Aprannaa Ahum mu Akisikuru Nyarewa: Nea Enti a Ahum a Ɛtu Mframa no Kanyan Akisikuru Ntua a Ɛde Nnipa Nkwa To asiane mu¶

Sɛ ahohuru bere anaa ahohuru bere mfiase aprannaa a ano yɛ den tu fa sare, kuayɛ asasetaw, anaa nkurow akɛse mu akwan a nsu mu nsu a ɛyɛ fĩ pii wom so a, ahum no anim a ɛyɛ nwini a ɛkɔ fam ne ahum a ɛbɔ no betumi akanyan ɔmanfo akwahosan ho haw a ɛyɛ hu ntɛm ara a wɔfrɛ no aprannaa a ɛyɛ hu. Wɔ November 2016 Melbourne, Australia adeyɛ a agye dimmɔne no mu no, mframa biako a ɛbɔe no maa dwumadibea a wɔhwɛ ntɛmpɛ ho ɔhome ho nkyerɛkyerɛmu a ɛboro so bɛboro 3,300 bae na nnipa 10 wuwui wɔ nnɔnhwerew kakraa bi mu, na ɛmaa nkurow akɛse mu ambulance po so ahyɛn ne ayaresabea ayarehwɛbea ahorow a wɔhwɛ wɔn a wɔyare denneennen no brɛe koraa. Nea ɛnte sɛ mmere mu akisikuru a ɛtaa ba a ryegrass anaa dua mu pollen aba a enni dɛm a ne kɛse yɛ 20 kosi 60 micrometers (0.0008 kosi 0.0024 inches) kyere wɔ hwene akwan no mu a asiane biara nni ho no, aprannaa a ɛbɔ kɔ soro no ma pollen aba mũ no nyinaa kɔ mununkum a ɛyɛ nwini ase baabi a nsu a ɛtwetwe no ma osmotic shock ba na mfiri a ɛpaapae. Pollen aburow biara a apaapae mu paapae yɛ starch granules ɔhaha pii a ɛyɛ nketenkete, a wɔde allergen akata so a ne kɛse yɛ 0.5 kosi 2.5 micrometers (0.00002 kosi 0.0001 inches) pɛ, a afei wɔpae kɔ fam kodu mmɔnten so wɔ mframa a ɛyɛ nwini a efi mu ba a ɛyɛ den mu na wɔhome tẽẽ kɔ ahurututu mu ntini ne alveoli a ɛba awiei no mu.

Esiane sɛ saa sub-micron bioaerosols yi twa hwene no ho hyia koraa nti, wɔn a wɔanya ahurututu mu yare a ɛde wɔn nkwa to asiane mu bere a aprannaa ayamtu sisii mu no mu bɛboro ɔha biara mu 40 kosi 60 nnya nhuu ayamtu da, efisɛ kan no na wɔanya bere mu sare atiridii a emu nyɛ den (allergic rhinitis) nkutoo. Sɛ wo anaa obi a ɔbɛn wo fi ase hwehwɛ mframa, ɔbɔ hwerɛma, anaasɛ ɔpere sɛ ɔbɛkasa wɔ kasamu a edi mũ mu bere a ahohuru bere mu ahum kɛse bi rebɔ no a, kɔ wo mpɔtam hɔfo nkyɛn ntɛm ara nɔma ahorow a egye ntɛmpɛ (911 wɔ United States ne Canada, 999 wɔ United Kingdom, 112 wɔ Europa Aman Nkabom no nyinaa mu, ne 000 wɔ Australia) na wofi ase de mmoa a edi kan a wɔde ma ahurututu mu ntrɛwmu dodow a ɛkɔ soro. Ɛsɛ sɛ wote sɛnea wodi mfitiasede bi ho dwuma nso ase ayamtu ntua, hu nhyehyɛe mu akisikuru a ɛma obi ho yɛ no hyew, ne guankɔbea dwoodwoo fi aprannaa ne anyinam ahoɔden.

Yɛ eyi mprempren¶

Sɛ ahohuru bere anaa ahohuru bere mfiase aprannaa a nsu mu nsu a ɛyɛ fĩ pii wom rebɛn, anaasɛ obi fi ase ɔfefe, ɔteɛteɛm, anaasɛ ne koko mu yɛ den bere a ahum retu wɔ anim a:

