THEmphumu nthawi zambiri a matenda osachiritsika zomwe zimafuna chithandizo chokhazikika, ngakhale pakati pa kuukira. The Mankhwala kuletsa mphumu sikupereka machiritso otsimikizika. Amapangitsa kupuma mosavuta powonjezera kutsegula kwa bronchi (bronchodilation) ndi kuchepetsa kutupa. Ambiri a iwo amagwidwa inhalation, zomwe zimawathandiza kuchitapo kanthu mwamsanga, ndi zotsatira zochepa kwambiri. Dokotala amayesanso kupereka mlingo wochepa kwambiri wa mankhwala kuti athetse zizindikiro ndi kulekerera kwabwino kwa mankhwala.

Komabe ngakhale kuti chithandizo chamankhwala chili chothandiza, anthu 6 mwa 10 aliwonse omwe ali ndi mphumu amalephera kuwongolera zizindikiro. Zimayambitsa ndi osauka kumvetsa matenda, mantha Zotsatira zoyipa ndi kuyiwala mankhwala. Komabe, zotsatira za mankhwala omwe amatengedwa pokoka mpweya ndizochepa poyerekeza ndi zoopsa zomwe zimadza ndi mphumu yoopsa komanso yafupipafupi.

• Ma metered aerosols. Muyenera kugwedeza aerosol bwino ndikuyigwira molunjika. Mutatha kuchotsa pang'onopang'ono m'mapapo, pumani pang'onopang'ono komanso mozama kwambiri kudzera pakamwa panu, ndikuyambitsa aerosol pa sekondi yoyamba ya kudzoza. Muyenera kugwira mpweya wanu kwa masekondi 5 mpaka 10, ndikupuma pang'onopang'ono.
• Dry powder inhalers (monga: Turbuhaler®). Machitidwewa ndi osavuta kugwiritsa ntchito chifukwa safuna kugwirizana kudzoza ndi kuyambitsa. Muyenera kupuma molimbika komanso mwachangu momwe mungathere, kutsekereza kupuma kwanu kwa masekondi 10 ndikutulutsa kunja kwa inhaler.
• Zipinda zopumira. Iwo ntchito ndi metered mlingo inhaler ana osakwana zaka 8 ndi okalamba. Kwa ana aang'ono, inhalation imachitika ndi chigoba cha nkhope, chomwe chiyenera kusungidwa kumaso kwa mpweya wodekha wa 6.

Anthu omwe ali ndi mphumu nthawi zambiri amafunsidwa kuti aziyang'anira kupuma kwawo. Mwachitsanzo, anthu ndi mphumu yoopsa, amatha kuyeza nsonga ya kutuluka kwawo kwa mpweya kunyumba (nsonga kutuluka) kuti asinthe mankhwala awo okha malinga ndi zotsatira zake. Maphunziro ayenera kuti adatengedwa kale.

Mankhwala

Pali magulu awiri a Mankhwala kuchepetsa zizindikiro za mphumu. Woyamba, wotchedwa zovuta kapena mankhwala opulumutsa, ayenera kumwedwa ngati zizindikiro. Ali ndi mpumulo wanthawi yomweyo, koma musadetse nkhawa ndi kutupa kwa bronchi.

Mankhwala ena ndi kuwongolera kapena chithandizo chakumbuyo. Ayenera kumwedwa tsiku lililonse, ngakhale pakalibe kupuma kwapang'onopang'ono pomwe mphumu ikakhala yocheperako komanso yosalekeza. Amathandizira kuchepetsa kutupa kwa bronchi ndikuchotsa zowukira. Ngati sichimwedwa pafupipafupi, kuchuluka kwa kuukira kumawonjezeka, monganso kufunika kwa mankhwala opulumutsa.

Chithandizo chamavuto (kapena kupulumutsa).

