Astım atağı olan çocuklarda oral metilprednizolon ile nebülize budesonidin etkinliğinin karşılaştırılması
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2005
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info:eu-repo/semantics/openAccess
Özet
Giriş: Astım atağı ile acil servise başvuran çocuklarda taburculuk sonrası oral metil prednizolon ve budesonid nebül tedavi seçeneği olarak tercih edilebilmektedir Bu çalışmanın amacı bu tedavi seçenekleri arasında fark olup olmadığını araştırmaktır. Gereç ve Yöntem: Çalışmaya 20 dakika ara ile 3 doz 0,15 mg/kg salbutamol nebül tedavisine yanıt vermeyen, 6-14 yaşları arasında 20 hasta alındı. Hastaların hepsine 3 gün süre ile 6x0,15 mg/kg/gün salbutamol nebül tedavisi uygulandı. 10 hastanın tedavisine 3 gün süre ile oral metilprednizolon 3x1mg/kg/gün (en çok 60mg/gün) (Grup 1), diğer hastaların tedavisine 3 gün süre ile 2x0,5mg/gün budesonid nebül eklendi (Grup 2). Bulgular: Her iki grup arasında yaş, cins, boy, ağırlık, hastalık süresi, atak sayısı, acile başvurduğu anda saptanan klinik parametreler ve astım bulguları yönünden bir fark yoktu (p>0,05). 0, 4, 8, 16, 24. saat, 3. ve 30. günlerde; astım skoru, pulmoner indeks, nabız ve solunum sayısı, öksürük, wheezing, PEF, arteriyel oksijen saturasyonu (SaO2 ), parsiyel arteriyel oksijen basıncı (PaO2), parsiyel arteriyel karbondioksit basıncı (PaCO2), FVC, FEV1, FEV1/FVC, FEF25-75, değerlendirildi. Hastalar taburcu edildikten 30 gün sonra tekrar değerlendirildi. Astım skoru, pulmoner indeks, solunum sayısı, öksürük ve wheezing'in düzelme süresi yönünden iki grup arasında anlamlı fark yoktu (p> 0,05). Nabız sayısı ise grup 1'de, grup 2'ye göre daha kısa sürede normal değerlere düştü (p<0,05). PEF, SaO2, PaO2 , PaCO2, FVC, FEV1, FEV1/FVC ve FEF25-75 deki düzelme; Grup 1'de daha belirgin olmasına rağmen, bu fark iki grup arasında istatistiksel olarak anlamlı değildi (p>0,05). Sonuç: Nebülize budesonidin orta-şiddetli astımlı çocuk hastalarda oral metilprednizolon kadar etkilidir. Bu grupta oral veya intravenöz metilprednizolon çeşitli nedenlerle verilemeyen çocuklarda, nebülize budesonidin kullanım kolaylığı, tolerabilitesi, etkinliği gözönüne alındığında oral metilprednizilona alternatif olabileceği kanaatine varıldı.
Introduction: In the present study, we aimed to compare the efficiency of peroral (p.o.) methylprednisolone and nebulized budesonide in children with moderate-severe asthma exacerbations. Material and Method: Twenty patients between the age of 6-14 years were included to the study and were unresponsive to nebulized salbutamol treatment at the dosage of 0.15 mg/kg for 3 times with 20 min. intervals. All the patients received nebulized salbutamol at the dosage of 6x0.15 mg/kg/day for 3 days. Ten patients (Group 1) received additional p.o. metylprednisolone at the dosage of 1 mg/kg for three times a day (maximum 60 mg/day), rest of the patients (Group 2) received additional nebulised budesonide at the dosage of 0.5 mg b.i.d for three days. Results: In the first examination of the patients; age, gender, height, weight, duration of disease, frequency asthma exacerbations, symptoms and the clinic parameters were similar in both groups (p>0,05). In the first day (0, 4, 8, 16, 24. hours), third day and the 30 th. day the following analyses were done: PEF, arterial oxygen saturation (SaO2), partial arterial oxygen pressure (PaO2), partial arterial carbon dioxide pressure (PaCO2), FVC, FEV1, FEV1/FVC, FEF25-75, pulmonary index, asthma score, pulse, cough, wheezing, respiration rate. The patients examined again 30 days after discharge. Asthma score, pulmonary index, respiratory rate, relief duration of cough and wheezing were similar in both groups (p>0.05). Pulse rate decreased into normal limits earlier in Group 1 than Group 2 (p<0,05). These clinical parameters were improved at the end of the study and it was statistically significant (p<0.05). We found that the following parameters: PEF, SaO2, PaO2, PaCO2, FVC, FEV1, FEV1/FVC, FEF25-75 were improved in the group of receiving p.o. methylprednisolone better than the nebulized budesonide, but it was not statistically significant (p>0.05). Pulse rate was returned to normal limits in shorter time in Group 1 than Group 2 (p<0.05). Conclusion: We believed that nebulized budesonide has equal efficacy to p.o. metilprednizolon in children with moderate-severe asthma. In this group, because of practical using, tolerability and safety, nebulized budesonide can be an alternative to methylprednisolone in children who has contraindications for oral or intravenous steroid administration.
Introduction: In the present study, we aimed to compare the efficiency of peroral (p.o.) methylprednisolone and nebulized budesonide in children with moderate-severe asthma exacerbations. Material and Method: Twenty patients between the age of 6-14 years were included to the study and were unresponsive to nebulized salbutamol treatment at the dosage of 0.15 mg/kg for 3 times with 20 min. intervals. All the patients received nebulized salbutamol at the dosage of 6x0.15 mg/kg/day for 3 days. Ten patients (Group 1) received additional p.o. metylprednisolone at the dosage of 1 mg/kg for three times a day (maximum 60 mg/day), rest of the patients (Group 2) received additional nebulised budesonide at the dosage of 0.5 mg b.i.d for three days. Results: In the first examination of the patients; age, gender, height, weight, duration of disease, frequency asthma exacerbations, symptoms and the clinic parameters were similar in both groups (p>0,05). In the first day (0, 4, 8, 16, 24. hours), third day and the 30 th. day the following analyses were done: PEF, arterial oxygen saturation (SaO2), partial arterial oxygen pressure (PaO2), partial arterial carbon dioxide pressure (PaCO2), FVC, FEV1, FEV1/FVC, FEF25-75, pulmonary index, asthma score, pulse, cough, wheezing, respiration rate. The patients examined again 30 days after discharge. Asthma score, pulmonary index, respiratory rate, relief duration of cough and wheezing were similar in both groups (p>0.05). Pulse rate decreased into normal limits earlier in Group 1 than Group 2 (p<0,05). These clinical parameters were improved at the end of the study and it was statistically significant (p<0.05). We found that the following parameters: PEF, SaO2, PaO2, PaCO2, FVC, FEV1, FEV1/FVC, FEF25-75 were improved in the group of receiving p.o. methylprednisolone better than the nebulized budesonide, but it was not statistically significant (p>0.05). Pulse rate was returned to normal limits in shorter time in Group 1 than Group 2 (p<0.05). Conclusion: We believed that nebulized budesonide has equal efficacy to p.o. metilprednizolon in children with moderate-severe asthma. In this group, because of practical using, tolerability and safety, nebulized budesonide can be an alternative to methylprednisolone in children who has contraindications for oral or intravenous steroid administration.
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Türkiye Acil Tıp Dergisi
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