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Clinical Findings, Diagnosis and Differential Diagnosis in Childhood Asthma

Year 2017, Volume: 9 Issue: 2, 13 - 23, 15.03.2017

Abstract

Abstract


Asthma is characterized by chronic airway inflammation with recurrent wheezing,dyspnea, chest tightness, and cough. Which is one of the most common chronic diseases of childhood, the prevalence of asthma all over the world varies between 1-18%. In our country the incidence varies between 2.8-14.5%. Pathogenesis of asthma includes airway inflammation, airway hyperresponsiveness and reversible air-way obstruction. In children aged over 5 and adolescents, the diagnosis of asthmais made by a carefully taken anamnesis, physical examination and pulmonary function tests (by showing reversibility, variability or airway hyperresponsiveness). Inchildren under the age of five, because functionally it is not possible to evaluate air-way obstruction, the diagnosis of asthma is based on clinical findings. Before asthma is diagnosed, differential diagnosis from other diseases showing similarsymptoms and signs should be performed.

References

  • Kaynaklar 1.Global Initiative for Asthma. Global Strategy for Asthma Ma-nagement and Prevention, 2016. Available from: www.ginasth-ma.org 2.Demir AU, Karakaya G, Bozkurt B, Sekerel BE, Kalyoncu AF.Asthma and allergic diseases in schoolchildren: third cross-sectional survey in the same primary school in Ankara, Tur-key. Pediatr Allergy Immunol 2004;15:531-8. 3.Saraclar Y, Kuyucu S, Tuncer A, Sekerel B, Sackesen C, Ko-cabas C . Prevalence of asthmatic phenotypes and bronchi-al hyperresponsiveness in Turkish schoolchildren: an Inter-national Study of Asthma and Allergies in Childhood (ISAAC)phase 2 study. Ann Allergy Asthma Immunol 2003;91:477-84.Erratum in: Ann Allergy Asthma Immunol 2004;92:87. 4.Sapan N. Prevalence of atopic diseases in school children inBursa. Allergy Clin Immunol 1994;169. 5.Liu AH, Spahn JD, Leung DYM. Childhood Asthma. In Behr-man RE, Kliegman RM, Jenson HB, eds. Nelson Textbook ofPediatrics, 17th edition. Unites States of America: WB Saun-ders Company: 2004. p 760-74. 6.Busse WW, Lemanske RF Jr. Asthma. N Engl J Med, 2001;344: 350-62. 7.Sly PD, Kusel M, Holt PG. Do early-life viral infections cau-se asthma? J Allergy Clin Immunol, 2010; 125: 1202-5. 8.Holgate ST. Genetic and environmental interaction in allergyand asthma. J Allergy Clin Immunol, 1999; 104: 1139-46. 9.Ober C, Vercelli D. Gene-environment interactions in human di-sease: nuisance or opportunity? Trends Genet, 2011; 27: 107-15. 10.Guilbert T, Moss MH, Lemanske Jr RF. Approach to infantsand children with asthma. In: Middleton’s Allergy Princip-les and Practice Seventh Edition. Eds. Adkinson Jr NF, Boch-ner BS, Busse WW, Holgate ST, Lemanske JR RF, Simons FER.Mosby 2009. p. 1319-43. 11.National Asthma Education and Prevention Program. ExpertPanel Report 3: guidelines for the diagnosis and managementof asthma: clinical practice guidelines. Bethesda (MD):NIH/National Heart, Lung and Blood Institute. 2007; August;Report No: 07-4051. Available from: https://www.ncbi.nlm.nih.gov/books/NBK7232 12.Busse WW. Asthma diagnosis and treatment: Filling in the in-formation gaps. J Allergy Clin Immunol 2011;128:740-50. 13.Stein RT, Holberg CJ, Morgan WJ, Wright AL, Lombardi E, Ta-ussing L, et al. Peak flow variability, methacholine responsi-veness and atopy as markers for detecting different wheezingphenotypes in childhood. Thorax. 1997;52:946-52. 14.Vater KZ, McBride JT. Pulmonary function testing in childho-od asthma. Immunol Allergy Clin North Am. 1998;18:133-48. 15.Cockcroft DW. Bronchoprovocation methods: direct challen-ges. Clin Rev Allergy Immunol. 2003;24:19-26. 16.Reddel HK, Marks GB, Jenkins CR. When can personal bestpeak flow be determined for asthma action plans? Thorax2004;59:922-4. 17.Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bo-usquet PJ, Burney PG,et al. Practical guide to skin prick testsin allergy to aeroallergens. Allergy. 2012 Jan 67(1):18-24. 18. Smith PH, Ownby DR. Clinical Significance of Immunoglo-bulin E. In: Middleton's Allergy Principles and Practice. Ad-kinson NF, Yunginer JW, Buse WW, Bochner BS, Holgate ST,Slomons FER, 7th eds. Mosby 2008.p.845-54. 19. Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, TanR, et al.; American Academy of Allergy, Asthma and Immu-nology; American College of Allergy, Asthma and Immu-nology, Allergy diagnostic testing: an updated practice para-meter. Ann Allergy Asthma Immunol. 2008;100:1-148. 20. Hamilton RG, Adkinson NF Jr. In vitro assays fort the diag-nosis of IgE mediated disorders. J Allergy ClinImmunol.2004;114:213-25. 21. Papadopoulos NG, Arakawa H, Carlsen K-H, Custovic A, GernJ, Lemanske R,et al. International consensus on (ICON) pe-diatric asthma. Allergy 2012;67:976-97. 22. Martinez FD. Recognizing early asthma. Allergy 1999; 54:24-8. 23. Bukstein D, Kraft M, Liu AH, Peters SP. Asthma end pointsand outcomes: what have we learned? The Journal of allergyand clinical immunology. 2006;118(4 Suppl):S1-15. 24. Volbeda F, Broekema M, Lodewijk ME, Hylkema MN, Red-del HK, Timens W, et al. Clinical control of asthma associa-tes with measures of airway inflammation. Thorax.2013;68(1):19-24. 25. Jayaram L, Parameswaran K, Sears MR. Induced sputum cellcounts: their usefulness in clinical practice. Eur Respir J.2000;16:150-158. 26. Bacci E, Cianchetti S, Bartoli M, Den-te FL, Di Franco A, Vagaggini B, et al. Low sputum eosinop-hils predict the lack of response to inhaled beclomethasonein symptomatic asthmatic patients. Chest 2006; 129: 565-72. 27. Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lund-berg JO, et al. An official ATS clinical practice guideline: in-terpretation of exhaled nitric oxide levels (FENO) for clini-cal applications. American journal of respiratory and criti-cal care medicine. 2011;184(5):602-15. 28. Jouaville LF, Annesi-Maesano I, Nguyen LT, Bocage AS, BeduM, Caillaud D. Interrelationships among asthma, atopy, rhi-nitis and exhaled nitric oxide in a population-based sampleof children. Clinical and experimental allergy:journal of theBritish Society for Allergy and Clinical Immunology.2003;33(11):1506-11. 29. Strunk RC, Szefler SJ, Phillips BR, Zeiger RS, Chinchilli VM,Larsen G, et al. Relationship of exhaled nitric oxide to clini-cal and inflammatory markers of persistent asthma in child-ren. The Journal of allergy and clinical immunology.2003;112(5):883-92. 30. Doherty G, Bush A. Diagnosing respiratory problems in yo-ung children. The Practitioner 2007;251:20, 2-5. 31. Pedersen S. Preschool asthma--not so easy to diagnose. PrimCare Respir J 2007;16:4-6. 32. Sly PD, Boner AL, Bjorksten B, Bush A, Custovic A, EigenmannPA,et al. Early identification of atopy in the prediction of per-sistent asthma in children. Lancet 2008;372:1100-6. 33. Mellis C. Respiratory noises: how useful are they clinically?Pediatr Clin North Am 2009;56:1-17. 34. Heikkinen T, Jarvinen A. The common cold. Lancet2003;361:51-9. 35. Castro-Rodriguez JA. The Asthma Predictive Index: a very use-ful tool for predicting asthma in young children. J Allergy ClinImmunol 2010;126:212-6.

