Kronik Öksürük Şikayeti ile Çocuk Göğüs Hastalıkları Polikliniğine Başvuran Hastaların Değerlendirilmesi

Amaç: Çocuklarda dört haftadan uzun süren öksürük kronik öksürük olarak adlandırılmaktadır. Bu çalışmada kronik öksürüğün altta yatan nedenlerinin saptanması amaçlandı. Gereç ve Yöntemler: Bu çalışmaya kronik öksürük nedeniyle 27 Aralık 2021- 30 Haziran 2022 tarihleri arasında Şanlıurfa Eğitim ve Araştırma Hastanesi Çocuk Göğüs Hastalıkları Polikliniğine başvuran 0-18 yaş arası hastalar dahil edildi.Bilinen kistik fibrozis, primer silyer diskinezi, interstisyel akciğer hastalığı, astım, bronkopulmoner displazi tanısı olan hastalar çalışma dışı bırakıldı. Kronik öksürüğe yaklaşımda “CHEST Guideline and Expert Panel Report” kılavuzu örnek alındı. Bulgular: Çalışmaya 153 hasta dahil edildi. Bu çalışmada kronik öksürüğün en sık nedenleri astım (%30.7), uzamış bakteriyel bronşit (%20.3), üst solunum yolu öksürük sendromu (%11.1) olarak sıralandı. Kronik öksürük olan hastaların %60.8’inde ıslak öksürüğün mevcut olduğu, ıslak öksürüğü olan hastalarda ise en sık tanıların uzamış bakteriyelbronşit (%33.3), pnömoni ve diğer akciğer enfeksiyonları (tüberküloz ve kist hidatik) (%17.2) ve bronşektazi (%12.9) olduğu görüldü. Kuru öksürüğü olan hastalarda ise en sık tanılar astım (%68.3), üst solunum yolu öksürük sendromu (%6.7) ve doğal iyileşme (%6.7) olarak sıralandı. Islak öksürük olan hastalarda kilo alamama şikayeti kuru öksürük olan hastalara göre daha belirgin iken (p<0.030) ateş, kilo kaybı ve desaturasyon sadece ıslak öksürük olan hastalarda mevcuttu. Sonuç: Kronik öksürüğün en sık nedenleri astım, uzamış bakteriyel bronşit, üst solunum yolu öksürük sendromudur. Kronik öksürüğü olan hastalarda dikkatli fizik muayene ve rehberlerin önerileri doğrultusunda yapılan tetkikler ile hastalara tanı konulup tedavi kararı verilmelidir.

Anahtar Kelimeler:

astım, çocuk, kronik öksürük, pnömoni, Bronşit

Evaluation of Patients with Chronic Cough Referred to Pediatric Pulmonology Outpatient Clinic

Objective: A cough that lasts longer than four weeks in children is called chronic cough. The aim of this study is to determine the underlying causes of chronic cough. Material and Methods: Patients aged 0-18 years who were referred to Şanlıurfa Training and Research Hospital pediatric pulmonology outpatient clinic between 27 December 2021 and 30 June 2022 due to chronic cough were enrolled. Patients with known cystic fibrosis, primary ciliary dyskinesia, interstitial lung disease, asthma, bronchopulmonary dysplasia were excluded from the study. The “CHEST Guideline and Expert Panel Report” guideline was used in the approach to chronic cough. Results: 153 patients were included in this study. The most common causes of chronic cough were asthma (30.7%), protracted bacterial bronchitis (20.3%), and upper respiratory tract cough syndrome (11.1%). Wet cough was present in 60.8% of the patients with chronic cough and the most common diagnosis in patients with wet cough were protracted bacterial bronchitis (33.3%), pneumonia and other lung infections (17.2%) and bronchiectasis (12.9%). The most common diagnoses were asthma (68.3%), upper airway cough syndrome (6.7%), and natural recovery (6.7%) in patients with dry cough. Failure to thrive was more common in patients with wet cough than patients with dry cough (p<0.030) and fever, weight loss and desaturation were only present in patients with wet cough. Conclusion: The most common reasons are asthma, protracted bacterial bronchitis and upper airway cough syndrome. The differential diagnosis should be made by pediatricians based on specific cough pointers, careful physical examination and tests performed in line with the recommendations of the guidelines.

Keywords:

asthma, child, chronic cough, pneumonia, Broncitis,

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Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest 2006;129: 260-83.
Singh D, Arora V, Sobti PC. Chronic/recurrent cough in rural children in Ludhiana, Punjab. Indian Pediatr 2002; 39: 23–29.
Leonardi GS, Houthuijs D, Nikiforov B, Volf J, Rudnai P, Zejda J, et al. Respiratory symptoms, bronchitis and asthma in children of Central and Eastern Europe. Eur Respir J 2002; 20: 890–98.
Pan G, Zhang S, Feng Y, Takahashi K, Kagawa J, Yu L, et al. Air pollution and children’s respiratory symptoms in six cities of Northern China. RespirMed 2010; 104: 1903–11.
Chow PY, Ng DK. Chronic cough in children. Singapore Med J. 2004;45:462-8.
Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Weir K, Grant CC, CHEST Expert Cough Panel. Use of Management Pathways or Algorithms in Children With Chronic Cough: CHEST Guideline and Expert Panel Report. Chest 2017;151:875–83.
Marchant J, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB, et al. Evaluation and outcome of young children with chronic cough. Chest 2006; 129:1132-41.
Global Initiative for Asthma. GINA report, global strategy for asthma management and prevention. Updated 2022. Available at: www.ginasthma.org.
Asilsoy S, Bayram E, Agin H, Apa H, Can D, Gulle S, et al. Evaluation of chronic cough in children. Chest 2008;134:1122-8.
Shields MD, Bush A, Everard ML, McKenzie S, Primhak R, British Thoracic Society Cough Guideline Group. Recommendations for the assessment and management of cough in children BTS guidelines. Thorax 2008;63:3-15.
Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group. British Thoracic Society Guideline for non-CF bronchiectasis. Thorax 2010;65:1–58.
Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, et al. Cough in children: definitions and clinical evaluation. Med J Aust 2006;184:398–403
Pedük Y. Çocuklarda kronik öksürük nedenlerinin değerlendirilmesi. (Uzmanlık tezi). Trabzon, Karadeniz Teknik Üniversitesi, 2013.
Ilarslan N, Gunay F, Haskologlu ZS, Bal SK, Tezcaner ZC, Kirsaclioglu CT, et al. Evaluation of children with chronic cough including obstructive sleep apnea: a single-center experience. Eur J Pediatr2019;178:189–97.
Chang AB, Robertson CF, Van Asperen PP, Glascow NJ, Masters IB, Teoh L, et al. A cough algorithm for chronic cough in children: a multicenter, randomized controlled study. Pediatrics 2013;131:e1576–83.
Karabel M, Kelekci S, Karabel D, Gurkan MF. The evaluation of children with prolonged cough accompanied by American College of Chest Physicians guidelines. Clin Respir J 2014;8:152–9.
Gedik AH, Cakir E, Torun E, Demir AD, Kucukkoc M, Erenberk U, et al. Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm. Ital J Pediatr 2015;41:73.