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Okul Öncesi Hışıltılı Çocuk Tedavisi ve İzlemine Güncel Yaklaşım

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

Kaynakça

  • 1. Brand PL, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2008;32:1096-110.
  • 2. Castro-Rodriguez JA, Garcia-Marcos L. Wheezing and asthma in childhood: an epidemiology approach. Allergol Immunopathol (Madr) 2008;36:280-90.
  • 3. Strachan D, Sibbald B, Weiland S, Aït-Khaled N, Anabwani G, Anderson HR, et al. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC). Pediatr Allergy Immunol 1997;8:161-76.
  • 4. Bhatt JM, Smyth AR. The management of pre-school wheeze. Paediatr Respir Rev 2011;12:70-7.
  • 5. Gadomski AM, Bhasale AL. Bronchodilators for bronchiolitis. Cochrane Database of Syst Rev 2006;3:CD001266.
  • 6. National Institues of Health Global Strategy for Asthma Management and Prevention. GINA NIH Publication 2009.
  • 7. Bacharier LB, Boner A, Carlsen KH, Eigenmann PA, Frischer T, Götz M, et al. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy 2008;63:5-34.
  • 8. Conner WT, Dolovich MB, Frame RA, Newhouse MT. Reliable salbutamol administration in 6- to 36-month-old children by means of a metered dose inhaler and Aerochamber with mask. Pediatr Pulmonol 1989;6:263-7.
  • 9. Kraemer R, Frey U, Sommer CW, Russi E. Short-term effect of albuterol, delivered via a new auxiliary device, in wheezy infants. Am Rev Respir Dis 1991;144:347-51.
  • 10. Chavasse R, Seddon P, Bara A, McKean M. Short acting beta agonists for recurrent wheeze in children under 2 years of age . Cochrane Database Syst Rev 2002;3: CD002873.
  • 11. Brand PL, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2008;32:1096-110.
  • 12. Taussig LM, Wright AL, Morgan WJ, Harrison HR, Ray CG. The Tucson Children’s Respiratory Study.I. Design and implementation of a prospective study of acute and chronic respiratory illness in children. Am J Epidemiol 1989;129:1219-31.
  • 13. Skoner DP, Greos LS, Kim KT, Roach JM, Parsey M, Baumgartner RA. Evaluation of the safety and efficacy of levalbuterol in 2-5-year-old patients with asthma. Pediatr Pulmonol 2005;40:477-86.
  • 14. Csonka P, Kaila M, Laippala P, Iso-Mustajärvi M, Vesikari T, Ashorn P. Oral prednisolone in the acute management of children age 6 to 35 months with viral respiratory infectioninduced lower airway disease: a randomized, placebocontrolled trial. J Pediatr 2003;143:725-30.
  • 15. Panickar J, Lakhanpaul M, Lambert PC, Kenia P, Stephenson T, Smyth A, Grigg J. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med 2009;360:329-38.
  • 16. Fox GF, Marsh MJ, Milner AD. Treatment of recurrent acute wheezing episodes in infancy with oral salbutamol and prednisolone. Eur J Pediatr 1996;155:512-6.
  • 17. Smith M, Iqbal S, Elliott TM, Everard M, Rowe BH. Corticosteroids for hospitalised children with acute asthma. Cochrane Database Syst Rev 2003;2:CD002886.
  • 18. Vuillermin PJ, Robertson CF, South M. Parent-initiated oral corticosteroid therapy for intermittent wheezing illnesses in children: systematic review. J Paediatr Child Health 2007;43:438-42.
  • 19. Everard ML, Bara A, Kurian M, Elliott TM, Ducharme F, Mayowe V. Anticholinergic drugs for wheeze in children under the age of two years. Cochrane Database Syst Rev 2005;3:CD001279.
  • 20. Wilson N, Sloper K, Silverman M. Effect of continuous treatment with topical corticosteroid on episodic viral wheeze in preschool children. Arch Dis Child 1995;72:317-20.
  • 21. McKean M, Ducharme F. Inhaled steroids for episodic viral wheeze of childhood. Cochrane Database Syst Rev 2000;2:CD001107.
  • 22. Bisgaard H, Hermansen MN, Loland L, Halkjaer LB, Buchvald F. Intermittent inhaled corticosteroids in infants with episodic wheezing. N Engl J Med 2006;354:1998-2005.
  • 23. Bisgaard H, Zielen S, Garcia-Garcia ML, Johnston SL, Gilles L, Menten J, et al. Montelukast reduces asthma exacerbations in 2- to 5-year-old children with intermittent asthma. Am J Respir Crit Care Med 2005;171:315-22.
  • 24. Knorr B, Franchi LM, Bisgaard H, Vermeulen JH, LeSouef P, Santanello N, et al. Montelukast, a leukotriene receptor antagonist, for the treatment of persistent asthma in children aged 2 to 5 years. Pediatrics 2001;108:E48.
  • 25. Robertson CF, Price D, Henry R, Mellis C, Glasgow N, Fitzgerald D, et al. Short-course montelukast for intermittent asthma in children: a randomized controlled trial. Am J Respir Crit Care Med 2007;175:323-9.
  • 26. Bacharier LB, Phillips BR, Zeiger RS, Szefler SJ, Martinez FD, Lemanske RF Jr, et Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with moderate-to-severe intermittent wheezing. J Allergy Clin Immunol 2008;122:1127-35.

