Phakathi neminyaka eyishumi edlule, ochwepheshe bezempilo abaningi baye baveza ukukhathazeka ngenxa yokwanda kwenani lemithi elinikezwa iziguli ukuphatha izimo ezihlukahlukene. Imithi inezimo ezimbi, futhi uma umuntu efuna ukuphuza imithi engayidingi, khona-ke bazibeka engozini ngenxa yemiphumela emibi emibi. Ngaphezu kwalokho, imithi idla imali futhi ithatha imithi ngokweqile iyonakalisa futhi iyanelisa.
Ucwaningo oluvusa phambili lubonisa ukuthi ingxenye eyodwa kwezintathu zabantu abane- asthma ehlolwe udokotela empeleni ayinayo. Okokuqala, abaningi balaba bantu baqale baxilongwa ngaphandle kokuhlomula kokuhlolwa kwe-physiologic (okungukuthi, i-spirometry noma i-pulmonary function tests) ngakho-ke bebengatholakali ngokungafanele ukuthi baqale. Okwesibili, laba bantu kungenzeka ukuthi babhekana nokuxolelwa kwesifuba sabo se-asthma.
I-Asthma Basics
I-asthma yisifo esingenasifo esihamba phambili esibhedlela esibangela ukuguquka kwe-air and obstinate hyper-response which can be turned out automatically or with medication . Okuphawulayo, i- bronchi iyimigwaqo emaphashini ahlala e-trachea, noma i-windpipe.
Ngesikhathi ukukhuphuka kwesifo se-asthma, noma ukuwohloka, i-bronchi iba yilapho isabela futhi iqala ukungena (ie, bronchospasm). Imithi esetshenziselwa ukuphefumula i-asthma ibandakanya i-corticosteroids ethengiswe nge-beta-agonist bronchodilators.
Izimpawu ezivamile zesifo sokuphefumula zihlanganisa iziqephu zokuphefumula, ukuqina kwesifuba, ukuqina kwesifuba kanye (isikhathi sokulala) ukukhwehlela. I-asthma ingabangwa yizifo, ukubhema, ukuzivocavoca, ukucindezeleka nokuningi.
Ukuxilongwa kwesifo se-asthma kusekelwe emlandweni wezokwelapha, ukuhlolwa kwemitholampilo, ukuhlolwa kokusebenza kwamapayipi (okungukuthi, i-spirometry) nokuhlola inselele yokuqeda i-methylcholine noma i-histamine.
I- spirometer iyisetshenziswa esetshenziselwa ukukala umsebenzi wamaphaphu nomsebenzi wamaphaphu ukuze ubone ukuthi umuntu uphefumle kangakanani. I-bronchodilator spirometry wuhlobo lwe-spirometry lapho umtholampilo eqala ukulawula i-bronchodilator ukuvula imimoya yomoya (njenge-beta-agonist) bese ubheka ukuphucula emaphashini okukhombisa ukuthi i-asthma.
Ngezinye izikhathi i-spirometry ayisekeli ukuxilongwa kwe-asthma kodwa umuntu usalokhu enecala lokuthi une-asthma. Kulezi zimo, ukuhlolwa kwenselele ye-bronchial kungenziwa. Ngokuhlolwa kobunzima, insizwa iqondisa i-bronchoconstrictor, efana ne-methylcholine noma i-histamine, eqinisa iminyango yomoya, futhi ibuke ubufakazi bokunciphisa ukusebenza kwamaphaphu okubonisa isifo se-asthma.
Ucwaningo olusha
Imiphumela evela kuJanuwari ka-2017 isifundo se-JAMA eshicilelwe ku-JAMA sikhombisa ukuthi umuntu oyedwa kwabayisithathu baseCanada abatholwe ukuthi une-asthma, empeleni akanalo.
