Ingaba I-Asthma Yakho Eyona Nzulu I-asthma Eosinophilic?
I-asthma ye-Eosinophilic, eyaziwa nangokuthi i-asthma, iyona nto ixhaphakileyo yesifo se- asthma esivakalayo ukuba ikhulile. Ikwahlula njenge- atopic , nto leyo ithetha ukuba kukho ukuthambekela kofuzo lwe-allergies ukuba yimbangela yesifo. Ngokungafani nezinye iintlobo ze-asthma, i-asthma ye-eosinophilic ine-inflammation ye-airway kwiimfumba zakho ze-sinus yonke indlela eya kwi-airways encinane emiphakeni yakho.
Ukuvuvukala kwi-asthma ye-eosinophili kwenzeka njengenxalenye yesiphumo sokumelana nesistim okanye sesigxina somzimba, esakhupha iseli elithile legazi elimhlophe elibizwa ngokuthi i- eosinophils . Xa unokwanda kweeseli ezimhlophe zegazi, uya kuba neempendulo ezivuthayo, ezikhokelela ekunyukeni kwendlela yakho yokuhamba. I-fluid kunye ne- mucus eziphumo zingakhokelela kwiindawo zokuhamba nge-airways (bronchioles) kwaye zibangele iimpawu zakho ze-asthma.
Ukukhula
Isifo se-asthma sisifo esivuthayo somoya wakho ongenza kube nzima ukuphefumula. Abantu aba-1 kwabangama-13 bafumana ubunzima besifo esingapheliyo kwaye phantse isiqingatha sabantu abachaphazelekayo ngesifo se-asthma banokuhlaselwa kwesifo se-asthma unyaka ngamnye. Yazi ukuba uninzi lwale miba lukhuselekile ukuba i-asthma ilawulwa kakuhle. Nangona ekuqaleni bekucingelwa ukuba yintlupheko enye, i-asthma inamaninzi amaninzi anokutshintsha indlela i-asthma yakho ingalawulwa ngayo kakuhle.
Abantu aba-1 kwabangu-10 abane-asthma bane-asthma enkulu.
Nangona ubukhulu be-asthma eosinophili engaziwa, kukho ukucinga ukuba ama-50 ukuya ku-60 kwiimeko ezingama-100 ze-asthma ezinzima kubantu abadala bangaba yi-asthma eosinophilic. Ukuba uneminyaka engaphezulu kwama-35 xa ufumene ukuba unesifo esibuhlungu sisifo se-asthma unomngcipheko ophezulu wokufumanisa ukuba une-asthma ye-eosinophilic.
Umngcipheko wakho ufana naluphi na isini sakho, kwaye unobungozi obuncinci bokufunyanwa nge-asthma eosinophilic ebuntwaneni bakho kunye neminyaka yobutsha.
Iimpawu
Uninzi lweempawu ze-asthma ye-eosinophili zifana nezinye iifom ze-asthma kuquka:
- Ukuqhawukelwa ngumphefumlo
- Ukuhlahlela
- Ukugubha
- Ukunyamezela esifubeni sakho
Kukho iimpawu ezimbalwa ezinokuthi zibekho ngokuqhelekileyo ezihambelana ne-asthma kuquka:
- Ukuhambisa amanzi kunye nokudibanisa ( i-rhinosinusitis engapheliyo )
- Iindidi zeeplastiki
- Ukwandiswa kweembumba zamanqam
- Ukulahleka kovumba (asemia)
Nangona i-asthma ye-eosinophilic isabela ngokukhuselana nomzimba ngokumalunga nokunyuka, abantu abaninzi abanokufumanisa ukuba abanayo i-allergies, i-mildews, okanye ezinye izifo eziqhelekileyo.
Ukuxilongwa
I-asthma ye-Eosinophilic isoloko ichongwa. Akunakutshatyalaliswa ngokuqhelekileyo nangona ubukhulu becinga ukuba buphakamileyo kunokuba bakholwa ngaphambili.