Çocukluk Çağı Astımında Klinik Bulgular, Tanı ve Ayırıcı Tanı

Year 2017, Volume: 9 Issue: 2, 13 - 23, 15.03.2017

Abstract

Öz

Astım; tekrarlayan hışıltı, nefes darlığı, göğüste sıkışma hissi ve öksürük  yakınmaların  olduğu kronik hava yolu inflamasyonu ile karakterize bir hastalıktır.  Ço-cukluk çağının en sık  kronik hastalıklarından biri olan astımın tüm dünyada preva-lansı  %1-18 arasında değişir. Ülkemizde sıklığı  %2,8-%14,5 arasında değişmektedir. Patogenezinde havayolu inflamasyonu, artmış havayolu duyarlılığı ve geri dönüşümlü havayolu obstrüksiyonu vardır. Astım tanısı beş yaş üstü çocuk ve genç erişkinlerde dikkatli bir öykü, fizik muayene ve solunum fonksiyon testleri ile (rever-sibilite, değişkenlik/variabilite veya hava yolları aşırı duyarlılığının gösterilmesi ) ilekonulur. Beş yaş altı çocuklarda astım tanısı hava yolu obstrüksiyonunun fonksiyonel olarak değerlendirmek mümkün olmadığından  büyük ölçüde klinik bulgulara dayanılarak konur. Astım tanısı konmadan önce benzer semptom ve bulgular gösteren diğer hastalıklardan ayırıcı tanı mutlaka yapılmalıdır.

