COVİD-19 Pandemisinde Çocuklarda Astım Atağı Sıklığı ve Hastalık Şiddetinin Değerlendirilmesi

Öz

Amaç: Her türlü alt solunum yolu enfeksiyonunda olduğu gibi, koronavirus hastalığı 2019 (COVİD-19) enfeksiyonunun da, astım ataklarını tetiklenebileceği ve astımı olan hastalarda enfeksiyonun daha ağır geçebileceği düşünülmektedir. Bu çalışmada COVİD-19 hastalığının astımlı çocuklardaki sıklığının saptanması ve bu hastalardaki hastalık şiddetinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Hastanemiz çocuk acil kliniğine Mart- Aralık 2020 tarihleri arasında astım atağı ile başvurmuş ve COVİD-19 tanısı için gerçek zamanlı polimeraz zincir reaksiyonu (RT-PCR) testi bakılmış hastalar geriye dönük olarak incelendi. Bulgular: Çalışmaya alınan 155 hastanın 85’i (%54.8) erkek cinsiyette ve ortanca yaş (IQR), 122.0 (66.0- 163.0)’dı. En sık başvuru şikayetlerinin öksürük (%70.3), ateş (%39.4) ve nefes darlığı (%29.7) olduğu belirlendi. Hastaneye yatışı yapılan hastaların 18’i (%81.8) orta atak, 4’ü (%18.2) ağır atak olarak değerlendirildi (p< 0.001). Yatış yapılan hastaların 10’u (% 45.5) kısmi kontrollü, 8’i (%36.4) kontrolsüzdü (p< 0.001). Çalışmaya alınan 155 hastanın 22’sinde (%14.2) COVİD-19 saptandı. Hastaların COVİD-19 tanısına göre atak şiddetinde ve servis yatış ihtiyacında farklılık saptanmadı (sırasıyla p=0.633, p=0.288). Sonuç: COVİD-19 enfeksiyonunun çocuklarda astım atak şiddetini ve hastaneye yatış ihtiyacını arttırmadığı saptanmıştır. COVİD-19 pandemisi sırasında astım hastaları için çocuk acil servis değerlendirmesinde bu durum önemlidir.

Anahtar Kelimeler

• Çocuk acil
• astım
• COVİD-19

Evaluation of the Frequency of Asthma Attack and Disease Severity in Children in the COVID-19 Pandemic

Öz

Objective: As with any lower respiratory tract infection, it is thought that coronavirus disease 2019 (COVID-19) infection may trigger asthma attacks, and the infection may be more severe in patients with asthma. The objective of this study was to establish the incidence of COVID-19 in children with asthma and to assess the disease severity in this patient group. Material and Methods: We retrospectively analyzed patients who were admitted to the pediatric emergency clinic at our hospital between March and December 2020 with asthma attacks. The patients underwent a real-time polymerase chain reaction (RT-PCR) test to diagnose COVID-19. Results: The study involved 155 patients, with 85 (54.8%) being male and the median age (IQR) was 122.0 (66.0- 163.0) months. The most common symptoms presented by these patients were cough (70.3%), fever (39.4%), and dyspnea (29.7%). Within the patients who required hospitalisation, 18 (81.8%) were diagnosed with moderate attack and 4 (18.2%) with severe attack (p< 0.001). Of the patients who were hospitalised, 10 (45.5%) were partially controlled and 8 (36.4%) were uncontrolled with respect to their medical condition (p<0.001). In the study, COVID-19 was detected in 22 (14.2%) out of 155 patients. According to the diagnosis of COVID-19, there was no difference in the severity of attacks or the requirement for ward hospitalization (p=0.633, p=0.288, respectively). Conclusion: COVID-19 infection does not increase the severity of asthma attacks or the need for hospitalization in children. This information is particularly important in the context of pediatric emergency care for asthma patients during the COVID-19 pandemic.

Anahtar Kelimeler

• pediatric emergency
• asthma
• COVID-19

Kaynakça

1. Lee OM, Sivasankar S, Pokrajac N, Smith Ch, Lumba-Brown A. Emergency department treatment of asthma in children: A review. J Am Coll Emerg Physicians Open;1:1552-61.z3.
2. Abrams EM, Szefler SJ. Managing Asthma during Coronavirus Disease-2019: An Example for Other Chronic Conditions in Children and Adolescents. J Pediatr 2020; 222: 221–6.
3. 2023 GINA Report, Global Strategy for Asthma Management and Prevention. Available at: https://ginasthma.org/2023-gina-main-report/
4. Matsumoto K, Saito H. Does asthma affect morbidity or severity of COVID-19? J Allergy Clin Immunol 2020; 146: 55–7.
5. Bozdemir T, Çolak D. COVID-19’da tanı yöntemleri. Canatan D, Alkan ŞŞ, editörler. Güncel COVID-19 Bilgileri. 1. Baskı. Ankara: Türkiye Klinikleri 2021.p.26-31.
6. Erensoy S. COVID-19 Pandemisinde SARS-CoV-2 ve Mikrobiyolojik Tanı Dinamikleri. Mikrobiyol Bul 2020;54:497-509.
7. Taylor E, Haven K, Reed P, Bissielo A, Harvey D, McArthur C, et al. A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study. BMC Med Imaging 2015;15:61.
8. Krivec U, Kofol Seliger A, Tursic J. COVID-19 lockdown dropped rate of paediatric asthma admissions. Arch Dis Child 2020; 105:809–10.

