Okul Öncesi Hışıltılı Çocuk Tedavisi ve İzlemine Güncel Yaklaşım

Yıl 2012, Cilt: 10 Sayı: 3, 98 - 102, 01.12.2012

Pınar Uysal Özkan Karaman

https://doi.org/10.4274/Jcp.10.05

Öz

Erken yaşta geçirilen hışıltı atakları ve havayolu hiperreaktivitesi daha sonragelişebilecek astım açısından ilk bulgu olabilir. Bu nedenle bu hastalara uygulanacaktedavi yaklaşımı önemlidir. Tedavinin ilk ve en önemli basamağı primer korunma vehastanın hastalığı hakkında eğitimidir. Epizodik viral ve çoklu-tetikleyicili hışıltının herikisinde de atak tedavisinde ilk tercih edilmesi gereken ilaçlar β2agonistlerdir.Bronkodilatatörler akut hışıltı ataklarında semptomatik rahatlama sağlarlar iken, oralkortikosteroidlerin ataklardaki yeri tartışmalıdır. Atak tedavisinde ailelerin oralkortikosteroid başlamaları önerilmemektedir. İdame tedavisinde, epizodik viral hışıltıdadüşük-orta doz inhale kortikosteroidlerin İKS devamlı kullanımı etkisizdir. Ancak, çoklutetikleyicili hışıltıda İKS'lerin yararlı etkileri bulunmaktadır. Çocuklarda yüksek dozinhale İKS'ler aralıklı kullanıldığında her iki hışıltı tipinde de etkili gibi görünmektedir.Fakat, kısa dönemde yüksek doz İKS'lerin büyüme üzerine olumsuz etkileri olmasınedeni ile rutin olarak kullanımları önerilmemektedir. Lökotrien reseptör antagonistleri LTRA çoklu tetikleyicili çocuklarda önerilebilir. Antihistaminikler, ketotifen vekromolinlerin hışıltılı çocuk tedavisinde yeri yoktur

Anahtar Kelimeler

Alevlenme, hışıltılı çocuk, tedavi

Current Approach to Treatment and Follow-Up of Pre-School Children with Wheezing

Öz

Exacerbations of wheezing or airway hyperreactivity in early years of life might be thefirst sign of developing asthma. Therefore, management of these children is important.The first and the most important step of the management is the primary preventionagainst asthma with education of the patient and his caregivers. In acute exacerbationof wheezing the most preferred treatment should be β2-agonists for both of the episodicand multi-trigger wheezing. Bronchodilators provide symptomatic relief in acutewheezy episodes but the evidence for oral steroid usage is contraversial for children.Parent initiated oral steroid courses cannot be recommended. Although maintenancetreatment with low to moderate continuous inhaled corticosteroids ICS in pureepisodic viral wheeze is ineffective, it has beneficial effects in multi-trigger wheezing.High dose ICS used intermittently are effective in children with both of the wheezingtypes, but this is associated with short term effects on growth and cannot berecommended as a routine. Leucotrien receptor antagonists LTRA might berecommended as continuous treatment for children with multi-trigger wheezing.Antihistamines, ketotifen and cromolyns do not have a role in management of wheezingin children

Anahtar Kelimeler

Exacerbation, wheezy child, treatment

Kaynakça

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