Uhlalutyo lwe-meta olupapashwe kwi-Internal Medicine lubonisa ukuba i-antibiotics kunye ne-systemic glucocorticoids zinxulunyaniswa nokusilela kunyango kubantu abadala.COPDukonyuka xa kuthelekiswa ne-placebo okanye akukho ngenelelo lonyango.

Ukuze kuqhutywe uphononongo olucwangcisiweyo kunye nohlalutyo lwe-meta, uClaudia C. Dobler, MD, iYunivesithi yaseBond, e-Australia, kunye nabanye bavavanya izilingo ezilawulwa ngokungahleliwe ze-68, kubandakanywa izigulane ze-10,758 zabantu abadala ezinobunzima obukhulu.COPDababenyangwa esibhedlele okanye kwisibhedlele sangaphandle.Uphononongo luqhathanise ukungenelela kwe-pharmacological kunye ne-placebo, ukunakekelwa kwesiqhelo okanye ezinye iindlela zokungenelela kwi-pharmacological.

Izibonelelo ze-antibiotics kunye ne-systemic glucocorticoids

Kuphononongo oluthelekisayo lweentsuku ezi-7 ukuya kwezi-10 zenkqubo ye-antibiotics kunye ne-placebo okanye ukhathalelo oluqhelekileyo lwezigulane ezilaliswayo okanye ezingaphandle, ekupheleni kwonyango, i-antibiotics inxulumene noxolelo lwe-acute exacerbation yesi sifo, kodwa ayinanto yakwenza ne ubunzima bokugqithiswa kunye nommandla wonyango (OKANYE = 2.03; 95% CI, 1.47- -2.8; umgangatho ophakathi kobungqina).Emva kokuphela kokungenelela kwonyango, kwisifundo sezigulane ezingaphandle kunye nokunyanzeliswa kwe-acute exacerbations, unyango lwe-antibiotic lwenkqubo lunokunciphisa izinga lokungaphumeleli kwonyango (OKANYE = 0.54; 95% CI, 0.34-0.86; amandla obungqina obuphakathi).Izigulana ezilaliswayo kunye nezigulana zangaphandle ezinobunzima obuphakathi okanye obuphakathi ukuya kobunzima, amayeza okubulala iintsholongwane anokunciphisa ubunzima bokuphefumla, ukukhohlela kunye nezinye iimpawu.

Ngokufanayo, kwizigulane kunye nezigulana ezingaphandle, i-systemic glucocorticoids ithelekiswa ne-placebo okanye ukhathalelo oluqhelekileyo.Emva kweentsuku ze-9-56 zonyango, i-glucocorticoids ye-systemic ayinakwenzeka ukuba ingaphumeleli (OR = 0.01; 95% CI, 0- 0.13; umgangatho wobungqina uphantsi), kungakhathaliseki ukuba imeko yonyango okanye iqondo lokunyuka okukhulu.Ekupheleni kweentsuku ze-7-9 zonyango, izigulane ezinobunzima obuncinci ukuya kwi-exacerbations enzima kwiklinikhi yezigulane ezingaphandle kunye nesibhedlele ziye zakhululeka i-dyspnea yazo.Nangona kunjalo, i-glucocorticoids ye-systemic idibaniswa nokunyuka kwenani leziganeko ezimbi ezipheleleyo kunye ne-endocrine.

Abaphandi bakholelwa ukuba ngokusekwe kwiziphumo zabo, oogqirha kunye noogxa babo kufuneka baqinisekiswe ukuba ii-antibiotics kunye ne-systemic glucocorticoids kufuneka zisetyenziswe kulo naliphi na i-acute exacerbation.COPD(nokuba ithambile).Kwixesha elizayo, banokukwazi ukugqiba kakuhle ukuba zeziphi izigulane eziza kuzuza kakhulu kolu nyango kwaye zeziphi izigulane ezingenakuzuza (ngokusekelwe kwi-biomarkers, kubandakanywa iprotheni ye-C-reactive okanye i-procalcitonin, i-eosinophils yegazi).

Kufuneka ubungqina obuninzi

Ngokutsho kwabaphandi, kukho ukunqongophala kwedatha ecacileyo malunga nokukhethwa kwe-antibiotics okanye unyango lwe-glucocorticoid, kunye nobungqina bokusetyenziswa kwamanye amayeza, kuquka i-aminophylline, i-magnesium sulfate, iziyobisi ezichasayo, i-corticosteroids e-inhaled, kunye ne-bronchodilators emfutshane.

Umphandi uthe uya kubatyhafisa oogqirha ekusebenziseni unyango olungaqinisekanga, olufana ne-aminophylline kunye ne-magnesium sulfate.Abaphandi bakholelwa ukuba nangona kukho izifundo ezininzi kwi-COPD, amaninzi amachiza okunyanga ukunyusa okubukhali kweCOPD akanabungqina obaneleyo.Ngokomzekelo, kwiklinikhi, sihlala sisebenzisa i-bronchodilators esebenza ixesha elifutshane ukukhulula i-dyspnea ngexesha lokunyuka kwe-COPD.Ezi ziquka abachasi be-muscarinic receptor antagonists (ipratropium bromide) kunye ne-beta receptor agonists (salbutamol).

Ukongeza kuphando olukumgangatho ophezulu, uphando oluthembekileyo kunyango lwamachiza, abaphandi baphinde bachaza ukuba ezinye iintlobo zongenelelo zinokufaneleka ukuba zifundwe.

"Ubungqina obukhulayo bobungqina bubonisa ukuba unyango oluthile lwe-non-pharmacological, ngakumbi abo baqala ukuzivocavoca kwangoko kwisigaba sokugqithisa, kunokuphucula ukunyanzeliswa okuphakathi ukuya kwizigulane zeCOPD esibhedlele.I-American Thoracic Society / European Respiratory Conference kwi-2017 Izikhokelo ezikhutshiweyo ziquka iingcebiso ezinemiqathango (umgangatho ophantsi kakhulu wobungqina) ngexesha lokulaliswa kwe-COPD esibhedlele, musa ukuqalisa ukuvuselelwa kwemiphunga, kodwa ubungqina obutsha buye bavela ukususela ngoko ukuba sifuna i-pulmonary exacerbations. Ubungqina obuninzi obuphezulu bomthambo wangethuba ngexesha lokunyanzeliswa kweCOPD ukuQinisekisa ukusebenza komthambo kwangethuba ukonyuka okuqatha kweCOPD.