1. Kɔ Fie Ntɛm ara Ansa na Cold Outflow Gust Front no Aba:
2. Sub-micron pollen starch granules a apaapae a ɛdɔɔso sen biara no tu kwan kɔ mframa a ɛyɛ nwini na ɛyɛ basabasa (gust front) a ɛba simma 10 kosi 30 ansa na osu no atɔ no mu.
3. Tu kɔ ɔdan kɛse anaa kar a ɛwɔ soro a ɛyɛ den mu ntɛm ara bere a wuhu sɛ mununkum tuntum a ɛtwetwe nsu reyɛ anaasɛ wote ɔhyew a ɛkɔ fam mpofirim ne mframa a ɛsakra wɔ da a nsu mu nsu pii wɔ mu no.
4. Seal Windows Nyinaa na Sesa Air Conditioning kɔ Internal Recirculation:
5. To abɔnten mfɛnsere, abrannaa pon, ne passive trickle vent biara mu denneennen.
6. Fa ofie HVAC nhyehyɛe ne kar wim tebea sohwɛ nhyehyɛe ahorow si ɔha biara mu nkyem 100 mframa a ɛsan di akɔneaba wɔ mu sɛnea ɛbɛyɛ a mframa a efi abɔnten no rentwe nkɔ ɔdan no mu anaa baabi a wɔtra mu, na dane HEPA (High-Efficiency Particulate Air) purifier a wɔahyɛ sɛ ɛbɛkyere nneɛma nketenkete akɔ fam akodu 0.3 micrometers.
7. Fa Ɔhome Baako Kasa Sɔhwɛ no Hwɛ sɛnea Mframa kwan no mu yɛ den:
8. Bisa onipa a asɛm no aka no no ma ɔnka kasamu mũ no nyinaa denden.
9. Ntuo a ɛkɔ fam: Otumi kasa wɔ nsɛmfua mu, ahurututu a wɔte, ɔhome a ɛbɔ boro ahome 20 simma biara, ne koma bɔ 100 kosi 120 simma biara.
10. Ntuo a emu yɛ den: Otumi ka nsɛmfua biako pɛ wɔ ahome ntam, ɔtra hɔ tẽẽ te sɛ tripod a ɔkura nkongua ano, suprasternal anaa intercostal retractions (honam ani a ɛnom wɔ menewa ase ne mpampam ntam), ne koma bɔ boro 120 simma biara.
11. Nkwa a ɛde nkwa to asiane mu kyere a ɛrebɛn: Ɔhome a ɛyɛ den dodo sɛ wobɛkasa koraa, cyanosis (anofafa anaa nsateaa nnadewa a ɛyɛ bruu-afitaa), adwene mu naayɛ anaa nna, bradycardia (koma a ɛbɔ brɛoo), anaa "koma a ɛyɛ komm" a mframa a ɛsen no asiw kɛse araa ma wontumi nte nnyigyei a ɛyɛ hwirema biara.
12. Fa 4x4x4 Reliever Protocol no di dwuma denam Pressurized Metered-Dose Inhaler (pMDI) ne Spacer so:
13. Fa onipa no tra ase tẽẽ (nhyɛ ɔyarefo a ɔwɔ ayamtu da sɛ ɔntra petee, na ɛno mia ahurututu no na ɛma ne menewa mu yɛ den).
14. Wosow beta-2 agonist (SABA) reliever inhaler a ɛyɛ adwuma bere tiaa te sɛ salbutamol (albuterol) anaa terbutaline denneennen, fa hyɛ valved holding chamber (spacer) mu, na fa 1 puff gu spacer no mu, na ma onipa no nhome 4 brɛoo, a emu dɔ fa spacer ano aduru no mu wɔ saa biako no akyi puff a ɛyɛ hu.
15. Tia saa nnidiso nnidiso pɛpɛɛpɛ yi mu mpren 4 wɔ ne nyinaa mu (wɔde ahome 4 a ɛsono emu biara, a ahome 4 wɔ puff biara mu).
16. Twɛn simma 4. Sɛ ahome no nsan mmaa sɛnea na ɛte kan no koraa a, fa ahome 4 foforo (a home 4 wɔ ahome biara mu) na frɛ nnuruyɛfo a wɔhwɛ ntɛmpɛ so ntɛm ara sɛ woannyɛ saa dedaw a.
17. Sɛ Spacer Biara Nni Hɔ a, Yɛ Chamber bi anaa Fa Direct Slow-Inhalation Technique Di Dwuma:
18. Wɔ ahurututu mu yare a emu yɛ den mu no, afiri a wɔde home tẽẽ a wɔde di dwuma kɔ ano a wɔmfa spacer nni dwuma no de nnuru no bɛyɛ ɔha biara mu nkyem 80 gu menewa no akyi sen sɛ ɛbɛkɔ ahurututu no so.
19. Sɛ wunni plastic spacer a wɔde di gua a, twa kwan bi kɔ krataa kuruwa a ɛho tew a ɛyɛ dry a wɔtow gu anaa plastic nsu toa a emu duru yɛ mililita 500 (16.9-fluid-ounce) ase na ama woanya dan a wɔde kura mu a wɔayɛ no yiye, anaasɛ ma onipa no home koraa, kata n’anofafa ano wɔ inhaler ano aduru no ho, mia pɛnkoro bere a worehome brɛoo na gyina hɔ pintinn wɔ 3 kosi 5 so sikani, na sɛ wɔma ho kwan a, wɔde sikɔne 10 kura wɔn home mu.
20. Yɛ nhyehyɛe ma Ambulance Gridlock na Siesie Wo Ho Ma Self-Triage anaa Pharmacist Rescue sɛ Networks no Hyehyɛ a:
21. Wɔ ɔmantam mu aprannaa ayamtu ɔyaredɔm mu no, nnipa mpempem pii a wɔfrɛ no frɛ adwumayɛbea a wɔhwɛ ntɛmpɛ so bere koro mu, na ambulance a wɔde kɔma ntonto betumi aboro ** nnɔnhwerew 2 kosi 4**.
22. Bere a woma open line anaa dispatch callback yɛ adwuma ma ɔyarefo a ne ho yɛ den anaasɛ ɔde ne nkwa to asiane mu no, kɔ so ma salbutamol (albuterol) puffs 4 simma 4 biara (anaasɛ puffs 6 kosi 8 simma 5 biara wɔ dispatcher akwankyerɛ ase wɔ ahoyeraw a ɛde ne nkwa to asiane mu). Sɛ ambulance ahorow nni hɔ koraa na ofirikafo a watu ne ho ama a ɔwɔ kar a wɔato mu (a wɔahyɛ sɛ ɔbɛsan de mframa akɔ baabiara) betumi adu ayaresabea dwumadibea a wɔhwɛ ntɛmpɛ so anaa nnurutɔnbea a wɔhwɛ ntɛmpɛ so wɔ simma 5 kosi 10 mu a, sɛ ɔyarefo no da so ara yɛ n’adwene na ɔkɔ so nya spacer puffs a ɛkɔ so wɔ kwan so nkutoo a, yɛ akwantu ho nhyehyɛe.