Mankhwala osokoneza bongo amatchulidwa ndi mawu osiyanasiyana, kuphatikizapo mankhwala a bronchodilator kuchita mwachangu kapena beta2 agonists wochita zazifupi. Amagwiritsidwa ntchito pokhapokha kuti athetse zizindikiro za kuukira (chifuwa, chifuwa, kupuma movutikira ndi kupuma movutikira) kapena musanayambe kuchita masewera olimbitsa thupi pa chifuwa chachikulu. Mu mphumu yofatsa, yapakatikati, chithandizo cha khunyu chingakhale mankhwala okhawo ofunikira.

Mankhwalawa akuphatikizapo salbutamol (Ventoline®, Ventilastin®, Airomir®, Apo-Salvent®, Novo Salmol®) kapena terbutaline (Bricanyl®). Amatengedwa pokoka mpweya ndikukulitsa ma airways mwachangu kwambiri, mphindi 1 mpaka 3. Pali zotsatirapo zochepa ngati zitagwiritsidwa ntchito nthawi zina, koma mu mlingo waukulu zingayambitse kunjenjemera, mantha ndi kugunda kwa mtima mofulumira. Mukamva kuti muyenera kumwa pafupipafupi (nthawi zambiri kuposa katatu pa sabata), zikutanthauza kuti mphumu siyimayendetsedwa mokwanira. Ndiye m'pofunika kugwiritsa ntchito maziko mankhwala kuchiza kutupa.

Ipratropium bromide inhalation (kawirikawiri). Ndi anticholinergic yomwe imalepheretsa kugwira ntchito kwa mankhwala omwe amachititsa kuti minofu ya m'mlengalenga igwirizane. Zocheperako kuposa ma beta2 agonists opumira, nthawi zina amagwiritsidwa ntchito ngati salolera kwa iwo. Zimatenga maola 1 mpaka 2 kuti zitheke.

Mankhwala osokoneza bongo ngati chithandizo choyambirira (chowongolera).

Mosiyana ndi mankhwala a khunyu kapena mankhwala opulumutsa, mankhwala a DMARD (control) samachepetsa msanga zizindikiro. Amagwira ntchito pang'onopang'ono ndipo amagwira ntchito nthawi yayitali pochepetsa kutupa komanso kuchuluka kwa khunyu. Ndicho chifukwa chake kuli kofunika kuwatenga tsiku ndi tsiku.

Mankhwala a Corticosteroids. Corticosteroids amachepetsa kutupa kwa mpweya ndipo motero kupanga ntchofu. Amatengedwa pang'onopang'ono ngati inhalation (kupopera), tsiku ndi tsiku (mwachitsanzo, Alvesco® ndi Pulmicort®). Dokotala amatchula mlingo wotsika kwambiri wogwira ntchito. Angathenso kutengedwa ngati mapiritsi a mphumu yoopsa kwa nthawi yochepa ya masiku angapo (mwachitsanzo: prednisolone, methylpredinosolone). Kaya atengedwa ndi mpweya kapena mapiritsi, amagwira ntchito mofananamo, koma kupuma kumapangitsa kuti mlingo wocheperako ukhale wochepa kwambiri, kuchitapo kanthu kokhazikika ndipo zotsatira zake zimakhala zochepa. Gulu lamankhwala ili ndilothandiza kwambiri polimbana ndi mphumu. Zotsatira zake zimamveka pakatha masiku angapo ogwiritsira ntchito.

Zotsatira zoipa

Amatengedwa ndi inhalation komanso pamlingo wocheperako, corticosteroids ali ndi zotsatira zochepa, ngakhale atatengedwa kwa nthawi yayitali. Kupsa mtima ndi kukalipa kapena mawonekedwe a mugut (kapena candidiasis, chifukwa cha yisiti kupanga zigamba zoyera pa lilime) ndizo zotsatira zofala kwambiri. Choncho, muyenera kutsuka pakamwa panu mukakoka mlingo uliwonse. Mapiritsi a Corticosteroid ali ndi zotsatira zamphamvu za nthawi yayitali (kufooka kwa mafupa, chiopsezo chowonjezeka cha ng'ala, etc.). Amawasungira milandu ya mphumu yoopsa, yokhudzana ndi mankhwala ena.

