Kungenzeka ukuthi wezwa isifo se-aspirin-esicindezelekile isifo sokuphefumula (i-AERD) okuthiwa i-astterma ka-Samter noma i-aspirin. Kunezimo ezintathu abantu abane-AERD bonke abanakho: i-asthma, isifo se-sinus ene- polyps yamazinyo , nokuzwela kwemithi ebizwa nge-NSAIDS (ikakhulukazi i-aspirin nayo yonke imithi evimbela i-enzyme ebizwa nge-COX-1).
I-AERD ithinta amaphesenti angu-0.3 kuya ku-0.9 wabantu abaningi kanye namaphesenti angu-10 kuya kwangu-20 abantu abaye bathola ukuthi bane-asthma. Nokho, i-pathophysiology yayo ayiqondakali kahle. Kubonakala sengathi kuthinta zonke izinhlanga ezilinganayo, ngesilinganiso esiphezulu seminyaka engu-35, kodwa kubonakala sengathi asizuze njengefa futhi kungenzeka ukuthi sithinte abesifazane kunamadoda.
Uma usola ukuthi uphenyowe noma utholakale, kunezindlela eziningana ezaza ukukusiza ukuphatha izimpawu futhi uphile kahle. Nansi okudingeka ukwazi.
Izimpawu
Uma une-AERD ungase uhlupheke ngokuhlanganiswa kweminye noma zonke izimpawu ezilandelayo:
- Sinusitis engapheliyo
- Ama-polyp nasal
- Ukulahlekelwa iphunga
- I-asthma
- Ukubhekana ne-NSAID (i-aspirin noma imithi efanayo), engabandakanya ukungqubuzana komzimba, ukuxubha, ukukhanda ikhanda, ukukhipha, ukukhwehlela, ukuvutha, i-bronchospasm, i-laryngospasm noma ubuhlungu besifuba. Lezi zimpawu zingase zenzeke ngemva kokuphuza utshwala.
Ungase ube nobunzima bokuphatha izimpawu ngezindlela ezivamile.
Isibonelo, ama-polyps we-nasal angase abuye ngokushesha ngemuva kokuthi asuswe ngokuhlinzwa. Ukubamba kanye nokuphefumula kunzima kungabangela ubunzima bokulala ebusuku nokulahlwa okulalayo kanye nokukhathala kwamalanga.
Kuyinto evamile ukuba abantu babe nezifo ezithintekayo ezingenza i-AERD yabo ibe yimbi kakhulu.
Lezi zingabandakanya i- rhinosinusitis ye- allergen, i-GERD, noma i -asthma eyenziwe ngokuzivocavoca . Lezi zimo kufanele zilawulwe ngokwehlukana ku-AERD futhi udokotela wakho angancoma izindlela ezingcono kakhulu.
Ukuxilongwa
Uma une-asthma, isifo se-sinus ene-polyps yangasese, futhi uye wayenakho noma usola ukuthi kungenzeka ukuthi usabele ngendlela ye-NSAID, udokotela wakho angase asole ukuthi unayo i-AERD. Ukuhlolwa okungeziwe kuyoba usizo ekuqinisekiseni lokhu okuxilongwa.
Ukuhlolwa okulodwa kuyinselelo ye-aspirin, okubandakanya ukunikeza amancane amakhemikhali e-aspirin ngezinsuku ezimbalwa endaweni yokudokotela lapho ungabhekwa khona ukuze uthole ukusabela. Ngemva kokukunika umthamo we-aspirin udokotela wakho angase avivinye amandla akho emaphaphu ukuze abone ukuthi sehlile.
Udokotela wakho angakhetha ukuhlela ezinye izivivinyo ukusiza ekuxilongweni kwe-AERD, kuhlanganise nokuhlolwa kwegazi. Ama-eosinophils amangqamuzana egazi amhlophe, izingxenye zesistimu yomzimba. Abantu abane-AERD bavame ukuba nezinamba eziningi ze-eosinophil ezinama-pops azo futhi zingase ziphakanyise amazinga wegazi. Amanye amangqamuzana omzimba omzimba afana nama-mast cell angase aphakanyiswe. Ungase ube namazinga aphakeme wezinto ezibizwa nge-cysteinyl leukotrienes. Ukuhlola kwe-CT, noma ezinye izivivinyo ze-imaging ukusiza ngeso lengqondo izimo zakho.
Kumele kuqashelwe ukuthi akekho kulezi zivivinyo ezicacile zokuxilongwa kwe-AERD kodwa zingasiza udokotela wakho ukuthola isithombe esicacile sesimo sakho.
Ukwelashwa Nokuphathwa
Ayikho ikhambi ye-AERD, futhi njengoba kuboniswe ngaphambili ukuthi ukukhubazeka kwelesi sifo akuqondi kahle ososayensi nabachwepheshe bezokwelapha. Noma kunjalo, kunezinketho eziningana zokwelashwa ezitholakalayo ukukusiza ukuthi uphathe izimpawu kangcono.
Enye indlela ukugwema ngokuphelele i-aspirin neminye imithi ye-NSAID (noma yimiphi imithi evimbela i-enzyme COX-1). I-Acetaminophen ingahle isetshenziswe esikhundleni salolu mithi, kodwa mhlawumbe kuphela emazingeni amancane (kufika ku-500mg).
Ukugwema i-aspirin ngeke kulawulwe ezinye izimpawu ezinjengezintambo zangasese, izifo zesono noma izimpawu ze-asthma.