Gyinaesi dua: aprannaa ayamtu a wosiw ano, triage, ne mass-casualty bronchodilation¶

flowchart TD
    Start["AHOHURU ANAA AHOHURU Mfiase Aprannaa A ƐBƐN - Sare a ɛkorɔn, nwura, anaa dua mu nsuo a ɛyɛ fĩ ho nkɔmhyɛ + gust front outflow kɔkɔbɔ"] --> Location{"So wo anaa ankorankoro a asiane kɛse wom - (hay fever, wheeze, anaa ayamtu abakɔsɛm) wɔ abɔnten?"}

    Location -->|YES: Outdoors or Windows Open| SealUp["SHELTER ANSA NA GUST FRONT HITS - 1. Kɔ dan mu anaa kɔ kar a wɔato mu mu simma 20-30 ansa na osu atɔ - 2. To mfɛnsere, apon, ne abɔnten mframa nyinaa mu - 3. Fa AC to 100% INTERNAL RECIRCULATION & run HEPA filter"]

    Location -->|NO: Symptoms Already Starting| Triage["RAPID RESPIRATORY SEVERITY TRIAGE - Hwɛ kasa, ɔhome ntɛmntɛm, retractions, honam ani kɔla, & ahurututu mu nnyigyei"]
    SealUp --> SymptomsCheck{"So obi nya ɔfe, ne koko mu yɛ den, - ahurututu, anaa ɔhome a ɛyɛ tiaa?"}
    SymptomsCheck -->|No Symptoms| Monitor["Tena dan mu nnɔnhwerew 2 kosi 4 bere a ahum no atwam akyi - Fa nnuru a wɔakyerɛw ama wo a wɔde siw ano (ICS) & antihistamine a wɔnom"]
    SymptomsCheck -->|Yes: Symptoms Present| Triage

    Triage -->|MILD TO MODERATE - Speaks in phrases, audible wheeze, sitting up| FourByFour["START 4x4x4 SALBUTAMOL / ALBUTEROL PROTOCOL - 1. Fa ɔyarefo tena ase gyina hɔ; mma wɔnnna fam da - 2. Ma puff 1 kɔ SPACER mu -> ɔyarefo no home 4 - 3. Tia mpɛn 4 (total 4 puffs / 16 spacer breaths) - 4. Twɛn simma 4 na san susuw kasa & adwuma a ɛfa ahome ho"]

    Triage -->|SEVERE OR LIFE-THREATENING - Single words only, blue lips, silent chest, exhaustion| CallEMS["FRE NHYEHYƐEƐ ADWUMA NTƐM NTƐM - (911 / 999 / 112 / 000) & ka sɛ 'Aprannaa a Ɛyɛ Den Asthma'."]

    FourByFour --> ImproveCheck{"So ahome & kasa nyaa ahoɔden koraa - wɔ simma 4 a edi kan no akyi?"}
    ImproveCheck -->|YES: Fully Relieved| PostCare["Hwɛ yiye nnɔnhwerew 4 (biphasic rebound risk) - Ma puffs 4 foforo sɛ wheeze san ba a; hwehwɛ aduruyɛ mu nhwehwɛmu"]
    ImproveCheck -->|NO: Still Breathless| CallEMS

    CallEMS --> ContinuousReliever["CONTINUOUS HIGH-DOSE BRONCHODILATION & STEROIDS - 1. Fa spacer so puffs 4 bio ma simma 4 biara bere a woretwɛn - 2. Sɛ ɔyarefo no akyerɛw prednisolone/prednisone a wɔnom - anaa SMART (budesonide/formoterol) adeyɛ nhyehyɛe a, fa ma mprempren - 3. Sɛ anaphylaxis kyerɛ sɛ ɛbom tra (tɛkrɛma a ɛho ahonhon, akisikuru, ahodwiriw), - fa Epinephrine a wɔde fa ntini mu (0.3-0.5 mg) gu asen akyi"]

Wim abɔde mu nneɛma ne ɔyare mmoawa a ɛfa aprannaa ayamtu ho¶

Sɛ wɔte nea enti a ahum pɔtee bi a ɛma ahurututu mu ntini mu yare no ase a, ɛboa ankorankoro, sukuu ahorow, wɔn a wɔyɛ abɔnten so dwumadi ahorow, ne dwumadibea ahorow a wɔhwɛ ntɛmpɛ so ma wɔhwɛ kwan sɛ ɔyaredɔm bɛba nnɔnhwerew kakraa bi ansa na wɔafrɛ 911 anaa 000 a edi kan no.

1. Wim Tebea Ho Engine a Ɛwɔ Afã Anan¶

Aprannaa ayamtu ɔyaredɔm hwehwɛ sɛ wim tebea a mframa ne mframa a ɛtwetwe no hyia pɛpɛɛpɛ:

1. Ɔfa 1 - Awɔw Bere/Ahohuru Bere mu Osu a Edi Kan ne Sare Nnyin: Osu a ɛtɔ kɛse wɔ awɔw bere awiei ne ahohuru bere mu no ma sare a ɛyɛ hyew (titiriw ryegrass a ɛtra hɔ daa, Lolium perenne, Timothy sare, Phleum pratense, anaa Parietaria/ragweed ahorow) nyin yiye wɔ asasetaw a ɛwɔ populated so nkurow akɛse mu, a ɛno akyi no, nna pii a ɛyɛ hyew, ɛyɛ kusuu, na mframa bɔ kɛse a ɛkanyan nhwiren a ɛsen biara na ɛma nsu mu nsu a ɛyɛ fĩ a enni dɛm no fi wim kɛse (nsu mu nsu a ɛyɛ fĩ dodow a ɛboro so boro aburow 100 kosi 500 wɔ mframa cubic mita biara mu).
2. Stage 2 - Convective Updraft Sweep: Bere a awɔw a ano yɛ den anim, dryline, anaa multicell squall line kɔ n’anim fa asasetaw a pollen pii wom no so awiabere no, ɔhyew buoyant updrafts anim wɔ ahum no anim vacuum ɔpepepem pii a mframa mu pollen grains a enni dɛm fi soro hye so kɔ soro kɔ humid mununkum nnyinaso wɔ 1,000 kosi 3,000 (anammɔn 3,300 kosi 9,800) sorokɔ.
3. Stage 3 - Osmotic Shock, Electrical Charging, and Mechanical Fragmentation: Wɔ mununkum a ɛwɔ nsuo a ɛyɛ nwini kɛseɛ no ase (baabi a nsuo a ɛyɛ nwini boro ɔha mu nkyekyɛmu 95 kɔsi 100) ne anyinam ahoɔden a ano yɛ den a ɛwɔ ahum nkwammoaa no mu:
4. Pollen nnua a enni dɛm no twetwe hypotonic mununkum mu nsu ntɛmntɛm fa wɔn mmoawa apon (osmotic turgor pressure surge).
5. Nsuo a ɛwɔ mu no boro abɔnten so pollen fasuo (exine ne intine) ahoɔden a ɛtwetwe no so, na ɛma aburow no pae te sɛ nsuo a ɛyɛ microscopic (osmotic lysis).
6. Bere koro no ara mu no, anyinam ahoɔden a ano yɛ den (10,000 kosi 100,000 volts wɔ mita biara mu) ne mfiri a wɔde twitwa nsu a ɛyɛ nwini kɛse ne graupel a ɛpaapae ntam no ma nsu a ɛwɔ nsu mu nsu a ɛyɛ nwini anaa fungal spores (Alternaria, Cladosporium) yɛ nsu a ɛwɔ nsu mu nketenkete a wotumi home (0.5 kosi 2.5 micrometers) na ɛwɔ hɔ.
7. Stage 4 - Cold Downdraft Concentration and Gust-Front Outflow Carpet-Bombing: Nsuo a ɛkɔ fam a osuo tɔ no de saa starch granules a ɛyɛ microscopic allergen-laden ɔpepepem pii yi kɔ fam ntɛmntɛm kɔ Asase ani. Sɛ mframa a ɛyɛ nwini a ɛyɛ den a ɛresiane no kɔ fam a, ɛtrɛw kɔ n’anim tẽẽ wɔ 40 kosi 100 km/h (25 kosi 62 mph) sɛ gust front (outflow boundary) a emu dɔ yɛ mita 100 kosi 400 pɛ (anammɔn 330 kosi 1,300) a emu nnɔ na ɛyɛ basabasa**. Esiane sɛ ɔhyew a wɔdannan no na ɛkata awɔw a efi mu ba no so nti, pollen asinasin a apaapae no ntumi ntrɛw nkɔ soro; mmom no, wɔmia wɔn ma wɔyɛ bioaerosol mununkum a aniwa nhu a ɛyɛ atuu wɔ fam wɔ onipa home sorokɔ pɛpɛɛpɛ simma 10 kosi 30 ansa na osu kɛse aba abɛhohoro mframa no ho atew.

2. Ntotoho: Bere Mu Atiridii a Ɛyɛ Daa ne Ɔyaredɔm a Ɛyare Aprannaa Akisikuru¶

Ayaresabea a wogye tom ne anammɔn anammɔn a wɔde di dwuma ansa na wɔakɔ ayaresabea¶

1. Ahurututu mu Akisikuru a Ahintaw a Wohu wɔ Wɔn a Wɔadi Kan Ayɛ Wɔn Ayayade no Mu¶

Esiane sɛ wɔn a wɔanya ayamtu a ɛyɛ aprannaa no mu bɛboro fã nnyaa ayamtu da nti, wɔntaa nhu nea ɛrekɔ so wɔ wɔn ahurututu mu. Nnipa pii gye di sɛ wɔrenya komayare, mfutuma rebɔ wɔn, anaasɛ wɔrehyia ehu:

• Persistent, Dry, Paroxysmal Cough: Wɔ mpanyimfo ne mmofra pii mu no, acute small-airway constriction mfiase no ɛnyɛ sɛ nnwom a wɔbɔ no tete, na mmom sɛ relentless, hacking dry cough a ɛyɛ kɛse bere biara a wɔhome abɔnten mframa.
• Ɔhome a Wɔhome ne Ɔhome a Wɔhome Bere Tenten: Esiane sɛ nhyɛso a ɛwɔ ahurututu mu kɔ soro bere a wɔrehome nti, ahurututu a ɛho ayɛ hyew na ayɛ mmerɛw no twetwe kɛse mpo bere a ɔyarefo no bɔ mmɔden sɛ ɔbɛhome no. Sɛ wohome a, ɛte sɛ nea ɛyɛ tiaa na ɛnyɛ den, bere a sɛ wohome a, egye bere tenten mmɔho abien kosi abiɛsa sen sɛnea ɛte daa na ɛma nnwom a ɛyɛ den a ɛyɛ abɛn (wheeze) ba.
• Dynamic Hyperinflation ("Air Trapping"): Esiane sɛ nea wɔayɛ no bɔne no tumi twe mframa ketewaa bi kɔ ahurututu mu ntini a ayɛ teateaa no mu nanso ontumi nyi mframa nwie ansa na ahome a edi hɔ no afi ase nti, mframa a ayɛ mmerɛw no bɛkyere wɔ ahurututu no mu. Koko no bɛyɛ sɛ toa na ɛtrɛw dodo, na ɛhyɛ ɔyarefo no ma ɔde ne ho to n’anim wɔ nsa a wɔatrɛw mu (tripod position) na ɔde kɔn ne mpampam ntini a ɛka ho di dwuma de twetwe mframa pa ketewaa bi a ɛyɛ asorɔkye no gu wɔn ahurututu a ɛboro so no so ara kwa.
• The Lethal "Silent Chest" Warning: Sɛ obi a ɔhwɛ no de n'aso to nea wɔayɛ no bɔne no moma so anaa n'akyi na ɔte ahomegyeɛ anaasɛ ɔhome nnyigyei a ɛfata bere a ɛda adi sɛ ɔyarefo no repere sɛ ɔbɛhome a, afei reyɛ ayɛ sɛ ahurututu mu yare no awie ɔha biara mu nkyem 100. Ɛkame ayɛ sɛ mframa biara nkɔ ahurututu no mu anaasɛ mfi mu; hypoxic bradycardia ne komayare bedi akyi wɔ simma kakraa bi mu gye sɛ wofi ase ma ahurututu mu trɛw a ano yɛ den ne mframa a wɔboa no fi ase ntɛm ara.

