Presentation is loading. Please wait.

Presentation is loading. Please wait.

Pınar Köksal1, Umut Gök Balcı1, Didem Çekiç1, Serkan Günalay1,

Similar presentations


Presentation on theme: "Pınar Köksal1, Umut Gök Balcı1, Didem Çekiç1, Serkan Günalay1,"— Presentation transcript:

1 Pınar Köksal1, Umut Gök Balcı1, Didem Çekiç1, Serkan Günalay1,
Assessment of Risk Factors in Acute Bronchiolitis Patients Admitted to Emergency Department Pınar Köksal, MD İzmir Tepecik Training and Research Hospital, TURKEY Pınar Köksal1, Umut Gök Balcı1, Didem Çekiç1, Serkan Günalay1, Duygu Çam1, Hande Kutlu1, Murat Anıl1, Kurtulus Ongel2 1 İzmir Tepecik Educational and Research Hospital , Clinic of Family Medicine, İzmir, Türkiye 2 İzmir Katip Çelebi University, Faculty of Medicine, Department of Family Medicine, İzmir, Türkiye

2 Overview Mortality in Children
Respiratory Tract Infections and Acute Bronchiolitis Risk Factors Study Conclusions

3 Mortality in children under 5 years of age
5.9 million children under the age of 5 died in 2015 worldwide Pneumonia & respiratory diseases are the second most common cause of death under 5 year old according to UNICEF Report 2015 Acute respiratory disease was 6th most common cause of mortality in Turkey, ( %3) Almost 6 million children under the age of 5 died in 2015 worldwide This mortality may be caused by many factors As you see in this chart from WHO Reports, Pneumonia and other LRTI are among the most common causes of mortality In Turkey, most common cause of mortality is accidents (%34) Ministry of Health, Infant Mortality Forms

4 Respiratory Tract Infections in Post-Neonathal Children
Cause of death Risk factors Prevention Pneumonia, or other acute respiratory infections Low birth weight Malnutrition Non-breastfed children Overcrowded conditions Vaccination Adequate nutrition Exclusive breastfeeding Reduction of household air pollution More than half of these early child deaths are due to conditions that could be prevented or treated with access to simple, affordable interventions The same is true for Pneumonia and other LRTI Risk factors include: Low birth weight, Malnutrition, Non-breastfed children, Overcrowded conditions And these risk factors can be eliminated by: Vaccination, Adequate nutrition, Exclusive breastfeeding, Reduction of household air pollution which may include smoking More than half of these early child deaths are due to conditions that could be prevented or treated with access to simple, affordable interventions

5 Acute Bronchiolitis Pathology; Signs and symptoms; Acute inflammation,
Edema, Necrosis of epithelial cells lining small airways, Increased mucus production Signs and symptoms; Begin with rhinitis, cough May progress to tachypnea, Wheezing, rales Use of accessory muscles, nasal flaring Bronchiolitis is a type of LRTI common in children Most common etiology of bronchiolitis is respiratory syncytial virus (RSV) Highest incidence of infection between December and March Image: momjunction.com

6 Risk Factors of Bronchiolitis
Unpreventable Age<12 weeks A history of prematurity Underlying cardiopulmonary disease Immunodeficiency Down Syndrome Cystic fibrosis Neuromuscular Disease and Pulmonary Abnormality Preventable Tobacco use prenatal smoking postnatal smoking secondhand smoking Heating source; wood stove & poor air quality Household crowding Lack of breastfeeding (> 6 mo) Hand hygiene Young, M, and Langley, J. Open Forum Infectious Diseases. Vol. 1. No. Suppl 1. Oxford University Press, 2014.

7 Smoking (A Preventable Risk Factor)
Tobacco smoke exposure  risk and severity of bronchiolitis  risk of hospitalization for bronchiolitis1 Maternal smoking  incidence of wheezing illness up to 6 years of age2 Household smoking 2x risk of lower respiratory tract infection in children3  Eliminate or reduce secondhand smoke exposure, including education of parents4 Therefore, AAP recommends eliminating reduce secondhand smoke exposure, including education of parents 1Strachan DP & Cook DG. Thorax 1997; 52(10): p905 2DiFranza JR, et al. Pediatrics 113. Supplement 3 (2004): p1007 3Li JSM, et al. Pediatr Pulmonol 1999;27: p5 4AAP Reports, 2009

