Klinik Araştırma ÖZET

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Amaç: Akut bronşiyolit tedavisinde nebülize beta agonist, nebülize steroid ve sistemik steroid tedavisi kullanılmakla birlikte etkinliği konusunda görüş birliği yoktur. Bu çalışmada akut bronşiyolit tedavisinde tartışmalı olan bu ajanların klinik etkinliğinin karşılaştırılması planlan- mıştır.

Gereç ve Yöntem: Çalışmaya Mayıs 2004-Ocak 2005 tarihleri arasında acil gözlem ünitesine akut bronşiyolit tanısı ile yatırılan 2 ay-2 yaş arası 360 çocuk alınmıştır. Hastalar randomize olarak 3 tedavi grubuna ayrılmış; Grup A’ya ardışık 3 doz nebülize beta agonist, Grup B’ye ardışık olarak nebülize beta agonist+nebülize steroid, Grup C’ye ardışık olarak nebülize beta agonist+sistemik steroid uygulanmıştır. Hastaların nabız, solunum sayısı, oksijen satürasyonu ve solunum skoru değerleri ilk başvuruda, 1-2-3. dozlardan sonra ve tedavi bitiminden 2 saat sonra değerlendirilmiştir.

Bulgular: Hastaların yaş ortalaması 6.4±3.4 ay olup, erkek/kız oranı 6,7 olarak belirlenmiştir.

Tedavi grupları kendi içinde ve dozlar arası değerlendirildiğinde; nabız, solunum sayısı, oksijen satürasyonu ve solunum skoru parametrelerinde tüm gruplar için düzelme olduğu saptanmıştır (p<0.05). Yalnızca nebülize beta agonist verilmesine kıyasla nebülize beta agoniste nebülize steroid veya sistemik steroid eklenmesinin nabız ve solunum skorunda daha iyi düzelme sağla- dığı saptanmıştır (p<0.05). Ancak, eklenen steroidin nebülize ya da sistemik olması fark yarat- mamıştır (p>0,05). Hospitalizasyon oranları steroid eklenen gruplarda %18 ve %17 iken, yal- nızca nebülize beta agonist uygulanan grupta daha yüksek (%36) bulunmuştur (p<0.05).

Sonuç: Akut bronşiyolit tedavisinde hem bronkodilatatörler hem de steroidler etkili bulunmuş- tur. Bronkodilatörlere inhale ya da sistemik steroid eklenmesi ile etkinlik artmakta ve hospitalizasyon oranı azalmaktadır. Ancak, bu ajanların akut bronşiyolit tedavisindeki yerini belirle- mek için kontrol grubu ile karşılaştıran çalışmalara gerek vardır.

Anahtar kelimeler: Akut bronşiyolit, tedavi, steroid, salbutamol ABSTRACT

Objective: Nebulized beta agonist, nebulized steroid and systemic steroids are being used in acute bronchiolitis treatment, but there is no consensus on the efficiacy of this regimen. In this study, comparison of clinical efficacies of these agents with uncertain outcomes was planned.

Material and Methods: The study was done with 360 children aged 2 months to 2 years who were admitted to the Emergency Department with the diagnosis of acute bronchiolitis. Patients were randomly assigned to 3 treatment groups; Group A was given 3 consecutive doses of nebulized beta agonist, Group B nebulized beta agonist + a nebulized steroid and Group C nebulized beta agonist + a systemic steroid. Pulse rate, respiratory rate, oxygen saturation and respiratory score were recorded at the admission, after 1st, 2nd and 3rd doses and 2 hours following the termination of the treatment.

Results: Mean age of the patients was 6.4±3.4 years, and girls/boys ratio was 6.7. In intergroup comparisons, a nebulized beta agonist plus a nebulized steroid or a asystemic steroid had yiel- ded better results than a nebulized beta agonist alone with respect to pulse rate and respiratory score in all comparator groups (p<0.05). However nebulized steroid or systemic steroid as an adjunct therapy caused no intergroup differences (p>0.05). Need for hospitalization in steroid groups were 18% and 17% which was significantly higher in nebulized beta agonist only group (36%) (p<0.05).

Conclusion: Both bronchodilators and steroids were found to be effective in the treatment of acute bronchiolitis Addition of inhaled or systemic steroids to the existing therapy increased efficacy of treatment and decreased the need for hospitalization. In order to define the role of these medications in the treatment of acute bronchiolitis, studies performed with comparator control groups are needed.

Key words: Acute bronchiolitis, treatment, salbutamol, steroid

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