References

  • Kaynaklar 1.Global Initiative for Asthma. Global Strategy for Asthma Ma-nagement and Prevention, 2016. Available from: www.ginasth-ma.org 2.Demir AU, Karakaya G, Bozkurt B, Sekerel BE, Kalyoncu AF.Asthma and allergic diseases in schoolchildren: third cross-sectional survey in the same primary school in Ankara, Tur-key. Pediatr Allergy Immunol 2004;15:531-8. 3.Saraclar Y, Kuyucu S, Tuncer A, Sekerel B, Sackesen C, Ko-cabas C . Prevalence of asthmatic phenotypes and bronchi-al hyperresponsiveness in Turkish schoolchildren: an Inter-national Study of Asthma and Allergies in Childhood (ISAAC)phase 2 study. Ann Allergy Asthma Immunol 2003;91:477-84.Erratum in: Ann Allergy Asthma Immunol 2004;92:87. 4.Sapan N. Prevalence of atopic diseases in school children inBursa. Allergy Clin Immunol 1994;169. 5.Liu AH, Spahn JD, Leung DYM. Childhood Asthma. In Behr-man RE, Kliegman RM, Jenson HB, eds. Nelson Textbook ofPediatrics, 17th edition. Unites States of America: WB Saun-ders Company: 2004. p 760-74. 6.Busse WW, Lemanske RF Jr. Asthma. N Engl J Med, 2001;344: 350-62. 7.Sly PD, Kusel M, Holt PG. Do early-life viral infections cau-se asthma? J Allergy Clin Immunol, 2010; 125: 1202-5. 8.Holgate ST. Genetic and environmental interaction in allergyand asthma. J Allergy Clin Immunol, 1999; 104: 1139-46. 9.Ober C, Vercelli D. Gene-environment interactions in human di-sease: nuisance or opportunity? Trends Genet, 2011; 27: 107-15. 10.Guilbert T, Moss MH, Lemanske Jr RF. Approach to infantsand children with asthma. In: Middleton’s Allergy Princip-les and Practice Seventh Edition. Eds. Adkinson Jr NF, Boch-ner BS, Busse WW, Holgate ST, Lemanske JR RF, Simons FER.Mosby 2009. p. 1319-43. 11.National Asthma Education and Prevention Program. ExpertPanel Report 3: guidelines for the diagnosis and managementof asthma: clinical practice guidelines. Bethesda (MD):NIH/National Heart, Lung and Blood Institute. 2007; August;Report No: 07-4051. Available from: https://www.ncbi.nlm.nih.gov/books/NBK7232 12.Busse WW. Asthma diagnosis and treatment: Filling in the in-formation gaps. J Allergy Clin Immunol 2011;128:740-50. 13.Stein RT, Holberg CJ, Morgan WJ, Wright AL, Lombardi E, Ta-ussing L, et al. Peak flow variability, methacholine responsi-veness and atopy as markers for detecting different wheezingphenotypes in childhood. Thorax. 1997;52:946-52. 14.Vater KZ, McBride JT. Pulmonary function testing in childho-od asthma. Immunol Allergy Clin North Am. 1998;18:133-48. 15.Cockcroft DW. Bronchoprovocation methods: direct challen-ges. Clin Rev Allergy Immunol. 2003;24:19-26. 16.Reddel HK, Marks GB, Jenkins CR. When can personal bestpeak flow be determined for asthma action plans? Thorax2004;59:922-4. 17.Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bo-usquet PJ, Burney PG,et al. Practical guide to skin prick testsin allergy to aeroallergens. Allergy. 2012 Jan 67(1):18-24. 18. Smith PH, Ownby DR. Clinical Significance of Immunoglo-bulin E. In: Middleton's Allergy Principles and Practice. Ad-kinson NF, Yunginer JW, Buse WW, Bochner BS, Holgate ST,Slomons FER, 7th eds. Mosby 2008.p.845-54. 19. Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, TanR, et al.; American Academy of Allergy, Asthma and Immu-nology; American College of Allergy, Asthma and Immu-nology, Allergy diagnostic testing: an updated practice para-meter. Ann Allergy Asthma Immunol. 2008;100:1-148. 20. Hamilton RG, Adkinson NF Jr. In vitro assays fort the diag-nosis of IgE mediated disorders. J Allergy ClinImmunol.2004;114:213-25. 21. Papadopoulos NG, Arakawa H, Carlsen K-H, Custovic A, GernJ, Lemanske R,et al. International consensus on (ICON) pe-diatric asthma. Allergy 2012;67:976-97. 22. Martinez FD. Recognizing early asthma. Allergy 1999; 54:24-8. 23. Bukstein D, Kraft M, Liu AH, Peters SP. Asthma end pointsand outcomes: what have we learned? The Journal of allergyand clinical immunology. 2006;118(4 Suppl):S1-15. 24. Volbeda F, Broekema M, Lodewijk ME, Hylkema MN, Red-del HK, Timens W, et al. Clinical control of asthma associa-tes with measures of airway inflammation. Thorax.2013;68(1):19-24. 25. Jayaram L, Parameswaran K, Sears MR. Induced sputum cellcounts: their usefulness in clinical practice. Eur Respir J.2000;16:150-158. 26. Bacci E, Cianchetti S, Bartoli M, Den-te FL, Di Franco A, Vagaggini B, et al. Low sputum eosinop-hils predict the lack of response to inhaled beclomethasonein symptomatic asthmatic patients. Chest 2006; 129: 565-72. 27. Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lund-berg JO, et al. An official ATS clinical practice guideline: in-terpretation of exhaled nitric oxide levels (FENO) for clini-cal applications. American journal of respiratory and criti-cal care medicine. 2011;184(5):602-15. 28. Jouaville LF, Annesi-Maesano I, Nguyen LT, Bocage AS, BeduM, Caillaud D. Interrelationships among asthma, atopy, rhi-nitis and exhaled nitric oxide in a population-based sampleof children. Clinical and experimental allergy:journal of theBritish Society for Allergy and Clinical Immunology.2003;33(11):1506-11. 29. Strunk RC, Szefler SJ, Phillips BR, Zeiger RS, Chinchilli VM,Larsen G, et al. Relationship of exhaled nitric oxide to clini-cal and inflammatory markers of persistent asthma in child-ren. The Journal of allergy and clinical immunology.2003;112(5):883-92. 30. Doherty G, Bush A. Diagnosing respiratory problems in yo-ung children. The Practitioner 2007;251:20, 2-5. 31. Pedersen S. Preschool asthma--not so easy to diagnose. PrimCare Respir J 2007;16:4-6. 32. Sly PD, Boner AL, Bjorksten B, Bush A, Custovic A, EigenmannPA,et al. Early identification of atopy in the prediction of per-sistent asthma in children. Lancet 2008;372:1100-6. 33. Mellis C. Respiratory noises: how useful are they clinically?Pediatr Clin North Am 2009;56:1-17. 34. Heikkinen T, Jarvinen A. The common cold. Lancet2003;361:51-9. 35. Castro-Rodriguez JA. The Asthma Predictive Index: a very use-ful tool for predicting asthma in young children. J Allergy ClinImmunol 2010;126:212-6.
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Details

