Title Fenotipovi astme dječje dobi i kontrola bolesti u različitim dobnim skupinama Title (english) Asthma phenotypes in childhood and disease control in different age groups Author Iva Mihatov Štefanović Mentor Ljerka Cvitanović-Šojat (mentor)Mentor Dorian Tješić-Drinković (komentor)Committee member Ivan Krolo (predsjednik povjerenstva)Committee member Sabina Rabatić (član povjerenstva)Committee member Alenka Gagro (član povjerenstva)Committee member Zora Zakanj (član povjerenstva)Committee member Neven Tudorić (član povjerenstva)Granter University of Zagreb Defense date and country 2014-04-29, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 616.31 - Stomatology Abstract Astma je heterogena bolest koju čine različiti fenotipovi s vjerojatno različitim, ali za sada nepoznatim uzrocima i prirodnim tijekom. Prospektivno praćenje bolesnika s različitim fenotipovima važno je zbog analize njihove stabilnosti, odgovora na terapiju i praćenja prirodnog tijeka bolesti, odnosno njenog trajanja.
Cilj istraživanja bio je utvrditi učestalost određenog fenotipa u različitim dobnim skupinama djece, postojanje i vrstu alergijske senzibilizacije, trajanje terapije te kontrolu bolesti u različitim fenotipovima kao i rast te funkciju nadbubrežne žlijezde na početku i na kraju istraživanja u bolesnika na inhalacijskim kortikosteroidima.
U prospektivnu petogodišnju studiju uključen je 201 bolesnik s novootkrivenom astmom. Podjela u kliničke fenotipove učinjena je prema PRACTALL-smjernicama, a od parametara su analizirani kontrola bolesti, trajanje terapije, učestalost pozitivne atopijske obiteljske anamneze i drugih atopijskih bolesti u različitim fenotipovima i dobnim skupinama, vrijednost score-a standardne devijacije (SDS) te ACTH i kortizol na početku i na kraju istraživanja kod bolesnika na inhalacijskim kortikosteroidima.
U većine bolesnika bolest je bilo moguće klasificirati u pojedini fenotip koji u većine ostaje stabilan, osim u djece predškolske dobi. U dobnim skupinama starijim od 3 godine alergijska astma je bila najčešći fenotip, najčešći alergen grinja (Dermatophagoides pteronyssinus), a bolest najbolje kontrolirana u odnosu na druge fenotipove. Virusima inducirana astma bila je češći fenotip u mlađoj, a astma potaknuta fizičkim naporom u starijoj dobi. U svim fenotipovima moguća je prisutnost atopije. Loša kontrola bolesti bila je najčešća u najmlađoj dobnoj skupini. Inhalacijski kortikosteroidi, u preporučenim dozama, nisu utjecali na rast niti na funkciju nadbubrežne žlijezde.
Obzirom na veću učestalost određenih fenotipova u određenoj dobi, moguće je da je ekspresija fenotipa funkcija dobi. Suprotno dosadašnjim istraživanjima, alergijska astma najčešći je fenotip već u predškolskoj dobi. Visoka učestalost alergijske preosjetljivosti u skupini male djece do 2 godine i virusima induciranoj astmi nalaže praćenje bolesnika jer se ne radi o prolaznoj sipnji, pa tako ostaje upitno koja je optimalna terapija za poremećaje sipnje u ranom djetinjstvu. Astma je kronična bolest bez obzira na fenotip.
Abstract (english) Asthma is a heterogeneous disease comprising several different phenotypes with probably different, but so far undefined causes and natural histories. Study designs based on longitudinal assessment of patients with different asthma phenotypes may improve understanding of their stability, natural history, persistence of disease and medication effectiveness.
The aim of this study was to determine the frequency of different phenotypes depending on age group, the existence and types of allergic sensitisation and disease control in different phenotypes, linear growth and function of the adrenal gland at the beginning and at the end of the study in patients taking inhaled corticosteroids.
This five year prospective study involved 201 patients with newly diagnosed asthma. PRACTALL guidelines were used to determine asthma phenotypes and disease control, treatment duration, the existence and types of allergic sensitisation in different phenotypes and age groups were monitored as well as height standard deviation score (SDS), ACTH and cortisol at the beginning and at the end of the study in patients taking inhaled corticosteroids.
Application of certain clinical parameters enables phenotype classification for most patients and it remains stable in most of them, except in preschool children. Allergic asthma was the most prevalent phenotype in all age groups older than 3 years, house dust mite was the most prevalent allergen and good disease control was significantly more frequent in allergic asthma than in other phenotypes. Viral induced asthma was more prevalent in the younger age group, while exercise induced asthma was more frequent in the older age group. Allergic sensitization can be expected in all phenotypes. The disease was the most poorly controlled in the youngest age group. Inhaled corticosteroids, in recommended doses, have no effect on linear growth or adrenal gland function.
Because of greater prevalence of some phenotypes in certain age groups, it is possible that age is a determinant factor for phenotype presentation. Contrary to previous research allergic asthma is the most prevalent phenotype already in preschool age group. High prevalence of allergic sensitisation in children aged 0-2 years and children with viral induced asthma requires monitoring of these patients because they do not represent sporadic viral wheeze. The optimal therapeutic strategy for wheezing disorders in early life remains unknown. Asthma is a chronic disease irrespective of phenotype.
Keywords
astma
fenotip
dijete
inhalacijski kortikosteroidi
rast
Keywords (english)
asthma
phenotype
child
inhaled corticosteroids
growth
Language croatian URN:NBN urn:nbn:hr:127:087797 Study programme Title: dental medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2017-03-21 13:12:00