Ukuba i-asthma ye-eosinophili yimbangela yesifuba sakho kwaye ayifumananga, unokuba nzima ukufumana isifo se-asthma esibi phantsi kolawulo. Ngokuqhelekileyo ufuna ukubonwa yi-pulmonologist ukuba unomdla. Nangona kunjalo, i-allergists kunye ne-immunologists inokukunceda ekuhloleni kwakho.
Eosinophil Cell Count
Ukwenza inani leseli yeeosinophil ukusuka kwisampuli ye-sputum esithathiweyo libhekwa njengesilinganiselo segolide esilinganiselweyo sokubala kweeseli ezivuthayo, kodwa kunzima ukufumana, ukuchitha ixesha kunye nokubukela.
Kudla ngokudinga ukusetyenziswa kwebhu lab ethile eneengcali.
Xa uqokelela i-specimen, ufuna ukuqinisekisa ukuba awunamathe, kodwa ukukhwehlela i-sputum kwi-airways yakho. Ukunceda ukunyusa isikhohlela, ugqirha wakho unokufumana isifo sengqondo sokuphefumula akunike umthamo we-albuterol okanye enye i-bronchodilator esebenza ngokukhawuleza. Olu unyango luyalandelwa kukunika i-saline hypertonic saline. Uxinzelelo oluphezulu lwe-saline xa unxilongo luvutha i-airways kwaye luncedisa ukukhwehlela. Ingqungquthela yokuqhawula isenokuhlaziywa kwilebhu ukuze ibone ukuba kukho ubukhulu be-1 ukuya kwezi-3 kuma-eosinophil e-100.
I-Airway Biopsy
Enye indlela yokufumanisa i-asthma kukuthatha i-biopsy ngexesha lokuhamba nge-bronchoscopy. Le nqubo inokwenziwa ukuba iqukumbele izifo ezininzi. Nangona kunjalo, le ndlela ayikhuthazwa kuphela ukufumanisa i-asthma ye-eosinophilic kuba yinkqubo engenayo idinga ukutyhulwa ngaphandle kokuba isampuli esaneleyo ye-sputum ayizange ifumaneke.
Ezinye iindlela
Ezinye iindlela ziye zaphuhliswa ukunceda ukufumanisa i-asthma. Ugqirha wakho unokujonga i-CBC (inani elipheleleyo legazi) ukujonga i-eosinophilia (ukunyuka kwama-eosinophil count). Nangona kunjalo, ukutolika i-eosinophil ephakamileyo egazini kufuneka kuphela yenziwe ngugqirha ekubeni ukuphakama okuphezulu kwigazi lakho akuqinisekisi ukuba une-asthma ye-eosinophilic. Kodwa ke, unokunceda ugqirha wakho ukuba ahluke ngakumbi naziphi na ezinye iimpawu onayo.
Ezinye izifo ezinokuthi ziqwalaselwe ukuba unayo inani eliphakanyisiweyo le-eosinophil egazini lakho liquka i-hypereosinophilic syndrome, ukuphazamiseka kokuzimela, ukungazi kakuhle, kunye neempendulo zonyango.
Uvavanyo olongezelelweyo olongezelelweyo lunokuthi lucatshungulwe njenge-sputum okanye i-blood eosinophil count: i-nitric oxide (e-nucleal exhaled) ye-nitric oxide (test) yokuphefumula kunye ne-periostin test blood. Ukuba une-asthma ye-eosinophilic, uya kubonisa ngokunyuka kwama-eosinophil egazini lakho kunye ne-sputum, i-immunoglobulin E, i-FeNO, ne-periostin.
I-FENO inokuba luncedo ekuncedeni ukuba uza kuphendula kwi-corticosteroids enganyangekiyo. Uvavanyo luya kwenziwa ngokusebenzisa idivayisi ebizwa ngeNIOX. Nangona kunjalo, ezininzi izinto zingathintela amanqanaba akho e-FeNO kuquka nokusetyenziswa kwe-steroids, iminyaka yobudala, isondo, inopy (ukuthambekela kokukhula kwimizimba), kunye nokubhema.
