Kusanthula kwa meta komwe kudasindikizidwa mu Internal Medicine kukuwonetsa kuti maantibayotiki ndi systemic glucocorticoids amalumikizidwa ndi zolephera zochepa zamankhwala mwa akulu omweCOPDkuchulukirachulukira poyerekeza ndi placebo kapena palibe chithandizo chamankhwala.

Pofuna kuwunikira mwadongosolo komanso kusanthula meta, a Claudia C. Dobler, MD, Bond University, Australia, ndi ena adayesa mayeso oyendetsedwa mwachisawawa a 68, kuphatikiza odwala akuluakulu a 10,758 omwe ali ndi kuchulukirachulukira kwamphamvu.COPDamene analandira chithandizo m’chipatala kapena m’chipatala.Kafukufukuyu anayerekezera njira zothandizira mankhwala ndi placebo, chisamaliro chachizolowezi kapena njira zina zothandizira mankhwala.

Ubwino wa maantibayotiki ndi systemic glucocorticoids

Poyerekeza masiku 7-10 a zokhudza zonse maantibayotiki ndi placebo kapena ochiritsira ochiritsira odwala kapena outpatient odwala, kumapeto kwa mankhwala, mankhwala okhudzana ndi chikhululukiro cha pachimake exacerbation matenda, koma alibe chochita ndi kuopsa kwa kuwonjezereka ndi malo ochiritsira (OR = 2.03; 95% CI, 1.47- -2.8; umboni wapakatikati wa umboni).Pambuyo pakutha kwa chithandizo chamankhwala, pakufufuza kwa odwala omwe ali ndi vuto lochepa kwambiri, chithandizo chamankhwala chophatikizira maantibayotiki chingathe kuchepetsa kulephera kwa chithandizo (OR = 0.54; 95% CI, 0.34-0.86; mphamvu yaumboni).Odwala ogonekedwa ndi odwala omwe ali ndi kukulitsa pang'ono kapena pang'ono mpaka koopsa, maantibayotiki amathanso kuchepetsa vuto la kupuma, kutsokomola ndi zizindikiro zina.

Mofananamo, kwa odwala ogona ndi odwala kunja, machitidwe a glucocorticoids amafananizidwa ndi placebo kapena chisamaliro wamba.Pambuyo pa masiku 9-56 a chithandizo, systemic glucocorticoids sichikhoza kulephera (OR = 0.01; 95% CI, 0- 0.13; ubwino wa umboni ndi wochepa), mosasamala kanthu za chilengedwe cha mankhwala kapena kuchuluka kwa kuwonjezereka kwakukulu.Pamapeto pa 7-9 masiku mankhwala, odwala ndi wofatsa kuti kwambiri exacerbations mu outpatient chipatala ndi m'chipatala anali dyspnea awo anamasuka.Komabe, machitidwe a glucocorticoids amalumikizidwa ndi kuwonjezeka kwa chiwerengero cha zochitika zonse zokhudzana ndi endocrine.

Ofufuza akukhulupirira kuti kutengera zomwe apeza, madokotala ndi anzawo ayenera kutsimikiziridwa kuti maantibayotiki ndi systemic glucocorticoids akuyenera kugwiritsidwa ntchito pakukulitsa kulikonse kwa matenda.COPD(ngakhale atakhala ochepa).M'tsogolomu, amatha kudziwa bwino odwala omwe angapindule kwambiri ndi mankhwalawa komanso omwe odwala sangapindule nawo (kuchokera ku biomarkers, kuphatikizapo C-reactive protein kapena procalcitonin, eosinophils ya magazi).

Pakufunika umboni winanso

Malinga ndi ofufuzawo, pali kusowa kwa chidziwitso chotsimikizika pa zokonda za maantibayotiki kapena mankhwala a glucocorticoid, komanso umboni wa kugwiritsa ntchito mankhwala ena, kuphatikiza aminophylline, magnesium sulfate, anti-inflammatory drugs, inhaled corticosteroids, ndi bronchodilators anthawi yochepa.

Wofufuzayo adanena kuti angalepheretse madokotala kugwiritsa ntchito mankhwala osavomerezeka, monga aminophylline ndi magnesium sulfate.Ochita kafukufuku amakhulupirira kuti ngakhale pali maphunziro ambiri pa COPD, mankhwala ambiri ochizira kuwonjezereka kwa COPD alibe umboni wokwanira.Mwachitsanzo, muzochita zamankhwala, timakonda kugwiritsa ntchito ma bronchodilator afupikitsa kuti athetse vuto la dyspnea panthawi yakuchulukira kwa COPD.Izi zikuphatikizapo ma muscarinic receptor antagonists (ipratropium bromide) ndi ma beta receptor agonists (salbutamol).

Kuphatikiza pa kafukufuku wapamwamba kwambiri, kafukufuku wodalirika wokhudzana ndi mankhwala osokoneza bongo, ochita kafukufukuwo adanenanso kuti njira zina zothandizira zingathandizenso kuphunzira.

"Umboni womwe ukukula ukusonyeza kuti njira zina zochiritsira zosagwiritsa ntchito mankhwala, makamaka zomwe zimayamba kuchita masewera olimbitsa thupi atangoyamba kumene, zimatha kuwonjezera kuwonjezereka kwapang'onopang'ono kwa odwala COPD m'chipatala.The American Thoracic Society/European Respiratory Conference mu 2017 Malangizo omwe adaperekedwawo akuphatikizapo malingaliro ovomerezeka (umboni wochepa kwambiri) panthawi yogonekedwa m'chipatala chifukwa cha kuwonjezereka kwa COPD, musayambe kukonzanso m'mapapo, koma umboni wina watsopano watulukira kuyambira pamenepo kuti tifunika chithandizo chamankhwala. Umboni wambiri wapamwamba kwambiri wolimbitsa thupi koyambirira panthawi yakuchulukirachulukira kwa COPD kuti Utsimikizire kuchita bwino kolimbitsa thupi koyambirira kwa COPD.