Popeza pali mitundu yosiyanasiyana ya inhaler yomwe imagwiritsidwa ntchito pochiza COPD , odwala ambiri amadzifunsa kuti "ndi yani yabwino kwambiri"? Ngakhale kuvomereza kuti ndizoopsa kuwonetsa kuti pali 'mankhwala abwino kwambiri' pa vuto lililonse, COPD, mankhwala amodzi amayamba kuima pamwamba pa ena, zomwe zapangitsa gululi kukhala "wothandizira mzere woyamba" kuti athetse COPD.
Kalasi ya mankhwala imatchedwa anticholinergic inhalers, yomwe ilipo pakali pano pa msika: Spiriva (tiotropium) ndi Turdoza (aclidinium bromide). Popeza Turdoza adabwera pa msika mu 2012, mayesero ambiri a zachipatala okhudzana ndi odwala COPD adagwiritsa ntchito mankhwala a Spiriva (omwe anadza pamsika mu 2004). Choncho, m'nkhani ino, tikambirana zambiri zokhudza Spiriva mwa kufotokozera mwachidule maphunziro awiri ofunika okhudza Tiotropium, omwe amathandiza kuti "malo oyamba odwala a COPD asankhe." Kenako tikambirana za zotsatira za Spiriva.
Kuyerekeza Spiriva
M'magazini ya New England Journal of Medicine (March 24, 2011), gulu la ofufuza linkafuna kupeza mwapadera mankhwala omwe amathandiza kupewa COPD kuchulukitsa: anticholinergics kapena agonists a long-acting beta. Pochita zimenezi, iwo ankafanizira Tiotropium (Spiriva, anticholinergic) ndi Salmeterol (Serevent, agonist wachitali wa beta) omwe ali odwala kwambiri.
Anayesa nthawi yomwe zidatengera odwala kuti achuluke kwambiri ku COPD. Apeza kuti odwala omwe amagwiritsira ntchito Spiriva anawombera 17 peresenti pangozi yawo ya kuchuluka kwa COPD ndipo kuchepa kwa 28% pa chiopsezo kuti kuwonjezeka kwakukulu. Odwala omwe adagwiritsa ntchito Spiriva anali ndi masiku 187 mpaka kuwonjezeka kwawo kumene odwala omwe ankagwiritsa ntchito Serevent anali ndi masiku 145 kuwonjezereka koyamba.
Kuonjezera apo, odwala omwe anatenga Spiriva anali ndi zochepa zofunikira za steroid (monga prednisone) ndi mankhwala opha tizilombo. Panalibe kusiyana kwa mitengo kapena mitundu ya zotsatira za mankhwala.
Phunziro lina mu New England Journal of Medicine (kuchokera mu 2008) linapeza momwe anayesera kumene adatsata odwala 3000 omwe anatenga Spiriva ndi kuwayerekeza ndi odwala 3000 omwe ankagwiritsa ntchito 'sham' inhaler. Magulu onsewa a odwala analoledwa kugwiritsa ntchito mankhwala awo panthawi yophunzira. Odwala omwe ankagwiritsa ntchito Spiriva, anali ndi mapapu abwino kwambiri, osachepera odwala, osachepera kupuma, komanso odwala omwe sanagwiritse ntchito Spiriva. Phunziroli linapangitsa ochita kafukufuku kuganiza kuti Spiriva amatha kusintha zizindikiro, kuchepetsa kuchulukitsa komanso kusintha moyo wa odwala omwe ali ndi COPD (poyerekeza ndi omwe sanagwiritse ntchito Spiriva).
Ngakhale kuti Spiriva ndi amene amayamba kusankha choyamba mu inhaler, palinso ma inhalers omwe amasonyezedwa ku COPD, monga Advair, Symbicort, ndi ena. Odwala ambiri amafuna oposa one inhaler, ndipo kwa odwala ena, Spiriva sali kusankha bwino (mwachitsanzo, ngati akukumana ndi zotsatira). Palinso ma inhalers omwe sayenera kuphatikizidwa ndi Spiriva (Mwachitsanzo, musagwiritse ntchito Spiriva ndi Combivent pamodzi )
Zotsatira za Spiriva ndizosowa kwambiri, ndipo zingaphatikizepo izi:
Kusungirako ziweto (makamaka amuna omwe ali ndi prostate yowonjezera)
Kuthamanga kwa mankhwala (ming'oma, kuyabwa, kuthamanga, kutupa kwa milomo / lilime / pakhosi)
Glaucoma (ululu wamaso, masomphenya osasangalatsa, kuona halos kapena mitundu yosamvetsetseka)
Zotsatira zambiri zowonjezera za Spiriva zikuphatikizapo:
Mlomo wouma
Matenda a Sinus
Chikhure
Masomphenya a Blurry
Kuthamanga mtima kwa mtima
Matenda opatsirana opuma
Kuti mumve zochititsa chidwi za zochitika za Spiriva (zofalitsidwa ku New England Journal of Medicine ), dinani apa.
Zotsatira
> Tashkin DP, Celli B, Senn S, et al. Kuyesa kwa zaka 4 za tiotropium mu matenda osokoneza bongo. N Engl J Med 2008; 359: 1543-54.
> Vogelmeier C, Hederer B, Glaab T, et al. Tiotropium ndi salmeterol pofuna kupewa zovuta za COPD. N Engl J Med 2011; 364: 1093-103.
> Wanzeru RA, Anzueto A, Cotton D, et al. Tiotropium Respemat inhaler ndi ngozi ya imfa mu COPD. N Engl J Med 2013; 369: 1491-501.