Kodi Nthenda Yanu Yophuka Kwambiri Ndi Yosavuta Kwambiri?
Nthenda yotchedwa Eosinophilic asthma, yomwe imadziwikanso kuti e-asthma, ndiyo njira yodziwika bwino ya mphumu yomwe imapezeka kuti ndi wamkulu. Amakhala ngati atopic , zomwe zikutanthauza kuti pali chibadwa cha chifuwa cha chifuwa chomwe chimayambitsa matenda. Kusiyana ndi mitundu ina ya mphumu, mphumu ya eosinophilic imakhala ndi kutupa kwapansi kuchokera kumapanga anu omwe mumakhala m'mapapo anu.
Kutupa kwa mphumu yotchedwa eosinophilic mphumu kumachitika ngati gawo la mankhwala osokoneza bongo kapena chitetezo cha mthupi, chomwe chimatulutsa selo loyera la magazi lotchedwa eosinophils . Mukakhala ndi kuwonjezeka kwa maselo oyera a magazi, mumakhala ndi mayankhidwe opweteka, omwe amachititsa kuti muzitha kuyendayenda. Mankhwalawa ndi madontho omwe amawoneka angapangitse kuti mitsempha yanu iwonongeke (bronchioles) ndikuyambitsa matenda a mphumu.
Kukula
Phumu ndi matenda opweteka a airways omwe angakulepheretseni kupuma. Pafupifupi anthu amodzi (1) mwa khumi ndi atatu (13) aliwonse amadwala matendawa ndipo pafupifupi theka la anthu omwe ali ndi mphumu ali ndi chifuwa cha mphumu chaka chilichonse. Dziwani kuti zambiri zazowonjezereka zimaletsedwa ngati mphumu ikulamulidwa bwino. Pamene poyamba ankaganiza kuti ndi matenda amodzi, mphumu imakhala ndi zigawo zambiri zomwe zingasinthe momwe mphumu yako imatha kuyendetsera bwino.
Pafupifupi 1 pa 10 aliwonse omwe ali ndi mphumu ali ndi mphumu yambiri.
Ngakhale kuchuluka kwa mphumu ya eosinophilic ndi yosadziŵika, pali lingaliro lakuti 50 mpaka 60 pa milandu 100 ya mphumu yambiri mwa akuluakulu akhoza kukhala ndi mphumu ya eosinophilic. Ngati muli ndi zaka zoposa 35 mukapezeka kuti muli ndi mphumu yoopsa mumakhala ndi chiopsezo chachikulu chopezeka kuti muli ndi mphumu ya eosinophilic.
Mavuto anu ali ofanana mosasamala za amuna anu, ndipo mulibe chiopsezo chachikulu chopezeka kuti muli ndi mphumu ya eosinophilic mu ubwana wanu ndi zaka zachinyamata.
Zizindikiro
Zambiri mwa zizindikiro za mphumu ya eosinophilic ndi zofanana ndi mitundu ina ya mphumu kuphatikizapo:
- Kupuma pang'ono
- Kukuda
- Kupuma
- Kukhazikika mu chifuwa chanu
Pali zizindikiro zochepa zimene zingakhalepo nthawi zambiri zosagwirizana ndi mphumu kuphatikizapo:
- Madzi osokoneza bongo ndi chisokonezo ( matenda aakulu a rhinosinusitis )
- Zosintha zamkati
- Kukulitsa zamkati zamphongo zamkati
- Kutaya kununkhiza (osmia)
Ngakhale kuti mphumu yotchedwa eosinophilic asthma imakhala ndi chitetezo cha mthupi chokhudzana ndi chifuwa, anthu ambiri omwe amapezeka kuti ali ndi vutoli samadwala ngati nkhungu, zofewa, kapena zina zotere.
Kudziwa
Kawirikawiri mphumu yosasemphana imakhala yosasanthuledwa. Sichimaganiziridwa kuti ndi wamba ngakhale kuti kuchulukira kumaganiziridwa kukhala koposa kuposa poyamba.
Ngati mphumu ya eosinophilic imayambitsa matenda a mphumu ndipo sichipezeka, mungathe kuvutika kuti mukhale ndi mphumu yoyipa. Kawirikawiri mumafuna kuti muwone ngati muli ndi nkhawa. Komabe, alangizi othandizana ndi matendawa ndi othandizira pazomwe mukufufuza.
Kuwerengera kwa Cell Eosinophil
Kupanga kuchuluka kwa maselo a eosinophil kuchokera ku sampulisi yomwe imapangitsa kuti ayambe kusuta imatengedwa kuti ndiyezo wa golide wa ma cell cell, koma n'zovuta kupeza, nthawi yowonongeka, ndi osamala.
Kawirikawiri imafuna kugwiritsa ntchito labu lapadera lomwe limagwiritsidwa ntchito ndi akatswiri.
