Iko Chirwere Chenyu Chakanaka Chaizvo Chisingatauri Chirwere Chepfungwa Here?
Eosinophilic asthma, iyo inozivikanwawo se e-asthma, ndiyo inonyanya kutaridzika yechirwere ichi chinowanzoongororwa muhukuru. Inotsanangurwa seanotopic , izvo zvinoreva kuti pane maitiro ekudzivirira kwechirwere kuti ave chikonzero chechirwere. Kusiyana nedzimwe mhando dzemafi, mweya wekusvibiswa unokonzerwa nehupenyu hunoputika kubva kumatanda ako kumativi ose kusvika kumhepo duku kudarika mapapu ako.
Kuvhiringidzika kubva kumhepo yakasvibhene inoitika sechikamu chechirwere chemuviri kana chitunha chemuviri chemasimba, chinobudisa musero weropa dema rinonzi eosinophils . Paunenge uine kuwedzerwa mumasero machena eropa, iwe unowanzova nekuputira mhinduro, iyo inoita kuti uwedzere mafambiro ako. Iyo inonaya uye kusviba kunoguma kunogona kutungamirira kumapasimusi mumhepo yako (bronchioles) uye zvinokonzera zviratidzo zvako zvechirwere.
Kuwanda
Chirwere chinokonzerwa nekuputika kwemhepo yako iyo inogona kuita kuti zvive zvakaoma kufema. Vanenge 1 kubva ku13 vanhu vanotambura nechirwere ichi chisingaperi uye inenge hafu yevanhu vakagadziriswa neApma vane kurwiswa kweputi gore roga rega. Ziva kuti dzakawanda zvekuwedzera izvi zvinodzivirirwa kana chirwere cheputi chinodzorwa zvakanaka. Kunyange zvazvo pakutanga yaifungidzirwa kuva chirwere chimwe chete, chirwere chemafi chinokonzerwa nehana dzakawanda dzinogona kugadzirisa maitiro ako epiyo anogona kunyatsogadziriswa.
Vanenge 1 kubva pa10 vanhu vane astmma vane chirwere chakanyanya.
Kunyange zvazvo kupararira kwekushaya chirwere chemafi isingazivikanwi, kune kumwe kufungidzira kuti 50 kusvika ku60 mumatambudziko zana ehutachiwana hwakanyanya muvanhu vakuru angave eosinophilic asthma. Kana iwe uri mukuru kudarika makumi matatu nemashanu kana iwe ukaonekwa kuti une asthma yakaoma iwe une dambudziko rakakura rekuongororwa kuti une eosinophilic asthma.
Dambudziko rako nderimwechete pasinei nehutano hwako, uye iwe hauna ngozi yakawanda yekuongororwa uine mweya unoshushi muhuduku hwako uye makore ekuyaruka.
Zviratidzo
Zvakawanda zvezviratidzo zvehuputi hwemafirimu zvakafanana nedzimwe mhando dzechirwere chinosanganisira:
- Kupfupika kwemhepo
- Kuchema
- Wheezing
- Kutsigira mubhokisi rako
Pane zviratidzo zvishomanana izvo zvingave zviripo zvisingawanzobatanidzi nehutachi kusanganisira:
- Nasal mvura uye kusanganiswa ( chronic rhinosinusitis )
- Nasal polyps
- Yakakura masaya mucous membrane
- Kurasikirwa kwekunhuhwirira (anosmia)
Kunyange zvazvo maitiro ehutachiona ehmhma inopindirana nehutachiona hwehutachiona hwehutachiona, vanhu vazhinji vanorwara nehuwandu hwavo havabvumi nehutano hwakadai semafuta, mildew, kana zvimwe zvinokonzera zvirwere.
Kuziva
Sosinophilic asthma inowanzoongororwa. Hazvifungidziri zvakajairika kunyange zvazvo huwandu hwehuwandu hunofungidzirwa kuti hwakakwirira kudarika kare hwakatenda.
Kana sosinophilic asthma inokonzera kuora kwako uye hauna kuonekwa, unogona kunetseka kuti uwedzere chirwere chako chakanyanya. Iwe kazhinji unoda kuonekwa ne pulmonologist kana iwe unonetseka. Zvisinei, allergists uye maununologist vanogonawo kubatsira mukuongorora kwako.
Eosinophil Cell Count
Kuita masero e-cell eosinophils kubva kune imwe sampu inokonzerwa nesimbi inofungidzirwa kuti ndiyo yegoridhe yakaenzana yezvokuvhiringidza masero echitokisi, asi zvakaoma kuwana, nguva yekudya, nekucherechedza zvinoenderana.
Inowanzodikanwa kushandiswa kwebazi rakashanda nevanodzidza.
