Kana iwe uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge wanyora. Kune vamwe, kuderera kwemapapu inoshanda kunogona kunyanya kuwedzera. Izvi zvinobatanidza nekuwedzera zviratidzo, zvakadai sekukanganiswa, kuputika, uye kupererwa kwemweya kunokanganisa kurara.
Ngozi dzeKubwinya kweApisma
Varwere vane husiku hukuru hunoshanduka muFiv1 yavo vanogonawo kunge vane zviratidzo zvemasikati akawanda uye vane urombo hwekushaya asthma.
Imwe pamusoro pechokwadi ndechokuti usiku hwemazuva hunogona kunge hwakabatana nekufa kwemafi. Makumi makumi manomwe kubva muzana evanhu vakafa uye 80 muzana yekumaporesa kusungwa kunokonzerwa nehmhma inowanikwa panguva dzemaawa. Kusiyana kwakakura kwepamusoro pekudzimara kwekuyerera hakuratidzirani nehutachiona hwehutachiona asi hupenyu huri panjodzi hunokonzera kuporesa kusungwa. Vakawanda vanorwara vanonzwisisa kuti zviratidzo zvakanyanya zvinowanzobatanidzwa nehuwandu hwekufa, asi vashomanana chaizvo vanoziva kuchinja kukuru kwemasikati kunopera kukurumidza kupera kuve chiitiko chekuda kwezvinhu zvisingabatsiri.
Zvinokonzera
Izvo hazvizivikanwe kana kupera kwemapapu ekushanda kunokonzerwa ne circadian rhythm kuchinja (kuchinja mumapapu basa nemhaka yezvinyorwa zvakaita seawa) kana kuti nenzira imwe neimwe yakabatana nehope pachayo. Havasi vese varwere vemafi, zvisinei, vanotambura nezvinetso usiku.
Pane zvimwe zvipimo zve physiologic zvinowanikwa panguva yehope dzinogona kubatsira kutsanangura kuti sei vamwe varwere vane chiremera vane zvinetso.
Kurwisana kunowedzera kuwedzera usiku uye mapapu basa inoderera sezvo nguva yekurara inowedzera. Iyi yekupedzisira ndeyechokwadi kune varwere vasina hutachiona, asi kwete kusvika pavanokura zviratidzo.
Kuziva
Nzira inonyanya kuenzaniswa yekuongorora nyeredzi yemahara ndeyekutarisa nguva yekurara kwepamusoro nekuyerera uye nepamusoro pekuyerera pakumuka.
Kana pane zvikamu zvinopfuura 15 kubva muzana zvakasiyana mukuyerera kwako, iwe une kuchinja kukuru kunogona kunge kuchikonzera zviratidzo zvako. Zvisinei, peak flow mamita haisi kunyanya kuona kuti FEV1 kuchinja. Iwe nemutapi wehutano wako unogona kuongorora izvi uye kutanga chirwere chekurapa .
Zvidzidzo zvehutema zvakaratidza kuti vazhinji vari 74 kubva muzana yevanhu vane astmma vane manheru ekumuka kamwe chete pavhiki, asi vazhinji vanoita 64 muzana vanogona kuva nehma usiku kana katatu pavhiki. Zvinonyanya kukosha, vazhinji vanoita makumi mana kubva muzana muzana yevanhu vane hutachiona hunoonekwa zviratidzo zviratidzo usiku.
Vanhu vane astmma vanogona kunge vasina hanya nezviratidzo zveusiku sechiratidzo chekushaya masimba masimba . Mune imwe yedzidzo, 26 muzana yevarwere vakayora mweya yavo ye "asthma" se "runyoro" yakatarwa ichiona zviratidzo zvechirwere zvakadai sekukanganiswa kusingaperi , kuputika, uye kupera kwekufema usiku. Zvakakosha kuziva zviratidzo izvi zveusiku sehutsiri hwekutonga nokuti chikamu chikuru chekufa kwevanhu vanofa nevakuru nevana kubva pamapfupa ekumanikidza uye kamwe kamwe rufu runoitika pakati peusiku ne8 am
Physiology Kubva Nocturnal Asthma
Nepo pasina munhu anoziva zvechokwadi, chirwere cheusiku usiku chakabatanidzwa ne:
- Kuderedza nitric oxide mazinga: Nokuti nitric oxide yakazara bronchodilator , kupera kwemazinga kunogona kutsanangura kuwedzera kwezviratidzo zveusiku.