8 Heating Source (A Preventable Risk Factor)
Bronchiolitis frequency  in houses using coal stove for heating (but not statistically significant) It causes indoor air pollution and predisposes to infection1 In infants and children in Nepal who reported more time spent next to stoves suffered more life threatening episodes of acute respiratory infections Wood-burning stove use and respiratory illness exposure were independently associated with higher risk2 According to a study by Morris K, et al. "Wood-burning stoves and lower respiratory tract infection in American Indian children.” 1Morris K, et al. American Journal of Diseases of Children (1990): p105 2British Medical Bulletin, 2003

9 Crowded Household (A Preventable Risk Factor)
Frequency of bronchiolitis is proportional to the number of family members1 Insidance of acute bronchiolitis  if more than 3 family member sleep in the same room2 baby only: %12 3 or more people: %22 According to a study by Morris K, et al. "Wood-burning stoves and lower respiratory tract infection in American Indian children.” 1Bosis S, et al, J Med Virol 2005;75(1): p101 2Etiler N & Aktekin MR, J Turgut Ozal Medical Center, 2000;7(3): p208

10 Study Patient Group Age 0 - 24 months, (total of 74 patient)
Admitted to emergency room Period of one week in March 2015 Izmir Tepecik Training and Research Hospital Wheezing complaints Diagnosed with acute bronchiolitis In this study, We questioned parents of children younger than 24 mo old admitted to ER with wheezing complaints and diagnosed with bronchiolitis

11 Material and Methods Parents were asked about Ages of children
Smoking history during pregnancy postpartum period household smoking inside home Previous bronchiolitis attacks Heating source of residence Sharing bedroom with the child Parents were asked about...

12 Age Groups Largest age group: 6 - 12 Mo
Previous studies established that this is the age period in which bronchiolitis is mostly seen

13 Household Smoking Smoking prevalence among women in our patient population (%31, %29 in another study) is significantly (almost 3 times) higher than women in Turkey (General: %27, Women: %13) Household smoking in a study found to be 34% in Turkey

14 Household Smoking by Age-Groups
This is the graph that shows Household Smoking by Age-Groups As you see, household do not pay attention to vulnerability of newborns or children to the effects of smoking Actually, 2 of patient younger than 3 months had respiratory arrest and couldn’t be saved, unfortunately As PCPs, we need to pay special attention to educating parents about this issue

15 Household Smoking vs Occurrence of Bronchiolitis Attacks
Household smoking prevalence is 70% among bronchiolitis patients in this study Household smoking prevalence is 34% in a comparable general population in Turkey1 Parents were asked if the patient had previous bronchiolitis attacks Among patients of month Not statistically meaningful Smoking vs Number of bronchiolitis attacks Bronch <2 Bronch ≥ 2 Total Smoking n = 29 (44%) n = 14 (22%) n = 43 (66%) Non-Smoking n = 8 (12%) n = 22 (34%) n = 65 Household smoking prevalence is 70% among bronchiolitis patients in our study However, this is significantly lower (34%) in a comparable general population in a study done in Turkey Therefore, we wanted to look at the relationship between Household Smoking and occurrence of previous bronchiolitis attacks The results were Not statistically meaningful, that is, household smoking does not seem to have any effect on number of bronchiolitis attacks. It was shown that bronchiolitis attacks are not common under 3 months 1Kucuk O, et al. JOPP Dergisi, 2012;4(3): p124

16 Heating Source In Turkey, choice of heating source is closely related to socioeconomic level Sharing Bedroom with the Child 73 of 74 patients sharing the bedroom at least with parents but some with also other siblings or grand parents Socioeconomic level of the patient population in the vicinity of our hospital is lower than the average of Turkey. As a result, households are more crowded and heating amenities of homes are of lower quality. To conserve, they rely on a single heating source in a single sleeping room. A study in a region with a contrasting socioeconomic level would be a good study to complement this one

17 Biases In the community near our hospital,
Socioeconomic level is lower Smoking prevalence among women is higher Many of the families are extended families In Turkey, Sleeping with baby during breastfeeding (commonly first 2 years) is traditional So as you have seen in our data Socioeconomic level is lower Smoking prevalence among women is higher Many of the families are extended families This is inevitably adds some bias to our study

18 Conclusion Smoking in the family, maternal smoking during pregnancy, heating sources and sleeping in the crowded room are some environmental risk factors for acute bronchiolitis Clinicians should counsel caregivers about exposing the infant or child to environmental tobacco smoke and about smoking cessation when assessing a child for bronchiolitis This study shows that smoking prevalence is higher in household of bronchiolitis patients However, this study needs to be expanded to include a more unbiased patient population 1Rosen LJ, et al. Pediatrics. 2012;129(1): p141

19 Thanks for your attention


Download ppt "Pınar Köksal1, Umut Gök Balcı1, Didem Çekiç1, Serkan Günalay1,"

Similar presentations


Ads by Google