I-Periostin yi-biomarker kwiiseli zakho ze-epithelial airway. Amanqanaba e-Periostin athambekele ekuphakanyisweni kwi-asthma eyenza amaseli athile omzimba (TH2) kunye nakwezinye iinjongo ziye zaboniswa ukuba zincwadana ephezulu yokuhlola i-sputum. Nangona kunjalo, iziphumo ziyahluka kwezinye izifundo kwaye uvavanyo alufumaneki lula. Iziphumo zokuhlawula i-sputum kunye negazi ze-eosinophil zibaluleke kakhulu kwi-FeNO kunye ne-periostin ngokutsho kweekliniki ezininzi kunye nezikhokelo.
Unyango
Ulwaphulo lokuqala lwe-asthma ye-eosinophili kufuneka lubandakanye i-regimen yakho yokwelapha ye-asthma. Ngokuqhelekileyo uza kuba nemiphumo emihle evela kwi-corticosteroids ekhuselweyo (ICS) esetyenziswe njengenxalenye yezikhokelo zonyango eziqhelekileyo zonyango. Nangona kunjalo, ukuba ugqirha wakho ufumene ukuba une-asthma ye-eosinophilic, banokutshintsha indlela eqhelekileyo esebenzisa ii-corticosteroids. Imithi yeCorticosteroid iquka:
- IQVAR (beclomethasone i-HFA)
- Pulmicort (budesonide)
- I-Flovent (i-fluticasone)
- I-Asmanex (i-mometasone)
- I-Azmacort (triamcinolone acetonide)
Nangona i-corticosteroids ixiliswe ngokuqhelekileyo ineempembelelo ezinobuncedo, abanye abantu bane-asthma eosinophilic e-steroid-refractory, oku kuthetha ukuba i-asthma yakho ayinayo i-symptmatic okanye inzuzo yeklinikhi ekukhuseleni i-corticosteroids. Ukuba uthe wanciphisa enye okanye ngaphezulu ye-corticosteroids engabonakaliyo apha ngasentla ngaphandle kokukhululeka kweempawu, ngoko uya kufuna ukuxoxa kunye nodokotela wakho kwezinye iilwimi ezandula kutshatyalaliswa ukuphatha i-asthma ye-eosinophilic.
Kukho iipilisi ezi-3 ezijoliswe kuzo ezifumene imvume ye-FDA ye-asthma yokugula:
- I-Xolair (omalizumab) iyeza-anti-immunogobulin E (IgE)
- I-Nucala (mepolizumab), eyayibizwa ngokuba yiBosatria, yinkqubo yeyeza ye-anti-interleukin-5 (IL5).
- I-Cinqair (i-reslizumab) yenye yeyeza ye-IL5 yeyeza
- I-Fasenra (benralizumab) iyona mveliso entsha ye-FDA evumelekileyo ye-FD5
Ezi ziyeza ezintathu ezichazwe ngasentla zibonise iziphumo ezintle ukuba usengumqondiso nangona ubambelela kakuhle kwi-regimen yakho enqunyiwe ye-corticosteroid. Kule miyeza emithathu, i-omalizumab iyancipha ukuba yincinci encinci, njengoko ichaphazela ukunyuka komzimba ngakumbi kune-mepolizumab kunye ne-reslizumab. Ezi zonyango zihlala zixhomekeke kakuhle ngeempembelelo ezincinci zecala kunye nokuba kunokwenzeka ukuba uya kukwazi ukunciphisa ukusebenzisa kwakho i-corticosteroids. Ukunciphisa ukusetyenziswa kwe-steroids kuzisa nokunciphisa imiphumo emibi engakhuphula umgangatho wobomi.