- Kuderedza beta 2-receptors: Zvose nhamba uye basa re beta 2 receptors-zvinogadzirisa zvinokonzerwa nehutachiona hunovhura marwadziro emhepo-kubva pakati pe4: 4 ne4: 4 mangwanani
- Kupera steroid receptors: Kufanana ne beta 2 receptors, zvose nhamba uye basa re-steroid receptors-rinoita kuti kuderedza kuputika-kunonoka usiku. Uku kuderera kunogona kunge kuri kukonzerwa nekuputika kwekuwedzera nekuda kwekushaiwa kwekupindura kumitumbi yako yakasikwa yakagadzirwa steroid kana steroid inorayirwa nachiremba wako.
- Abnormal pituitary basa: Kugadzira cortisol, hormone yakagadzirwa nehutu hwepituitary, inorara usiku hwose. Uku kuderedza kunosanganiswa nekuderera kweFiV1 . Kurapa varwere vane cortisol yakadzika ne hydrocortisone (arapeutic steroid), inobatanidzwa nekuvandudzika mu FEV1.
- Melatonin: Varwere vane chirwere chemasikati vanonzi vakave nehutachiona hwema melatonin vachienzaniswa nevarwere vasingazivikanwi nehuputi.
Kurapa
Vakawanda vanorwara vane asthma usiku vanosangana zviyero sekuenzanisa kana kuti zvakasimba zvinoramba zvichiripo maererano nemitemo yeNHLBI. Iwe unofanirwa kubatwa maererano nemirairo iyi, asi iwe neunopa wako angada kuongorora zvimwe zvemashoko anotevera kana iwe uchifunga kuti une chirwere chemasikati:
- Inhaled glucocorticoids: Mune chienzanidzo ichienzanisa 800 micrograms (kunyanya vana kweAazmacort inhaler) nenguva ye3 masikati zuva rimwe nerimwe kune chidimbu chechidimbu chechimwe chimwechete pazuva, 3 pm masikati yakashanda pamwe chete kanomwe pazuva. Apo dosing payakashandurwa kusvika 8:30 am kana 5 masikati kuti zvive nyore, kamwe chete zuva rega rega 5:30 masikati dosing yakaramba ichiita nani kupfuura katatu pazuva pazuva dosing, asi mangwanani ekutanga dosing akaita zvakanyanya.
- Inhaled β2 adrenergic agonists: Long-acting β2 agonists, yakafanana nekununura kwenyu inhaler asi inopedza maawa matanhatu kana kupfuura sa salmeterol, yakaratidzwa kugadzirisa basa remapapu usiku, kurara kwehutano, uye hutano hwehupenyu hwehusiku hwemazuva.
- Muchirevo β2 adrenergic agonists: Oral maitiro e albuterol anopiwa seanonoka kusununguka piritsi inowedzera mangwanani nepamusoro pemhepo inopfuurira mafirati uye ichideredza kufamba uye kupera kwekufema.
- Theophylline: Mhando dzakasiyana dze theophylline dzine zvakasiyana siyana. Imwe inogona kunyanya kubatsira masikati masikati ndeyegadziriro yakagadzirirwa kuva nepamusoro-soro usiku-kufanana neUniphyl-paunenge uine zviratidzo zvakawanda. Neyi regimen, theophylline maitiro anoderera mukati mezuva uye varwere vanowanikwa mashoma emigumisiro kupfuura neyendarama dosing.
- Kurapwa kwemamwe mamiriro ezvinhu anowedzera kuora mwoyo : Zvimwe zvirwere zvehutano, sezvakaita gastric reflux, zvinetso zvechivi , uye kuneta, zvinogona kukuvadza mweya wako. Kana iwe uine zviratidzo zvemazuva masikati , iva nechokwadi chokuti hausi pangozi yemamiriro aya.
Sources:
> Ginsberg D. Mhuka isingazivikanwi muhombodo - Kuongorora masikati neApmma muvana. McGill Journal of Medicine: MJM . 2009; 12 (1): 31-38.
> Martin RJ. Nocturnal Asthma. Kusvika pari zvino. https://www.uptodate.com/contents/nocturnal-asthma.