| Abstract | Uvod: Cilj našeg je istraživanja bio odrediti razliku u pojavnosti naporom inducirane
bronhokonstrikcije i prijevremenog prekida spiroergometrijskog testiranja zbog subjektivnih
tegoba u djece s GERB-om, GERB+astmom i astmom.
Ispitanici i metode: Proveli smo retrospektivnu studiju na 98 ispitanika koji su svrstani su u
tri skupine: GERB (N = 32), GERB+astma (N = 32), astma (N = 34). Pregledani su sljedeći
podaci: parametri vitalnih funkcija, antropološka mjerenja, klinički pregled, osnovni
laboratorijski parametri, ispitivanje plućnih parametara (spirometrija, difuzijski kapacitet), 24-
satna pH-metrija jednjaka, spiroergometrijsko testiranje prema modificiranom Bruce
protokolu.
Rezultati: U djece u skupini s GERB+astmom nije utvrđena statistički učestalija pojavnost
naporom inducirane bronhoopstrukcije u odnosu ostale dvije skupine. Također nije utvrđena
statistički značajna razlika u učestalosti prijevremenog prekida testa opterećenja traženog od
strane ispitanika među ispitivanim grupama. Najčešći razlog prijevremenog prekida testa bio
simptom zaduhe, a slijede kašalj, stridor, mučnina/povraćanje i vrtoglavica. Statistički
značajna razlika uočena je samo za simptom stridora koji je bio najučestaliji u GERB skupini.
Multivarijantnom analizom je utvrđena statistički značajna povezanost simptoma kašlja i
broja refluksnih epizoda, stupnja opterećenja i PEF-a; zaduhe s MEF75, centilom BMI,
vrijednosti maksimalne VCO2 i krvnog tlaka prije testa opterećenja; stridora s vrijednosti
MET-a, te dišnom rezervom. Od spiroergometrijskih parametara utvrđena je statistički
značajna razlika za postignuto opterećenje koje je bilo najniže u astma skupini u odnosu na
GERB+astma te za maksimalni primitak kisika i kisikov puls koji su bili značajno niži u
astma skupini u odnosu na preostale dvije skupine.
Zaključak: Nije nađena razlika u pojavnosti naporom inducirane bronhoopstrukcije u djece s
GERB-om i astmom u odnosu na one s GERB-om bez astme. Također nema razlike u
pojavnosti simptoma koji dovode do prekida testiranja među ispitivanim grupama.
Nepodnošenje tjelesnog napora kod GERB-a nema specifični obrazac spiroergometrijskih
pokazatelja. Pokazana je povezanost simptoma u naporu koji dovode do prekida testa s
određenim spiroergometrijskim parametrima. Daljnje prospektivno istraživanje na
bolesnicima s GERB-om koji slabije podnose tjelesni napor od posebnog je interesa zbog
veličine u problema u pedijatrijskog populaciji. |
| Abstract (english) | OBJECTIVE: To determine the prevalence of exercise - induced bronchoconstriction (EIB)
and symptoms-induced cessation of cardiopulmonary exercise testing (CPET) among
children with gastroesophageal reflux disease (GERD), GERD + asthma and asthma.
METHODS: This was a retrospective study involving 98 children previously divided into a
three groups: GERD (N=32), GERD+asthma (N=32), asthma (N=34). Following parameters
were analysed: parameters of vital functions, anthropological measurements, clinical
examination, basic laboratory parameters, lung function testing (spirometry, diffusing
capacity), 24-hour esophageal pH-metry, CPET according to the modified Bruce protocol.
RESULTS: Among children with GERD + asthma there was not statistically frequent
prevalence of EIB in relation to the other two groups. There was also no statistically
significant difference in the incidence of symptom-induced cessation of CPET among the
examined groups.
The most common symptom-induced cessation of CPET was a dyspnea, followed by
coughing, wheezing, nausea / vomiting and dizziness. A statistically significant difference
was observed only for stridor that was most frequent in the GERD group. Multivariate
analysis revealed a statistically significant correlation between symptoms of coughing and
the number of reflux episodes, degree of load and PEF; dyspnea with MEF75, BMI
percentile, VCO2max and pretest blood pressure; stridor with MET, and breathing reserve.
CPET parameters showed statistically significant differences in the achieved load, which was
the lowest in the asthma group in relation to asthma+GERD and for maximum oxygen uptake
and oxygen pulse, which were significantly lower in the asthma group compared to the other
two groups.
CONCLUSION: There was no difference in the prevalence of EIB in asthma+GERD group
compared to group with GERD without asthma. Also there is no difference in the incidence
of symptom-induced cessation of CPET among the studied groups. Exercise intolerance in
patients with GERD has no specific pattern of CPET parameters. There was correlation
between the symptom-induced cessation of CPET and specific CPET parameters. Further
prospective study in patients with GERD who do not handle physical effort is of particular
interest because of the size of the problem in the pediatric population. |
