Diğer

Hisiltili Çocukta Tani ve Ayirici Tani (Hangisi Astim)

  • Remziye Tanaç

J Curr Pediatr 2005;3(1):-

Hisiltili çocuk (wheezy infant) son yillarda pediatrinin gündeminde tartisilmakta olan ve bu konuda pek çok arastirmanin yapildigi bir klinik tablodur. Bu gün en çok üzerinde durulan ve arastirmalara neden olan konu ise bu çocuklarin ileri dönem prognozudur.Hisiltinin klasik tanimlanmasi; alt solunum yollarinin obstriktif patolojilerinde olusan genellikle patolojik (normalde zorlu ekspiratuvar manevrada da duyulan) ekspratuvar bir sestir. Havanin obstriktif hava yollarinda yaptigi turbulans ve hava yollari çeperlerinin olusturdugu titresime bagli olarak gelisir.Genellikle pulmoner hastaliklarin seyrinde olusan inflamasyon, bronkospazm ve mukozal ödemin hava yollarini daraltmasi ile ortaya çikar.Bu sekilde olusan hisilti, hastalarda tek bir atak seklinde baslayip bitebilir. Uzun süreli olabilir veya yineleyen ataklar seklinde gelisebilir. Bu nedenle hisiltili çocuk tanimlanirken hisiltinin dört haftadan daha uzun sürmesi, persistan hisilti; üç veya daha fazla atak seklinde gelismesi ise yineleyen hisilti olarak tanimlanmaktadir. Ayrica bu hisilti ataklarinin bronkodilatatör veya antiinflamatuvar tedavi ile düzelmesi viral infeksiyonlarla da tetiklenebilmesi diger bir özelligidir.Her yasta farkli etiyolojik etkenler akut, persistan veya yineleyen hisilti nedeni olarak ortaya çikabilirler. Bu nedenler Tablo 1’de gösterilmektedir:


Etiyolojide görülen nedenlerin taniya giderken oldukça detayli bir sekilde degerlendirilmesi, olgunun tanisinin konmasi için iyi bir ayirici taninin yapilmasi gereklidir.


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