Zaka khumi zapitazi, akatswiri ambiri azaumoyo adandaula chifukwa cha kuchuluka kwa mankhwala omwe adapatsidwa kwa odwala kuti athetse mavuto osiyanasiyana. Mankhwala amakhala ndi zotsatira zovuta, ndipo ngati munthu amamwa mankhwala omwe sakufunikira, ndiye kuti amadziika pangozi chifukwa cha zotsatira zoipa. Komanso, mankhwala amadzipiritsa ndalama komanso kumwa mankhwala mopitirira muyeso ndi owononga komanso osokoneza.
Kafukufuku wochititsa chidwi akusonyeza kuti munthu mmodzi pa atatu alionse amene ali ndi matenda a asthma omwe ali ndi dokotala alibe kwenikweni. Choyamba, ambiri mwa anthuwa anapezeka kuti alibe phindu la kuyesera kwa thupi (ie, spirometry kapena pulmonary function tests) ndipo motero anapeza kuti ayamba kuyambitsa. Chachiwiri, anthu awa akhoza kuti anakhululukidwa ku mphumu yawo.
Maziko Osambira a Phumu
Nthenda ya mphumu ndi matenda aakulu omwe amachititsa kuti munthu asatulukire mpweya wabwino komanso amadzimva kuti amatha kuthamanga mofulumira kapena amamwa mankhwala . Zindikirani, bronchi ndi njira m'mapapu omwe amachokera ku trachea, kapena mphepo.
Panthawi ya kuchuluka kwa mphumu, kapena kuwonjezereka, bronchi imakhala yowonongeka ndipo imayamba kuphulika (mwachitsanzo, bronchospasm). Mankhwala ogwiritsira ntchito mphumu amapezekanso mankhwala a corticosteroids ndi opaleshoni ya beta-agonist bronchodilators.
Zizindikiro zofala za mphumu zimaphatikizapo zizindikiro za kupuma, kupuma, chifuwa cholimba komanso (chifuwa). Nthenda yodwala mphumu ikhoza kuyambitsa matenda, kusuta, kuchita masewera olimbitsa thupi, nkhawa ndi zina zambiri.
Kutulukira kwa mphumu kumayambira pa mbiri yachipatala, kuyeza kwachipatala, kuyezetsa ntchito ya pulmona (ie, spirometry) ndi kuyesa kutsutsa kwachimake pogwiritsa ntchito methylcholine kapena histamine.
Spirometer ndi chipangizo chomwe chimagwiritsidwa ntchito poyeza mapepala a ntchito ndi mapapu a munthu kuti azindikire momwe munthu akupuma bwino. Bronchodilator spirometry ndi mtundu wa spirometry kumene wodwala amayamba kumupatsa bronchodilator kutsegula mpweya (monga beta-agonist) ndikuyang'ana kusintha kwa mapapu omwe amasonyeza kuti ndi mphumu.
Nthawi zina spirometry sichikuthandizani kupeza matenda a mphumu komabe munthu amakayikira kuti ali ndi mphumu. M'mayeserowa, mayesero okhwima achimake angathe kuchitidwa. Ndi kuyesedwa kovuta kwachangu, katswiri amatsogolera bronchoconstrictor, monga methylcholine kapena histamine, yomwe imawombera airways, ndipo imayang'ana umboni wa kuchepa kwa mapapu ntchito yosonyeza mphumu.
Kafukufuku Watsopano
Zotsatira za maphunziro a kutalika kwa January 2017 zomwe zinalembedwa ku JAMA zikusonyeza kuti munthu mmodzi mwa atatu mwa anthu akuluakulu a ku Canada omwe amapezeka kuti ali ndi mphumu sikuti ali nazo.
Phunziroli, anthu 613 omwe adafunsidwa mwachangu kuchokera ku mizinda yayikulu kwambiri ku Canada anayesedwa pakati pa January 2012 ndi February 2016. Onsewa anali ndi zaka 18 ndipo anapeza kuti ali ndi mphumu pazaka zisanu zapitazi. Ophunzira mu phunziroli anakwaniritsa zotsatila izi:
- Mbiri yosuta fodya kapena mbiri yosuta fodya yosachepera zaka 10 (kulepheretsa anthu omwe ali ndi matenda odwala matenda osokoneza bongo )
- Kugwiritsa ntchito mankhwala a prednisone (glucocorticoid) a nthawi yaitali
- Osakhala ndi pakati kapena akuyamwitsa
- Amatha kuchita spirometry
- Palibe matenda a mtima, kupwetekedwa, kapena kuchepa kwa miyezi itatu yapitayi (zotsutsana ndi kuyesedwa kovuta)
Ngati n'kotheka, ochita kafukufukuwo adapeza zolemba za ma ARV kuchokera kwa madokotala omwe adziwa kuti ali ndi matenda a mphumu. Phunziroli, 24 peresenti ya madokotala a m'deralo sanayankhe kwa wopempha zomwe akufuna kudziwa.
Pafupikitsa maulendo angapo, ochita kafukufukuyu adagwiritsa ntchito mamita othamanga pamtunda komanso kuyang'anira mazenera, bronchodilator spirometry, ndi mayesero ovuta omwe amachititsa kuti asakhale ndi mphumu. Anthu omwe alibe chifuwa cha mphumu adasiya kuyamwa mankhwala awo a mphumu ndikuyambirananso pakapita chaka. Ofufuzawa adafunanso kupeza njira zina zomwe anthu sankakhala ndi mphumu.