Ma bronchodilator omwe amagwira ntchito nthawi yayitali. Izi zimaperekedwa mophatikizana pamene inhaled corticosteroids yokha sikwanira kuthetsa zizindikiro za mphumu. The beta2 agonists Kuchita kwa nthawi yayitali kumayambitsa bronchodilation kwa maola 12. Kuchita kwawo kumatha kukhala kofulumira mumphindi 3 mpaka 5 ngati formoterol® (ex Foradil®, Asmelor®) kapena pang'onopang'ono pakatha mphindi 15 ngati salmeterol (Serevent®). Amagwiritsidwa ntchito limodzi ndi corticosteroid. Pali ma inhalers omwe amaphatikiza mitundu iwiri yamankhwala monga Seretide® (fluticasome / salmeterol). Kuphatikizana ndi formoterol (Symbicort®, Innovair® ndi Flutiform®) angagwiritsidwenso ntchito ngati mankhwala opulumutsa, ngakhale amakhalanso ndi kutupa kwa nthawi yaitali.

Antileukotrienes. Kutengedwa pakamwa, amachepetsa kutupa komwe kumayambitsidwa ndi leukotrienes, zinthu zomwe zimathandizira kuyankha kotupa.Ku France, antileukotrienes ilipo: montelukast (Singulair®). Ku Canada, palinso lezafirlukast (Accolate®). Atha kugwiritsidwa ntchito okha kapena kuphatikiza ndi inhaled corticosteroids. Amasonyezedwa kuti atetezere mphumu pakuchita masewera olimbitsa thupi, mu mphumu yofatsa, kwa anthu omwe mphumu yawo simayendetsedwa ndi corticosteroids yopuma yokha, komanso kwa iwo omwe amagwiritsa ntchito molakwika utsi wawo.

Theophylline. Ndi akale kwambiri a bronchodilator (monga: Theostat®). Imagwiritsidwa ntchito kawirikawiri masiku ano, chifukwa mlingo wothandiza wopanda mavuto ndizovuta kupeza. Ikhoza kulembedwa ngati piritsi kuti mutenge ndi chakudya chamadzulo kwa anthu omwe amavutika kumwa mankhwala opopera.

Anti-immunoglobulin E. Mankhwalawa amapangidwa pofuna kuchiza chifuwa chachikulu cha mphumu mwa anthu omwe mphumu yawo imakhala yovuta kuwalamulira ndi mankhwala ena. Omalizumab (Xolair®) ndi mankhwala okhawo m'kalasili omwe amapezeka mu 2015. Amaperekedwa ngati jekeseni wa subcutaneous kamodzi kapena kawiri pamwezi.

Lingaliro la dokotala, Dr Annabel Kerjan pulmonologist:

Munthu akakhala ndi mphumu, sayenera kuvomereza kukhala ndi zizindikiro popanda kuchita chilichonse. Simuyenera, mwachitsanzo, kulekerera kupuma movutikira, chifuwa chaching'ono, kupuma movutikira usiku. Matendawa sayenera kuloledwa kusinthika, chifukwa ngati ife kutopa popanda kuchiza, chifukwa akhoza amanyozetsa bronchi m'kupita kwa nthawi, zikubweretsa kuipiraipira okhazikika zizindikiro, ndi zowawa kwambiri pafupipafupi matenda sekondale ndi hospitalizations. Ndi bwino kupeza ndi dokotala mankhwala osachepera ogwira.

Izi ndizofunikira makamaka kwa makolo a ana omwe ali ndi mphumu. Nthawi zambiri amazengereza kupereka mankhwala kwa ana awo ndipo izi ndizomveka. Koma pamenepa, iwo akulakwitsa. Anawa ayenera kupatsidwa mwayi wokulitsa bwino chuma chawo chopuma kuti azitha kupezeka akadzakula. Ndiyeno, mwana yemwe ali ndi zizindikiro za mphumu yosachiritsika amagona bwino, amavutika ndi masewera ndipo amakula bwino. Pomwe ndi chithandizo, akumva bwino ndikusunga bronchi yake mtsogolo.