Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Clinical Analysis of Children Diagnosed with Recurrent Croup
Tekrarlayan Krup Tanısı Alan Çocukların Klinik Analizi
Belgin USTA GÜÇa, Suna ASİLSOYb, Fulya ÖZERc
aBaşkent University Adana Dr. Turgut Noyan Application and Research Center, Adana, TURKEY
bDepartment of Pediatric Allergy, Dokuz Eylül University Faculty of Medicine, İzmir, TURKEY
cDepartment of Otorhinolaryngology, Başkent University Faculty of Medicine, Ankara, TURKEY
Turkiye Klinikleri J Pediatr. 2021;30(1):15-21
doi: 10.5336/pediatr.2020-75218
Article Language: EN
Full Text
ABSTRACT
 Objective: Croup is a common disease in childhood, characterized by barking cough, hoarseness and inspiratory stridor. When symptoms show recurrent and/or persistent characteristics, attention must be paid in terms of other underlying diseases. Our aim is to retrospectively review the long term results of our follow-up patients with recurrent croup and to discuss the etiology and final diagnosis and treatment of this clinic description in the light of the literature. Material and Methods: This study included patients who had 3 or more croup attacks per year. The patients' frequency of attacks, triggers, persistancy of the complaints, atopic dermatitis, rhinitis symptoms, family history of atopy were derived from their medical records. Laboratory results [total eosinophil count, immunoglobulin E levels, skin prick test, gastroesophageal reflux (GER) tests] and treatments were evaluated. Results: 100 patients aged between 7 months and 14 years with recurrent croup diagnosis were evaluated. Of them, 77 were males, the median frequency of attacks was 4 (3- 10) times a year. In 17% of the patients, upper respiratory infection, in 24% spasmodic character, and in 59% both were determined as triggers. In 12% atopic dermatitis, in 42% rhinitis, in 36% atopy, in 33% GER disease, in 26% persistant croup, in 55% laryngotracheobronchitis (LTB) was detected. When laryngoscopy was performed on persistant croup patients, laryngomalacia was detected in 9% and GER findings were found in 15%. Of the patients, 48 were given inhaled steroid treatment, 7 were given reflux treatment and 26 received combination of inhaled steroid and reflux treatments, 8 were treated only during attacks. Conclusion: Recurrent croup is generally a benign clinical picture. Atopy, LTB and GER may be associated with recurrent croup. The patients who are detected to be atopic, and/or respond well to inhaled steroid must be closely monitored in terms of reactive airway disease. Persistent cases necessitate a multidisiplinary approach.

Keywords: Allergy and immunology; cough; gastroesophageal reflux; pediatrics; croup; endoscopy
ÖZET
 Amaç: Krup, çocukluk çağında sık görülen havlar tarzda öksürük, ses kısıklığı, stridor ile karakterize bir hastalıktır. Semptomlar tekrarlayıcı ve/veya persistan özellik gösterdiğinde altta yatan farklı hastalıklar açısından dikkatli olunmalıdır. Amacımız, tekrarlayan krup ile takip edilen hastalarımızın uzun dönem sonuçlarını retrospektif olarak gözden geçirmek; bu klinik tanımlamanın etiyolojisini, nihai tanılarını ve tedavisini literatür ışığında tartışmaktır. Gereç ve Yöntemler: Çalışmaya, yılda 3 veya daha fazla krup atağı geçiren hastalar alındı. Hastaların tıbbi kayıtlarından atak sıklığı, tetikleyiciler, yakınmaların persistan olup olmadığı, atopik dermatit, rinit bulguları, ailede atopi öyküsü kaydedildi. Laboratuvar sonuçları [total eozinofil sayısı, immünglobulin E seviyeleri, deri prick test, gastroözofageal reflü (GÖR) tetkikleri] ve tedavileri değerlendirildi. Bulgular: Yaşları 7 ay-14 yaş arasında olan, tekrarlayan krup tanılı 100 hasta değerlendirildi. Hastaların 77'si erkek, atak sıklığı yılda 4 (3-10) idi. Krup atakları, hastaların %17'sinde üst solunum yolu enfeksiyonu ile %24'ünde spazmodik karakterde, %59'unda her ikisi de tetikleyici olarak saptandı. Hastaların %12'sinde atopik dermatit, %42'sinde rinit, %36'sında atopi, %33'ünde GÖR hastalığı, %26'sında persistan krup, %55'inde laringotrakeobronşit (LTB) tespit edildi. Persistan kruplu hastalara uygulanan laringoskopide %9 laringomalazi, %15 GÖR bulguları görüldü. Hastaların 48'ine inhale steroid tedavisi, 7'sine reflü tedavisi, 26'sına reflü tedavi ile inhale steroid tedavisi, 8'ine sadece atak sırasında tedavi verilmişti. Sonuç: Tekrarlayan krup, genelde iyi seyirli bir klinik tablodur. Atopi, LTB ve GÖR tekrarlayan krup olguları ile birliktelik gösterebilir. Sık tekrarlayan ya da yakınmaları persiste olan olgularda multidisipliner yaklaşım gereklidir. Atopisi saptanan, inhale steroid tedavisine yanıtı iyi olan hastalar, reaktif havayolu hastalığı açısından yakın takip edilmelidir.

Anahtar Kelimeler: Alerji ve immünoloji; öksürük; gastroözofageal reflü; pediatri; krup; endoskopi
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