Astımda atak tedavisi

Astım, kolayca tanınabilen klinik bulgu ve semptomları olan, inflamatuvar bir hastalıktır. Astım atağı, astımlı bir hastada hızla ilerleyen nefes darlığı, öksürük, hışıltı ve göğüste baskı hissi yakınmalarının varlığı ve ekspiratuvar hava akımında azalmayı yansıtan zirve akım hızı (PEF) ve 1. saniyedeki zorlu ekspiratuvar volum (FEV1) gibi solunum fonksiyon testi (SFT) parametrelerinin ölçümü ile tanınır. Bu yazıda GINA rehberi temel alınarak ağırlıklı olarak astım atağının tedavisi anlatılacaktır.
Anahtar Kelimeler:

Astım, Çocuk, Anti-astmatik ajanlar

Management of asthma attack

Asthma is an inflammatory disease with easily recognized clinical signs and symptoms. Exacerbation of asthma is defined as rapidly progressive increase in shortness of breath, cough, wheezing, or chest tightness and a decrease in expiratory airflow that can be qualified by measurement of pulmonary function tests such as the peak expiratory flow (PEF) and forced expiratory volume in 1 second (FEV1). This review mainly focuses on the treatment of acute asthma considering the recommendations of GINA guideline.

Kaynakça

1. National Heart, Lung, and Blood Institute (NHLBI). National Asthma Education and Prevention Program (NAEPP). Guidelines for the Diagnosis and Managernent of' Asthma. National Institutes of Health (NIH) publication 97-4053, April 1997.

2. Global Initiative for Asthma, Global Strategy for asthma management and prevention. National Institutes of Health (2005) NIH publication no. 02–3659.

3. Geelhoed GC, Landau LI, Le Souef PN. Evaluation of SaO2 as a predictor of outcome in 280 children presenting with acute asthma. Ann Emerg Med 1994; 23:1236-1241.

4. FitzGerald JM, Grunfeld A. Status asthmaticus. In: Linchtenstein LM, Fauci AS, editors. Current Therapy in Allergy, Immunology and Rheumatology. 5th ed. St. Jouis, MO: Mosby; 1996;63-67.

5. Gershel JC, Goldman HS, Stein RE, Shelov SP, Ziprkowski M. The usefulness of chest radiographs in first asthma attack. N Engl J Med 1983;309:336-339.

6. Chien JW, Ciufo R, Novak R, et al. Uncontrolled oxygen administration and respiratory failure in acute asthma. Chest 2000;117:728-733.

7. Edmonds ML, Camargo CA Jr, Pollack CV Jr, Rowe BH. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database Syst Rev 2003;CD002308.

8. Turner MO, Patel A, Ginsburg S, FitzGerald JM. Bronchodilator delivery in acute airflow obstruction. A meta-analysis. Arch Intern Med 1997;157:1736-1744.

9. Covar RA, Spahn JD. Treating the wheezing infant. Pediatr Clin North Am 2003;50:631-654.

10. Shrestha M, Bidadi K, Gourlay S, Hayes J. Continuous vs intermittent albuterol at high and low doses in the treatment of severe acute asthma in adults. Chest 1996;110:42-47.

11. Rudnitsky GS, Eberlein RS, Schoffstall JM, et al. Comparison of intermittent and continuously nebulized albuterol for treatment of asthma in an urban emergency department. Ann Emerg Med 1993;22:1842-1846.

12. Rudnitsky GS, Eberlein RS, Schoffstall JM, Mazur JE, Spivey WH. Continuous versus intermittent albuterol nebulization in the treatment of acute asthma. 13. Ann Emerg Med 1993;22:1847-1853.

13. Reisner C, Kotch A, Dwarkin G. Continuous versus frequent intermittent nebulization of albuterol in acute asthma: a randomized, prospective study. Ann Allergy Asthma Immunol 1995;75:41-47.

14. Bohn D, Kissoon N. Acute asthma. Pediatr Crit Care Med 2001;2:151-163.

15. Cates C, FitzGerald JM, O’Byrne PM. Asthma. Clin Evidence 2000;3:686-700.

16. Rodrigo G, Rodrigo C, Burschtin O. A meta-analysis of the effects of ipratropium bromide in adults with acute asthma. Am J Med 1999;107:363-370.

17. Plotnick LH, Ducharme FM. Should inhaled anticholinergics be added to β2 agonists for treating acute childhood and adolescent asthma ? A systematic review BMJ 1998;317:971-977.