Mukakusonkhanitsa zojambulazo, mukufuna kuonetsetsa kuti simukuthira mateti, koma mukukakuta makoti mumtsinje wanu. Kuti athandize sputum, dokotala wanu akhoza kukhala ndi opaleshoni ya kupuma kukupatsani mlingo wa albuterol kapena bronchodilator wotsatila. Pambuyo pake mankhwalawa amatengedwa ndi kukupatsani saline hypertonic nebulazed. Mchere wamchere wambiri umawomba umawopsya mpweya ndipo umathandizira kukopa chifuwa. Zomwe zimagwedezeka zimatha kuganiziridwa mu labata kuti awone ngati palipo zazikulu zoposa 1 mpaka 3 pa zana 100 za eosinophils.
Njira Yoyenda Pansi
Njira ina yodziwiratu kuti e-astma ndikutenga chiwombankhanga chapakati pa bronchoscopy. Njirayi ikhoza kuchitidwa pofuna kuthetsa matenda osiyanasiyana. Komabe, njirayi sichikulimbikitsidwa kokha kuti muzindikire mphumu ya eosinophilic chifukwa ndi njira yowopsya yomwe imafuna kuti munthu asakhale pansi pokha pokhapokha ngati sitingathe kupeza chitsanzo chokwanira chokhala ndi sampula.
Njira Zina
Njira zina zakhazikitsidwa pofuna kuthandizira kupeza matenda a e-asthma. Dokotala wanu angayang'ane CBC (chiwerengero chathunthu cha magazi) kuti afufuze za eosinophilia (kuchulukitsa chiwerengero cha eosinophil count). Komabe, kutanthauzira mapepala apamwamba m'magazi ayenera kungopangidwa ndi dokotala chifukwa chokwera m'magazi anu sichikutsimikizira kuti muli ndi mphumu ya eosinophilic. Komabe, zingathandize dokotala wanu kusiyanitsa zizindikiro zina zomwe muli nazo.
Matenda ena omwe angaganizidwe ngati muli ndi eosinophil yowerengera m'magazi anu mumaphatikizapo matenda a hypereosinophilic, matenda osokoneza bongo, osadziwika bwino, komanso mankhwala.
Mayesero aŵiri ena angatengedwe ngati mankhwala opatsirana amadzimadzi omwe amachititsa kuti azitha kupuma kapena magazi a eosinophil: kachilombo kamene kamatulutsa nitric oxide (FeNO) kuyesera kupuma ndi test periostin. Ngati muli ndi mphumu ya eosinophilic, mumakonda kuwonetsa ma eosinophils m'magazi anu ndi ziphuphu, immunoglobulin E, FeNO, ndi periostin.
FeNO ikhoza kukhala yothandiza kumatsimikizira ngati mungayankhe ndi corticosteroids yosakanizidwa. Mayeso angathe kupangidwa pogwiritsa ntchito chipangizo chotchedwa NIOX. Komabe, zifukwa zambiri zingakhudzire Fego yanu kuphatikizapo kugwiritsa ntchito steroids, zaka, kugonana, atopy (chizoloŵezi chokhala ndi chifuwa), ndi kusuta fodya.
Periostin ndizomwe zimagwira ntchito m'maselo anu apakati. Maseŵera a periostin amayamba kukwera pamwamba pa mphumu yomwe imayambitsa maselo ena a chitetezo (TH2) ndipo mu maphunziro ena awonetsedwa kuti ndibwino kwambiri kuti ayesere sputum. Komabe, zotsatira zimakhala zosiyana mu maphunziro ena ndipo mayeso sapezeka mosavuta. Ziwerengero zamatenda komanso magazi a eosinophil ndi apamwamba kwambiri kwa FeNO ndi periostin malinga ndi madokotala ambiri ndi malangizo.
Chithandizo
Chithandizo choyamba cha mphumu ya eosinophilic ikuyenera kukhala ndi dongosolo lanu lachidziwitso la mankhwala a mphumu. Kawirikawiri mumakhala ndi zotsatira zabwino kuchokera ku corticosteroids (inavomerezedwa ndi ICS) yomwe imagwiritsidwa ntchito ngati gawo la malangizo oyenera a chithandizo cha mphumu. Komabe, ngati adokotala akupeza kuti muli ndi mphumu ya eosinophilic, angasinthe njira yogwiritsira ntchito corticosteroids. Mankhwala a corticosteroid ndi awa:
- QVAR (beclomethasone mwini HFA)
- Pulmicort (budesonide)
- Flovent (fluticasone proprionate)
- Asmanex (mometasone)
- Azmacort (triamcinolone acetonide)
Ngakhale kutentha kwa corticosteroids nthawi zambiri kumakhala ndi zotsatira zabwino, anthu ena ali ndi steroid-refractory eosinophilic mphumu, zomwe zimangotanthauza kuti mphumu yanu ilibe chizindikiro kapena mankhwala opindula ndi corticosteroids. Ngati mwasintha khungu limodzi kapena angapo la corticosteroid yosatulutsidwa pamwambapa popanda mpumulo, ndiye kuti mukufuna kukambirana ndi dokotala ena mwa mankhwala omwe atulukira posachedwapa kuti athetse mphumu ya eosinophilic.