Uhlolo loLiso
Ukulandelelwa kunconywa nje ngokuba unyango olujoliswe kuzo aluyonyango, kodwa unyango. Yilungiselele ukuvavanya ngezikhathi ezithile kwaye uxoxe ngale ndlela kunye nodokotela wakho ekuqeshweni okulandelelweyo:
- Uvavanyo lokusebenza kwepulmonary
- Iimpawu ezivela ekutyelelweni kokugqibela (ukuphucula okanye ukugqithisa)
- Ubunzima be-asthma exacerations
- Isixazululo seengxaki ezifana nokulahlekelwa ngephunga
- Ubume bezempilo
- Ukulandelwa koMgangatho woPhando loBomi
- Uhlaziyo lweLebhu
Ukuqokwa okusemgangathweni oluqhelekileyo malunga neenyanga ezine emva kokuqala unyango olujoliswe kulo. Ukuba ufumane iziphumo ezintle, uya kugcinwa kwiyeza elinqunyiwe. Ukuba iziphumo zincinci ukuba ziyingqinisiso, ngokuqinisekileyo uya kuqhubeka uhlaziywa kumachiza unyaka ongaphambi kokuvavanya ukutshintsha okanye ukongeza iimishishini ezongezelelweyo. Ukuba awuzange ube nasiphi na impendulo emva kweenyanga ezine, ugqirha wakho uya kumisa iyeza kwaye akutshintshele kwelinye unyango olujoliswe kuyo.
Ugqirha wakho unokufuna ukulandelela amanqanaba egazi we-IgE xa uthatha i-omalizumab. Ngelixa amazinga a-IgE angaxilongo i-asthma ye-eosinophilic, ukuphendula ngokuthethelela kwimeko ye-omalizumab kuya kuba kukubona ukunciphisa amanqanaba akho egazini e-IgE egazi.
ILizwi
Nangona i-asthma ye-eosinophili idibene ne-asthma enamandla, unyango lunokwenzeka ukuba lufumene kakuhle. I-asthma engeyiyo i-eosinophilic iyakwenza kube nzima ukulawula ukunyuka kwama-asthma okungagcini nje kuphela umgangatho wobomi kodwa kungasongela ubomi. Ukusebenza kunye ne-pulmonologist yakho kunye neendlela ezijoliswe kuzo kunokukunceda ukuba ubuyisele umgangatho wobomi obufanelekile kwaye unganciphisa ubukhulu bentsholongwane yakho ye-asthma exacerbations.
> Imithombo:
> I-Clinical Utility yeFractional Exhaled Nitric Oxide (i-FeNO) kwi-Asthma Management. I-Arhente yoPhando lwezeMpilo kunye ne-Quality website. Ukuhlaziywa ngo-Dec 20, 2017. https://effectivehealthcare.ahrq.gov/topics/asthma-nitric-oxide/research/.
> Buhl, R, Humbert, M, Bjermer, L, Chanez, P, Heaney, LG ,. Holgate, S. (2017). I-asthma ye-eosinophilic ephezulu: indlela yokwenza isivumelwano. I-European Respiratory Journal. 49: 1700634, INGXELO: 10.1183 / 13993003.00634-2017.
> I-Eosinophilic Asthma. Ukusebenzisana kweMelika ye-website ye-Eosinophilic Disorders. http://apfed.org/about-ead/eosinophilic-asthma. Ukuhlaziywa nge- 12/19/2017.
> Ininzi ye-Asthma Dat Recent. Amacandelo okuLawula nokuKhuselwa kwezifo. http://www.cdc.gov/asthma/most_recent_data.htm. Updated 6/2017.
> Wagener AH, de Nijs SB, uLutter R, et al. Ukuqinisekiswa kwangaphandle kwegazi eosinophil, FE (NO) kunye ne-serum periostin njengezithuba ze-sputum eosinophil kwi-asthma. Thorax 2015; 70: 115
> Walford, HH & Doherty, TA. (2014). Ukuxilongwa kunye nokulawulwa kwe-asthma ye-eosinophilic: imbono yase-US. J I-Asthma Allergy. 7: 53-65, yenze: 10.2147 / JAAS39119.