Astım ve KOAH'lı hastalarda tremor, çarpıntı ve kramp sıklığı ve bunları etkileyen faktörler
The frequency and the factors effect that of tremor, palpitation and cramps in patients with COPD and asthma
Yazar: SEMA DEMİR
Danışman: PROF. DR. ALİ FUAT KALYONCU
Hacettepe Üniversitesi / Tıp Fakültesi / Göğüs Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2008
Konu: Göğüs Hastalıkları = Chest Diseases

Özet:
Amaç : Çalışmamızda; tedavi esnasında ortaya çıkan tremor, çarpıntı ve kramp yan etkilerinin sıklığı ve önceden öngörülebilirliği araştırılmıştır.Hastalar ve Yöntem : Hacettepe Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalında, 2007 Şubat ayı boyunca, polikliniğe başvuran tüm hastalara tanıları, tedavileri ve çeşitli tedavi nedenli yan etkilere ait standart bir anket uygulandı. Bu hastalar, 15.,30. ve 180. günlerde kontrole çağrıldı veya telefonla aranılarak, durumları ve çeşitli yakınmaları açısından prospektif olarak izlendi.Bulgular: Çalışmamızda , başvuru esnasında, kramp % 63.9, tremor %33.4 ve çarpıntı % 30.4 oranında bulundu. BD tedavisine bağlı tremor oluşan hasta grubunda, betamimetik kullanımı %90.6 olarak saptandı. Başvuruda tremoru olan 100 hastadan 90'ınında (%90), başvurudan itibaren yapılan 15.,30. ve 180. gün kontrollerinde tremor devam etmekteydi. Yeni ilaç başlanan veya ilaç değişimi yapılan 32 hastanın sekizinde (%25) tremor, beşinde (%15.6) çarpıntı, üçünde ise (%9.3) kramp oluşması veya artışı tespit edildi. Bu hastalardan ikisinin tremoru, 15. gün ve 30. günde kaybolmuştu. Altı (%75) hastada ise; tremor 180.gün kontrolünde de devam etmekteydi. Çarpıntı, bir hastada 30. gün, kramp ise bir hastada 15.gün kontrolünde kaybolmuştu.Sonuçlar: Çalışmamızda, tremor, kramp ve çarpıntı gibi ilaç yan etkilerinin, toplumda bildirilen oranlardan daha fazla olduğu görülmüştür. Yan etkilerin, hastalığın kendisiyle, betamimetik ve teofilin kullanımıyla direk ilişkili olduğu saptanmıştır. Astımlılarda KOAH'lılara göre yan etki sıklığı anlamlı olarak daha fazladır. İlaçla oluşan yan etkilerin ise sıklıkla betamimetiklere bağlı olduğu görülmüştür. Önceden tremoru olmayan hastalarda, betamimetik kullanımı ile tremor oluşma riski 14 kat artmıştır. Yeni tedavi başlanan hastalardaki tremor ; çarpıntı ve kramptan anlamlı olarak daha yüksek oranlarda saptanmıştır. Çalışmamızda, önceden bildirilen oranlarda tolerans gelişimi saptanmamıştır; 15., 30. ve 180. günlerde bu yan etkilerin büyük ölçüde devam ettiği görülmüştür.

Abstract:
Aim: To evalute the frequency and the predictability of side effects including tremor, cramps and palpitation according to treatment, in patients with COPD and asthma.Patients and Method: We performed a standard questionniare to the patients about their diagnosis, treatment, and side effects of the treatment in February 2007, at Hacettepe University, Faculty of Medicine, Department Of Chest Diseases. We examined the clinical status of the patients and side effects of the treatment at 15th, 30 th, and 180 th day of the treatment prospectively.Results: Rates were: tremor, 33.4%; cramps, 63.9%; palpitation, 30.4%. The usage of ß2- agonists in patients with tremor, developed due to BD therapy was 90.6%. Tremor was still present at 15th, 30 th, and 180 th days of examinations in 90% of patients with tremor at admission. We found that new and/or increased tremor, palpitation and cramps in 25%, 15,6% and 9,3% of 32 patients treated with new drugs or of whose drugs were changed, respectively. 2/8 of the patients? tremor was disappared at 15 th and 30 th days of treatment. However, 6/8 of the patients?tremor were still present at 180th day of exam. 1/5 of palpitation and 1/3 of cramp was disappeared at 30th and 15th days of exam respectively.Conclusions: This study demonstrates that side effects of drugs like tremor, palpitation and cramp are more common in our patients compared to general population. These side effects directly related to primary disease and use of ß2- agonists and theophylline. The rate of side effects are more common in patients with asthma than the patients with COPD significantly. Side effects due to drugs were mostly due to ß2- agonists. The risk of tremor due to ß2- agonists in patients without previous tremor was increased 14 times more. Tremor was found to be more common than palpitation and cramp significantly. Another finding of our study is that tolerance was not developed in that much reported in the literature. The majority of the side effects were still present at 15 th, 30 th and 180 th days of treatment.ABSTRACTThe Frequency and The Factors Effect That of Tremor, Palpitation and Cramps in Patients with COPD and AsthmaSema Demir, MD, Thesis in Chest DiseasesAim: To evalute the frequency and the predictability of side effects including tremor, cramps and palpitation according to treatment, in patients with COPD and asthma.Patients and Method: We performed a standard questionniare to the patients about their diagnosis, treatment, and side effects of the treatment in February 2007, at Hacettepe University, Faculty of Medicine, Department Of Chest Diseases. We examined the clinical status of the patients and side effects of the treatment at 15th, 30 th, and 180 th day of the treatment prospectively.Results: Rates were: tremor, 33.4%; cramps, 63.9%; palpitation, 30.4%. The usage of ß2- agonists in patients with tremor, developed due to BD therapy was 90.6%. Tremor was still present at 15th, 30 th, and 180 th days of examinations in 90% of patients with tremor at admission. We found that new and/or increased tremor, palpitation and cramps in 25%, 15,6% and 9,3% of 32 patients treated with new drugs or of whose drugs were changed, respectively. 2/8 of the patients? tremor was disappared at 15 th and 30 th days of treatment. However, 6/8 of the patients?tremor were still present at 180th day of exam. 1/5 of palpitation and 1/3 of cramp was disappeared at 30th and 15th days of exam respectively.Conclusions: This study demonstrates that side effects of drugs like tremor, palpitation and cramp are more common in our patients compared to general population. These side effects directly related to primary disease and use of ß2- agonists and theophylline. The rate of side effects are more common in patients with asthma than the patients with COPD significantly. Side effects due to drugs were mostly due to ß2- agonists. The risk of tremor due to ß2- agonists in patients without previous tremor was increased 14 times more. Tremor was found to be more common than palpitation and cramp significantly. Another finding of our study is that tolerance was not developed in that much reported in the literature. The majority of the side effects were still present at 15 th, 30 th and 180 th days of treatment.