Kusenokwenzeka ukuba uye wakuva isifo se-aspirin-esichengeni isifo sokuphefumula (i-AERD) kuthiwa yi-Samter's triad okanye i-aspirin-induced asthma. Kukho imimiselo emithathu apho abantu abane-AERD bonke banakho: i-asthma, isifo se-sinus kunye ne- polyps nasal , kunye novelwano kwimithi ebizwa ngokuba yi-NSAIDS (ngokukhethekileyo i-aspirin kunye nayo yonke imithi evimba i-enzyme ebizwa nge-COX-1).
I-AERD ithintela i-0.3 ukuya kwi-0.9 yepesenti yoluntu jikelele kunye neepesenti ezi-10 ukuya kuma-20 zabantu abaye bafumanisa ukuba bane-asthma. Nangona kunjalo, i-pathophysiology yayo ayiqondwa kakuhle. Kubonakala kuthintela zonke iindidi zamaqela ngokulinganayo, ngokulinganiselwa kwiminyaka eyi-35 ubudala, kodwa kungabonakali ukuba zizuze kwaye ziyakwazi ukuthintela abafazi kunamadoda.
Ukuba ukrokreka ukuxilongwa okanye ufumaniswe ukuba kukho, kukho eziliqela eza kuzokukunceda ukulawula iimpawu kwaye uphile kakuhle. Nakhu okufuneka ukwazi.
Iimpawu
Ukuba unayo i-AERD unokufumana ubunzima bokubambisana nezinye okanye zonke ezi zilandelayo:
- Sinusitis engapheliyo
- Iindidi zeeplastiki
- Ukulahlekelwa ngephunga
- Isifuba
- Ukuphendula kwi-NSAID (i-aspirin okanye imichiza efanayo), enokubandakanya ukuxinwa kwamanzi, ukuxubha, ukukhwaza intloko, ukunyunyuza, ukukhwehlela, ukuvutha, i-bronchospasm, i-laryngospasm okanye intlungu yesifuba. Ezi zimpawu zingenzeka emva kokusela utywala.
Unokuba nobunzima bokunyanga iimpawu ngeendlela eziqhelekileyo.
Ngokomzekelo, iiplasps zangasese zikwazi ukubuyela ngokukhawuleza emva kokuba zisuswe ngugqirha. Ukudibanisa kunye nokuphefumula ukuphefumula kungakhokelela ekubeni kunzima ukulala ebusuku kunye nokulahlwa okulalayo kunye nokukhathala kwamini.
Kuqhelekile ukuba abantu babe nezifo ezigqithisayo ezingenza i-AERD ibe yimbi.
Ezi zibandakanya i- rhinosinusitis , i-GERD, okanye i -asthma eyenziwa ngumzimba . Ezi meko mazilawulwe ngokwahlukileyo kwi-AERD kwaye ugqirha wakho unokuncoma ukhetho olungcono.
Ukuxilongwa
Ukuba unesifo se-asthma, isifo se-sinus kunye ne-polyp nasps, kwaye uye wayetyala okanye usenokukrokra ukuba usenokusabela kwi-NSAID, ugqirha wakho unokugxeka ukuba unayo i-AERD. Uvavanyo olongezelelweyo luya kunceda ekuqinisekiseni le ngxaki.
Uvavanyo olulodwa lucelomngeni lwe-aspirin, okubandakanya ukunika amancinci amancinci kwi-aspirin kwiintsuku ezimbalwa kwindawo yokufumana unyango apho ungaqwalaselwa khona ukuba uphendule. Emva kokukunika umthamo we-aspirin ugqirha wakho unokuvavanya umthamo wakho wamaphaphu ukuze ubone ukuba uye wehla.
Ugqirha wakho angakhetha ukuyalela ezinye iimvavanyo zokunceda ekuxilongeni kwe-AERD, kuquka iimvavanyo zegazi. I-Eosinophil iyingqambela zegazi ezimhlophe, izixhobo ze-immune system. Abantu abane-AERD banamathuba amaninzi ama-eosinophil kwiiplasps zabo zangasese kwaye banokuphakamisa amanqanaba egazi ngokunjalo. Amanye amaseli omzimba afana neeseli zesigxina nazo zinokuphakanyiswa. Unokuthi unamanqanaba aphakamileyo yezinto ezibizwa nge-cysteinyl leukotrienes. Iimvavanyo ze-CT, okanye ezinye iimvavanyo zokucinga ukulungiselela ukucinga ngeso sono sakho.
Kufuneka kuqatshelwe ukuba akukho nanye kwezi zivivinyo ezicacileyo ukuxilongwa kwe-AERD kodwa unokunceda ugqirha wakho ukuba afumane umfanekiso ocacileyo weemeko zakho.
Unyango no lawulo
Akukho nonyango ye-AERD, kwaye njengoko kuthethwa ngaphambili kwimizimba ye-pathophysiology yesi sifo ayiqondwa kakuhle ngabaososayensi nabaqeqeshi bezonyango. Nangona kunjalo, kukho iindlela ezininzi zokonyango ezikhoyo ukukunceda ukuphatha kakuhle iimpawu.
Enye indlela yokuphepha i-aspirin kunye neminye imishanguzo ye-NSAID (nayiphi na imithi evimbela i-enzyme COX-1). I-Acetaminophen ingasetyenziselwa endaweni yile miyeza, kodwa mhlawumbi kuphela kumanani aphantsi (ukuya kuma-500mg).
