Figen GÜLEN, Esen DEMİR, Ezgi ULUSOY SEVERCAN, Raziye Burcu GÜVEN BİLGİN, Remziye TANAÇ

Atipik hışıltılı çocuklarda erken tanı prognozu etkilemektedir

Amaç: Tekrarlayan hışıltı atakları çocuklarda okul öncesi dönemde en sık karşılaşılan durumlardan biridir. Hışıltı birçok neden sonucunda ortaya çıkabilecek bir durum olması nedeniyle tipik ve atipik hışıltı olmak üzere iki gruba ayrılmıştır. Çalışmamızda kliniğimiz tarafından izlenen atipik hışıltılı çocukların genel özelliklerinin ortaya konulması amaçlanmıştır.Gereç ve Yöntemler: Alerji kliniğine 2000-2015 yılları arasında üç ve daha fazla hışıltı nedeniyle başvurup izleminde bronşektazi, yabancıisim aspirasyonu, tekrarlayan aspirasyon pnömonisi, kistik fibrozis, bronkopulmoner displazi, doğuştan anomaliler, tüberküloz gibi altta yatan bir hastalık saptanmış olan 302 hasta çalışmaya alınarak değerlendirilmiştir.Bulgular: Çalışmamızda hastaların 127’si (%42,1) kız, 175’i (%57,9) erkekti. Hastaların etiyolojik tanı dağılımını; bronkopulmoner displazi (%21,9), bronşiolitis obliterans (%16,6), bronşektazi (%14,5), bronşiolitis obliterans + primer immün yetmezlik (%12,3), kistik fibrozis (%10,3), bronşektazi + primer immün yetmezlik (%7,9), tekrarlayan aspirasyon pnömonisi (%3,6), yabancı cisim aspirasyonu (%3,3) ve diğer hastalıklar (%9,6) oluşturmaktaydı. Yüksek rezolüsyonlu akciğer tomografisinde mozaikoligemi, bronşektazi, atelektazi, bronşiolektazi ve küçük hava yolu hastalığı en belirgin bulgulardı. Hastaların ortalama 40 ay süreli izlemleri sonucunda klinik, radyolojik ve solunum işlevlerine göre %9,2’sinde kötüleşme, %33,9’unda gerileme olduğu %56,7’sinin stabil kaldığı gözlendi. Bronşiolitis obliterans, bronşiolitis obliterans + primer immün yetmezlik ve bronkopulmoner displazili hastalarda üçüncü hışıltıdan sonra hastaneye başvuru bronşektazi, bronşektazi + primer immün yetmezlik ve kistik fibrozlu hastalara göre daha erkendi. Başvuru süreleriyle son izlem sonuçları karşılaştırıldığında 0–6 ayda başvuran hastalarda bulgularda gerileme %63,4 iken geç başvuranlarda (5 yıldan sonra) gerileme %7,5 olarak saptandı.Çıkarımlar: Sonuç olarak tekrarlayan hışıltısı olan çocuklar atipik hışıltı nedenleri açısından araştırılmakta gecikilmemelidir. Erken tanı ve tedavi prognozda etkilidir.

Early diagnosis effects the prognosis in children with atypical wheeze

Aim: Recurrent wheezing is a common problem in preschool children.It is classified into two groups because there can be many reasons forwheeze: typical and atypical. The aim of this study was to identify thegeneral features of atypical wheezy children.Material and Methods: Three hundred two children who presented toour clinic between 2000 and 2015 for three or more wheezing attacksand were diagnosed as having an underlying disease such as bronchiectasis, foreign body aspiration, recurrent aspiration pneumonia, cystic fibrosis, bronchopulmonary dysplasia, congenital anomalies, and tuberculosis, were included in the study.Results: In this study, 127 (42.1%) girls and 175 (57.9%) boys were evaluated. The diagnostic distribution of the patients was as follows: bronchopulmonary dysplasia (21.9%), bronchiolitis obliterans (16.6%), bronchiectasis (14.5%), bronchiolitis obliterans + primary immunodeficiency (12.3%), cystic fibrosis (10.3%), bronchiectasis + primary immunodeficiency (7.9%), recurrent aspiration pneumonia (3.6%) and foreign body aspiration (3.3%), and other diseases (9.6%). Mosaic oligemia, bronchiectasis, atelectasis, bronchiolectasis, and small airway disease were the most distinct findings on high-resolution lung tomography. When the patients were evaluated clinically, radiologically, and according to pulmonary functions after an average period of 40 months, it was seen that 9.2% deteriorated, 33.9% regressed, and 56.7% remained stable. Presentation to hospital after the first attack occurred earlier in patients with bronchopulmonary dysplasia, bronchiolitis obliterans and bronchiolitis obliterans + primary immunodeficiency compared with patients with bronchiectasis, bronchiectasis + primary immunodeficiency, and cystic fibrosis. When presentation time and outcomes were evaluated, it was found that 63.4% of patients who presented to hospital early (0–6 months) and 7.5% of patients who presented late (after 5 years) had regression.Conclusion: Recurrent wheezy children must be promptly evaluated for an underlying disease. Early diagnosis and treatment influence the prognosis.

