Mumakore gumi adarika, nyanzvi dzakawanda dzehutano dzakaratidza kushushikana pamusoro pokukwira kwenhamba yemishonga inopiwa kuvarwere kuti vabate mamiriro akasiyana-siyana. Mishonga ine migumisiro yakaipa, uye kana munhu aifanira kutora mishonga yavasingadi, zvino vanozviisa pangozi yezvakaipa. Uyezve, kushandisa mishonga kunodhura mari uye kutora mishonga yakawandisa kunoparadza uye kunogadzirisa.
Kuongorora kutsva kunoratidza kuti chetatu chevanhu vane chiremba-vakaonekwa kuti asthma havakwanisi kuva nayo. Chokutanga, vazhinji vevanhu ava vakatanga kuongororwa vasina ruzivo rwepfungwa yekuongorora muviri (kureva, spirometry kana mapirmoni test function) uye naizvozvo zvakange zvisina kuonekwa kuti zvinotanga kutanga. Chechipiri, vanhu ava vangangodaro vakawana kuregererwa kubva kuhma yavo.
Asthma Basics
Chirwere chinogara chisingaiti chirwere chemhepo chinokonzera kushandiswa kwezvinyorwa zvekudzivirira kwemafirimu uye maronchial hyper-responsiveness inogona kushandurwa pakarepo kana nemishonga . Nenzira, maronchi ndiyo nzira dziri mumapapu anowanikwa kubva muchechea, kana mhepo.
Munguva yekuwedzera kwemafi, kana kuti kuwedzera, bruchi inenge isina simba uye inotanga kupera (kureva, bronchospasm). Mishonga inoshandiswa kurapa chirwere ichi inosanganisira inhaled corticosteroids uye inhaled beta-agonist bronchodilators.
Zviratidzo zvinowanzoonekwa zve asthma zvinosanganisira zvikamu zvekufema, kuputika, chifuva chisimbiso uye (usiku-nguva) chifukidziro. Chirwere chinogona kukonzerwa nemakumbo, kusvuta, kurovedza muviri, kushungurudzika uye zvimwe.
Kuongororwa kweAhmhma kunobva pane zvakaitika mune zvehutano, kuchipatori kuongororwa, kuongororwa kwepermonary function (kureva, spirometry) uye kurwisana kunopesana nekuedza kupedza kushandisa methylcholine kana histamine.
Spirometer chigadzirwa chinoshandiswa kupima mapapiro emunhu uye mapapu emvura kuti aone kuti munhu ari kufema zvakadini. Bronchodilator spirometry rudzi rwe spirometry apo chiremba anotanga kuisa bronchodilator kuzarura mhepo (sezvakaita beta-agonist) uye zvino inotarisa kuvandudzwa kwemapapu ekuratidza kuti inonzi asthma.
Dzimwe nguva spirometry haitsigire kufungidzirwa kwehutema asi munhu achiri kunyunyuta kuva nechirwere cheputi. Muzviitiko izvi, donchial chinetso chekuedza chinogona kuitwa. Nebonchial challenge test, nyanzvi inotungamirira bronchoconstrictor, yakadai semethylcholine kana histamine, iyo inoomesa airways, uye inotsvaka uchapupu hwekuderera kwemapapu chinoratidzira chinonzi asthma.
Tsvakurudzo Itsva
Migumisiro inobva munaJanuary 2017 yakareba kwenguva refu yakabudiswa muJAMA inoratidza kuti mumwe wevatatu vevakuru vechiCanada vachangobva kuonekwa kuti vane asthma havaiti, chaizvoizvo, vane.