Pali njira zitatu zothandizira zomwe zalandira mgwirizano wa FDA kwa asthma yovuta:
- Xolair (omalizumab) ndi mankhwala oletsa anti-immunogobulin E (IgE)
- Nucala (mepolizumab), omwe poyamba ankatchedwa Bosatria, ndi mankhwala oletsa anti-interleukin-5 (IL5)
- Cinqair (reslizumab) ndi mankhwala ena omwe amatsutsa IL5
- Fasenra (benralizumab) ndi mankhwala atsopano a anti-IL5 ovomerezeka a FDA
Mankhwala atatu omwe tawatchula pamwambawa asonyeza zotsatira zabwino ngati mukhalabe ndi zizindikiro ngakhale kuti mukutsatira ndondomeko yanu ya corticosteroid regimen. Pa mankhwala atatuwa, omalizumab amayamba kukhala osapindulitsa kwambiri, chifukwa zimakhudza matendawa makamaka kuposa mepolizumab ndi reslizumab. Mankhwalawa amavomerezedwa bwino ndi zotsatira zochepa zomwe zingatheke kuti mutha kuchepetsa kugwiritsa ntchito corticosteroids. Kuchepetsa kugwiritsa ntchito mankhwala a steroids kumabweretsanso kuchepetsa mavuto omwe angakulepheretseni kukhala ndi moyo.
Kuwunika Kuchiza
Kuwongolera kumalimbikitsidwa ngati mankhwala ochiritsidwa sakuchiritsidwa, koma chithandizo. Konzekerani kuyesedwa nthawi ndi nthawi ndikukambilana zotsatirazi ndi dokotala wanu pamasankha otsogolera:
- Ntchito yamakono yoyesedwa
- Zizindikiro zomwe zakhala zikubwera kuchokera kumapeto omaliza (zowonjezera kapena zowonjezereka)
- Kuchuluka kwa kuphulika kwa mphumu
- Kuthetsa mavuto monga kuperewera kwa fungo
- Chikhalidwe chonse cha thanzi
- Kufufuza kafukufuku wa moyo
- Kufufuza kwa Laboratory
Msonkhano wotsatila wotsatira uli pafupi miyezi 4 mutangoyamba kulandira chithandizo. Ngati mwapeza zotsatira zabwino, mudzasungidwa pa mankhwala omwe mukufunikira. Ngati zotsatira zake sizing'onozing'ono, ndiye kuti mukupitiriza kuyesedwa pa mankhwala kwa chaka chimodzi musanayambe kusanthula kusintha kapena kuwonjezera mankhwala ena. Ngati simunayankhepo pakatha miyezi inayi, dokotala wanu akhoza kusiya mankhwalawo ndikukutumizirani kuchipatala china.
Dokotala wanu angayesetsenso kufufuza magazi a IgE ngati mutenga omalizumab. Ngakhale kuti matenda a IgE sakuzindikira kuti matenda a mphumu, amachiza omalizumab amatha kuona kuchepetsa thupi lanu lonse la magazi.
Mawu Ochokera
Ngakhale kuti mphumu ya eosinophilic imakhudzana ndi mphumu yambiri, chithandizo n'chotheka ngati chikupezeka bwino. Nthenda yotchedwa asthma yosavomerezeka imakhala yovuta kuthetsa kuopsa kwa mphumu zomwe sizikuipitsa moyo wanu koma zingakhale zoopsa. Kugwira ntchito ndi pulmonologist wanu ndi mankhwala opatsirana kungakuthandizeni kubwezeretsa umoyo umene mukuyenera ndipo ungachepetse kuchuluka kwa maulamuliro anu a mphumu.
> Zotsatira:
> The Clinical Use of Fractional Exhaled Oitid Oxide (FeNO) mu Kugonjetsa Kachilombo. Bungwe la Healthcare Research ndi Quality webusaiti. Idasinthidwa pa 20, 2017. https://effectivehealthcare.ahrq.gov/topics/asthma-nitric-oxide/research/.
> Buhl, R, Humbert, M, Bjermer, L, Chanez, P, Heaney, LG,. Holgate, S. (2017). Kachilombo kosasunthika kosasunthika: njira yokambirana. European Respiratory Journal. 49: 1700634, DOI: 10.1183 / 13993003.00634-2017.
> Chisokonezo cha Eosinophilic. Chiyanjano cha American for Eosinophilic Disorders webusaitiyi. http://apfed.org/about-ead/eosinophilic-asthma. Kusinthidwa 12/19/2017.
> Zambiri zaposachedwa za mphumu. Maofesi a Kuletsa ndi Kuteteza Matenda. http://www.cdc.gov/asthma/most_recent_data.htm. Kusinthidwa 6/2017.
> Wagener AH, de Nijs SB, Lutter R, et al. Kutsimikiziridwa kwina kunja kwa magazi, E (NO) ndi serum periostin monga mapepala a ziphuphu zamatsenga a mphumu. Thorax 2015; 70: 115
> Walford, HH & Doherty, TA. (2014). Kuzindikira ndi kusamalira mphumu ya eosinophilic: njira ya US. J Nthendayi. 7: 53-65, yesani: 10.2147 / JAAS39119.