Tekrarlayan Hışıltılı Çocuklarda Etiyolojik Değerlendirme

Öz

Amaç: 1 ay ila 3 yaş arasında olup, en az üç kez hışıltı atağı geçirmiş olan çocuklarda etiyolojinin ortaya konması ve ek olarak atopinin eşlik ettiği çoklu-tetiklenen hışıltısı olan çocuklar ile viral (epizodik) hışıltısı olan çocukların birbiriyle karşılaştırılması amaçlanmıştır.Gereç ve Yöntemler: Çalışmaya en az üç hışıltı atağı geçirmiş olan toplam 261 çocuk alındı. Etiyolojiyi aydınlatmak üzere, ayrıntılı öykü ve fizik muayenenin yanı sıra, tam kan sayımı, periferik kanda eozinofil sayısı, serum immünglobulin düzeyleri, ter testi, PPD, akciğer grafisi, gastroösefageal reflü sintigrafisi, allerjen spesifik IgE, deri ‘prick’ testi sonuçları hastaların dosyalarından retrospektif olarak kaydedildi.Bulgular: 142 olgu (% 54.4) viral hışıltı atağı, 54 olgu (% 20.7) atopinin eşlik ettiği çoklu-tetiklenen hışıltı atağı, 12 olgu (% 4.6) gastroösefageal reflü, 9 olgu (% 3.4) yabancı cisim aspirasyonu, 8 olgu (%3.1) kistik fibrozis ve 6 olgu (%2.3) bronkopulmoner displazi tanısı aldı. Viral hışıltılı çocuklarda ilk atak yaşının atopinin eşlik ettiği çoklu-tetiklenen hışıltısı olanlara göre daha düşük olduğu belirlendi (p=0.0001). Ayrıca, atopinin eşlik ettiği çoklu-tetiklenen hışıltısı olan gruptaki çocuklar, viral hışıltılı gruptaki çocuklar ile karşılaştırıldığında annede astım, ailede atopi ve çocukta atopik dermatit öyküsü sıklığı anlamlı derecede yüksek bulundu (sırasıyla p=0.01, p=0.0001 ve p=0.0001).Sonuç: Hayatın ilk üç yılında tekrarlayan hışıltısı olan çocuklarda etiyolojiyi ortaya çıkarmanın, erken tedavi ve prognoz açısından oldukça önemli olduğu düşünülmektedir.

Anahtar Kelimeler

• Atopi çocuk, Etiyoloji, Hışıltılı çocuk, Viral enfeksiyon

Etiological Evaluation of Recurrent Wheezing in Children

Öz

Objective: The aim of the study was to investigate wheezing etiology in children aged between 1 month to 3 years who had suffered at least three wheezing episodes and additionally to compare children suffering from multiple-trigger wheeze accompanied with atopy with children who had viral (episodic) wheeze. Material and Methods: This study included 261 patients who had a history of at least three wheezing episodes. In addition to a detailed history and physical examination, the complete blood count, blood eosinophils, serum immunoglobulin levels, sweat chloride test, PPD skin testing, lung X-ray, scintigraphy for gastroesophageal reflux, allergen spesific IgE, and allergen skin prick test results were recorded from the hospital files of the patients retrospectively to clarify the etiology of the wheezing episodes.Results: We diagnosed 142 patients (54.4%) with viral wheeze, 54 patients (20.7%) with multiple-trigger wheeze accompanied by atopy, 12 patients (4.6%) with gastroesophageal reflux disease, 9 patients (3.4%) with foreign body aspiration, 8 patients (3.1%) with cystic fibrosis, and 6 patients (2.3%) with bronchopulmonary dysplasia. The age of children with viral wheeze at the first episode was younger than those of children with multiple-trigger wheeze accompanied by atopy (p=0.0001). In addition, the rate of maternal asthma, family history of atopy, and atopic dermatitis history in the child were found to be significantly higher in children with multiple-trigger wheeze accompanied by atopy in comparison to children with viral wheeze (p=0.01, p=0.0001, and p=0.0001 respectively).conclusion: We believe that it is very important to explore the etiology of wheezing episodes in children in the first three years of life for early treatment and prognosis

