir Med 2003; 97(5): 533-536.
  • 14. Todi VK, Lodha R, Kabra SK. Effect of addition of single dose of oral montelukast to standard treatment in acute moderate to severe asthma in children between 5 and 15 years of age: a randomised, double-blind, placebo controlled trial. Arch Dis Child 2010; 95(7): 540-543. Epub 2010 Jun 3.
  • 15. Morris CR, Becker AB, Piñieiro A, Massaad R, Green SA, Smugar SS, Gurner DM. A randomized, placebo-controlled study of intravenous montelukast in children with acute asthma. Ann Allergy Asthma Immunol 2010; 104(2): 161-171.
  • 16. Nelson KA, Smith SR, Trinkaus K, Jaffe DM. Pilot study of oral montelukast added to standard therapy for acute asthma exacerbations in children aged 6 to 14 years. Pediatr Emerg Care 2008; 24(1): 21
  • 17. Harmanci K, Bakirtas A, Turktas I, Degim T. Oral montelukast treatment of preschool-aged children with acute asthma. Ann Allergy Asthma Immunol. 2006; 96(5): 731-735.

The Effects of Montelukast in Children Between 6-16 Years with Moderate-Severe Acute Asthma Attack

Yıl 2017, Cilt: 39 Sayı: 3, 1 - 8, 12.10.2017
https://doi.org/10.20515/otd.323970

Öz

Abstract: The aim of this study is to evaluate
the effect to respiratory parameters (retraction, asthma attack score-AAS,
positive expiratory flow rate- PEFR-, dispnea parameters, auscultation) of
montelukast in children aged between 6-16 years admitted with moderate or
severe acute asthma attacks.  In this
study, thirty children presented with moderate or severe asthma attack were
evaluated. The study is a randomized, double blind, placebo-controlled parallel
trial. The patients were randomly divided into two groups. All patients were
given nebulized salbutamol (0.15 mg/kg), ipratropium bromide (250 mcg/doz), 1
mg/kg of oral methyl prednisolone and O2 as initial treatment. In addition to
these medications, the placebo of montelukast 5 mg was given orally in the
Group I, and  montelukast 5 mg drug was
given orally to the patients in the Group II. Then, additional 0.15 mg/kg
nebulized Salbutamol and 250 mcg/dosage Ipratropium bromides were given twice
with 20 minute interval. Besides, the patients were evaluated at 0., 20., 40.,
60., 90., 120., 180., and 240. minutes for the criteria of therapeutic response
such as respiratory parameters.  The mean
age of children in the study group was 9 (between 6.5-16), male to female
ration (M/F) was 1. In the first group, mean age 9.5, M/F:0.87. Median age was
9 and (M/F) was 1.14 in Group II. No significant difference was determined
between groups in terms of respiratory parameters. Nevertheless, the average
rate of improvements in the respiratory parameters in group II was higher than
group I. The rates of improvement in the average scores at every evaluation
times were higher in the group II    in
comparison with the group I. However, the differences between the groups at
every evaluation time were not significant statistically (p>0.05). The use
of montelukast in children aged between 6-16 years with acute asthma
exacerbation seems to be effective in improvement of respiratory parameters,
especially in PEFR and AAS.