Ukukhula kwama-polyp nasal kunganciphisa ngokusebenzisa ama-steroid injection, ukususwa okuhlinzekwayo, noma ukuhlanganiswa kokubili. Amaphilisi e-nasal aqukethe ama-steroids kanye nokunisela kwamanzi angasiza futhi ekulawuleni ezinye izimpawu zomzimba nezinkinga zesinus.
Imithi yama-montelukast ne-zafirlukast nayo isetshenziswa kaningi futhi ijwayele ukusiza kakhulu ekulawuleni izimpawu kunezinye izidakamizwa ze-asthma, kuhlanganise ne-beta-agonists. I-corticosteroids engasetshenzisiwe nayo isetshenziselwa ukuphatha i-asthma futhi kungadingeka ukusebenzisa le mithi nsuku zonke. Ngezinye izikhathi i-prednisone yomlomo isetshenzisiwe, kodwa ngokuvamile kuphela uma iminye imithi ihlulekile ukulawula izimpawu ngoba i-oral steroids iba nemiphumela emibi kakhulu engathandeki.
I-Aspirin Desensitization
Enye indlela, ekhonjiswe ukuthi iphumelela kakhulu, iwukuba i-aspirin ifuna ukususwa kwenhliziyo. Ucwaningo luye lwabonisa ukuthi i-aspirin deensitization elandelwa umthamo wokulondoloza nsuku zonke we-aspirin inganciphisa ukwakhiwa kwama-polyp nasal kanye nezifo ze-sinus kanye nokuthuthukisa izikolo ze-asthma.
Amanani we-aspirin anikezwa endaweni yokwelapha lapho ungabhekwa khona ukuze uthole ukusabela. Ukuhlelwa kwezokwelapha ngokuvamile kumtholampilo enezokwelapha abanolwazi (ukungena esibhedlela ngokuvamile akudingekile). Amanani aqala amancane futhi kancane kancane akhula ngesamba sokusulaza uhlelo lwakho emithini. Lokhu kufana nokuphathwa kwe-immunotherapy ye-allergies.
Ubufakazi bubonisa ukuthi ukuxoshwa kwe-aspirin kuyindleko ephumelelayo futhi kunenzuzo kubantu abaningi abane-diagnosis ye-AERD. Ukuthuthukiswa kungabonakala emva kwamasonto amane kuphela yokwelapha. Ucwaningo luye lwabonisa ukuthuthukiswa ezikoleni zomzimba, ukuzwa iphunga, nokunciphisa inani lemithi edingekayo yokulawula izimpawu zesifo se-asthma.
Akubona bonke abantu abane-AERD abafanelekile ukuxoshwa kwe-aspirin. Akufanele ube nalokhu ukwelashwa uma ukhulelwe, unesilonda sesisu, ukuphazamiseka kwegazi, noma izimpawu zesifo se-asthma.
Kukhona izingozi ezihlobene ne-aspirin deensitization futhi lokhu kufaka phakathi ukubeka izimpawu ze-AERD yakho kuhlanganise nezinkinga ezinkulu zokuphefumula. Futhi, noma yimiphi imiphumela emibi engenzeka ngesikhathi ithatha i-aspirin, njengezinkinga zesisu noma ukuphuma kwegazi, ingenzeka ngesikhathi se-aspirin. Kumele ukhulume nodokotela wakho noma wemithi mayelana nemiphumela emibi futhi uqiniseke ukuthi i-aspirin ngeke iphazamise noma yimiphi imithi ongayithatha.
Ngemuva kokuba usuhlanjululwe ukususwa kwe-aspirin kudingekile ukuthi uqhubeke nokuthatha umthamo wesondlo we-aspirin nsuku zonke ukuze uqhubeke nokungafuneki. Ekuqaleni lesi sifo singase sibe ngaphezu kuka-1300 mg ngosuku kodwa, ngokufanele, udokotela wakho uzokwehlisa kancane kancane inani le-aspirin oyithathayo. Amanani aphansi njengo-81mg ngosuku (isilinganiso esivamile kakhulu kubantu abanesifo senhliziyo) baye baboniswa ngempumelelo.
Uma ukhathazekile ngemiphumela emibi kanye nezivumelwano osuvele ufunde ngazo, yazi ukuthi inqubo isinyathelo ngesinyathelo, ngakho zama ukugxila ezintweni ezilodwa ngesikhathi. Udokotela wakho uzokuqondisa phakathi, ukulandelela imiphumela emibi, futhi uqaphele noma yikuphi ukuphikisana.
> Imithombo:
> I-Aspirin-Inwetshwa Izifo Zokuphefumula (AERD). I-American Academy Yokuguqulwa Kwesifo Sokuvuthwa Kwegazi Nokuzivocavoca. https://www.aaaai.org/conditions-and-treatments/library/asthma-library/aspirin-exacerbated-respiratory-disease
> U-Rachel U. Lee noDonald D. Stevenson. I-Aspirin-Ikhukhumezekile Izifo Zokuphefumula: Ukuhlolwa Nokuphathwa. Ukuphefumula kwesifo sofuba Immunol Res. 2011 Jan; 3 (1): 3-10.
> UJohn W Steinke noJeff M Wilson. I-aspirin-yandisa isifo sokuphefumula: ukuqonda kwe-pathophysiological kanye nentuthuko emitholampilo. I-J Asthma Ukuzivocavoca. 2016; 9: 37-43.