Kulolu cwaningo, abangu-613 ababambe iqhaza ngokungahleliwe bevela emadolobheni amakhulu kunawo wonke aseCanada bahlolwa phakathi kukaJanuwari 2012 noFebruwari 2016. Abahlanganyeli babeneminyaka engenani engu-18 ubudala futhi bathola ukuthi bane-asthma phakathi neminyaka emihlanu eyedlule. Abahlanganyeli ocwaningweni bahlangabezana nalezi zindlela ezilandelayo:
- Umlando wokubhema noma umlando wokubhema ungaphansi kweminyaka eyi-10 yepakthi (ukukhipha abathintekayo abanezifo ezingavamile zokuphefumula )
- Akukho ukusetshenziswa kwe-prednisone (glucocorticoid) yesikhathi eside
- Ungakhulelwe noma ukondla
- Iyakwazi ukwenza i-spirometry
- Ayikho isifo senhliziyo, isifo sohlangothi, noma i-aneurysm ezinyangeni ezintathu ezedlule (ukuphikisana nokuhlolwa kokuncintisana kwenselele)
Uma kunokwenzeka, abacwaningi bathola amarekhodi okuhlola kusukela odokotela abathintekayo mayelana nokuthi laba bantu bebengatholwa kanjani ukuthi bane-asthma. Esicwaningweni, amaphesenti angu-24 emadokotela omphakathi awazange aphendule izicelo zomcwaningi wolo lwazi.
Phakathi nochungechunge lokuvakashelwa amasonto ambalwa, abacwaningi basebenzise ikhaya eliphakeme lokugeleza kwamamitha kanye nokuqapha kwezimpawu, i-bronchodilator spirometry, kanye nokuhlolwa kobunzima bokuhlola ukuhlola ukuthi ubani ongenayo i-asthma. Labo ababambiqhaza abangenayo i-asthma base bexoshwa imishanguzo yabo ye-asthma futhi bahlolwa kabusha phakathi nenkathi yonyaka. Abacwaningi nabo bafuna ukusungula ezinye izindlela zokuxilongwa ezimweni lapho abahlanganyeli bengenayo i-asthma.
Ekugcineni, isifo se-asthma sasibanjwe ngabahlanganyeli abangu-203 kwabangu-613 (amaphesenti angu-33.1). Ngaphezu kwalokho, abathintekayo abangu-181 (amaphesenti angu-29.5) baqhubeka bengenayo ubufakazi besifo se-asthma emva kwezinyanga ezingu-12 zokulandelela. Abahlanganyeli abayishumi nambili (amaphesenti amabili) babengenayo i-asthma, kodwa kunalokho babe nemibandela engathà sina ye-cardiorespiratory eyayingakaqondwa kabi yizinyanga zomphakathi. Okokugcina, abahlanganyeli abaye baxilongwa nge-asthma baphikisa ukuthi kwakungenakwenzeka ukuba baqale bahlolwe besebenzisa ukuhlolwa kokusebenza kwamapulmoni nokuhlolwa kokunciphisa ukuhamba kwamagunya kunelabo abaye baqinisekiswa yi-asthma.
Imininingwane emibili ephawulekayo ingatholakala kulesi sifundo:
- Abantu abadala abatholwe ukuthi bane-asthma abadala-abadala bangase bangaqhubeki babe nesifo se-asthma noma badinga imithi ye-asthma kuze kube phakade.
- Ngemihlahlandlela yomtholampilo, odokotela abaningi kudingeka basebenzise ukuhlolwa kokuhlolwa kwe-physiologic, njenge-bronchodilator spirometry, ukuhlola kahle i-asthma endaweni yokuqala. Ukuthembela kalula emlandweni wesiguli, ukuhlolwa ngokomzimba, kanye ne-acumen yomtholampilo ayanele uma uthola lesi simo.