Paunenge uchiunganidza shanduro, iwe unoda kuve nechokwadi kuti hausi kupfira mate, asi unokwidza up sputum kubva mumhepo yako. Kuti ubatsire kukurudzira tsvina, chiremba wako angave ane chirwere chekufema anokupa chirwere che albuterol kana chimwe chekutsvaira garodilator. Iyi kurapa inoteverwa nekukupa nebulazed hypertonic saline. Iyo yakakwirira yakakura ye saline kana inhaled inoshungurudza mhepo uye inobatsira kukurudzira kukanganiswa. Izvo zvakagadzirirwa zvinogona kuongororwa mubasa kuti zvione kana kune hupo hwehukuru kupfuura 1 kusvika ku3 pazana zana eosinophils.
Airway Biopsy
Imwe nzira yekuziva kuti e-asthma ndeyekutora chikwata chekuenda kune imwe nguva munguva yebronchoscopy. Iyi nzira inogona kuitwa kuitira kugadzirisa zvirwere zvakawanda. Zvisinei, iyi nzira haisati yakurudzirwa kuti iongorore hutachiona hwemhepo sezvo iri nzira inopesana inoda kuti kune imwe nzvimbo kunze kwekuti sampuko yakakwana ye sputum isingakwanisi kuwanikwa.
Zvimwe Nzira
Dzimwe nzira dzakagadzirwa kuti dzibatsire kuongorora e-asthma. Chiremba wako anogona kutarisa CBC (yakazara ropa count) kutarisa eosinophilia (yakawedzera eosinophil count). Zvisinei, kududzira zvizere zveeosinophilsi muropa zvinofanira kungoitwa chete nechiremba kubva pane zvakakosha muropa rako hazvivimbisi kuti iwe une mweya unofadza. Zvinogona, zvakadaro, kubatsira chiremba wako mukuwedzera kusiyanisa chero humwe zviratidzo zvauri kuita.
Zvimwe zvirwere zvinogona kuonekwa kana iwe uine eosinophil yepamusoro yepamusoro muropa rako zvinosanganisira hypereosinophilic syndrome, autoimmune disorders, adrenal insufficiency, uye kupindurwa kwemishonga.
Mimwe miedzo miviri inogona kuonekwa sechirwere cheputum inokonzerwa kana kuti ropa eosinophil chiverengero: chikamu chinokonzerwa ne nitric oxide (FeNO) kuedza kufema uye test periostin yeropa. Kana iwe uine mahara ehsinophilic asthma, iwe unowanzoonesa kuwedzera eosinophils muropa rako uye sputum, immunoglobulin E, FeNO, uye periostin.
FeNO inogona kubatsira mukubatsira kufanotaura kana iwe ungapindura nekodticosteroids inoputika. Muedzo unogona kuitwa uchishandisa chiguniti chinonzi NIOX. Zvisinei, zvinhu zvakawanda zvinogona kuchinja mazana ako eEFC kusanganisira kushandisa steroids, zera, zvepabonde, atopy (chido chekuvandudza marwadzo), uye kusvuta chimiro.
Periostin inonzi biomarker munharaunda yako yemhepo epithelial cells. Periostin mazinga anowanzove akakwidziridzwa mune asthma iyo inobatsira mamwe maune immune (TH2) uye mune zvimwe zvidzidzo zvakaratidzwa kuva chimiro chakanakisisa chekuedza sputum. Zvisinei, zvigumisiro zvinosiyana mune zvimwe zvidzidzo uye muedzo hausi nyore nyore. Kunyunyuta kweputum uye ropa eosinophil zvikwereti zvichiri kuwedzerwa kune FeNO uye periostin maererano nevechiremba vazhinji nemitemo.
Kurapa
Kutanga-mutsara mushonga wekusagadzikana kwemafi inofanirwa kusanganisira chirongwa chako chetachiona chetachiona. Kazhinji iwe uchava nemigumisiro yakaisvonaka kubva kuine corticosteroids inhaled (ICS) iyo inoshandiswa sechikamu chemitemo yakagadzirirwa yekurapwa kwechirwere. Zvisinei, kana chiremba wako akawana kuti iwe une mweya unoshushikana, unogona kuchinja nzira inoshandiswa yakashandiswa ne corticosteroids. Mishonga yeCorticosteroid inosanganisira:
- QVAR (beclomethasone proprionate HFA)
- Pulmicort (budesonide)
- Flovent (fluticasone proprionate)
- Asmanex (mometasone)
- Azmacort (triamcinolone acetonide)
Kunyange zvazvo corticosteroids inoputika inowanzova nemigumisiro inobatsira, vamwe vanhu vane steroid-refractory eosinophilic asthma, iyo inongoreva kuti mweya wako wepimusi hauna zviratidzo kana kliniki inobatsira kubva mukurwisa corticosteroids. Kana iwe wakanyora imwe kana kuti yakawanda yeharuti inoratidzirwa yakanyorwa pamusoro apa pasina kuratidzwa kwechiratidzo, ipapo iwe unoda kuzokurukura nachiremba wako zvimwe zvezvitsva zvinowanikwa munguva pfupi yapfuura kuti tibate maitiro eosinophilic asthma.
