Ünal ULUCA, Özlem KESKİN, Bülent GÖGEBAKAN, Sinan BALABAN, Mehmet KESKİN, Ercan KÜÇÜKOSMANOĞLU

Çocuklarda akut astım atağı tedavisinde sistemik ve yüksek doz inhale kortikosteroidlerin erken ve geç dönem etkinliğinin karşılaştırılması

Amaç: Bu çalışmada akut astım atağı ile başvuran ço- cuklarda sistemik steroidler ile yüksek doz inhale steroid- lerin etkinliğinin karşılaştırılması amaçlandı. Gereç ve yöntem: Akut astım atağı ile gelen çocuklar randomize olarak iki gruba ayrıldı. Hastalara 1 mg/kg oral yoldan metilprednisolon (Sistemik Steroid Grubu, Grup 1, n=27) veya bir kez 4000 μg inhale flutikazon (İnhale Steroid Grubu, Grup 2, n=35) verildi. Tedaviyi izleyen birer saat aralıklarla dört saat boyunca astım skoru, birinci saniyede üflenen zorlu ekspiratuar hacim (FEV1) ve zirve ekspiratuar akım (PEF) değerleri ölçüldü. Birincil sonuç hastaneye yatış oranı, ikincil sonuçlar ise astım skoru, FEV1 ve PEF sonuçları ve oksijen saturasyonu ile değerlendirildi. Bulgular: Hastaların geliş anı ile tedavinin dördüncü saati ve hastaların rahat olduğu dönemde PEF değerleri Grup 1’de sırasıyla, 173, 223, 220 L/dk (p

The comparison of early and late effectiveness of systemic and high dose inhaled glucocorticoids in the management of acute asthma attacks in children

Objective: In this study it was aimed to compare effec- tiveness of systemic steroids and inhaled corticosteroids in children who applied with acute asthmatic attack. Materials and methods: Children with acute asthmatic at- tack were randomly allocated to two groups; 1 mg/kg per oral methylprednisolone was given to Group 1 (Systemic steroid group, n=27), and 4000 μg inhaled fluticasone to Group 2 (Inhaled steroid group, n=35). Following treat- ment patients were evaluated for four hours, at one-hour intervals by asthma score, forced expiratory volume in first-second (FEV1) and peak expiratory flow (PEF). Pri- mary outcome of this study was the rate of hospital admis- sions and secondary outcome were asthma score, FEV1, PEF and oxygen saturation. Results: Significant improvements were obtained in mea- sured parameters in both Group 1 and Group 2. Values of measured parameters at hospital admission, 4th hour of treatment and while patients were in comfort were as fol- low: PEF values (Group 1: 173, 223, 220 L/min, p <0.001): Group 2 113, 141 , 192 L/min, p <0.001); FEV 1 (Group 1: 74.9%, 89.5%, 85.6%, p <0.0001; Group 2: 96, 89.8, 93.2 %, p <0.0001); O2 saturation (Group 1:93.2%, 95.6%, 96.8%, p <0.0001, Group 2: 93%, 95.2%, 96.6%, p<0.001); and asthma score (Group 1: 9.4, 6.6, 5.7, p<0.001, Group 2: 9.3, 6.8, 6.5, p<0.001). In all measured parameters significant improvements were observed with treatment modalities within both groups. No significant differences were found in all parameters between Group 1 and Group 2 (p>0.05). Conclusion: No significant differences were found in asth- ma score, FEV 1 and PEF parameters between systemic high-dose methylprednisolone and inhaled fluticasone treatment modalities in acute asthmatic attacks of children.

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