Pamapeto pake, mphumuyi inalembedwa mu magawo 203 mwa 613 (33.1 peresenti). Komanso, anthu 181 (29.5 peresenti) anapitirizabe kukhala ndi umboni wa mphumu pambuyo pa miyezi 12 yotsatira. Ophunzira khumi ndi awiri (awiri peresenti) sanakhale ndi mphumu, koma adakhala ndi matenda akuluakulu a mtima omwe poyamba sanawadziwitse ndi madokotala a m'midzi. Pomalizira pake, ophunzira omwe anadziŵa kuti ali ndi mphumuyi adatulukira kuti sanagwiritsidwe ntchito poyesedwa ndi kuyesa kupuma kwa mpweya kusiyana ndi omwe amakhulupirira kuti chifuwa cha mphumu chinatsimikiziridwa.
Zidziŵitso ziwiri zodziwika zimatha kusonkhanitsidwa kuchokera ku phunziro ili:
- Anthu akuluakulu omwe amadziwika kuti ali ndi chifuwa chachikulu cha mphumu sangapitirize kukhala ndi mphumu kapena amafunika mankhwala a mphumu kosatha.
- Malinga ndi malangizo othandizira, madokotala ambiri amafunika kuyesa kuyezetsa magazi, monga bronchodilator spirometry, kuti adziwe bwinobwino asthma pomwepo. Kudalira kokha mbiriyakale ya odwala, kuyerekezera thupi, ndi matenda a chipatala sali okwanira pakupeza vutoli.
Tawonani kuti phunziroli lili ndi zolephereka zomwe zimapangitsa kuti zikhale zovuta kupanga zotsatira za aliyense yemwe ali ndi mphumu. Mwachidziwitso, ochita kafukufukuwa sanatulutse anthu ambiri omwe ali ndi mphumu yambiri (ie, iwo omwe amafuna mankhwala a prednisone a nthawi yaitali) ndipo 45 peresenti ya ophunzira omwe amaphunzira amapempha mankhwala tsiku ndi tsiku kuti athetse mphumu yawo. Choncho, kukhululukidwa pakati pa anthu omwe ali ndi mphumu yovuta kwambiri sitingayesedwe. M'malo mwake, chiŵerengero chachikulu cha kukhululukidwa (33.1 peresenti) chimagwiranso ntchito kwa omwe amapezeka kuti ali ndi chifuwa chachikulu. Ndipotu, kufufuza kwina kwa nthawi yaitali pofufuza anthu akuluakulu odwala mphumu ya chifuwa chachikulu pakati pa anthu omwe ali ndi matenda oopsa amasonyeza kuti chiwongoladzanja chikuchepa.
Kuwonjezera pamenepo, chifukwa ena mwa iwo analibe zolemba kuchokera pamene anapezeka kuti ali ndi mphumu, kapena poyamba adapezeka kuti alibe phindu la kuyezetsa matenda, sadziwa bwino momwe angapewere odwala omwe ali ndi mphumu pachiyambi. Mwa kulankhula kwina, ena omwe adalandira "chikhululukiro" sangakhale ndi mphumu pachiyambi.
Zomwe Izi Zikutanthauza
Pafupifupi 75 peresenti ya ana omwe ali ndi mphumu pamapeto pake amachokera ku ukalamba. Komabe, kafukufuku wasonyeza kuti chikhululukiro pakati pa anthu omwe ali ndi mphumu ya mphumu yokalamba ndi yotsika kwambiri. Kafukufuku wamakono, komabe, akusonyeza kuti anthu akuluakulu kuposa momwe amalingalirira kale akhoza kupeza chikhululukiro cha asthma. Akuluakuluwa safunanso mankhwala awo a mphumu.
Ngati inu kapena wokondedwa wanu mwapezeka kuti muli ndi chifuwa chachikulu cha mphumu, chonde lolani izi mu malingaliro:
- Mbali imodzi ya kayendedwe ka vutoli ndi kuyang'anira. Ngati zizindikiro zanu zimachepa kapena kuchoka, mungafunike mankhwala ochepa kapena opanda mphumu, motero. Muyenera kuyang'anitsitsa zizindikiro zanu ndi zovuta zokhudzana ndi mphumu (ie, "kuthamanga kwa mphumu") ndi kugawana nzeru ndi dokotala wanu.
- Muyeneranso kugwiritsa ntchito chiwongoladzanja cha mamita kuti muwone momwe mphumu yanu imayendera kunyumba. Ngati mupeza kuti mphumu yanu ikutha, bwererani kwa dokotala wanu kuti muyambe kuyesa. Mwinanso simufunikira mankhwala anu a mphumu.
Pomaliza, ngati mwapezeka kuti muli ndi mphumu ya munthu wamkulu, koma dokotala wanu sanagwiritsepo ntchito spirometry kapena mayeso ena opatsirana kuti atsimikizidwe kuti ali ndi vutoli, mungafune kukonzekera kukaonana ndi katswiri yemwe adzayese. Chinthu chachikulu chochotsa phunziroli ndi chakuti kuyesera kwa physiologic n'kofunika kuti mupeze matenda a asthma-ndipo zotsatizana zamakono zimalimbikitsa kuyesa.
> Zosowa
> Aaron, SD, ndi al. Kubwerezanso kwa Kusanthula kwa Akuluakulu Omwe Ali Ndi Nthenda Yophulika ya Dokotala. JAMA. 2017; 317: 269-279.
> Otsogolera Aphungu ndi Utsogoleri. American Academy of Asthma, Mankhwala Oletsera & Immunology. https://www.aaaai.org/
> Hollingsworth, HM ndi O'Connor GT. Mphumu-Kodi Pano Lero, Tili M'mawa? JAMA. 2017; 317: 262-263.
> Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr .. Chaputala 55. Chisokonezo. Mu: Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr .. eds. The Atlas of Family Medicine, 2e . New York, NY: Hill ya McGraw; 2013.