2. Sεdeε Wobεyε 4x4x4 Spacer Rescue Technique no yie¶

Aduruyɛ mu nhwehwɛmu a National Asthma Council Australia, Global Initiative for Asthma (GINA), ne British Thoracic Society yɛe no kyerɛ sɛ pressurized metered-dose inhaler (pMDI) a wɔde abata valved spacer ho no tu mpɔn te sɛ (na ɛyɛ ntɛm sɛ wɔde besi hɔ sen) ayaresabea plug-in jet nebulizer, bere a ɛkwati aerosol a wɔde bɛpete ɔhome mu mmoawa no:

1. Fa Ɔyarefo no Si hɔ: Fa onipa no tena akongua so tẽẽ anaasɛ fa wo ho to ɔfasu so na fa wɔn mmati kɔ n’anim kakra. Gyae kɔla anaa moma so ahama biara a ɛyɛ den.
2. Siesie Inhaler ne Spacer no:
3. Yi kyɛw no fi blue reliever pMDI (salbutamol 100 micrograms / albuterol 90 micrograms wɔ puff biara mu) no mu.
4. Wosow inhaler no tẽẽ sekan 3 kosi 5 na fa ano aduru no hyɛ akyi ring a ɛwɔ valved spacer no mu denneennen.
5. Deliver Puff 1 (Tidal Breathing Ɔkwan a Wɔfa so Yɛ):
6. Fa spacer ano aduru no to ɔyarefo no sẽ ntam a wɔde anofafa a wɔatoto mu denneennen atwa ho ahyia (anaasɛ mia mmofra akataso so wɔ abofra a onnii mfe 4 hwene ne n’ano).
7. Mia canister no pɛnkoro na fa ogya 1 puff gu spacer no mu, na ma ɔyarefo no home na ɔnkɔ mu nkakrankakra fa wɔn ano mpɛn 4.
8. Fa Puffs 2, 3, ne 4 ma:
9. Wosow bere tiaa bi, fa gya Puff 2 (ahome 4 brɛoo), Puff 3 (4 brɛoo home), ne Puff 4 (4 brɛoo home).
10. Simma 4 Nhwehwɛmu a Wɔsan Yɛ no:
11. Twɛn simma 4 bere a worehwɛ wo koko a ɛkeka ne ho, kasa tenten, ne anofafa kɔla.
12. Sɛ woda so ara reyɛ ahurututu, wofefe, anaasɛ worehome wɔ simma 4 mu a, ntɛm ara san yɛ kyinhyia foforo a ɛyɛ 4 puffs (4 homes per puff).
13. Maximum Pre-Hospital Dosing: Bere a wɔretwɛn ambulance a ɛkyɛ wɔ bere a aprannaa kɛse bi retu ayamtu no, mpanyimfo ne mmofra a wɔadi boro mfe 6 a wɔwɔ ahokyere kɛse mu betumi anya puffs 4 simma 4 biara (anaasɛ puffs 6 kosi 8 simma 5 biara ama ɔpanyin a ɔwɔ ahokyere a ɛde ne nkwa to asiane mu wɔ dispatcher akwankyerɛ ase dwoodwoo). Bere tiaa mu nsunsuanso bɔne a efi salbutamol/albuterol a wɔde di dwuma kɛse mu ba, te sɛ nsa a ɛwosow ne koma a ɛbɔ ntɛmntɛm no, yɛ nea wɔhwɛ kwan sɛ efi nnuruyɛ mu ba na asiane nnim koraa sen sɛnea obi gyae ahomegye a wɔansa.

3. Adwuma a Wɔyɛ no Ntɛmntɛm Bere a Akisikuru Ho Aduru Biara Nni Hɔ Wɔ baabi a Wɔyɛ no¶

Esiane sɛ wɔn a aprannaa ayɛ wɔn ayamtu no mu ɔha biara mu 40 kosi 60 nni afiri a wɔde home bere a ahum no tu nti, wɔn a wɔrehwɛ no ne abusua mufo taa hyia ɔkwan a ɛyɛ hu bere a ambulance ahorow akyɛ no:

• Fɛm Reliever Inhaler Ntɛm ara (Samaritan Pa Bronchodilator Kyɛfa):
• Wɔ aprannaa ayamtu ntua a ɛde wo nkwa to asiane mu mu no, ntwentwɛn wo nan ase sɛ wubebisa afipamfo, mfɛfo adwumayɛfo, akyerɛkyerɛfo, anaa wɔn a wɔretwam sɛ obi kura salbutamol/albuterol inhaler bruu anaa budesonide/formoterol inhaler anaa.
• Fa nsa anaa ntama a ɛho tew popa ano aduru no, anaa fa krataa kuruwa a ɛho tew a wɔayɛ no yiye anaa plastic nsu-toa ntam kwan a wɔatwitwa so tow afiri a wɔde home a woafɛm no sɛnea ɛbɛyɛ a anom ntumi nkɔ tẽẽ biara, na fa 4x4x4 protocol no ma.
• Hwɛ sɛ Nnurutɔnbea Bi Wɔ Nantew Ntɛm ara anaa Simma 2 Kar kwan mu:
• Wɔ amansin te sɛ Australia (Schedule 3 Pharmacist-Only Medicine), United Kingdom (Emergency Supply regulations), Canada, ne European Union afã horow no, wɔama mpɔtam hɔ nnuruyɛfo tumi wɔ mmara kwan so sɛ wɔmfa emergency salbutamol (albuterol) inhaler ne spacer mma a oduruyɛfo nkyerɛw krataa bere a ɔhome mu ntɛmpɛ bi aba.
• Bere a Ɛsɛ sɛ wode Epinephrine Auto-Injector (EpiPen / Jext / Emerade / Auvi-Q) Di Dwuma:
• Nnipa pii a wɔn ho yɛ wɔn hyew kɛse wɔ sare ho anaasɛ wɔn ho yɛ wɔn hyew wɔ aduan ho no kura intramuscular epinephrine (adrenaline) auto-injector sɛ mpo wonni salbutamol inhaler a.
• Epinephrine yɛ alpha ne beta-2 adrenergic agonist a ɛnyɛ nea wɔpaw a ɛyɛ den a ɛma ahurututu mu ntini a ɛyɛ mmerɛw no dwo ntɛmntɛm na ɛtew mframa kwan mu ntini a ɛyɛ mmerɛw no so.
• Sɛnea akwankyerɛ a ɛfa resuscitation ne anaphylaxis ho kyerɛ no, sɛ ɔyarefo bi rehu amane wɔ bronchospasm a ɛde nkwa to asiane mu (ontumi nkasa, cyanotic, koko a ɛyɛ komm, anaasɛ ɔhwe ase) na biara da systemic anaphylaxis su biara adi anaasɛ ɔwɔ beta-2 agonist inhaler ho kwan biara bere a ɔrehyia nea ɛreba sɛ phyxiation a, ɔde rema no intramuscular epinephrine auto-injector (0.3 mg ma mpanyimfo ne mmofra a wɔboro kilogram 30 [66 lb]; 0.15 mg ma mmofra a wɔn mu duru yɛ kilogram 15 kosi 30 [33 kosi 66 lb]) a wɔde kɔ asen mfinimfini akyi (vastus lateralis) betumi agye nkwa bere a adwumayɛfo a wɔhwɛ ntɛmpɛ so yɛ ho biribi no.
• Positioning, Calm Pursed-Lip Breathing, ne Nea ƐNSƐ sɛ Woyɛ:
• MMFA ɔyarefo no nkɔ nsu a ɛyɛ hyew mu anaasɛ mma wɔnhome nsu a ɛyɛ hyew: Nsu a ɛyɛ hyew kɛse ne nsu a ɛyɛ hyew betumi akanyan reflex bronchoconstriction wɔ hyper-reactive mframa kwan mu na ama pollen no mu apaapae bio.
• MMA ɔyarefo no nhome nkɔ krataa kotoku mu: Krataa kotoku a wɔsan home yɛ anansesɛm a ne bere atwam a ɛfa mframa a wɔde ma a ɛboro so a ɛtew oxygen a wɔde honhom kaa no (\(FiO_2\)) so ntɛmntɛm na ebetumi akum ɔyarefo a ɔwɔ ayamtu a onni hypoxic.
• Tete ɔyarefo no ma ɔhome nkakrankakra mfa ne hwene mu (a ɛma ɛyɛ hyew, ɛma ɛyɛ nwini, na ɛsepa nneɛma nketenkete biara a aka wɔ dan mu) na ɔhome nkakrankakra fa anofafa a wɔabɔ no akuturuku (te sɛ nea wɔbɔ brɛoo wɔ soup a ɛyɛ hyew so), a ɛma sentimita 5 kosi 10 nsu a ɛwɔ intrinsic positive end-expiratory pressure (auto-PEEP) wɔ mframa kwan no mu de stent no ahurututu nketenkete bue bere a wɔrehome no.

Siw a wosiw ano ma wɔn a wɔwɔ hay fever wɔ ahohuru bere ne ahohuru bere mfiase¶

Sɛ wofefe wɔ bere bi mu, w’aniwa yɛ wo yaw, anaasɛ wo hwene mu yɛ wo yaw wɔ sare anaa nnua mu nsu a ɛyɛ fĩ bere mu a, nnuruyɛfo bu wo sɛ asiane kɛse wom sɛ wubenya ɔyaredɔm a ɛyɛ aprannaa ayamtu sɛ mpo w’ahurututu ate nka sɛ ɛwɔ apɔwmuden koraa bere nyinaa a:

1. Fi ase de Corticosteroid Spray a Wɔde Fa Anom Daa ne Preventer Inhaler di dwuma Mfiase wɔ Pollen Bere mu:
2. Fi ase fa intranosal corticosteroid spray (fluticasone, mometasone, anaa budesonide) a wɔde petepete so da biara da di dwuma adapɛn 2 kosi 4 ansa na sare mu nsu a ɛyɛ fĩ a ɛsen biara no adu, a wɔde antihistamine a wɔnom da biara da ka ho.
3. Sɛ daa a woanya ahurututu a ɛnyɛ den, ɔfe anadwo, anaa wo koko a ɛyɛ den wɔ ahohuru bere anaa apɔw-mu-teɛteɛ mu a, nya daily inhaled corticosteroid (ICS) preventer (anaasɛ budesonide/formoterol anti-inflammatory reliever). Wɔ afe 2016 Melbourne ɔyaredɔm no mu no, ɛkame ayɛ sɛ na Ayarefoɔ a wɔwɔ ICU ayamtu no mu ɔha mu nkyekyɛmu aduɔkron NNYƐ aduru a wɔde siw ICS ano daa.
4. Mfa Ahohuru Bere Mu Da a Womfa Blue Reliever Inhaler + Spacer:
5. Fa salbutamol (albuterol) pMDI a ɛwɔ hɔ nnɛ ne valved spacer a ne kɛse te sɛ kotoku mu sie wo bag ne fie mmoa a edi kan kit mu wɔ ahohuru bere ne ahohuru bere mfiase nyinaa.
6. Hwɛ Official Pollen ne Thunderstorm Asthma Kɔkɔbɔ Ntɛmntɛm Nhyehyɛe So:
7. Wɔ nna a wɔahyɛ sɛ High anaa Extreme ma sare mu nsuo ne aprannaa a ano yɛ den nyinaa mu no, twa abɔnten agumadi nneyɛe, mmirikatu, ne abɔnten akwantuo mu wɔ awia ne anwummerɛ convective window mu.
8. Hyɛ N95 / P2 / FFP2 Respirator a Ɛyɛ Tight-Fitting Sɛ Wokyere Wo Wɔ Abɔnten Bere a Gust Anim:
9. Sɛ wɔhyɛ wo ma wɔnantew abɔnten bere a mframa a ɛsen pollen pii rebɔ a, hyɛ NIOSH N95, Australian/NZ P2, anaa European FFP2 home afiri a ɛhyɛ mu denneennen (anyɛ yiye koraa no, ɛtwetwe anyɛ yiye koraa no sub-micron nneɛma nketenkete ɔha biara mu nkyem 94 kosi 95) na home fa wo hwene mu denneennen kosi sɛ wobɛkɔ dan mu.
10. Ahum Akyi Efĩ a Wɔde Fi Adan Mu:
11. Sɛ wohyɛ mu bere a wode wo ho ahyɛ mu akyi a, yi akyi ntade ntɛm ara, hohoro w’anim ne w’anim, na yɛ sterile saline nasal rinse.

Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

Nsɛm a wɔtaa bisa¶

Dɛn nti na aprannaa ayamtu ntua no sii simma 20 ANSA na osu refi ase atɔ sen sɛ ɛbɛtɔ bere a osu retɔ?¶

Pollen starch granules a apaapae a wɔde afiri ketewaa bi hwɛ mu a ɛdɔɔso sen biara no tu kwan kɔ ahum no mframa a ɛyɛ nwini a efi mu ba (ahum no anim), a etu mmirika kilomita 10 kosi 30 (akwansin 6 kosi 19) di osu a ɛtɔ ankasa no anim no mu. Wɔ mununkum no ase no, nsu a ɛyɛ fĩ no hohoro na ɛpae yɛ asinasin a ne kɛse yɛ micrometer 0.5 kosi 2.5, na afei mframa a ɛyɛ nwini a ɛba fam piapia no kɔ fam na wɔbɔ kɔ abɔnten wɔ fam ansa na ahum no retu. Osu kɛse a ɛtɔ fam akyiri yi no boa ankasa ma wɔhohoro na wɔpopa nsu mu nsu a ɛsensɛn hɔ fi wim tebea a ɛwɔ fam no mu, na ɛno nti na mfɛnsere a edi awu sen biara ne mframa a ɛyɛ kusuu anaasɛ ɛyɛ kusuu kakra a ɛbɔ ansa na osu no aba no.

So obi a onnyaa ayamtu da wɔ n’asetra nyinaa mu betumi ahia ambulance ankasa anaasɛ obewu bere a aprannaa ayamtu bi rekɔ so no?¶

Yiw: asiane akyi ɔyaredɔm ho nhwehwɛmu a efi 2016 Melbourne asiane ne ɔyaredɔm a ɛte saa ara a ɛbaa London, Naples, Wagga Wagga, ne Ahvaz mu no kyerɛe sɛ nnipa a wɔkɔɔ dwumadibea ahorow a wɔhwɛ ntɛmpɛ so no mu ɔha biara mu nkyem 40 kosi 60 nni kan nhuu ayamtu biara, na na pii nnim sɛnea afiri a wɔde home a ɛma obi ho tɔ no te. Nanso, na saa nnipa a wɔyɛɛ wɔn basabasa no mu ɔha biara mu 95 kosi 99 wɔ bere bi mu sare atiridii (akisikuru a ɛma obi ho yɛ no hyew) na na nipadua no tumi ko tia nyarewa (wɔkura IgE antibodies) wɔ ryegrass anaa fungal akisikuru ho. Esiane sɛ pollen a enni dɛm no ntumi nkɔ ahurututu a ɛwɔ fam no mu da wɔ nna a ɛfata mu nti, na wɔansɔ wɔn mframa kwan a ɛwɔ fam no anhwɛ da kosii sɛ aprannaa no bubuu pollen no mu yɛɛ no ​​nneɛma nketenkete a ne kɛse yɛ micrometer 2 a etumi hyɛn wɔn ahurututu mu kɔ akyiri.

Sɛ menom aduru a wɔde ko tia histamine a wɔnom te sɛ cetirizine, loratadine, anaa fexofenadine bere a mifi ase hwirew bere a ahum retu no a, so ɛno bɛma ayamtu ntua no agyae?¶

Dabi: bere a nnuru a wɔde kum anom a ɛnyɛ nea ɛma obi dwo ansa na ahum atu no boa ma mframa kwan a ɛwɔ soro a wɔfefe ne histamine ho sɛnkyerɛnne a emu nyɛ den so tew no, nnuru a wɔde ko tia histamine a wɔnom no gye simma 30 kosi 60 ansa na akɔ mogya mu dodow a ɛsen biara na entumi nsan ahurututu mu ntini a ɛyɛ mmerɛw a ɛyɛ den (a cysteinyl leukotrienes, prostaglandin na ɛkanyan kɛse no D2, ne cholinergic akwan a ɛka histamine ho). Aprannaa ayamtu ntua a emu yɛ den hwehwɛ sɛ wɔhome ahurututu mu trɛw (salbutamol/albuterol denam spacer anaa budesonide/formoterol so) na ama mframa kwan mu ntini a ayɛ mmerɛw no adwo ntɛm ara, ne corticosteroids a ɛbɛma mframa kwan a ɛwɔ fam no ayɛ komm.

