Tuesday, 27 November 2007

Το βρογχικό άσθμα μπορεί να ελεγχθεί, να είναι ρυθμισμένο, όμως η ασθένεια μπορεί να μεταβάλλεται κατά τη διάρκεια του χρόνου. Λόγω της φύσης της ασθένειας είναι σημαντικό να γίνονται σε τακτά χρονικά διαστήματα (που καθορίζει ο ιατρός) ιατρικές εξετάσεις και λειτουργικός έλεγχος της αναπνοής για πιθανή αναθεώρηση της θεραπευτικής αγωγής, σύμφωνα με τις νέες εξετάσεις και δεδομένα.

Στα παρακάτω σημεία πρέπει να δοθεί ιδιαίτερο βάρος:

αξιολόγηση-μέτρηση-παρακολούθηση

ενημέρωση-εκπαίδευση ασθενούς

έλεγχος παραγόντων που πιθανόν επιδεινώνουν το άσθμα

θεραπεία φαρμακευτική.

Η αξιολόγηση να παίρνει υπ όψη:

Τη συχνότητα και ένταση των συμπτωμάτων, τη χαμηλή πνευμονική λειτουργία, τον περιορισμό των  καθημερινών δραστηριοτήτων.Την ανάγκη για περισσότερες εισπνοές.

Τον κίνδυνο για παροξύνσεις, προοδευτική απώλεια πνευμονικής λειτουργίας, παρενέργειες φαρμάκων.

Η εκπαίδευση του ασθενούς και η σπουδαιότητα να του μάθουμε να αυτοελέχεται, να γνωρίζει πότε είναι  σταθεροποιημένος, και πότε πλησιάζει μια παρόξυνση, και τι τότε πρέπει να κάνει, σύμφωνα με ένα γραπτό θεραπευτικό πλάνο, για αναχαίτιση της νόσου.

Πρέπει να αυξήσουμε τις ευκαιρίες  εκπαίδευσης του ασθματικού ασθενούς, τόσο στο ιατρείο(και ο γιατρός πρέπει να αυξήσει το χρόνο επικοινωνίας  με τον ασθενή και την εκπαίδευσή του), όσο και στο σχολείο (Δημοτικό ,Γυμνάσιο, Λύκειο) ή και σε άλλους χώρους ή συλλόγους, με συνδυασμένη ενημέρωση, και για τη μάστιγα του καπνίσματος.

Προσπάθεια ελέγχου και ελάττωσης παραγόντων πρόκλησης άσθματος στο μικρο και μάκρο- περιβάλλον (ελάττωση των ακάρεων, γύρεων, καπνών, αέριων ρύπων..καπνίσματος-ενεργητικού και παθητικού)

Σημαντικό είναι η θεραπεία και αντιμετώπιση τυχόν ρινίτιδας, της γαστροοισοφαγικής παλινδρόμισης, της παχυσαρκείας, της υπνικής άπνοιας, του στρές, της κατάθλιψης,- καταστάσεις που πολλές φορές συνυπάρχουν και ο ασθενής δεν μπορεί να μπει σε ύφεση, να ρυθμιστεί, αν δεν αντιμετωπιστούν και αυτά τα συνυπάρχοντα νοσήματα.

Η Φαρμακευτική θεραπεία πρέπει να είναι η κατάλληλη για τον έλεγχο του άσθματος και να εντατικοποιείται σε περίπτωση παρόξυνσης ή να μειώνεται όταν υπάρχει βελτίωση.

θεραπευτική προσέγγιση SMART:

(Στό τεύχος του  British Medical Journal, BMJ 2007;335:513 (8 /9/2007), ο Peter J. Barnes σχολιάζει τα συμπεράσματα νέων μελετών απο τη χρήση ενός μόνο εισπνεόμενου φαρμάκου-στη θεραπεία του άσθματος- που περιέχει συνδιασμό βουδεζονίδης και φορμοτερόλης, τόσο για τη θεραπεία συντήρησης όσο και για έκτακτη (ανάγκης) ή κατ επίκληση θεραπεία.

Η νέα θεραπευτική προσέγγιση -ονομάστηκε
SMART -Symbicort Maintenance and Reliever Therapy- απο τη μοναδική χρήση μιάς συσκευής, του Symbicort, τόσο για τη θεραπεία συντήρησης όσο και την κατ επίκληση ή την εντατικοποίηση της αγωγής σε περίπτωση επερχόμενου παροξυσμού. Εναλλακτική πρόταση , σε σχέση με την σταθερή αγωγή και την κατ επίκληση λήψη β2 διεγέρτη βραχείας δράσης.


Ο συνδιασμός βουδεζονίδης/φορμοτερόλης και σαν θεραπεία συντήρησης και σαν θεραπεία ανάγκης, λαμβανόμενη μία ή δυό φορές τη μέρα, είναι επιτυχής περισσότερο απο άλλα κλασσικά θεραπευτικά σχήματα στο να ελέγξει το άσθμα (γράφει ο
Barnes) Δηλαδή ελάττωση παροξύνσεων που θα χρειαζόταν κορτικοστεροειδή απο το στόμα, στο μισό, και ελάττωση των εισαγωγών στο Νοσοκομείο.

 Η επιδείνωση  του άσθματος, όταν λαμβάνουν β2 βραχείας δράσης κατ επίκληση, μπορεί να συμβεί με αργή εξέλιξη, και αύξηση συμπτωμάτων, ενώ ο ασθενής αυξάνει τις εισπνοές του β2 και η φλεγμονή εξελίσεται ανεξέλεκτη.Αυτό δεν θα συμβεί με τη νεότερη θεραπεία και οι ασθενείς συμορφώνοται καλύτερα σ αυτήν.


Εάν όμως ο ασθενής χρειάζεται, επιπλέον, περισσότερες απο εξη εισπνοές- του συνδιασμού βουδεζονίδης/φορμοτερόλης πρέπει να επισκεφθεί τον γιατρό του.

Κατάλληλοι ασθενείς για την θεραπεία αυτή, ειναι ασθενείς με μέτριο και σοβαρό άσθμα.) 

 

Τα εισπνεόμενα κορτικοστεροειδή είναι διαπιστωμένα τα πλέον αποτελεσματικά φάρμακα για τον μακροχρόνιο έλεγχο του άσθματος σε όλες της ηλικίες.

Στον μακροχρόνιο έλεγχο έχουν θέση τα λευκοτριένια και οι χρωμώνες και οι Β2 διεγέρτες μακράς δράσης.

 Η omalizumab  νέο ανοσοτροποποιητικό φάρμακο, προστίθεται στο σοβαρό άσθμα, όταν έχει ένδειξη.

 

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Friday, 15 May 2009 07:23:52 (GTB Daylight Time, UTC+03:00)
Greeting. It is curious that physical courage should be so common in the world and moral courage so rare.
I am from Japan and know bad English, please tell me right I wrote the following sentence: "Seo school is now in session on seo, snake oil, ninjas, and how ittybiz came to be.Seo is cramming instead of studying."

:D Thanks in advance. Lavi.
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Super excited to see more of this kind of stuff olinne.
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