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

Yıl 2012, Cilt: 10 Sayı: 3, 98 - 102, 01.12.2012
https://doi.org/10.4274/Jcp.10.05

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

Kaynakça

  • 1. Brand PL, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2008;32:1096-110.
  • 2. Castro-Rodriguez JA, Garcia-Marcos L. Wheezing and asthma in childhood: an epidemiology approach. Allergol Immunopathol (Madr) 2008;36:280-90.
  • 3. Strachan D, Sibbald B, Weiland S, Aït-Khaled N, Anabwani G, Anderson HR, et al. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC). Pediatr Allergy Immunol 1997;8:161-76.
  • 4. Bhatt JM, Smyth AR. The management of pre-school wheeze. Paediatr Respir Rev 2011;12:70-7.
  • 5. Gadomski AM, Bhasale AL. Bronchodilators for bronchiolitis. Cochrane Database of Syst Rev 2006;3:CD001266.
  • 6. National Institues of Health Global Strategy for Asthma Management and Prevention. GINA NIH Publication 2009.
  • 7. Bacharier LB, Boner A, Carlsen KH, Eigenmann PA, Frischer T, Götz M, et al. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy 2008;63:5-34.
  • 8. Conner WT, Dolovich MB, Frame RA, Newhouse MT. Reliable salbutamol administration in 6- to 36-month-old children by means of a metered dose inhaler and Aerochamber with mask. Pediatr Pulmonol 1989;6:263-7.
  • 9. Kraemer R, Frey U, Sommer CW, Russi E. Short-term effect of albuterol, delivered via a new auxiliary device, in wheezy infants. Am Rev Respir Dis 1991;144:347-51.
  • 10. Chavasse R, Seddon P, Bara A, McKean M. Short acting beta agonists for recurrent wheeze in children under 2 years of age . Cochrane Database Syst Rev 2002;3: CD002873.
  • 11. Brand PL, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J 2008;32:1096-110.
  • 12. Taussig LM, Wright AL, Morgan WJ, Harrison HR, Ray CG. The Tucson Children’s Respiratory Study.I. Design and implementation of a prospective study of acute and chronic respiratory illness in children. Am J Epidemiol 1989;129:1219-31.
  • 13. Skoner DP, Greos LS, Kim KT, Roach JM, Parsey M, Baumgartner RA. Evaluation of the safety and efficacy of levalbuterol in 2-5-year-old patients with asthma. Pediatr Pulmonol 2005;40:477-86.
  • 14. Csonka P, Kaila M, Laippala P, Iso-Mustajärvi M, Vesikari T, Ashorn P. Oral prednisolone in the acute management of children age 6 to 35 months with viral respiratory infectioninduced lower airway disease: a randomized, placebocontrolled trial. J Pediatr 2003;143:725-30.
  • 15. Panickar J, Lakhanpaul M, Lambert PC, Kenia P, Stephenson T, Smyth A, Grigg J. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med 2009;360:329-38.
  • 16. Fox GF, Marsh MJ, Milner AD. Treatment of recurrent acute wheezing episodes in infancy with oral salbutamol and prednisolone. Eur J Pediatr 1996;155:512-6.
  • 17. Smith M, Iqbal S, Elliott TM, Everard M, Rowe BH. Corticosteroids for hospitalised children with acute asthma. Cochrane Database Syst Rev 2003;2:CD002886.
  • 18. Vuillermin PJ, Robertson CF, South M. Parent-initiated oral corticosteroid therapy for intermittent wheezing illnesses in children: systematic review. J Paediatr Child Health 2007;43:438-42.
  • 19. Everard ML, Bara A, Kurian M, Elliott TM, Ducharme F, Mayowe V. Anticholinergic drugs for wheeze in children under the age of two years. Cochrane Database Syst Rev 2005;3:CD001279.
  • 20. Wilson N, Sloper K, Silverman M. Effect of continuous treatment with topical corticosteroid on episodic viral wheeze in preschool children. Arch Dis Child 1995;72:317-20.
  • 21. McKean M, Ducharme F. Inhaled steroids for episodic viral wheeze of childhood. Cochrane Database Syst Rev 2000;2:CD001107.
  • 22. Bisgaard H, Hermansen MN, Loland L, Halkjaer LB, Buchvald F. Intermittent inhaled corticosteroids in infants with episodic wheezing. N Engl J Med 2006;354:1998-2005.
  • 23. Bisgaard H, Zielen S, Garcia-Garcia ML, Johnston SL, Gilles L, Menten J, et al. Montelukast reduces asthma exacerbations in 2- to 5-year-old children with intermittent asthma. Am J Respir Crit Care Med 2005;171:315-22.
  • 24. Knorr B, Franchi LM, Bisgaard H, Vermeulen JH, LeSouef P, Santanello N, et al. Montelukast, a leukotriene receptor antagonist, for the treatment of persistent asthma in children aged 2 to 5 years. Pediatrics 2001;108:E48.
  • 25. Robertson CF, Price D, Henry R, Mellis C, Glasgow N, Fitzgerald D, et al. Short-course montelukast for intermittent asthma in children: a randomized controlled trial. Am J Respir Crit Care Med 2007;175:323-9.
  • 26. Bacharier LB, Phillips BR, Zeiger RS, Szefler SJ, Martinez FD, Lemanske RF Jr, et Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with moderate-to-severe intermittent wheezing. J Allergy Clin Immunol 2008;122:1127-35.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Collection
Yazarlar

