Management of Wheezy Infant

Yıl 2013, Cilt: 7 Sayı: 2, 99 - 105, 01.08.2013

Pınar Uysal Özkan Karaman

Öz

Wheezing is a high pitched polyphonic sound which occurred as a result of narrowing of the lower airways. The ‘wheezy infant’ is a complex situation which includes heterogen phenotypes and a group of diseases with different pathophysiological mechanisms. Three different wheezing phenotypes are defined according to age and sex of children, atopic backgroud, and patients’ risk factors. These 3 phenotypes are ‘transient early wheezing’, ‘non-atopic persistant wheezing’, and ‘atopic wheezing’ (asthma). Because the wheezing episodes seen in early years of life that might be the first sign of developing asthma, it is important to discriminate transient or persistant wheezing in infancy. Unfortunately, there are not any biochemical or genetic markers which can be used to predict the development of asthma in small children. Therefore, description of phenotypes of wheezing and establishment of appropriate treatment modalities are the most important approach to determine the progress of the disease

Anahtar Kelimeler

Asthma, Phenotype, Wheezy infant, Diagnosis, Treatment

Hışıltılı Çocuğa Yaklaşım

Öz

Hışıltı, alt havayollarında oluşan daralma nedeni ile meydana gelen yüksek titreşimli polifonik bir sestir. "Hışıltılı çocuk" içerisinde heterojen fenotipleri barındıran ve patofizyolojisi birbirinden ayrı bir grup hastalığı kapsayan kompleks bir durumdur. Hışıltının görüldüğü yaşa ve cinsiyete, atopik zemine ve hastanın taşıdığı risk faktörlerine göre üç farklı hışıltı fenotipi belirlenmiştir. Bunlar geçici erken hışıltı, atopik olmayan persistan hışıltı, atopik hışıltı (astım)dır. Erken çocukluk döneminde geçici ya da persistan hışıltının ayırımı önemli bir sorundur. Hayatın erken döneminde geçirilen hışıltı atakları daha sonra gelişebilecek astım açısından ilk bulgu olabileceği için, sütçocukluğu döneminde geçici veya persistan hışıltı ayırımının yapılması önemlidir. Fakat, küçük çocuklarda astım gelişimini öngören biyokimyasal veya genetik bir belirleyici yoktur. Hışıltı fenotiplerinin belirlenmesi ve tedavinin uygun bir biçimde düzenlenmesi hastalığın seyrini belirleyen en önemli yaklaşımdır.

Anahtar Kelimeler

Astım, Fenotip, Hışıltılı çocuk, Tanı, Tedavi

Kaynakça

• 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.
• Castro-Rodriguez JA, Garcia-Marcos L. Wheezing and Asthma in childhood: An epidemiology approach. Allergol Immunopathol (Madr) 2008;36:280-90.
• Tuncer A. Çocukluk çağında bronşial astma. Katkı Pediatri Dergisi: H.Ü.T.F 1997;18:712-23.
• Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J 1998;12:315-35.
• Tang EA,  Matsui E, Wiesch DG, Samet JM. Epidemiology of Asthma and Allergic Diseases. In Adkinson NF, Busse WW (eds). Middleton’s Allergy: Principles and Practice. China: Elsevier, 2011.
• Taussig LM, Wright AL, Holberg CJ, Halonen M, Morgan WJ, Martinez FD. Tucson Children’s Respiratory Study:1980 to present. J Allergy Clin Immunol 2003;111:661-75.
• Castro-Rodriguez JA, Holberg CJ, Morgan WJ, Wright AL, Martinez FD. Increased insidence of asthmalike symptoms in girls who become overweight or obese during the school years. Am J Respir Crit Care Med 2001;163:1344-9.
• Stein RT, Sherrill D, Morgan WJ, Holberg CJ, Halonen M, Taussig LM, et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 1999;354:541-5.
• Shen X, Bhargava V, Wodicka GR, Doerschuk CM, Gunst SJ, Tepper RS. Greater airway narrowing in immature than in mature rabbits during methacholine challenge. J Appl Physiol 1996;81:2637-43.
• Taussig LM. Wheezing in infancy: When is it asthma? Pediatr Pulmonol Suppl 1997;16:90-1.
• Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995;332:133-8.
• 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.
• Guilbert TW, Morgan WJ, Krawiec M, Lemanske RF Jr, Sorkness C, Szefler SJ, et al. The prevention of early asthma in kids study: design, rationale and methods for the Childhood Asthma Research and Education network. Control Clin Trials 2004;25:286-310.
• 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(4 Pt 1):1403-6.
• Martinez FD, Wright AL, Holberg CJ, Morgan WJ, Taussig LM. Maternal age as a risk factor for wheezing lower respiratory illnesses in the first year of life. Am J Epidemiol 1992;136:1258-68.
• Saglani S, Wilson N, Bush A. Should preschool wheezers ever be treated with inhaled corticosteroids? Semin Respir Crit Care Med 2007;28:272-85.
• Sekhsaria S, Alam M, Sait T, Starr B, Parekh M. Efficacy and safety of inhaled corticosteroids in combination with a long-acting beta2- agonist in asthmatic children under age 5. J Asthma 2004;41:575- 82.
• Tasche MJ, Uijen JH, Bernsen RM, de Jongste JC, van der Wouden JC. Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma: A systematic review. Thorax 2000;55:913-20.
• Pelkonen AS, Malmström K, Sarna S, Kajosaari M, Klemola T, Malmberg LP, Mäkelä MJ. The effect of montelukast on respiratory symptoms and lung function in wheezy infants. Eur Respir J 2012 Jul 12. [Epub ahead of print].
• Pediatr 1998;133:608-12.
• Izquierdo-Alonso JL, de Miguel-Díez J. Economic impact of pulmonary drugs on direct costs of stable chronic obstructive pulmonary disease. COPD 2004;1:215-23.