Ekubeni kukho iintlobo ezahlukeneyo ze-inhalers ezisetyenziselwa ukunyanga i- COPD , ezininzi izigulane ziyakwazi ukuzibuza ukuba "ngubani na owona mhle?" Nangona uvuma ukuba kuyingozi ukuvelisa ukuba kukho 'elinye iyeza elincinci' nayiphi na imeko, kwimeko I-COPD, elinye iklasi lamachiza lithatha ukuma ngaphezu kweminye, eliye lafumanisa le klasi isihloko "se-arhente yokuqala-line" ekuphatheni iCOPD.
Iklasi leyeza libizwa ngokuba yi-anticholinergic inhalers, apho kukho ezimbini kwiimarike ngoku: i-Spiriva (tiotropium) neTurdoza (aclidinium bromide). Ukususela ngoTurdoza weza kwiimarike ngo-2012, ubuninzi bezilingo zeekliniki ezibandakanya izigulane zeCOPD zasebenzisa imishanguzo ye-Spiriva (eya kufika emarike ngo-2004). Ngaloo ndlela, kweli nqaku, siza kuthetha ngokumalunga ne-Spiriva ngokushwankathela izifundo ezimbini ezibalulekileyo zophando malunga neTiotropium, exhasa isikhundla sayo "ukukhetha kokuqala kwe-inhaler kwizigulane zeCOPD." Emva koko, siza kuxubusha imiphumo emibi ye-Spiriva.
Ukuthelekisa i-Spiriva
Ngomhla ka-Matshi 24 ka-2011 we- New England Journal of Medicine (enye yeengxelo zamagqirha zonyango), iqela labaphandi lithembele ukufumana ukuba yeyiphi imichiza yemichiza ilungile ekukhuseleni ukukhushulwa kwe-COPD: i-anticholinergics okanye i-agonists yexesha elide. Ukuze benze njalo, bafanisa i-Tiotropium (i-Spiriva, i-anticholinergic) kunye ne-Salmeterol (i-Serevent, i-agaist ye-beta ende ende ende) kwizigulane ezinomlinganiselo othe ngqo kwiCOPD.
Balinganisa ixesha elithathayo ukuba izigulane zifumane ukukhushulwa kwe-COPD yokuqala. Bafumene ukuba izigulane ezasebenzisa i-Spiriva zancitshiswa ngo-17% kwengozi yazo yokukhushulwa kwe-COPD kunye nokunciphisa u-28% engozini kumngcipheko omkhulu. Izigulane ezazisisebenzisa i-Spiriva zineentsuku ezingama-187 kwaze kwaba yinto yokuqala yokugxiliswa apho izigulane ezasebenzisa iSerevent zineentsuku ezili-145 ukuya kweyokuqala.
Ukongezelela, izigulana ezithatha i-Spiriva zangezinye iimfuno ze-steroids (ezifana ne-prednisone) kunye neyeza-antibiotics. Kwakungekho nantlukwano kwiirhafu okanye iintlobo zemiphumo emibi evela kumachiza.
Olunye uphando kwiNew England Journal of Medicine (ukususela ngo-2008) lufunyenwe luvavanyo apho balandela izigulane ezingama-3000 ezithatha i-Spiriva kwaye zafanisa nezigulane ezingama-3000 ezisebenzisa 'sham' inhaler. Amaqela amabini ezigulane avunyelwe ukusebenzisa amanye amayeza ngexesha lokufunda. Kodwa izigulane ezasebenzisa i-Spiriva, nangona kunjalo, zinomsebenzi ophucula umphunga, izibhedlele ezimbalwa, ukungaphumeleli kokuphefumula, kunye neziphumo ezingcono kwiziphumo zophando kunezigulane ezingazange zisebenzise i-Spiriva. Olu phofu lukhokelela abaphandi ukuba baphumelele ukuba i-Spiriva inokuphucula iimpawu, ukunciphisa ukunyuka kwamanzi kunye nokuphucula umgangatho wobomi kwizigulane ngeCOPD (xa kuthelekiswa nalabo abangasebenzisi iSpiriva).
Nangona i-Spiriva yinto yokuqala yokukhetha inhaler, kukho ezinye i-inhalers eziboniswe kwi-COPD, njenge-Advair, Symbicort, nabanye. Izigulane ezininzi zidinga ngaphezu kweyodwa inhaler, kwaye kwezinye izigulane, i-Spiriva ayilona khetho olukhethekileyo (umzekelo, ukuba bafumana imiphumo emibi). Kukho ezinye i-inhalers ezingafanelanga ukudibaniswa ne-Spiriva (umzekelo, ungasebenzisi iSpiriva kunye ne-Combivent kunye )
Imiphumo emibi ye-Spiriva inqabile kakhulu kwaye ingaquka:
Ukugcinwa kwee-urinary (ngokukodwa kwindoda ene-prostate eyandisiweyo)
Ukusabela okuvakalayo (umquba, ukubetha, ukukhawuleza, ukuvuvukala kwemilomo / ulwimi / umphimbo)
I-Glaucoma (intlungu yesiso, imbono ephosakeleyo, ukubona i-halos okanye imibala engapheliyo)
Iziphumo eziqhelekileyo ezichaphazelekayo ze-Spiriva ziquka:
Umlomo omile
Usulelo lweSinus
Umqala obuhkungu
Umbono ogqabileyo
Iqondo lentliziyo ephakamileyo
Izifo ezithintekayo zokuphefumula
Ngomxholo othakazelisayo we-Perspectives inqaku ngeempembelelo ezingezantsi ze-Spiriva (epapashwe kwi- New England Journal of Medicine ), nqakraza apha.
Imithombo
> Tashkin DP, Celli B, uSenn S, et al. Uvavanyo lweminyaka emine ye-tiotropium kwisifo esingapheliyo sesiphene. N Engl J Med 2008; 359: 1543-54.
> Vogelmeier C, Hederer B, Glaab T, et al. I-Tiotropium ngokumelene ne-salmeterol ekuthintela ukunyanzeliswa kwe-COPD. N Engl J Med 2011; 364: 1093-103.
> Ihlakaniphile RA, iAnzueto A, iCotton D, et al. I-Tiotropium Inempendulo ye-Respiratory and the risk of death in COPD. N Engl J Med 2013; 369: 1491-501.