Ukugwema i-aspirin ayiyi kulawula ezinye iimpawu ezifana ne-polyp nasal, izifo zesinus okanye iimpawu ze-asthma.
Ukukhula kweeplasps zangasese kunganciphisa ngokusebenzisa ii-injection ze-steroid, ukususwa kokucoca, okanye ukudibana kokubili. Iipraysi ze-Nasal eziqukethe i-steroids kunye nokunkcenkceshela kwamanzi nazo zinokuba luncedo ekulawuleni ezinye iimpawu zomzimba kunye neengxaki ze-sinus.
Amachiza ama-montelukast kunye ne-zafirlukast asetyenziswa rhoqo kwaye athambekele ekuncedeni ngakumbi ekulawuleni iimpawu kunamanye amayeza e-asthma, kuquka ne-beta-agonists. I-corticosteroids engabonakaliyo isetyenziselwa ukulawula i-asthma kwaye kunokufuneka ukuba usebenzise la mayeza rhoqo imihla ngemihla. Ngezinye izikhathi i-prednisone yomlomo isetyenzisiwe, kodwa ngokuqhelekileyo kuphela ukuba amanye amayeza ayiphumelelanga ukulawula iimpawu kuba i-oral steroids inomdla ongathandekiyo.
I-Aspirin Desensitization
Olunye ukhetho, oluye lwabonisa ukuba lunempumelelo kakhulu, luyi-aspirin deensitization. Ucwaningo luye lwabonisa ukuba i-aspirin yokususa intshutshiso elandelwa yimizi yesondlo yansuku zonke ye-aspirin inokunciphisa ukubunjwa kwama-polyp nasal kunye nezifo ze-sinus kunye nokuphucula amanqaku e-asthma.
Amanani e-aspirin anikezelwa kwimeko yezokwelapha apho unokubekwa esweni ukuze uphendule. Ukusetyenziswa kwezonyango ngokuqhelekileyo kwiklinikhi enezonyango zabasebenzi abanonophelo (izibhedlele ezingagulanga isigulane asikho imfuneko). Amanani aqala amancinci kwaye ngokunyuka kancinci kunyuka kwindleko yokunciphisa inkqubo yakho kwiyeza. Oku kuyafana nokunyanga kwama-immunotherapy ngenxa yokudityaniswa.
Ubu bungqina bokuba i-aspirin deensitization ixabisa kakhulu kwaye inenzuzo kubantu abaninzi abanokuxilongwa kwe-AERD. Ukuphuculwa kungabonakala emva kweeveki ezine zonyango. Izifundo zibonise ukuphucula kumanqaku omnxeba, ukuvakala komnxeba, nokunciphisa inani lemithi efunekayo ukulawula iimpawu ze-asthma.
Akunabo bonke abantu abane-AERD abanelungelo lokusasaza i-aspirin. Akufanele ube nale nyango xa ukhulelwe, unesilonda sesisu, ukuphazamiseka kwegazi, okanye iimpawu ze-asthma ezingaqinisekanga.
Kukho iingozi ezinxulumene ne-aspirin deensitization kwaye ziquka ukucima iimpawu ze-AERD yakho kuquka neengxaki zokuphefumula ezinzima. Kwakhona, nayiphina imiphumo eyenzekayo xa kuthatha i-aspirin, njengeengxaki zesisu okanye ukuphuma kwegazi, inokwenzeka ngexesha le-aspirin. Umele uthethe ugqirha okanye umseli-mveliso malunga nemiphumo emibi kwaye uqinisekise ukuba i-aspirin ayiyi kuphazamisa nayiphi na enye imichiza onokuyithatha.
Emva kokuba ufumene i-aspirin intshukumo yokubaluleka kuyimfuneko ukuqhubeka nokuthatha umthamo wesondlo we-aspirin imihla ngemihla ukuqhubeka nokungafuneki. Ekuqaleni le dose ingaba ngaphezu kwe-1300 mg ngosuku kodwa, ngokuqinisekileyo, ugqirha wakho uya kuncipha kancane kancane inani le-aspirin oyithathayo. Amanqanaba angaphantsi kwama-81mg ngosuku (i-dose eqhelekileyo kubantu abaneentsholongwane zomzimba) sele iboniswe ngempumelelo.
Ukuba uxinekeke kwimiphumo emibi kunye neeprotokthi ozifunda ngazo, yazi ukuba le nkqubo yinyathelo-nyathelo, ngoko zama ukugxila kwinto enye ngelo xesha. Ugqirha wakho uya kukukhokela kulo lonke, ulandele imiphumo emibi, kwaye uqaphele nayiphi na ingqinano.
> Imithombo:
> I-Aspirin-Exacerbated Respiratory Disease (AERD). I-American Academy ye-Allergy Asthma ne-Immunology. https://www.aaaai.org/conditions-and-treatments/library/asthma-library/aspirin-exacerbated-respiratory-disease
> URaily U. Lee noDonald D. Stevenson. I-Aspirin-Exacerated Respiratory Disease: UkuVavanywa noLawulo. I-allergies Asthma Immunol Res. 2011 uJan; 3 (1): 3-10.
> UJohn W Steinke noJeff M Wilson. I-Aspirin-iyancipha isifo sokuphefumula: ukuqonda kwe-pathophysiological kunye nenkqubela yeklinikhi. J I-Asthma Allergy. 2016; 9: 37-43.