18. Lanes SF, Garrett JE, Wentworth CE 3rd, Fitzgerald JM, Karpel JP. The effect of adding ipratropium bromide to salbutamol in the treatment of acute asthma: a pooled analysis of three trials. Chest 1998;114:365-372.

19. Rodrigo GJ, Rodrigo C. First line therapy for adult patients with acute asthma receiving a multiple dose protocol of ipratropium bromide plus albuterol in the emergency department. Am J Respir Crit Care Med 2000;161:1862-1868.

20. Craven D, Kercsmar CM, Myers TR, O'riordan MA, Golonka G, Moore S. Ipratropium bromide plus nebulized albuterol for the treatment of hospitalized children with acute asthma. J Pediatr 2001;138:51-58.

21. Goggin N, Macarthur C, Parkin PC. Randomized Trial of the Addition of Ipratropium Bromide to Albuterol and Corticosteroid Therapy in Children Hospitalized Because of an Acute Asthma Exacerbation. Arch Pediatr and Adoles Med 2001;155:1329-1334.

22. Lipworth BJ. Treatment of acute asthma. Lancet. 1997; 350:SII18-23.

23. Lemanske RF Jr, Busse WW. 6. Asthma: Factors underlying inception, exacerbation, and disease progression. J Allergy Clin Immunol 2003;111:502-519.

24. Ratto D, Alfaro C, Sipsey J, Glovsky MM, Sharma OP . 25. Are intravenous corticosteroids required in status asthmaticus ? JAMA 1988;260:527-529.

25. Harrison BD, Stokes TC, Hart GJ, Vaughan DA, Ali NJ, Robinson AA. Need for intravenous hydrocortisone in addition to oral prednisolone in patients admitted to hospital with severe asthma without ventilatory failure. Lancet 1986; 1:181-184.

26. Rachelefsky G. Treating exacerbations of asthma in children. The role of systemic corticosteroids. Pediatrics 2003;112:382-397.

27. Smith M, Iqbal S, Elliott TM, Everard M, Rowe BH. Corticosteroids for hospitalised children with acute asthma. Cochrane Database Syst Rev 2003;CD002886.

28. American Academy of Allergy, Asthma and Immunology. AAAI Initiatives: Update on pediatric asthma: Promoting best practice 1999; Milwaukee,Wisconsin.

29. O'Driscoll BR, Kalra S, Wilson M, Pickering CA, Carroll KB, Woodcock AA. Double-blind trial of steroid tapering in acute asthma. Lancet 1993;341:324-327.

30. FitzGerald JM, Shragge D, Haddon J, et al. A randomized, controlled trial of high dose, inhaled budesonide versus oral prednisone in patients discharged from the emergency department following an acute asthma exacerbation. Can Respir J 2000;7:61-67.

31. Foresi A, Morelli MC, Catena E. Low dose budesonide with the addition of increased dose during exacerbations is effective in long term asthma control. On behalf of the Italian Study Group. Chest 2000;117:440-446.

32. Edmonds ML, Camargo CA Jr, Pollack CV Jr, Rowe BH. The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: a meta-analysis. Ann Emerg Med 2002;40:145-154.

33. Nuhoglu Y, Bahceciler NN, Barlan IB, Başaran M. The effectiveness of high-dose inhaled budesonide therapy in the treatment of acute asthma exacerbations in children. Ann Allergy Asthma Immunol 2001;86:318-322.

34. Nannini LJ Jr, Pendino JC, Corna RA, Mannarino S, Quispe R. Magnesium sulphate as a vehicle for nebulized salbutamol in acute asthma. Am J Med 2000;108:193-197.

35. Parameswaran K, Belda J, Rowe BH. Addition of intravenous aminophylline to beta2-agonists in adults with acute asthma. Cochrane Database Syst Rev 2000;4.

36. Mitra A. The current role of intravenous aminophylline in acute paediatric asthma. Minerva Pediatr 2003;55:369-375.

37. Yung M, South M. Randomised controlled trial of aminophylline for severe acute asthma. Arch Dis Child. 1998;79:405-410.

38. Gupta VK, Cheifetz IM. Heliox administration in the pediatric intensive care unit: An evidence-based review. Pediatr Crit Care Med 2005; 6:204–211.

39. Kudukis TM, Manthous CA, Schmidt GA, et al. Inhaled helium–oxygen revisited: effect of inhaled helium– oxygen during the treatment of status asthmaticus in children. J Pediatr 1997; 130:217–224.

40. NAEPP Expert Panel Report Guidelines for the Diagnosis and Management of Asthma-Update on Selected Topics 2002, NIH Publication No. 97-4051.

Kaynak Göster