Okul öncesi hışıltılı çocuk tedavisi ve izlemine güncel yaklaşım

Erken yaşta geçirilen hışıltı atakları ve havayolu hiperreaktivitesi daha sonra gelişebilecek astım açısından ilk bulgu olabilir. Bu nedenle bu hastalara uygulanacak tedavi yaklaşımı önemlidir. Tedavinin ilk ve en önemli basamağı primer korunma ve hastanın hastalığı hakkında eğitimidir. Epizodik (viral) ve çoklu-tetikleyicili hışıltının her ikisinde de atak tedavisinde ilk tercih edilmesi gereken ilaçlar β2 agonistlerdir. Bronkodilatatörler akut hışıltı ataklarında semptomatik rahatlama sağlarlar iken, oral kortikosteroidlerin ataklardaki yeri tartışmalıdır. Atak tedavisinde ailelerin oral kortikosteroid başlamaları önerilmemektedir. İdame tedavisinde, epizodik (viral) hışıltıda düşük-orta doz inhale kortikosteroidlerin (İKS) devamlı kullanımı etkisizdir. Ancak, çoklu tetikleyicili hışıltıda İKS'lerin yararlı etkileri bulunmaktadır. Çocuklarda yüksek doz inhale İKS'ler aralıklı kullanıldığında her iki hışıltı tipinde de etkili gibi görünmektedir. Fakat, kısa dönemde yüksek doz İKS'lerin büyüme üzerine olumsuz etkileri olması nedeni ile rutin olarak kullanımları önerilmemektedir. Lökotrien reseptör antagonistleri (LTRA) çoklu tetikleyicili çocuklarda önerilebilir. Antihistaminikler, ketotifen ve kromolinlerin hışıltılı çocuk tedavisinde yeri yoktur.

Current approach to treatment and follow-up of pre-school children with wheezing

Exacerbations of wheezing or airway hyperreactivity in early years of life might be the first sign of developing asthma. Therefore, management of these children is important. The first and the most important step of the management is the primary prevention against asthma with education of the patient and his caregivers. In acute exacerbation of wheezing the most preferred treatment should be β2-agonists for both of the episodic and multi-trigger wheezing. Bronchodilators provide symptomatic relief in acute wheezy episodes but the evidence for oral steroid usage is contraversial for children. Parent initiated oral steroid courses cannot be recommended. Although maintenance treatment with low to moderate continuous inhaled corticosteroids (ICS) in pure episodic (viral) wheeze is ineffective, it has beneficial effects in multi-trigger wheezing. High dose ICS used intermittently are effective in children with both of the wheezing types, but this is associated with short term effects on growth and cannot be recommended as a routine. Leucotrien receptor antagonists (LTRA) might be recommended as continuous treatment for children with multi-trigger wheezing. Antihistamines, ketotifen and cromolyns do not have a role in management of wheezing in children.

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Başlangıç: 2003
Yayıncı: Erkan Mor

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