Muchidzidzo ichi, vanhu 613 vaitora chikamu kubva kune gumi mumaguta makuru eCanada vakaongororwa pakati paJanuary 2012 naFebruary 2016. Vadzidzi vacho vose vaiva nemakore gumi nemasere uye vakawana vane asthma mumakore mashanu apfuura. Vatori vechikamu muchidzidzo vakawana zvinotevera:
- Hakuna nhoroondo yefodya kana nhau yekusvuta zvishoma pane makore gumi emakore (kusabvisa vatori vechiitiko vane chirwere chisingagadziriswi chepemmonic disease )
- Hapana kushandisa kwenguva yakareba prednisone (glucocorticoid) kurapwa
- Haana pamuviri kana kunwisa
- Inokwanisa kuita spirometry
- Hapana chirwere chemwoyo, chirwere, kana aneurysm mukati memwedzi mitatu yapfuura (zvinopesana nehurumende yekuedza kuedza kuongororwa)
Kana zvichibvira, vatsvakurudzi vakawana zvinyorwa zvekutsvaga kubva kuvarapi vevatori vechikamu pamusoro pekuti vanhu ava vakatanga sei vanorwara vane asthma. Muchidzidzo, 24 muzana yemagariro emunharaunda havana kupindura kune vatsvakurudzi vakakumbira ruzivo rwakadaro.
Pakati pezvikamu zvekushanyira kwevhiki dzinoverengeka, vatsvakurudzi vakashandisa kumba kwepamusoro mamita ekuyerera uye kutarisa kwechiratidzo, bronchodilator spirometry, uye serial bronchial mutsva miedzo yekuziva kuti ndiani asina chirwere. Vaya vaitora pasina pfufimasi vakabva vasumurwa pamishonga yavo yepmma uye kuongororwazve munguva yegore. Vatsvakurudzi vakatsvaga kuti vawane mamwe maitiro ekuongorora maitiro apo vatori vechikamu vakanga vasina asthma.
Pakupedzisira, astmma yakatongwa kunze kwema203 evanhu 613 (33.1%). Uyezve, 181 vatori vechikamu (29.5 kubva muzana) vakaramba vasina humwe humwe hutachiona hwehma mushure memwedzi gumi nembiri yekutevera. Vadzidzi vane gumi navaviri (vaviri kubva muzana) havana chirwere chemafi, asi panzvimbo iyi vaiva nemafungiro epamusoro ekurasira kwemafirimu ayo akanga asina kuongororwa nevarapi vemunharaunda. Pakupedzisira, vatori vechikamu vainge vaongororwa nehutachiona vakatadza kuti vasati vamboona kuti vanoshandisa zvirongwa zvemapurmoni uye kuongororwa kwemhepo kunopfurikidza kune avo vakagadziriswa nechirwere cheputi.
Pfungwa mbiri dzinokosha dzinogona kuwanikwa kubva pane chidzidzo ichi:
- Vanhu vakuru vanowanzonzi vane munhu mukuru-vanotanga kusvika kuhutachiona havakwanise kuramba vachiine chirwere kana kuti vanoda mishonga yekurapa nokusingaperi.
- Purogiramu yemakiriniki, vanachiremba vakawanda vanoda kushandisa physiologic kuongorora kuongororwa, zvakadai sebronchodilator spirometry, kunyatsoongorora chirwere cheputi panzvimbo yekutanga. Kunyatsovimba nechiitiko chevarwere, kuongorora kwepanyama, uye kliniki acumen hazvikwani kana uchitarisa chiitiko ichi.
Cherechedza kuti chidzidzo ichi chakange chiine zvikanganiso zvinoita kuti zvive zvakaoma kugovera zvibereko kune umwe neumwe ane asthma. Kunyanya, vatsvakurudzi vakashaya vanhu vazhinji vane huwandu hwemhepo yakasimba (kureva, avo vanoda kurapwa kwenguva refu-prednisone) uye 45 muzana chete yevatori vechidzidzo vanenge vachida mishonga zuva rega roga kuti varambe vaine mafi. Nokudaro, kuregererwa pakati pevatori vechikamu vane chirwere chakanyanya kuoma hachikwanisi kufungidzirwa. Pane kudaro, kuwedzera kwekuregererwa kwezinga kwakachengetwa (33,1 muzana) kunoshanda kune avo vekutanga vakaongororwa vane mhepo yakasimba yea asthma. Zvechokwadi, zvimwe zvidzidzo zvemazuva ekuongorora kutsva kwevanhu vakuru vemazuva ekuregererwa kwevaya pakati pevaya vane ruzhinji rwehutano hwechirwere zvinoratidza kuti kuregererwa kwemari kwakaderera.
