Njengoba kunezinhlobo ezihlukahlukene ze-inhalers ezisetshenziselwa ukuphatha i- COPD , iziguli eziningi zingase zizibuze ukuthi "yiyiphi engcono kakhulu?" Nakuba uvuma ukuthi kuyingozi ukufakazela ukuthi kukhona 'umuthi owodwa owodwa' kunoma yisiphi isimo, uma kwenzeka I-COPD, imithi eyodwa yemithi ijwayele ukuma ngaphezu kwamanye, okuthole leli klasi isihloko "se-ejenti yokuqala" ekuphatheni i-COPD.
Iklasi lemithi ibizwa ngokuthi i-anticholinergic inhalers, okuyikhona okwamanje emakethe: I-Spiriva (tiotropium) neTurdoza (aclidinium bromide). Njengoba iTurdoza ifike emakethe ngo-2012, iningi lezilingo zomtholampilo ezibandakanya iziguli zeCOPD zasebenzisa imithi uSpiriva (eya emakethe ngo-2004). Ngakho-ke, kule ngqungquthela, sizoxoxa ikakhulukazi ngo-Spiriva ngokufingqa izifundo ezimbili ezibalulekile zocwaningo mayelana neTiotropium, esekela isikhundla sayo "ukukhetha kokuqala kwe-inhaler kubaguli be-COPD." Khona-ke, sizoxoxa ngemiphumela emibi ye-Spiriva.
Ukuqhathanisa i-Spiriva
Ngomagazini ka-March 24, 2011 we- New England Journal of Medicine (enye yezincwadi zezokwelapha eziyinhloko), iqembu labacwaningi belithemba ukuthola ukuthi imiphi imithi yokwelashwa engcono ekuvimbeleni ukucindezeleka kwe-COPD: ama-anticholinergics noma ama-agonists asebenza isikhathi eside. Ukuze benze kanjalo, bafanisa i-Tiotropium (Spiriva, i-anticholinergic) ne-Salmeterol (i-Serevent, i-agaist ye-beta ende-eside) ezigulini ezinezilinganiso ezilinganayo kuya kwe-COPD ezinzima.
Balinganisa isikhathi esathatha ukuba iziguli zithole ukuqhuma kokuqala kwe-COPD. Bathole ukuthi iziguli ezasebenzisa i-Spiriva zanciphisa ngo-17% engozini yazo yokukhushulwa kwe-COPD futhi ukunciphisa okungu-28% engozini ukuze kube nzima kakhulu. Iziguli ezasebenzisa i-Spiriva zinezinsuku ezingu-187 kuze kube yilapho ukuqhuma kwabo kuqala lapho iziguli ezazisetshenziswa eServent zinezinsuku ezingu-145 ekuqhakambiseni kokuqala.
Ngaphezu kwalokho, iziguli ezithatha i-Spiriva zinesidingo esingaphansi kwe-steroids (njenge-prednisone) nemithi elwa namagciwane. Kwakungekho umehluko kumazinga noma izinhlobo zemiphumela emibi evela emithini.
Esinye isifundo eNew England Journal of Medicine (kusukela ngo-2008) sathola ukuhlolwa lapho balandela iziguli ezingu-3000 ezithatha i-Spiriva zaziqhathanisa neziguli ezingu-3000 ezasebenzisa i- "sham" inhaler. Womabili amaqembu eziguli avunyelwe ukusebenzisa ezinye izidakamizwa ngesikhathi sesifundo. Kodwa iziguli ezazisisebenzisa i-Spiriva, zineziphuzo ezingcono kakhulu zokuhlinzeka ngamapayipi, izimbalwa zokugula izifo, ukungaphumeleli kokuphefumula, kanye nezibalo ezingcono ezihlolweni zesifo kuneziguli ezingazange zisebenzise i-Spiriva. Lolu cwaningo lwaholela abacwaningi ukuba baphethe ngokuthi uSpiriva angathuthukisa izimpawu, anciphise ukucindezeleka futhi athuthukise izinga lempilo yeziguli ezine-COPD (uma kuqhathaniswa nalabo abangazange basebenzise i-Spiriva).
Nakuba i-Spiriva yiyona eyokukhetha kuqala i-inhaler, kunezinye inhalers ezikhonjiswe ku-COPD, njenge-Advair, Symbicort, nabanye. Iziguli eziningi zidinga okungaphezu kweyodwa i-inhaler, kanti kwezinye iziguli, i-Spiriva ayiyona into enhle kakhulu (isibonelo, uma ihlangabezana nemiphumela emibi). Kunamanye ama-inhaler akufanele ahlanganiswe no-Spiriva (isibonelo, ungasebenzisi iSpiriva no-Combivent ndawonye )
Imiphumela emibi ye-Spiriva ayifani kakhulu, futhi ingafaka:
Ukugcinwa kwe-Urinary (ikakhulukazi emadodeni ane-prostate ekhulisiwe)
Ukusabela okwenziwe okwehla (ukuvuthwa, ukushaywa, ukuqhuma, ukuvuvukala kwezindebe / ulimi / umphimbo)
I-glaucoma (ubuhlungu bamehlo, umbono obonakele, ukubona ama-halos noma imibala engavamile)
Imiphumela emibi kakhulu ejwayelekile ye-Spiriva ihlanganisa:
Umlomo omile
Ukutheleleka kweSinus
Umphimbo obuhlungu
Umbono ogqamile
Ukushaya kwenhliziyo ephakeme
Izifo eziphezulu zokuphefumula
Ukuze uthole impendulo ezithakazelisayo ze-Perspectives essay mayelana nemiphumela emibi ye-Spiriva (eshicilelwe eNew England Journal of Medicine ), chofoza lapha.
Imithombo
> Tashkin DP, Celli B, Senn S, et al. Isivivinyo seminyaka engu-4 se-tiotropium esifo sesifo se-pulmonary chronic obstructive. N Engl J Med 2008; 359: 1543-54.
> Vogelmeier C, Hederer B, Glaab T, et al. I-Tiotropium ngokumelene ne-salmeterol yokuvimbela ukukhushulwa kwe-COPD. N Engl J Med 2011; 364: 1093-103.
> I-RA ehlakaniphile, i-Anzueto A, iCotton D, et al. I-Tiotropium I-inhaler ye-Respimat kanye nobungozi bokufa ku-COPD. N Engl J Med 2013; 369: 1491-501.