Kune zvikamu zvitatu zvinotarisirwa nemishonga inogamuchira FDA mvumo yekugadzirisa asthma:
- Xolair (omalizumab) imishonga inorwisa anti-immunogobulin E (IgE)
- Nucala (mepolizumab), yaichimbozivikanwa seBosatria, inonzi anti-interleukin-5 (IL5) mishonga yechikoro
- Cinqair (reslizumab) imwe mishonga inopesana neI5 class
- Fasenra (benralizumab) ndiyo itsva yeDAA inorambidzwa anti-IL5 mishonga yechikoro
Iyo mishonga mitatu iri pamusoro apa yakaratidza migumisiro inofadza kana iwe uchiri kuratidza zviratidzo pasinei nekuchengetedzwa kwakanaka kune yako yakatemwa corticosteroid regimen. Pakati pemishonga mitatu, omalizumab inofanirwa kunge isina kubudirira, sezvo inokonzera mishonga yakanyanya kunyanya kupfuura mepolizumab uye reslizumab. Iyi mishonga inowanzochengetedzwa zvakanaka nezvisingabatsiri nemigumisiro nemukana wekuti iwe uchakwanisawo kuderedza kushandiswa kwako kwe corticosteroids. Kuderedza kushandiswa kweSteroids kunounza kuderedzwa kwemigumisiro yechirwere inogona kuwedzera hupenyu hwako.
Kuongorora Kurapa
Kuitevera kunokurudzirwa sezvinodiwa kurapwa hakusi mushonga, asi kurapa. Iva wakagadzirira kuongorora nguva uye nekukurukurirana zvinotevera nachiremba wako pakutevedza mazita:
- Pulmonary function testing
- Zviratidzo zvakawanikwa kubva pakupedzisira kwekushanya (kuvandudzwa kana kukura)
- Kuwedzerwa kwekuwedzera kwemafi
- Kugadzirisa kwezvinetso zvakadai sekurasikirwa kwekunhuwa
- Yakazara yehutano hwehupenyu
- Kuchengetedza Uhu hwehupenyu tsvakurudzo
- Laboratory analysis
Chirongwa chekutevera mushure memwedzi inenge mwedzi mina mushure mekutanga kurapwa kwakananga. Kana wakave nemigumisiro yakanaka, iwe uchachengetwa pamishonga inorayirwa. Kana zvikamu zvishoma zvisinganyanyi kuenzanisa, ipapo iwe unogona kuramba uchitarirwa pamishonga kusvikira kune gore usati waongorora kuchinja kana kuwedzera mamwe mishonga. Kana usina kumbove nemhinduro pashure pemwedzi mina, ipapo chiremba wako angangomira mishonga uye akuendese kune imwe inorapwa.
Chiremba wako angadawo kuongorora mazinga eropa aIgE kana akatora omalizumab. Kunyange zvazvo IgE mazinga asingatauri maitiro eosinophilic asthma, chiitiko chekurapa kumhinduro kune omalizumab chaizove kuwona kuderedzwa kwehuwandu hwehuwandu hweAIDS yeAIDS.
Shoko Rinobva
Kunyange zvazvo nyuchi dzemuviri dzinosangana nechirwere chakasimba, kurapwa kunogona kuonekwa kana kuonekwa zvakanaka. Kusarudzwa kwehupenyu hwemhepo huchaita kuti zvive zvakaoma kudzora kuwedzera kwechimiro chisingaiti kuti uwedzere hupenyu hwako humwe chete asi hunogona kutyisa upenyu. Kushanda ne pulmonologist yako nechinangwa chekurapa kunogona kukubatsira kuti udzoke huhu hwehupenyu hwaunofanirwa uye hunogona kuderedza kuwanda kwehutachiona hwako hwehutachiona.
> Sources:
> The Clinical Utility yeFractional Exhaled Nitric Oxide (FeNO) muAsthma Management. Sangano reEalthcare Research uye Quality website. Yakapedzwa musi wa20, 2017. https://effectivehealthcare.ahrq.gov/topics/asthma-nitric-oxide/research/.
> Buhl, R, Humbert, M, Bjermer, L, Chanez, P, Heaney, LG ,. Holgate, S. (2017). Nyaya yakasimba yekusagadzikana kwepifupa: nzira yepamusoro yekubatana. European Respiratory Journal. 49: 1700634, DOI: 10.1183 / 13993003.00634-2017.
> Eosinophilic Asthma. American Partnership for Eosinophilic Disorders website. http://apfed.org/about-ead/eosinophilic-asthma. Updated 12/19/2017.
> Nyaya Ichangopfuura Yemafiropiyo Dhiyabhorosi Dat. Nzvimbo dzeDaase Control uye Kudzivirira. http://www.cdc.gov/asthma/most_recent_data.htm. Updated 6/2017.
> Wagener AH, de Nijs SB, Lutter R, et al. Kunze kwekugadzirisa ropa eosinophils, FE (NO) uye serum periostin sezvikamu zveputum eosinophils mu asthma. Tora 2015; 70: 115
> Walford, HH & Doherty, TA. (2014). Kuongororwa uye kutungamirirwa kwehutachiona hwehupenyu husingaperi: maonero eUnited States. J Nyuchi Dzemarudzi. 7: 53-65, nei: 10.2147 / JAAS39119.