Pınar Uysal Bu kişi benim

Özkan Karaman Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2012
Yayımlandığı Sayı Yıl 2012 Cilt: 10 Sayı: 3

Kaynak Göster

APA Uysal, P., & Karaman, Ö. (2012). Okul Öncesi Hışıltılı Çocuk Tedavisi ve İzlemine Güncel Yaklaşım. Güncel Pediatri, 10(3), 98-102. https://doi.org/10.4274/Jcp.10.05
AMA Uysal P, Karaman Ö. Okul Öncesi Hışıltılı Çocuk Tedavisi ve İzlemine Güncel Yaklaşım. Güncel Pediatri. Aralık 2012;10(3):98-102. doi:10.4274/Jcp.10.05
Chicago Uysal, Pınar, ve Özkan Karaman. “Okul Öncesi Hışıltılı Çocuk Tedavisi Ve İzlemine Güncel Yaklaşım”. Güncel Pediatri 10, sy. 3 (Aralık 2012): 98-102. https://doi.org/10.4274/Jcp.10.05.
EndNote Uysal P, Karaman Ö (01 Aralık 2012) Okul Öncesi Hışıltılı Çocuk Tedavisi ve İzlemine Güncel Yaklaşım. Güncel Pediatri 10 3 98–102.
IEEE P. Uysal ve Ö. Karaman, “Okul Öncesi Hışıltılı Çocuk Tedavisi ve İzlemine Güncel Yaklaşım”, Güncel Pediatri, c. 10, sy. 3, ss. 98–102, 2012, doi: 10.4274/Jcp.10.05.
ISNAD Uysal, Pınar - Karaman, Özkan. “Okul Öncesi Hışıltılı Çocuk Tedavisi Ve İzlemine Güncel Yaklaşım”. Güncel Pediatri 10/3 (Aralık 2012), 98-102. https://doi.org/10.4274/Jcp.10.05.
JAMA Uysal P, Karaman Ö. Okul Öncesi Hışıltılı Çocuk Tedavisi ve İzlemine Güncel Yaklaşım. Güncel Pediatri. 2012;10:98–102.
MLA Uysal, Pınar ve Özkan Karaman. “Okul Öncesi Hışıltılı Çocuk Tedavisi Ve İzlemine Güncel Yaklaşım”. Güncel Pediatri, c. 10, sy. 3, 2012, ss. 98-102, doi:10.4274/Jcp.10.05.
Vancouver Uysal P, Karaman Ö. Okul Öncesi Hışıltılı Çocuk Tedavisi ve İzlemine Güncel Yaklaşım. Güncel Pediatri. 2012;10(3):98-102.