Persistan rinitli çocuklarda bronş aşırı duyarlılığını saptamak için metakolin challenge testinin kullanımı

Amaç: Çocukluk çağında persistan rinit sıklığı gün geçtikçe artmaktadır. Persistan rinitli hastaların önemli bir kısmında bronşial hiperrekativite (BHR) ve astım görülebildiğinden, bu hastalarda astım gelişme riskini gösterebilecek olan belirteçlerin kullanılması klinik takipte çok önemlidir. Bu çalışmada çocukluk çağındaki persistan rinit astım ilişkisinin bronşial methacoline challenge testi (BMCT) kullanılarak gösterilmesi ve persistan rinitli hastalarda astım gelişme riskiyle ilişkili diğer faktörlerin araştırılması amaçlanmıştır. Gereç ve Yöntem: Persistan rinit bulguları olan 6-18yaş arası hastalar ayrıntılı öykü, fizik muayene, spirometriyle değerlendirildi. Muayene bulguları ve spirometri bulguları normal olan hastalar ile muayene bulguları ve nazal inflamasyon bulguları orta-ağır rinitle uyumlu hastalar çalışmaya alındı ve cilt prik testiyle atopi durumları, BMCT yapılarak BHR’leri değerlendirildi. Bulgular: Çalışmaya 73 hasta alındı. Yaş ortalaması 9±2,7yıl olarak bulundu. Hastaların %45,2’sinin erkek, %63’ü alerjik, %45,2’sinde ailede atopi öyküsü olduğu saptandı. BMCT ile hastaların %82,2Sinde BHR tespit edildi. BHR saptanan hastaların %24,7’sinde şiddetli; %32,9’unda orta, %24,7’sinde hafif derecede BHR olduğu gözlendi. Ortanca kan eosinofil sayısı (BEC) 320/mm3; IgE düzeyi 160 kU/ltidi. Alerjik hastaların, alerjik olmayanlara kıyasla IgE, BEC değerleri istatistiksel olarak anlamlı düzeyde yüksekti. BHR olan hastaların başvuru yaşı daha küçük, BEC daha yüksekti. Çoklu değişkenli analizde hasta yaşının <9 yıl; BEC >300/mm3 ve IgE düzeyinin >250IU/lt olması BMCT ile bronşial hiperreaktivite saptanma olasılığının arttığı gösterildi. Sonuç: Persistan rinit yakınması olan her hasta BHR ve astım gelişme riski açısından mutlaka izlenmelidir. Bu açıdan atopi tetkikleri yapılmalı ancak atopi saptanmasa da bu hastalaraki BHR ve astım gelişme olasılığı akılda tutulmalıdır.

Anahtar Kelimeler:

rinit, atopi, bronş provakasyon testi, bronşial hiperreaktivite, çocukluk, kan eosinofil sayısı

Use of methacoline challenge test to detect bronchial hyperresponsiveness in children with persistent rhinitis

Purpose: The incidence of persistent rhinitis in childhood is increasing day by day. Since bronchial hyperreactivity (BHR) and asthma can also be seen in a significant proportion of patients with persistent rhinitis, the use of markers that may indicate the risk of developing asthma in these patients is very important in clinical follow-up. In this study, it was aimed to demonstrate the relationship between persistent rhinitis and asthma in childhood using the bronchial methacoline challenge test (BMCT) and to investigate other factors associated with the risk of developing asthma in patients with persistent rhinitis. Materials and Methods: Patients aged 6-18 years who presented with findings of persistent rhinitis were evaluated with a detailed history, physical examination, and spirometry. Patients with normal examination findings and spirometry findings, and patients whose examination findings and nasal inflammation findings were compatible with moderate-to-severe rhinitis were included in the study, and their atopy status was evaluated by skin prick test, and their BHR was evaluated by BMCT. Results: Seventy-three patients were included in the study. The mean age was 9±2.7years, 45.2% of the patients were male. 63% of the patients were allergic and family history of allergy was present in 45.2% of the patients. 82.2% of the patients had BHR detected with BMCT. The median blood eosinophil count (BEC) was 320/mm3 and the IgE level was 160kU/L. Patients with atopy had statistically significantly higher IgE and BEC values compared with non-allergic patients. Patients with BHR were found to be younger, and had higher median BEC values. In multivariant analysis, it was observed that the patient's age<9 years, BEC values>300/mm3, and IgE levels>250IU/L increased the probability of detecting BHR with BMCT. Conclusion: Care should be taken for every patient with persistent rhinitis because of the risk of BHR and asthma. Atopy examinations should be performed, but the possibility of developing BHR and asthma should not be overlooked even in the patients who are non- allergic.

Keywords:

atopy, blood eosinophil count, bronchial challenge test, bronchial hyperreactivity, childhood, rhinitis,

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