INTRODUCTION
Wheezing is a common public health problem in preschool children,
especially in children under one year old, causing frequent
hospitalizations. 1, 2 Wheezing is one of the most
common respiratory symptoms in childhood, and according to
epidemiological studies, the frequency of wheezing is 25% in the first
3 years and 46% in the first 5 years. 2-5 Wheezing
child is a heterogeneous situation with different phenotypes. Optimal
treatment is required to reduce the frequency and severity of episodes
in future period. Since the causes and pathogenesis of wheezing in
children are very different, determining the wheezing phenotype and
appropriate regulation of the treatment is the most important approach
that determines the course of the disease. 5-7
The simplest clinical classification of wheezing: 2, 3,
5, 8 episodic viral wheezing (EVW) and multiple trigger wheezing (MTW).
The most common phenotype is EVW. Episodic viral wheezing is
characterized by the fact that the wheezing attack is triggered by a
viral upper respiratory tract infection (URTI) and the patient is
asymptomatic between the attacks. In this group, respiratory tract
infection is usually evaluated clinically, not by microbiological
diagnosis. Among the most causative agents are rhinovirus, respiratory
syncytial virus (RSV), coronavirus, human metapneumovirus, parainfluenza
virus and adenoviruses. 2, 5 Although episodic viral
wheezing usually regresses around the age of 6, some patients may
continue at school age or turn into the MTW phenotype.8 In the second type of MTW, attacks can be triggered
not only by viral respiratory infections but also by allergens, air
pollutants or exercise. 8
Differentiation of temporary or persistent wheezing in early childhood
is an important problem. Since wheezing attacks in the early period of
life may be the first sign of asthma that may develop later, determining
the risk factors for the development of asthma in infancy is important
in terms of prognosis. However, there is no biochemical or genetic
marker that predicts the development of asthma in small children. Asthma
predictive index (API) has been developed to predict who will develop
asthma among children under five years age with recurrent wheezing.9, 10 After the first definition of this index, the
criteria were reviewed and the modified asthma predictive index (mAPI)
was defined. 10 If mAPI is negative in the first 3
years, it is predicted that very probably there will be no asthma at 6
years of age, whereas if mAPI is positive in the first 3 years, it is
predicted that the possibility of developing asthma in the future is
higher. 11
Leukotriene receptor antagonists (LTRAs) block cysteinyl leukotriene
receptors, which are known to be very important in wheezing
pathophysiology. Leukotrienes are proinflammatory mediators released
mainly by mast cells, triggering bronchoconstriction, eosinophil
chemotaxis and mucus secretion in the respiratory tract, causing
increased vascular permeability. After all, LTRA’s have significant
anti-inflammatory and bronchoprotective effects. 4, 7,
12 However, the results of studies investigating the effect of the use
of LTRAs as maintenance or intermittent therapy on the frequency and
severity of attacks in children with EVW are contradictory.13-15 The aim of this study is to evaluate the
effectiveness of montelukast in pediatric patients with episodic
wheezing and API negative.
MATERIAL AND METHODS
This is a single center study. Patients who applied with recurrent
wheezing attacks to the pediatric allergy outpatient clinic at Mersin
City Hospital between 01/07/2019 - 01/08/2020 were included in the
study. In patients with recurrent wheezing between the ages of 0-6,
physical examinations were performed and eosinophil, total IgE, food mix
sps IgE (milk, egg, soy wheat, nuts, fish), phadiotop (inhalant allergen
sps IgE), skin prick tests were performed and the results were recorded
in their files. The skin prick test was conducted with dermatophagoides
pteronisinus, dermatophagoides farinae, alternaria, grain pollen, grass
pollen, weed pollen, cat dog epithelium.
Episodic viral wheezing was evaluated as wheezing that develops
following a URTI and is characterized by episodes without complaints
between wheezing episodes. Upper respiratory tract infection was defined
as the persistence of at least 2 of the following 5 symptoms: sneezing,
coughing, nasal congestion, runny nose or fever (38.0°C) for 2
consecutive days.
The mAPI of all patients was evaluated. According to this index, at
children who had four or more wheezing episodes, having 1 major or 2
minor criteria was considered positive.
Modified asthma predictive index:
Major criteria: 1. Doctor-diagnosed asthma in mother or father 2.
Doctor-diagnosed atopic dermatitis 3. Sensitivity to at least one
aeroallergen and Minor criteria: 1. Food allergy 2. Wheezing other than
URTI 3. It was evaluated as eosinophilia (≥4%) in peripheral blood
(Table 1). 16
Table 1. mAPI