Uyezve, nokuti vamwe vatori vechikamu vakanga vasina magwaro kubva panguva yavakamboonekwa kuti vane asthma, kana kuti pakutanga vakaongororwa vasina ruzivo rwekuongororwa kuongororwa, hazvisi pachena kuti vangani vatori vechikamu vakanga vasina kuonekwa kuti vane asthma pakutanga. Mune mamwe mazwi, vamwe vatori vechikamu avo vakawana "kuregererwa" vangave vasina kumbova nechirwere chekutanga mumhepo.
Izvi Zvose Zvinorevei
Inenge 75 muzana yevana vane asthma vanozopedzisira vaine mamiriro ekura. Zvisinei, kutsvakurudza kwakaratidza kuti kuregererwa pakati pevaya vane hutachiona hwemunhu mukuru huri pasi. Kudzidza kwemazuva ano, zvisinei, zvinoratidza kuti vamwe vanhu vakuru kupfuura avo vaifungidzirwa kare vanogona kuwana kuregererwa kwemhepo yakasimba. Vakuru ava vangave vasisada mishonga yavo yephma.
Kana iwe kana munhu waunoda ave akaonekwa kuti ane munhu mukuru-wekutanga kusvika pachirwere, tapota chengeta zvinotevera mupfungwa:
- Chikamu chekutungamirirwa kwechiitiko ichi kuongorora. Kana zviratidzo zvako zvichideredza kana kuti zvigadziriswe, unogona kudikanwa kana kuti kwete mishonga yekudzivirira mweya, maererano. Iwe unofanirwa kuongorora zviratidzo zvako uye kuwedzera kwekusimudzira mweya (kureva, "kurwisa kwechirwere") uye kugovera ruzivo urwu nechiremba wako.
- Iwe unofanirwawo kushandisa nhamba yepamusoro yemamita kuti uone kuti mweya wako unotungamirirwa sei kumba. Kana iwe ukaona kuti yako yepimma iri kugadzirisa, dzokera kune chiremba wako kuti uongorore zvakare. Iwe unogona kunge usingadi mishonga yako yephma zvakare.
Pakupedzisira, kana iwe wakarongerwa uine munhu mukuru-kubuda kwemafi, asi chiremba wako haana kumboshandisa spirometry kana kumwe kuongorora kuongororwa kuti ave nechokwadi chekuongorora, iwe ungada kuronga kushanyirwa nemumwe nyanzvi uyo achaita izvi. Imwe huru inotora kubva padzidzo iyi ndeyekuti kuongorora kwepodologist kunokosha kuti uongorore hutenda-uye mazano ezvino anopa kukurudzirwa kwakadaro.
> Sources
> Aaron, SD, et al. Kuongororazve kwekutsvaga muvanhu vakuru neAchiremba-Anoona Chirwere cheAhma. JAMA. 2017; 317: 269-279.
> Nyaya Dzematambudziko uye Kutungamira. American Academy of Asthma, Allergy & Immunology. https://www.aaaai.org/
> Hollingsworth, HM uye O'Connor GT. Chirwere-Iko Nhasi, Yaenda Mangwana? JAMA. 2017; 317: 262-263.
> Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr .. Chitsauko 55. Chirwere. Mu: Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr .. eds. The Color Atlas of Family Medicine, 2e . New York, NY: McGraw-Hill; 2013.