Anahtar Kelimeler

• Atopic child, Etiology, Wheezing infant, Viral infection

Kaynakça

1. Cortés Alvarez N, Martín Mateos MA, Plaza Martín AM, Giner Muñoz MT, Piquer M, Sierra Martínez JL. Risk factors of developing asthma in children with recurrent wheezing in the first three years of life. Allergol Immunopathol (Mard) 2007; 35: 228-31.
2. 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.
3. Uysal P, Karaman Ö. Hışıltılı çocuğa yaklaşım. Türkiye Çocuk Hast Derg 2013;2:99-105.
4. Wright AL. Epidemiology of asthma and recurrent wheeze in childhood. Clin Rev Allergy Immunol 2002; 22: 33-44.
5. Just J, Saint-Pierre P, Gouvis-Echraghi R, Boutin B, Panayotopoulos V, Chebahi N, et al. Wheeze phenotypes in young children have different courses during the preschool period. Ann Allergy Asthma Immunol 2013; 111: 256-61.
6. Bacharier LB, Phillips BR, Bloomberg GR, Zeiger RS, Paul IM, Krawiec M, et al. Severe intermittent wheezing in preschool children: A distinct phenotype. J Allergy Clin Immunol 2007; 119: 604-10.
7. Castro-Rodriguez JA, Garcia-Marcos L. Wheezing and Asthma in childhood: An epidemiology approach. Allergol Immunopathol (Madr) 2008; 36: 280-90.
8. Simon MR, Havstad SL, Wegienka GR, Ownby DR, Johnson CC. Risk factors associated with transient wheezing in young children. Allergy Asthma Proc 2008; 29: 161-5.

9. Beigelman A, Bacharier LB. Infection-induced wheezing in young children. J Allergy Clin Immunol 2014; 133: 603-4.
10. Lewis S, Richards D, Bynner J, Butler N, Britton J. Prospective study of risk factors for early and persistent wheezing in childhood. Eur Respir J 1995;8:349-56.
11. Martinez FD. What have we learned from the Tucson Children’s Respiratory Study? Paediatr Respir Rev 2002;3:193-7.
12. Stein RT, Martinez FD. Asthma phenotypes in childhood: Lessons from an epidemiological approach. Paediatr Respir Rev 2004;5:155-61.
13. Taussig LM, Wright AL, Holberg CJ, Halonen M, Morgan WJ, Martinez FD. Tucson’s Children’s Respiratory Study: 1980 to present. J Allergy Clin Immunol 2003;111:661-75.
14. Castro-Rodriguez JA. The Asthma Predictive Index: A very useful tool for predicting asthma in young children. J Allergy Clin Immunol 2010;126:212-6.
15. Ferguson DM, Crane J, Beasley R, Horwood LJ. Perinatal factors and atopic disease in childhood. Clin Exp Allergy 1997;27:1394- 401.
16. Young SP, Le Souef, Geelhoed GC, Stick SM, Turner KJ, Landau LI. The influence of family history of asthma and parental smoking on airway responsiveness in early infancy. N Engl J Med 1991;324:1168-73.
17. Ostro BD, Lipsett MH, Mann JK, Wiener MB, Selner J. Indoor air pollution and asthma: Results from a panel study. Am J Respir Crit Care Med 1994;149:1400-6.
18. Strachan DP. Hay fever, hygiene and house hold size. Br Med J 1989; 74: 422-6.
19. Martinez FD, Wright AL, Holberg CJ, Morgan WJ, Taussig LM. Maternal age as a risk factor for lower respiratory illnesses in the first year of life. Am J Epidemiol 1992; 136:1258-68.
20. İnal A, Güneşer SK, Altıntaş AU, Yılmaz M, Karakoç GB. Hışıltılı çocuklarda etiyoloji: Dört yıllık verilerimiz. Türkiye Çocuk Hast Derg 2009; 3: 24-30.
21. Çevik D, Ecevit Ç, Altınöz S, Kocabaş Ö, Kavaklı T, Öztürk A. Hışıltılı çocuklarda risk faktörleri ve etiyoloji. Toraks Dergisi 2007; 8: 149- 55.
22. Fischer GB, Sarria EE, Mattiello R, Mocelin HT, Castro-Rodriguez JA. Post infectious bronchiolitis obliterans in children. Paediatr Respir Rev 2010; 11: 233-9.
23. Heffelfinger JD, Davis TE, Gebrian B, Bordeau R, Schwartz B, Dowell SF. Evaluation of children with recurrent pneumonia diagnosed by World Health Organization criteria. Pediatr Infect Dis J 2002; 21:108-12.
24. Boufersaoui A, Smati L, Benhalla KN, Boukari R, Smail S, Anik K, Aouameur R, Chaouche H, Baghriche M. Foreign body aspiration in children: Experience from 2624 patients. Int J Pediatr Otorhinolaryngol 2013; 77: 1683-8.
25. Karaman O, Uğuz A, Uzuner N. IgG subclasses in wheezing infants. Indian J Pediatr 1999; 66: 345-9.
26. Oner AF, Caksen H, Celik A, Cesur Y, Uner A, Arslan S. Serum immunoglobulins and immunoglobulin G subclasses with recurrent wheezing. Indian J Pediatr 2000; 67: 861-4.
27. Jain A, Patwari AK, Bajaj P, Kashyap R, Anand VK. Association of gastroesophageal reflux disease in young children with persistent respiratory symptoms. J Trop Pediatr 2002; 48: 39-42.