PDF

___

El-Gamal YM, El-Sayed SS. Wheezing in infancy. World Allergy Organ J 2011; 4: 85–90.
Brown MA, von Mutius E, Morgan WJ. Clinical assessment and diagnostic approach to common problems. In: Taussig, LM, Landau LI, Le Souef PM, Martinez FD, Morgan WJ, Sly PD, editors. Pediatric respiratory medicine. Vol. 2nd edition. Philadelphia: Mosby Elsevier; 2008.p.112– 3.
Süleyman A, Güler N. Hışıltılı çocuğa güncel yaklaşım. J Turk Fam Physician 2011; 1: 4–10.
Alper Gürz A, Artıran İğde FA, Dikici MF, Yarış F. Approach to Wheezy Infant In Primary Care. Turk J Fam Med 2013; 7: 18–25.
Tanaç R. Hışıltılı çocukta tanı ve ayırıcı tanı (Hangisi Astım?). Güncel Pediatri 2005; 71: 12–4.
VanDevanter DR, Kahle JS, O’Sullivan AK, Sikirica S, Hodgkins PS. Cystic fibrosis in young children: A review of disease manifestation, progression, and response to early treatment. J Cyst Fibros 2016; 15: 147–57.
Fitzgerald DA, Shapiro AJ. When to suspect primary ciliary dyskinesia in children. Paediatr Respir Rev 2016; 18: 3–7.
Dehlink E, Hogg C, Carr SB, Bush A. Clinical phenotype and current diagnostic criteria for primary ciliary dyskinesia. Expert Rev Respir Med 2016; 10: 1163–75.
Dodge JA. A millennial view of cystic fibrosis. Dev Period Med 2015; 19: 9–13.
Davidson LM, Berkelhamer SK. Bronchopulmonary Dysplasia: Chronic Lung Disease of Infancy and Long-Term Pulmonary Outcomes. J Clin Med 2017; 6: 4.
Shapiro AJ, Zariwala MA, Ferkol T, Davis SD, Sagel SD, Dell SD, et al. Diagnosis, monitoring, and treatment of primary ciliary dyskinesia: PCD foundation consensus recommendations based on state of the art review. Pediatr Pulmonol 2016; 51: 115–32.
Lucas JS, Paff T, Goggin P, Haarman E. Diagnostic Methods in Primary Ciliary Dyskinesia. Paediatr Respir Rev 2016; 18: 8–17.
Fitzgerald DA, Shapiro AJ. When to suspect primary ciliary dyskinesia in children. Paediatr Respir Rev 2016; 18: 3–7.
Yu J. Postinfectious bronchiolitis obliterans in children: lessons from bronchiolitis obliterans after lung transplantation and hematopoietic stem cell transplantation. Korean J Pediatr 2015; 58: 459–65.
Tomikawa SO, Rodrigues JC. Current research on pediatric patients with bronchiolitis obliterans in Brazil. Intractable Rare Dis Res 2015; 4: 7–11.
Pekcan S, Özçelik U. Bronşiyolitis obliterans. Hacattepe Tıp Dergisi 2008; 39: 16–21.
Redding GJ. Bronchiectasis in children. Pediatr Clin North Am 2009; 56: 157–71.
Al Subie H, Fitzgerald DA. Non-cystic fibrosis bronchiectasis. J Paediatr Child Health 2012; 48: 382–8.
Chang AB, Redding GJ, Everard ML. Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatr Pulmonol 2008; 43: 519–31.
Twiss J, Metcalfe R, Edwards E, Byrnes C. New Zealand national incidence of bronchiectasis “too high” for a developed country. Arch Dis Child 2005; 90: 737–40.
Jesenak M, Banovcin P, Jesenakova B, Babusikova E. Pulmonary manifestations of primary immunodeficiency disorders in children. Front Pediatr 2014; 2: 77.
Haidopoulou K, Calder A, Jones A, Jaffe A, Sonnappa S. Bronchiectasis secondary to primary immunodeficiency in children: longitudinal changes in structure and function. Pediatr Pulmonol 2009; 44: 669–75.
Bastardo CM, Sonnappa S, Stanojevic S, et al. Non-cystic fibrosis bronchiectasis in childhood: longitudinal growth and lung function. Thorax 2009; 64: 246–51.
Kapur N, Masters IB, Chang AB. Longitudinal growth and lung function in pediatric non-cystic fibrosis bronchiectasis: what influences lung function stability? Chest 2010; 138: 158–64.
Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Pediatric bronchiectasis: No longer an orphan disease. Pediatr Pulmonol 2016; 51: 450–69.
Cazzato S, Poletti V, Bernardi F, et al. Airway inflammation and lung function decline in childhood post-infectious bronchiolitis obliterans. Pediatr Pulmonol 2008; 43: 381–90.
Zhang L, Irion K, Kozakewich H, et al. Clinical course of postinfectious bronchiolitis obliterans. Pediatr Pulmonol 2000; 29: 341–50.