Kaynakça

  • 1. E.R. McFadden,Jr. Acute Severe Asthma. Am J Respir Crit Care Med 2003, 168: 740-759
  • 2. Reiss TF, Sorkness CA, Stricker W. Effects of montelukast, a potent cysteinyl leıkotriene receptor antogonist, on bronchodilation in asthmatic subjects treated with and without inhaled corticosteroids. Thorax 1997; 52: 45-48.
  • 3. National Heart, Lung and Blood Institute, World Health Organisation. Global Initiative for Asthma. management and prevention. 2009 Update. 2009; NIH Publication No 02-3659 National Institutes of Health; 2009. Publication No. 02-3659:http://ginasthma.com/GuidelinesResources?11=2 12=0 (Assess date: 3 May 2010)
  • 4. Williams SG, Schmidt DK, Redd SC, Storms W. Key clinical activities for quality asthma care. Recommendations of the National Asthma Education and Prevention Program. MMWR Recomm Rep. 2003 Mar 28;52(RR-6):1-8.
  • 5. Pişgin Volkan B. Hafif persistan ve orta persistan astımlı çocuklarda montelukast ile zafirlukastın etkinliğinin karşılaştırılması. İstanbul 2008 Uzmanlık tezi
  • 6. Salvi SS, Krishna MT, Sampson AP. The anti inflammotory effects of leukotriene modifiying drugs and their use in asthma. Chest 2001; 119:1533-1546.
  • 7. Knoor B, Franchi L, Bisgaard M, et al. Montelukast, a leukotriene receptor antagonist, for the treatment persistent asthma in children aged 2 to 5 years. Pediatrics 2001; 180: 48.
  • 8. Kay AB, Bousquet J, Holt PG, Kaplan AP. Allergy and Allergic Diseases. Currie GP, Lipworth BJ. Antileukotrien agents. 2nd edition, Volume-1, Wiley-Blackwell publishing, 2008, 694-714
  • 9. Castro Rodriguez JA, Holberg CJ, Wright AL, Martinez FD. A Clinical index to define risk of asthma in young children with recurrent wheezing .Am J Respir Crit Care Med 2000; 162: 1403-1406
  • 10. Skoner D. Montelukast in 2- to 5- Year- Old Children With Asthma. Pediatric Pulmonology (Suppl) 2001; 21: 46-48 11. Ramsay CF, Pearson D, Mildenhall S, Wilson AM. Oral montelukast in acute asthma exacerbations: a randomised, double-blind, placebo-controlled trial. Thorax 2010; 18. [Epub ahead of print].
  • 12. Camargo CA Jr, Gurner DM, Smithline HA, Chapela R, Fabbri LM, Green SA, Malice MP, Legrand C, Dass SB, Knorr BA, Reiss TF. A randomized placebo-controlled study of intravenous montelukast for the treatment of acute asthma. J Allergy Clin Immunol 2010; 125(2): 374-380.
  • 13. Çilli A, Kara A, Ozdemir T, Oğüş C, Gülkesen KH. Effects of oral montelukast on airway function in acute asthma. Respir Med 2003; 97(5): 533-536.
  • 14. Todi VK, Lodha R, Kabra SK. Effect of addition of single dose of oral montelukast to standard treatment in acute moderate to severe asthma in children between 5 and 15 years of age: a randomised, double-blind, placebo controlled trial. Arch Dis Child 2010; 95(7): 540-543. Epub 2010 Jun 3.
  • 15. Morris CR, Becker AB, Piñieiro A, Massaad R, Green SA, Smugar SS, Gurner DM. A randomized, placebo-controlled study of intravenous montelukast in children with acute asthma. Ann Allergy Asthma Immunol 2010; 104(2): 161-171.
  • 16. Nelson KA, Smith SR, Trinkaus K, Jaffe DM. Pilot study of oral montelukast added to standard therapy for acute asthma exacerbations in children aged 6 to 14 years. Pediatr Emerg Care 2008; 24(1): 21
  • 17. Harmanci K, Bakirtas A, Turktas I, Degim T. Oral montelukast treatment of preschool-aged children with acute asthma. Ann Allergy Asthma Immunol. 2006; 96(5): 731-735.
Toplam 16 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Beyhan Küçükbayrak Bu kişi benim

Koray Harmancı

Gülşen Köse Bu kişi benim

Hülya Anıl

Yayımlanma Tarihi 12 Ekim 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 39 Sayı: 3

Kaynak Göster

Vancouver Küçükbayrak B, Harmancı K, Köse G, Anıl H. Orta-Ağır Akut Astım Atağı ile Başvuran 6-16 Yaş arası Çocuklarda Montelukastın Etkinliğinin Belirlenmesi. Osmangazi Tıp Dergisi. 2017;39(3):1-8.


13299        13308       13306       13305    13307  1330126978