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ID naloge: 53 Letnik: 1998 Predmet: pediatrija
Vpliv protivnetne terapije na število in težo okužb dihal pri otrocih z astmo
Avtor: Primož Kotnik
Mentor: prof.dr. Rajko Kenda, dr.med
Somentor: Dora Jeler-Kacar, dr.med.
Izhodišca. Astma je kronicna vnetna bolezen dihal. Protivnetno zdravljenje z inhalacijskimi glukokortikosteroidi velja za najbolj ucinkovito zdravljenje zmerne in hude kronicne astme pri odraslih in otrocih. Edina omejitev za njihovo uporabo so stranski ucinki. Z našo raziskavo smo poskusili ugotoviti, ali ima redno zdravljenje otrok z astmo z inhalacijskimi glukokortikosteroidi imunosupresivni stranski ucinek. Ocenjevali smo pogostost in težo okužb dihal pri otrocih z astmo, ki se redno zdravijo z inhalacijskimi glukokortikosteroidi, v primerjavi z otroci z astmo, ki se z njimi ne zdravijo. Naša hipoteza je bila, da ima redno zdravljenje otrok z astmo z inhalacijskimi glukokortikosteroidi imunosupresivni stranski ucinek. Otroci z astmo, ki se redno zdravijo z inhalacijskimi glukokortikosteroidi imajo pogostejše in težje okužbe dihal, kot otroci z astmo, ki se z inhalacijskimi glukokortikosteroidi redno ne zdravijo.
Metode. Raziskava je bila prospektivna in je trajala eno leto. V raziskavo je bilo vkljucenih 20 otrok z blago in zmerno astmo, starih od 7 let 0 mesecev do 14 let 11 mesecev (povprecna starost 9 let 4 meseci), 7 deklic, 13 deckov. Razporejeni so bili v dve skupini (n = 10). Ena skupina je bila redno zdravljena z inhalacijskimi glukokortikosteroidi (flutikazon propionat), druga ne. Zaradi moralnih, eticnih in strokovnih nacel preiskovancev nismo mogli uvrstiti v skupine nakljucno. Otroci so, ob pomoci staršev, v dnevnik beležili simptome okužbe dihal in astme, ter merili najvecjo hitrost pretoka zraka pri izdihu in telesno temperaturo. Ob pojavljanju simptomov in klinicnih znakov okužbe dihal so se oglasili v pulmološki ambulanti Pediatricne klinike. Tu smo ocenili prisotnost okužbe dihal in njeno težo.
Rezultati. Otroci z astmo, v skupini, ki ni bila redno zdravljena z inhalacijskimi glukokortikosteroidi so imeli okužbo dihal skupaj 26-krat (mediana 2,5 okužbe dihal/preiskovanca/leto), okužbe dihal so skupno trajale 207 dni (mediana 6 dni/okužbo dihal) in so bile 9-krat ocenjene s težavnostnjo stopnjo 1, 13-krat s stopnjo 2 in 4-krat s stopnjo 3. Otroci z astmo, v skupini, ki je bila redno zdravljena z inhalacijskimi glukokortikosteroidi pa so imeli okužbo dihal skupaj 27-krat (mediana 3 okužbe dihal/preiskovanca/leto), okužbe dihal so skupno trajale 198 dni (mediana 7 dni/okužbo dihal) in so bile 12-krat ocenjene s težavnostnjo stopnjo 1, 13-krat s stopnjo 2 in 2-krat s stopnjo 3. Skupini preiskovanih otrok se med seboj za nobenega od opazovanih parametrov ne razlikujeta statisticno znacilno, kar smo ugotovili z Wilcoxonovim testom z vsoto rangov (p > 0,05).
Zakljucki. Na osnovi rezultatov naše raziskave ne moremo trditi, da redno zdravljenje z majhnimi odmerki (200 g/dan) inhalacijskih glukokortikosteroidov (flutikazon propionat) vpliva na povecanje pogostosti in teže okužb dihal pri otrocih z astmo. Ne moremo torej trditi, da ima klinicno pomemben imunosupresivni stranski ucinek.
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[Abstract / English version]
Vpliv protivnetne terapije na število in težo okužb dihal pri otrocih z astmo
Author: Primož Kotnik
Mentor: prof.dr. Rajko Kenda, dr.med
Co-mentor: Dora Jeler-Kacar, dr.med.
Backgrounds. Asthma is a chronic inflammatory respiratory disease. Anti-inflammatory therapy with inhalatory glucocorticosteroids is considered the most effective long-term therapy for patients with moderate and severe chronic asthma. Side effects of glucocorticosteroids are the only limitation for their use. In our study we wanted to find out if long-term therapy with inhalatory glucocorticosteroids has an imunosupresive side effect. We estimated the frequency and severity of respiratory infections of children with asthma, that receive long-term therapy with inhalatory glucocorticosteroids in comparison with those that do not. Our hypothesis was that long-term therapy of children with asthma with inhalatory glucocorticosteroids has an imunosupresive side effect. Children with asthma that receive long-term therapy with inhalatory glucocorticosteroids have more frequent and more severe respiratory infections than those children with asthma that do not.
Methods. The study was prospective and lasted one year. It included 20 children with mild and moderate asthma, aged 7 years 0 months to 14 years 11 months (average 9 years, 4 months), 7 girls, 13 boys. They were divided into two groups of ten children (n = 10). One group received long-term therapy with inhalatory glucocorticosteroids (fluticasone propionate), the other did not. Because of moral, ethical and medical principles children were placed into two groups non-randomly. Children, with help of their parents, kept a diary of symptoms and clinical signs of respiratory infection and asthma. They measured their peak expiritory flow rate and body temperature. In case of emergence of symptoms and clinical signs of respiratory infection they were admitted to pulmonary ambulance of the Pediatric clinic. Here we estimated the presence and severity of their respiratory infection.
Results. Children with astma in the group that did not receive long-term therapy with inhalatory glucocorticoids had respiratory infections in total 26 times (median 2,5 respiratory infections/child/year), respiratory infections lasted in total 207 days (median 6 days/respiratory infection), and were 9 times estimated as severity grade 1, 13 times as grade 2, and 4 times as grade 3. Children with astma in the group that received long-term therapy with inhalatory glucocorticosteroids had respiratory infections in total 27 times (median 3 respiratory infections/child/year), respiratory infections lasted in total 198 days (median 7 days/respiratory infection), and were 12 times estimated as severity grade 1, 13 times as grade 2, and 2 times as grade 3. Groups of observed children didn't statisticaly significantly differ in any of the studied parameters. For statistical estimation we used Wilcoxon signed-rang test (p > 0,05).
Conclusions. On the basis of the results of our study we can't conclude, that long-term therapy with low doses (200 g/day) of inhalatory glucocoticosteroids (fluticasone propionate) increases the frequency and severity of respiratory infections in children with asthma. We can't conclude that it has a clinically relevant imunosupresive effect.
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