Primary Language Turkish
Journal Section makale
Authors

Prof. Dr. Nihat Sapan

Publication Date March 15, 2017
Published in Issue Year 2017 Volume: 9 Issue: 2

Cite

APA Sapan, P. D. N. (2017). Çocukluk Çağı Astımında Klinik Bulgular, Tanı ve Ayırıcı Tanı. Klinik Tıp Pediatri Dergisi, 9(2), 13-23.
AMA Sapan PDN. Çocukluk Çağı Astımında Klinik Bulgular, Tanı ve Ayırıcı Tanı. Pediatri. March 2017;9(2):13-23.
Chicago Sapan, Prof. Dr. Nihat. “Çocukluk Çağı Astımında Klinik Bulgular, Tanı Ve Ayırıcı Tanı”. Klinik Tıp Pediatri Dergisi 9, no. 2 (March 2017): 13-23.
EndNote Sapan PDN (March 1, 2017) Çocukluk Çağı Astımında Klinik Bulgular, Tanı ve Ayırıcı Tanı. Klinik Tıp Pediatri Dergisi 9 2 13–23.
IEEE P. D. N. Sapan, “Çocukluk Çağı Astımında Klinik Bulgular, Tanı ve Ayırıcı Tanı”, Pediatri, vol. 9, no. 2, pp. 13–23, 2017.
ISNAD Sapan, Prof. Dr. Nihat. “Çocukluk Çağı Astımında Klinik Bulgular, Tanı Ve Ayırıcı Tanı”. Klinik Tıp Pediatri Dergisi 9/2 (March 2017), 13-23.
JAMA Sapan PDN. Çocukluk Çağı Astımında Klinik Bulgular, Tanı ve Ayırıcı Tanı. Pediatri. 2017;9:13–23.
MLA Sapan, Prof. Dr. Nihat. “Çocukluk Çağı Astımında Klinik Bulgular, Tanı Ve Ayırıcı Tanı”. Klinik Tıp Pediatri Dergisi, vol. 9, no. 2, 2017, pp. 13-23.
Vancouver Sapan PDN. Çocukluk Çağı Astımında Klinik Bulgular, Tanı ve Ayırıcı Tanı. Pediatri. 2017;9(2):13-2.