Qaphela ukuthi lolu cwaningo lunemikhawulo eyenza kube nzima ukukhiqiza imiphumela kubo bonke abane-asthma. Ngokucacile, abacwaningi abafaki inani labantu abanomqondo olinganiselwe wokuthola isifo sofuba (okungukuthi, labo abadinga ukwelashwa kwe-prednisone yesikhathi eside) kanye namaphesenti angu-45 kuphela abahlanganyeli abathintekayo bafuna imithi yansuku zonke yokulawula i-asthma yabo. Ngakho-ke, ukuxoxwa phakathi kwabahlanganyeli abane-asthma enzima kakhulu akunakulinganiselwa. Esikhundleni salokho, izinga eliphezulu lokuxoxisana libheke (amaphesenti angu-33.1) kuphela kulabo abatholwa ukuthi bane-asthma enamandla. Eqinisweni, ezinye izifundo ze-longitudinal ezihlolisisa izinga lokukhishwa kwama-asthma labantu abadala abalingana nalabo abanesifo sokuqina kwesifo kubonisa ukuthi izinga lokuxolelwa liphansi.
Ngaphezu kwalokho, ngoba abanye ababambiqhaza babengenalo imibhalo kusukela lapho beqala ukuthola ukuthi bane-asthma, noma ekuqaleni baxilongwa ngaphandle kokuhlomula kokuhlolwa kokuhlola, akucaci ukuthi bangaki abahlanganyeli abatholwe ukuthi bane-asthma kuqala. Ngamanye amazwi, abanye ababambiqhaza abathola "ukuxolelwa" kungenzeka ukuthi abazange babe nesifo sengculaza endaweni yokuqala.
Lokho Okusho Konke
Cishe amaphesenti angama-75 ezingane abane-asthma ekugcineni aphumelele isimo ngokukhula kwabantu abadala. Kodwa-ke, ucwaningo luye lwabonisa ukuthi ukuxoxwa phakathi kwalabo abanezifo eziphuthumayo eziphuthumayo kuncane kakhulu. Isifundo samanje, noma kunjalo, sikhombisa ukuthi abantu abadala kakhulu kunokuba bacatshangwe ngaphambilini bangathola ukukhululwa kwe-asthma ekhudlwana. Laba bantu abadala ngeke besadinga imithi yabo ye-asthma.
Uma wena noma othandekayo uthola ukuthi une-asthma ekhulile, sicela ugcine okulandelayo engqondweni:
- Ingxenye yokuphathwa kwalesi simo iwukuqapha. Uma izimpawu zakho ziyancipha noma zikhishwa, ungadinga imishanguzo encane noma engekho i-asthma, ngokulandelana. Kumele uqaphele izimpawu zakho kanye nezimo eziphuthumayo ze-asthma (okungukuthi, "ukuhlasela kwe-asthma") futhi wabelane ngalolu lwazi nodokotela wakho.
- Kumele futhi usebenzise imitha yokuphakama ye-peak ukuhlola ukuthi i-asthma yakho ilawulwa kahle kangakanani ekhaya. Uma uthola ukuthi i-asthma yakho iyakhipha, buyela kudokotela wakho ukuze ubuyekeze kabusha. Ngeke usadinga imithi yakho ye-asthma.
Okokugcina, uma uthola ukuthi une-asthma esemdala, kodwa udokotela wakho akakaze asebenzise i-spirometry noma ezinye izivivinyo zokuxilonga ukuqinisekisa ukuxilongwa, ungase ufune ukuhlela ukuvakasha nomchwepheshe ozokwenza lezi zivivinyo. Omunye omkhulu osusa kulolu cwaningo ukuthi ukuhlolwa kwe-physiologic kuyadingeka ukuze uhlolisise i-asthma-futhi iziqondiso zamanje zincoma ukuhlolwa okunjalo.
> Imithombo
> Aaron, SD, et al. Ukubukezwa kabusha kokuqhathaniswa kwabantu abadala abane-Asthma Eyaziwa Ngokwenyama. I-JAMA. 2017; 317: 269-279.
> I-Asthma Abacebisi Nokuphathwa. I-American Academy of Asthma, Ukuzivocavoca & Immunology. https://www.aaaai.org/
> Hollingsworth, HM no-O'Connor GT. I-Asthma-Lapha Namuhla, Ekusasa? I-JAMA. 2017; 317: 262-263.
> Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr .. Isahluko 55. Isifo somoya. Ku: Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr .. eds. Umbala we-Atlas of Family Medicine, u-2e . ENew York, NY: McGraw-Hill; 2013.