Mu February 2010, Food and Drug Administration (FDA) inachenjeza za mankhwala a mphumu omwe ali ndi agonist (LABAs) omwe amagwira ntchito nthawi yaitali, monga Advair ndi Symbicort. Mabungwe a LABA akhala akupezeka ku United States kuyambira m'ma 1990 monga mankhwala othandizira kuti azisamalira mphumu. Chifukwa cha maphunziro osiyanasiyana omwe amasonyeza kuti akhoza kugwiritsiridwa ntchito kwa LABA ndi kuwonetsa zizindikiro za mphumu (kuphatikizapo imfa ya mphumu), a FDA adalimbikitsa motsutsana ndi ntchito za LABA pofuna kuchiza mphumu pokhapokha ngati ziri zofunikira ndithu.
Mmalo mogwiritsa ntchito mankhwala a mphumu omwe ali ndi LABAs, a FDA amalimbikitsa kugwiritsa ntchito mankhwala ena, makamaka opaleshoni ya corticosteroids , monga mankhwala olamulira a asthma. Njira zina zimakhala ndi leukotriene blockers monga montelukast (Singulair) , omalizumab (Xolair) ndi theophylline. Mankhwala a mphumu omwe ali ndi LABAs, kuphatikizapo Advair, ayenera kugwiritsidwa ntchito kwa anthu omwe sagwiritsidwa ntchito ndi mankhwala ena monga tawatchula pamwambapa, kapena kuwonjezereka kwafupipafupi komwe kumafuna maulendo obwera mwadzidzidzi, hospitalizations kapena kugwiritsa ntchito mankhwala amodzi kapena ojambulidwa ndi corticosteroids.
Monga katswiri wa mphumu, ndikudabwa ndi chenjezo latsopano la FDA. Palibe deta yatsopano yothandizira chenjezo lotero kuchokera ku Chenjezo la Black Box lomwe laperekedwa kale ku mankhwala a LABA. The FDA imatchula maphunziro awiri makamaka omwe amasonyeza kuti LABAs akhoza kuwonjezera zizindikiro za mphumu, kuphatikizapo imfa ya mphumu. Maphunziro awiriwa akuphatikizapo Salmeterol Multicenter Pulofesa Yoyesera Kafukufuku (SMART) ndi phunziro la Serevent Nationwide Surveillance (SNS).
SMART inachitika mu 1996, ndi salmeterol (a LABA) yoperekedwa kwa anthu opitirira 13,000 okhala ndi mphumu. Ena mwa anthuwa anali kutenga mankhwala ena oletsa mphumu; ena amangogwiritsa ntchito salmeterol tsiku lililonse. Ngakhale kuti salmeterol imapezeka kuti ndi yotetezeka, zimawoneka kuti zimayambitsa matenda ambiri a mphumu, odwala matenda a mphumu ndi imfa ya mphumu mu anthu a ku America.
Pamene ophunzira a ku America ku maphunziro a SMART anali kuyang'anitsitsa, adapezeka kuti ali ndi mphumu yambiri ngati gulu, komabe sankagwiritsa ntchito steroid yosakanizidwa kuti athetse mphumu yawo. Pamene anthu a ku America omwe anali kugwiritsa ntchito steroid osakanizidwa anayesedwa, iwo amene anapatsidwa salmeterol sadaonekepo mavuto ambiri chifukwa cha ntchito yake.
Kafukufuku wa SNS anayerekeza zotsatira za kawiri-tsiku tsiku ndi tsiku la LABA Serevent (salmeterol) mpaka maulendo anayi a tsiku salbutamol (European version of albuterol) pa ulamuliro wa mphumu mwa anthu opitirira 25,000 omwe ali ndi mphumu. Ngakhale kuti chiwerengero cha anthu ophedwa ndi mphumu chidawonjezeka kwambiri, izi zinkangokhalapo chifukwa cha ngozi ndipo sizinali kunja kwa chiwerengero cha imfa mwa anthu omwe ali ndi chifuwa chachikulu cha mphumu. Phunziroli linasindikizidwa mu 1993, ndi zotsatira zomwe zimapezeka kwa FDA pamaso pa LABAs kuti zivomerezedwe kuti zigwiritsidwe ntchito ku United States.
Ma LABA ndiwo mankhwala omwe amagwiritsidwa ntchito kwambiri pochiza mphumu pazaka 15 kapena zoposa zapitazi ku United States. Ngakhale maphunzirowa ali pamwamba komanso kudera nkhaŵa kwa FDA, chiwerengero cha imfa ya mphumu yakhala ikuchepa zaka 10 kapena zoposa zapitazo.
Kodi mukuyenera kumwa mankhwala a mphumu omwe ali ndi LABA, monga Advair kapena Symbicort? Inu nokha ndi dokotala wanu mukhoza kupanga chisankho ichi. Komabe, ngati mutenga LABA, ndibwino kuti muwone dokotala wanu akambirane za kuopsa ndi phindu la mankhwalawa. Ndikofunika kuti musaleke kumwa mankhwala alionse, kuphatikizapo a LABA, musanalankhulane ndi dokotala wanu.
Phunzirani zambiri za ngozi ndi phindu la kugwiritsa ntchito Advair .
> Zotsatira:
> Nelson HS, Weiss ST, Bleeker ER, et al. Salmeterol Multicenter Pulofesa Wofufuza za Phumu. Chifuwa. 2006; 129: 15-26.
> Nelson HS. Beta-Ochita Zakale Pakati pa Aphungu Ambiri: Umboni wakuti mankhwalawa ndi otetezeka. Primary Respiratory Care Journal. 2006; 15: 271-77.
> Castle W, Fuller R, Hall J, Palmer J. Serevent Padziko Lonse Kuyang'anitsitsa: Kufanizitsa Salmeterol ndi Salbutamol mu Matenda a Asthmatic Amene Amafuna Nthawi Zonse Bronchodilator Chithandizo. BMJ. 1993; 306: 1034-7.