Salbutamol (albuterol) a wɔde home bruu a wɔde home ahe na ɛdɔɔso dodo sɛ wɔkyɛ ambulance bɛboro dɔnhwerew biako wɔ tebea a egye ntɛmpɛ a nnipa pii mu a?¶

Wɔ ayamtu a emu yɛ den anaasɛ ɛde nkwa to asiane mu a egye ntɛmpɛ a ambulance nkitahodi ahorow ahyɛ mu ma mu no, nnuruyɛ mu awuduru ho animdefo ne ɔhome ho akwankyerɛ ahorow si so dua sɛ hypoxia (oxygen a enni mframa kwan a wɔato mu) di awu wɔ simma kakraa bi mu, bere a salbutamol/albuterol a wɔhome no wɔ ahobammɔ kɛse. Sɛ wodi 4x4x4 nhyehyɛe no akyi (4 puffs via spacer simma 4 biara) kɔ so kosi sɛ ahome bɛkɔ yiye anaasɛ ayarehwɛfo bɛba a, ɛyɛ ahobammɔ na egye nkwa. Bere a wɔde dɔnhwerew biako ahome 20 kosi 40 akyi mpo no, nea efi mu ba titiriw ne nsa a ɛwosow, ahomegye, ne koma a ɛbɔ ntɛmntɛm, a ɛnyɛ den sɛ nnuruyɛfo betumi adi ho dwuma bere a ɔyarefo no mframa kwan abue no.

Dɛn nti na plastic spacer a wɔde bedi dwuma ho hia kɛse bere a ayamtu a emu yɛ den reba no sen sɛ wɔde afiri a wɔde home no bɛpete ano tẽẽ kɛkɛ?¶

Sɛ obi rehome mframa 30 kosi 40 simma biara wɔ ahurututu mu yare a emu yɛ den mu a, ontumi nyɛ biako sɛ wɔbɛmia afiri a wɔde home toa mu ne sɛ wɔbɛhome brɛoo simma 4, na saa ara nso na ontumi nkura ne home mu sikɔne 10. Sɛ wɔtow afiri a wɔde home a wɔahyɛ no den kɔ anom tẽẽ bere a wɔrehome ntɛmntɛm a, ɛpae aerosol nsu a ɛtɔ no ɔha biara mu nkyem 80 kosi 90 a ɛyɛ kilomita 100 dɔnhwerew biara (mph 62) tẽẽ kɔ tɛkrɛma ne menewa no akyi, baabi a wɔmene no kɔ yafunu no mu a asiane biara nni ho. Sɛ wɔtow puff biako gu valved spacer mu a, ɛma nnuru nketenkete a ɛyɛ nsuyiri no sɛn dan no mu ma enti ɔyarefo no betumi ahome mpɛn 4 kɛkɛ wɔ n’ankasa awosu mu, na ɛde nnuru a ɛboro mmɔho 3 kosi 4 akɔ ahurututu a ayɛ mmerɛw no mu tɔnn.

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Saa akwankyerɛ yi yɛ nsɛm a wɔde ma na ɛnsi adwumayɛfoɔ aduruyɛ mu nhwehwɛmu anaa nsaanodwuma a wɔde ma mmoa a ɛdi kan ananmu. Yɛhyɛ nyansa denneennen sɛ fa International Federation of Red Cross and Red Crescent Societies (IFRC), wo man Red Cross fekuw, St John Ambulance, anaa wo man ayamtu fapem so yɛ Mmoa a Edi Kan, Akisikuru Ho Dwumadi, ne CPR adesua a wɔagye atom.

Akwankyerɛ ahorow a ɛfa ho¶

• Asthma ntua mmoa a edi kan ne inhaler protocols
• Allergic reactions ne anaphylaxis ayarehwɛ a egye ntɛmpɛ
• Aprannaa ne anyinam ahobammɔ
• Derecho, mframa a ɛkɔ tẽẽ, ne microburst nkwagye
• Nnɔmba a egye ntɛmpɛ sɛnea ɔman biara te

Fibea ne aban akwankyerɛ¶

• National Asthma Council Australia: Australia Asthma Handbook - Ɔyaredɔm Aprannaa Ahum Ho Ayaresa Akwankyerɛ ne 4x4x4 Mmoa a Edi Kan Nhyehyɛe.
• Victoria Department of Health & Bureau of Meteorology (Australia): Ɔyaredɔm Aprannaa Ahum Ho Nkɔmhyɛ Nhyehyɛe ne Ɔmanfoɔ Akwahosan Mmuaeɛ Akwankyerɛ (Post-2016 Melbourne Review).
• Wiase Nyinaa Dwumadie a Ɛfa Akisikuru Ho (GINA): Wiase Nyinaa Nhyehyɛeɛ a Wɔde Di Akisikuru Ho Dwumadie ne Siw Ano - Akisikuru a ɛreyɛ kɛseɛ ne nea ɛyɛ den a ɛyɛ hu ho dwumadie.
• Wiase Akwahosan Ahyehyɛde (WHO) & Wiase Nyinaa Allergy Ahyehyɛde (WAO): Wim Tebea Nsakrae, Mframa Ho Adesua, Osmotic Pollen Paepae, ne Ɔhome mu Nyarewa a Ɛfa Aprannaa Ho.
• British Thoracic Society (BTS), NICE, ne Scotland Intercollegiate Guidelines Network (SIGN): Britania Akwankyerɛ a ɛfa Akisikuru Ho Dwumadie Ho.
• Centers for Disease Control and Prevention (CDC, United States) & American Academy of Allergy, Asthma & Immunology (AAAAI): Aprannaa mu Akisikuru Akwan, Sub-Pollen Bioaerosols, ne Ntɛmntɛm Bronchodilator Ahosiesie.