Beyhan KÜÇÜKBAYRAK, KORAY HARMANCI, Gülşen KÖSE, Hülya ANIL

Orta-Ağır Akut Astım Atağı ile Başvuran 6-16 Yaş arası Çocuklarda Montelukastın Etkinliğinin Belirlenmesi

Öz: Bu çalışmanın amacı orta veya ağır şiddette astım atağı ile başvuran 6-16 yaşlar arasındaki hastalardaki solunum parametrelerine (retraksiyon, astım atak skoru, pozitif ekspirasyon akış hızı, dispne parametreleri, oskültasyon bulguları) montelukastın etkisini araştırmaktır. Çalışmamıza orta ve ağır şiddette akut astım atağı ile başvuran 30 astımlı çocuk dahil edildi. Çalışma; randomize, çift kör, plasebo kontrollü, paralel bir incelemedir. Tüm hastalara başlangıç tedavisi olarak nebulize salbutamol All patients were given nebulized salbutamol (0.15 mg/kg), ipratropium bromid (250 mcg/doz), oral metilprednizolon (1 mg/kg) ve oksijen verildi. Bu tedavilere ek olarak Grup I’deki hastalara 5 mg plasebo, Grup II’dekilere montelukast 5 mg oral olarak verildi. Ardından her iki gruba da 20 dakika aralarla 2 kez daha 0,15 mg/kg nebulize salbutamol ile 250 mcg/doz nebulize ipratropium bromür verildi. Hastalar 0., 20., 40., 60., 90., 120., 180. ve 240. dakikalarda respiratuar parametrelerle tedavi etkinliği açısından tekrar değerlendirildi. Çalışmaya dahil edilen çocukların yaşları 6,5 ile 16 arasında değişmekte ve ortanca yaş 9, erkek kız oranı eşitti. Grup I’de hastaların median yaşı 9,5 yaş, erkek kız oranı 0.87 idi. Grup II’de hastaların median yaşı 9 yaş, erkek kız oranı 1.14 idi. Tedavi öncesi gruplar arasında çalışma parametreleri arasında anlamlı fark bulunmadı (p > 0.05). Bununla birlikte grup-II’deki ortalama solunum parametrelerindeki düzelme oranı grup-I’e göre daha yüksek bulundu. Grup II’deki hastaların astım atak skorlarındaki düzelme tüm dakikalarda diğer gruba göre daha yüksekken, aradaki fark istatistiksel olarak anlamlı değildi (p > 0.05). Montelukastın 6-16 yaş arası orta veya ağır şiddette astım atağı ile başvuran çocuklarda kullanımında PEFR’de ve astım atak skorlarının düzelmesinde etkili olduğu saptanmıştır.

Anahtar Kelimeler:

Akut astım, anti-astmatik ilaçlar, çocuklar

The Effects of Montelukast in Children Between 6-16 Years with Moderate-Severe Acute Asthma Attack

Abstract: The aim of this study is to evaluate the effect to respiratory parameters (retraction, asthma attack score-AAS, positive expiratory flow rate- PEFR-, dispnea parameters, auscultation) of montelukast in children aged between 6-16 years admitted with moderate or severe acute asthma attacks. In this study, thirty children presented with moderate or severe asthma attack were evaluated. The study is a randomized, double blind, placebo-controlled parallel trial. The patients were randomly divided into two groups. All patients were given nebulized salbutamol (0.15 mg/kg), ipratropium bromide (250 mcg/doz), 1 mg/kg of oral methyl prednisolone and O2 as initial treatment. In addition to these medications, the placebo of montelukast 5 mg was given orally in the Group I, and montelukast 5 mg drug was given orally to the patients in the Group II. Then, additional 0.15 mg/kg nebulized Salbutamol and 250 mcg/dosage Ipratropium bromides were given twice with 20 minute interval. Besides, the patients were evaluated at 0., 20., 40., 60., 90., 120., 180., and 240. minutes for the criteria of therapeutic response such as respiratory parameters. The mean age of children in the study group was 9 (between 6.5-16), male to female ration (M/F) was 1. In the first group, mean age 9.5, M/F:0.87. Median age was 9 and (M/F) was 1.14 in Group II. No significant difference was determined between groups in terms of respiratory parameters. Nevertheless, the average rate of improvements in the respiratory parameters in group II was higher than group I. The rates of improvement in the average scores at every evaluation times were higher in the group II in comparison with the group I. However, the differences between the groups at every evaluation time were not significant statistically (p>0.05). The use of montelukast in children aged between 6-16 years with acute asthma exacerbation seems to be effective in improvement of respiratory parameters, especially in PEFR and AAS.

Keywords:

Acute asthma, anti-asthmatic agents, children,

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