Çocuklarda Kronik Öksürük
Özet
Çocuklarda kronik öksürük, pediatrik yaş grubunda sık karşılaşılan ve hem çocuk hem de ailesi için önemli bir morbidite kaynağı olan klinik bir durumdur. Akut öksürük çoğu zaman kendini sınırlayan enfeksiyonlara bağlıyken, kronik öksürük altta yatan özgül bir hastalığın ilk ve bazen tek bulgusu olabilir. Uluslararası kılavuzlara göre çocukluk çağında kronik öksürük, dört hafta veya daha uzun süren öksürük olarak tanımlanmakta ve erişkinlerden farklı bir tanısal yaklaşım gerektirmektedir. Çocuklarda kronik öksürüğün değerlendirilmesinde temel hedef, ciddi ve ilerleyici hastalıkların erken dönemde saptanması, gereksiz tetkik ve tedavilerden kaçınılması ve nedene yönelik etkin bir yönetim stratejisinin uygulanmasıdır. Tanısal yaklaşımda ayrıntılı öykü alma ve dikkatli fizik muayene temel basamakları oluşturur. Öksürüğün karakteri (ıslak veya kuru), zamanlaması ve eşlik eden alarm bulguları ayırıcı tanıda yol göstericidir. Uzamış bakteriyel bronşit, astım, üst hava yolu öksürük sendromu ve gastroözofageal reflü hastalığı çocuklarda sık görülen nedenler arasında yer alırken; bronşektazi, kistik fibrozis ve primer siliyer diskinezi gibi durumlar kronik pürülan öksürüğün önemli nedenleridir. Tedavi yaklaşımı, öksürüğün baskılanmasından ziyade altta yatan etiyolojinin hedeflenmesine dayanmalıdır. Bu bölümde çocuklarda kronik öksürüğün fizyopatolojisi, etiyolojisi, tanısal yaklaşımı ve güncel tedavi prensipleri literatür eşliğinde ele alınmaktadır.
Referanslar
Morice AH, Millqvist E, Bieksiene K, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020;55(1):1901136. doi: 10.1183/13993003.01136-2019.
Chang AB, Oppenheimer JJ, Weinberger MM, et al. Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report. Chest. 2017;151(4):884-890. doi: 10.1016/j.chest.2017.01.025.
Marchant JM, Masters IB, Taylor SM, et al. Evaluation and outcome of young children with chronic cough. Chest. 2006 May;129(5):1132-41. doi: 10.1378/chest.129.5.1132. PMID: 16685002.
Mazzone SB, McGarvey L. Mechanisms and Rationale for Targeted Therapies in Refractory and Unexplained Chronic Cough. Clin Pharmacol Ther. 2021;109(3):619-636. doi: 10.1002/cpt.2003.
Polverino M, Polverino F, Fasolino M, et al. Anatomy and neuro-pathophysiology of the cough reflex arc. Multidiscip Respir Med. 2012;7(1):5. doi: 10.1186/2049-6958-7-5.
Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):260S-283S. doi: 10.1378/chest.129.1_suppl.260S.
Shields MD, Bush A, Everard ML, et al. BTS guidelines: Recommendations for the assessment and management of cough in children. Thorax. 2008;63 Suppl 3:iii1-iii15. doi: 10.1136/thx.2007.077370.
Gallucci M, Pedretti M, Giannetti A, et al. When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children. Front Pediatr. 2020;8:433. doi: 10.3389/fped.2020.00433.
Ruffles TJC, Marchant JM, Masters IB, et al. Outcomes of protracted bacterial bronchitis in children: A 5-year prospective cohort study. Respirology. 2021;26(3):241-248. doi: 10.1111/resp.13950.
Redondo M, Keyt H, Dhar R, et al. Global impact of bronchiectasis and cystic fibrosis. Breathe (Sheff). 2016;12(3):222-235. doi: 10.1183/20734735.007516.
Stillwell PC, Wartchow EP, Sagel SD. Primary Ciliary Dyskinesia in Children: A Review for Pediatricians, Allergists, and Pediatric Pulmonologists. Pediatr Allergy Immunol Pulmonol. 2011;24(4):191-196. doi: 10.1089/ped.2011.0099.
Venkatesan P. 2025 GINA report for asthma. Lancet Respir Med. 2025:S2213-2600(25)00242-5. doi: 10.1016/S2213-2600(25)00242-5.
Pratter MR. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):63S-71S. doi: 10.1378/chest.129.1
Chang AB, Lasserson TJ, Gaffney J, et al. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev. 2006;(4):CD004823. doi: 10.1002/14651858.CD004823.pub3.
Referanslar
Morice AH, Millqvist E, Bieksiene K, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020;55(1):1901136. doi: 10.1183/13993003.01136-2019.
Chang AB, Oppenheimer JJ, Weinberger MM, et al. Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report. Chest. 2017;151(4):884-890. doi: 10.1016/j.chest.2017.01.025.
Marchant JM, Masters IB, Taylor SM, et al. Evaluation and outcome of young children with chronic cough. Chest. 2006 May;129(5):1132-41. doi: 10.1378/chest.129.5.1132. PMID: 16685002.
Mazzone SB, McGarvey L. Mechanisms and Rationale for Targeted Therapies in Refractory and Unexplained Chronic Cough. Clin Pharmacol Ther. 2021;109(3):619-636. doi: 10.1002/cpt.2003.
Polverino M, Polverino F, Fasolino M, et al. Anatomy and neuro-pathophysiology of the cough reflex arc. Multidiscip Respir Med. 2012;7(1):5. doi: 10.1186/2049-6958-7-5.
Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):260S-283S. doi: 10.1378/chest.129.1_suppl.260S.
Shields MD, Bush A, Everard ML, et al. BTS guidelines: Recommendations for the assessment and management of cough in children. Thorax. 2008;63 Suppl 3:iii1-iii15. doi: 10.1136/thx.2007.077370.
Gallucci M, Pedretti M, Giannetti A, et al. When the Cough Does Not Improve: A Review on Protracted Bacterial Bronchitis in Children. Front Pediatr. 2020;8:433. doi: 10.3389/fped.2020.00433.
Ruffles TJC, Marchant JM, Masters IB, et al. Outcomes of protracted bacterial bronchitis in children: A 5-year prospective cohort study. Respirology. 2021;26(3):241-248. doi: 10.1111/resp.13950.
Redondo M, Keyt H, Dhar R, et al. Global impact of bronchiectasis and cystic fibrosis. Breathe (Sheff). 2016;12(3):222-235. doi: 10.1183/20734735.007516.
Stillwell PC, Wartchow EP, Sagel SD. Primary Ciliary Dyskinesia in Children: A Review for Pediatricians, Allergists, and Pediatric Pulmonologists. Pediatr Allergy Immunol Pulmonol. 2011;24(4):191-196. doi: 10.1089/ped.2011.0099.
Venkatesan P. 2025 GINA report for asthma. Lancet Respir Med. 2025:S2213-2600(25)00242-5. doi: 10.1016/S2213-2600(25)00242-5.
Pratter MR. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):63S-71S. doi: 10.1378/chest.129.1
Chang AB, Lasserson TJ, Gaffney J, et al. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev. 2006;(4):CD004823. doi: 10.1002/14651858.CD004823.pub3.
