Hışıltılı Çocuğa Yaklaşım

Hışıltı, alt havayollarında oluşan daralma nedeni ile meydana gelen yüksek titreşimli polifonik bir sestir. "Hışıltılı çocuk" içerisinde heterojen fenotipleri barındıran ve patofizyolojisi birbirinden ayrı bir grup hastalığı kapsayan kompleks bir durumdur. Hışıltının görüldüğü yaşa ve cinsiyete, atopik zemine ve hastanın taşıdığı risk faktörlerine göre üç farklı hışıltı fenotipi belirlenmiştir. Bunlar geçici erken hışıltı, atopik olmayan persistan hışıltı, atopik hışıltı (astım)dır. Erken çocukluk döneminde geçici ya da persistan hışıltının ayırımı önemli bir sorundur. Hayatın erken döneminde geçirilen hışıltı atakları daha sonra gelişebilecek astım açısından ilk bulgu olabileceği için, sütçocukluğu döneminde geçici veya persistan hışıltı ayırımının yapılması önemlidir. Fakat, küçük çocuklarda astım gelişimini öngören biyokimyasal veya genetik bir belirleyici yoktur. Hışıltı fenotiplerinin belirlenmesi ve tedavinin uygun bir biçimde düzenlenmesi hastalığın seyrini belirleyen en önemli yaklaşımdır.

Anahtar Kelimeler:

Astım, Fenotip, Hışıltılı çocuk, Tanı, Tedavi

Management of Wheezy Infant

Wheezing is a high pitched polyphonic sound which occurred as a result of narrowing of the lower airways. The ‘wheezy infant’ is a complex situation which includes heterogen phenotypes and a group of diseases with different pathophysiological mechanisms. Three different wheezing phenotypes are defined according to age and sex of children, atopic backgroud, and patients’ risk factors. These 3 phenotypes are ‘transient early wheezing’, ‘non-atopic persistant wheezing’, and ‘atopic wheezing’ (asthma). Because the wheezing episodes seen in early years of life that might be the first sign of developing asthma, it is important to discriminate transient or persistant wheezing in infancy. Unfortunately, there are not any biochemical or genetic markers which can be used to predict the development of asthma in small children. Therefore, description of phenotypes of wheezing and establishment of appropriate treatment modalities are the most important approach to determine the progress of the disease

Keywords:

Asthma, Phenotype, Wheezy infant, Diagnosis, Treatment,

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