Evaluation of Risk Factors, Etiology, Diagnosis, and Auxiliary Diagnostic Methods of Children With Recurrent Wheezing Between 1-24 Months
Ali Furkan Çetin, Öner ÖzdemirObjective: Wheezing should be evaluated separately from recurrent lower respiratory tract infections in terms of both etiology and risk factors. Early initiation of etiologic studies and good identification of risk factors are important in terms of the prognosis of the disease.
Methods: In this study, children between the ages of 1-24 months who had at least three recurrent wheezing attacks or who had wheezing lasting more than 1 month were examined. Cases who received a specific diagnosis for recurrent wheezing or were followed up as one of the wheezing phenotypes were compared. Between 2010 and 2012, the files of children between 1 and 24 months who had at least three recurrent wheezing attacks or who had wheezing lasting more than 1 month were examined at the Istanbul Medeniyet University Göztepe Training and Research Hospital. A total of 970 files were scanned and 76 cases were included in the study. The cases were examined by file scan and families were called by phone for incomplete information. History, socioeconomic/demographic characteristics, physical examination findings, laboratory and imaging results, and etiological causes were retrospectively recorded.
Results: In 76 cases with repeated wheezing in this study; early transient wheezing was 16% (n=12), persistent atopic wheezing was 21% (n=16), non-atopic wheezing was 25 % (n=19), and specific diagnosed cases were 38% (n=29). When all cases were taken into consideration, an echocardiogram was performed in 79% of cases, thoracic CT in 26% of cases, videofluoroscopy in 5%, and esophagus-stomach-duodenum X-ray in 25% of cases, pHmeter in 34% and bronchoscopy in 8% of cases. In the group of 29 people who received a specific diagnosis with these diagnostic and imaging techniques; gastroesophageal reflux disease (GERD) 44% (n=13), aspiration pneumonia secondary to GERD 7% (n=2), GERD + oropharyngeal dysfunction 10% (n=3), bronchopulmonary dysplasia 10% (n=3), foreign body aspiration 7% (n=2), aspiration secondary to gastric volvulus 3% (n=1), bronchogenic cyst 3% (n=1), bronchiectasis 3% (n= 1), dilated cardiomyopathy was detected in 3% (n=1) and hypereosinophilic syndrome in 3% (n=1) patients. Cystic fibrosis was detected in one of the 64 patients who underwent sweat testing, and the diagnosis was confirmed by mutation analysis. When all the cases were examined, it was observed that winter is 45% (n=34) of the attack season at the time of admission due to wheezing. However, there was no statistical difference between the groups. When the first attack times of the cases presenting due to wheezing attack are examined; In 59% (n=49) it was detected between 1-6 months and there was no significant difference between the groups. Again, when all the cases were examined, 28% (n=21) girls and 72% (n=55) boys were detected, and there was no statistically significant difference between the groups. In all cases, the maternal age was 59.6% (n=45) and under 29 years of age, while 40.8% (n=31) cases were 30 years of age or older and there was no statistical difference between the groups. When the cases were evaluated in terms of growth retardation, it was statistically significantly higher in the group with a specific diagnosis (p<0.01). According to the presence of smokers in the family, the smoking rates of the cases in the wheezing phenotypes group were statistically significantly higher than the cases in the specific diagnosed group. When total IgE levels were examined in the group containing wheezing phenotypes, a significant elevation was detected in cases with persistent atopic wheezing (p<0.01). In addition, the eosinophil percentage of the early transient wheezing group was significantly lower than that of the persistent atopic and non-atopic wheezing diagnostic groups (p<0.01); There was no significant difference between the persistent atopic group and the non-atopic group.
Conclusions: In terms of recurrent wheezing attack cases, being in winter, case age between 1-6 months, maternal age being under 29 years of age, gender being male was found to be significantly higher. Wheezing phenotype group demographic characteristics of the presence of smokers at home was significantly higher, while in the group of cases with specific diagnosis, growth retardation on physical examination was significantly higher it was found to be significantly higher.