9. Kenyon CC, Hill DA, Henrickson SE, Bryant-Stephens TC, Zorc JJ. Initial effects of the COVID-19 pandemic on pediatric asthma emergency department utilization. J Allergy Clin Immunol Pract 2020; 8:2774–6.e1
10. Gupta A, Bush A, Nagakumar P. Asthma in children during the COVID-19 pandemic: lessons from lockdown and future directions for management. Lancet Respir Med 2020; 8:1070-1.
11. Metbulut AP, Mustafaoğlu Ö, Şen G, Yüksek SK, Çelik İK, Akça H, et al. Evaluation of the Clinical and Laboratory Findings of Asthmatic Children with SARS-CoV-2 Infection. Int Arch Allergy Immunol 2021;182:989-6.
12. Hui D, Dong X, Zhang JJ, Cao Y, Akdis M, Huang P, et al. Clinical characteristics of 182 pediatric COVID-19 patients with different severities and allergic status. Allergy 2021;76:510-32.
13. Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Calò CarducciFI, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health 2020;4:653–61.
14. Yılmaz K, Gozupirinççioğlu A, Aktar F, Akın A, Karabel M, Yolbas I, et al. Evaluation of the novel coronavirus disease in Turkish children: Preliminary outcomes. Pediatr Pulmonol 2020;55:3587-94.
15. Cura Yayla BC, Özsürekçi Y, Aykaç K, Derin Oygar P, Laçinel Gürlevik S, İlbay S, et al. Characteristics and Management of Children with COVID-19 in Turkey. Balkan Med J 2020;37:341-7.
16. Wang L, Foer D, Bates DW, Boyce JA , Zhou L. Risk factors for hospitalization, intensive care, and mortality among patients with asthma and COVID-19. J Allergy Clin Immunol 2020;146:808-12.
17. Swann OV, Pollock L, Holden KA, Munro APS, Bennett A, Williams TC, et al. Comparison of UK paediatric SARS-CoV-2 admissions across the first and second pandemic waves. Pediatr Res 2023;93:207-16.
18. Jin M, Chen C, Huang J, Zhang F, Dong T, Zhang M, et al. Clinical characteristics of COVID-19 patients with asthma in Wuhan, China: a retrospective cohort study. J Asthma 2022;59:230-8.
19. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV2 Infection in Children. N Engl J Med 2020;382:1663-5.
20. Lippi G, Plebani M. The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. Clin Chem Lab Med 2020;58:1063–9.
21. Wang D, Ju XL, Xie F, Lu Y, Li FY, Huang HH, et al. Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China. Chinese J Pediatr 2020;58:269–74.
22. Zheng F, Liao C, Fan Q, Chen H, Zhao X, Xie Z, et al. Clinical characteristics of children with coronavirus disease 2019 in Hubei, China. Current Medical Science 2020;40:275-80.
23. Sun D, Li H, Lu XX, Xiao H, Ren J, Zhang FR, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center’s observational study. World J Pediatr 2020;16:251-9.
24. Keleş YE, Pekçevik Y, Yılmaz D, Sarıoğlu FC, Demirçelik Y, Aksay AK et al. Thorax Computed Tomography Imaging and Chest X-Rays Results in Children with Different Clinical-Stages of COVID-19. J Pediatr Inf 2023; 17:119-27.
25. Palabiyik F, Kokurcan SO, Hatipoglu N, Cebeci SO, Inci E. Imaging of COVID-19 pneumonia in children. Br J Radiol 2020;93:20200647.
26. Ma H, Hu J, Tian J, Zhou X, Li H, Laws MT, et al. A single-center, retro- spective study of COVID-19 features in children: A descriptive investi- gation. BMC Med 2020;18:123.
27. Li W, Cui H, Li K, Fang Y, Li S. Chest computed tomography in children with COVID-19 respiratory infection. Pediatr Radiol 2020:50:796-9.
28. Das KM, Alkoteesh JA, Al Kaabi J, Al Mansoori T, Winant AJ, Singh R, et al. Comparison of chest radiography and chest CT for evaluation of pediatric COVID-19 pneumonia: Does CT add diagnostic value? Pediatr Pulmonol 2021;56:1409-18.