Lefu la Seoa la Asthma: Hobaneng ha Liphefo Tse Tsoang ke Sefefo li Tsosa Litlhaselo tsa Asma tse Sokelang Bophelo bo Bongata¶

Ha sefefo se matla sa selemo kapa mathoasong a lehlabula se aparela makhulo, lithota tsa temo, kapa litselaneng tsa litoropo tse nang le peō e phofshoana e ngata, moea o batang oa sefefo le moea o matla oa sefefo li ka baka koluoa ​​​​ea bophelo bo botle ea sechaba e tsejoang ka ** Nakong ea ketsahalo e tummeng hampe ea November 2016 Melbourne, Australia, sefofane se le seng se ile sa hlahisa lipuo tsa phefumoloho tse fetang 3,300 tsa lefapha la tšohanyetso le mafu a 10 ka mor'a lihora tse ngata, likepe tsa ambulense tsa litoropo le litsi tsa tlhokomelo e matla ea sepetlele. Ho fapana le ho kula ho tloaelehileng ha nako ea selemo moo lithollo tsa ryegrass kapa peō ea lifate tse bolelele ba 20 ho isa ho 60 micrometers (0.0008 ho 0.0024 inches) li qabeletsoe ka mokhoa o se nang kotsi ka har'a linko, lialuma li phahamisetsa peō ea limela e phofshoana ka har'a maru a mongobo moo ho monyehang ha metsi. Peō e 'ngoe le e 'ngoe e phatlohileng ea peō e pshatleha ho ba makholo a microscopic, li-starch granules tse koahetsoeng ke allergen tse ka bang 0.5 ho isa ho 2.5 micrometers (0.00002 ho 0.0001 inches), tse ntan'o phatlolloa ho ea fihla seterateng ka moea o batang o phallang ka matla 'me li huleloa ka ho toba ka har'a phefumoloho.

Hobane li-sub-micron bioaerosols li feta nko ka ho feletseng, karolo e fetang 40 ho ea ho 60 lekholong ea bahlaseluoa ba nang le lefu la bronchospasm e sokelang bophelo nakong ea ketsahalo ea sealuma ha ba e-s'o ka ba fumanoa ba e-na le asthma pele, ba kile ba ba le feberu e fokolang ea selemo feela (allergic rhinitis). Haeba uena kapa motho e mong ea haufi le uena a qala ho feheloa ke moea, ho hema kapa ho sokola ho bua ka mantsoe a felletseng joalo ka ha sefefo se matla nakong ea selemo, buisana le sebaka sa heno hang-hang. dinomoro tsa tshohanyetso (911 United States le Canada, 999 United Kingdom, 112 ho pholletsa le European Union, le 000 Australia) le ho qala thuso ea pele ea tekanyo e phahameng ea bronchodilator. U boetse u lokela ho utloisisa mokhoa oa ho laola motheo tlhaselo ea sefuba, hlokomela tsamaiso ho hana ho hana, le tšireletso e sireletsehileng ho eona lialuma le lehalima.

Etsa sena hona joale¶

Haeba selemo se nang le peō e phofshoana e ngata kapa sefefo sa lialuma sa mathoasong a lehlabula se atamela, kapa haeba motho e mong a qala ho khohlela, ho tsubella, kapa ho ba le sefuba se thibaneng nakong ea sefefo se matla:

1. Kena Ka Katlung Hang-hang Pele Cold Outflow Gust Front e Fihla:
2. Motsoako o phahameng ka ho fetisisa oa li-sub-micron pollen starch granules o tsamaea ka hare ho moea o batang, o moferefere o tsoang ka ntle (ka pele) o fihlang metsotso e 10 ho isa ho e 30 pele pula e na.
3. Tsamaea ka har'a moaho o moholo kapa koloi e kaholimo hang ha u bona maru a lefifi a ntse a haha ​​​​kapa u utloa ho theoha ha mocheso oa tšohanyetso le moea o fokang letsatsing la peō e ngata.
4. **Tiisa Windows Tsohle ebe o Fetola Boemo ba Moea hore o boele o boele ka hare **:
5. Koala fensetere e 'ngoe le e 'ngoe e ka ntle, lemati la balcony, 'me u koale moea o kenang ka thata.
6. Beha litsamaiso tsa lehae tsa HVAC le litsamaiso tsa taolo ea boemo ba leholimo ba koloi ho 100% phesente e ka hare ea moea o potolohang e le hore moea o tsoang kantle o se ke oa huleloa ka phaposing kapa sebakeng sa bolulo, ebe o bulela HEPA (High-Efficiency Particulate Air) purifier e lekantsoeng ho tšoara likaroloana ho fihla ho 0.3 micrometer.
7. Lekola Botebo ba Sefofane ka ho Sebelisa Teko ea Puo ea Moea o le Mong:
8. Kopa motho ea amehileng hore a bue polelo e feletseng ka lentsoe le phahameng.
9. Tlhaselo e itekanetseng: O khona ho bua ka lipoleloana, molumo o utloahalang oa ho hema, lebelo la ho phefumoloha ka holimo ho 20 ka motsotso, ho otla ha 100 ho isa ho 120 ka motsotso.
10. Tlhaselo e matla: O khona ho bua lentsoe le le leng feela lipakeng tsa ho hema, ho lula o otlolohile ka mokhoa oa tripod o ts'oara mophetho oa setulo, ho suprasternal kapa intercostal retractions (ho anya letlalo botlaaseng ba 'metso le lipakeng tsa likhopo), ho otla ka holimo ho 120 ka motsotso.
11. **Ho tšoaroa ho kotsi bophelong ho atametse **: Ho felloa ke moea haholo ho bua ho hang, cyanosis (molomo o boputsoa bo boputsoa kapa manala a menoana), pherekano kapa ho otsela, bradycardia (ho otla ha pelo butle), kapa "sefubeng se khutsitseng" moo phallo ea moea e koetsoeng ka matla hoo ho ke keng ha utloahala molumo oa ho kokomoha.
12. Laola 4x4x4 Reliever Protocol U sebelisa Pressurized Metered-Dose Inhaler (pMDI) le Spacer:
13. Lulisa motho a otlolohile (le ka mohla u se ke ua qobella mokuli oa asthma hore a robale fatše, e leng se hatellang sekoti le ho mpefatsa ho bipetsana).
14. Shake a short-acting beta-2 agonist (SABA) reliever inhaler e kang salbutamol (albuterol) kapa terbutaline ka matla, e kenye ka ** valve holding chamber (spacer)**, 'me u fane ka **1 puff ka spacer **, etsa hore motho a nke **4 butle, phefumoloho e tebileng eo molomo o le mong ka mor'a sebaka se le seng.
15. Pheta tatelano ena e nepahetseng makhetlo a 4 ka kakaretso (likhōhō tse 4 tse arohaneng, tse nang le phefumoloho e le 'ngoe).
16. Ema metsotso e 4. Haeba phefumoloho e sa khutlela ho tloaelehileng ka ho feletseng, fana ka ** li-puffs tse ling tse 4 (ka ho phefumoloha ha 4 ka ho hema) ** 'me u letsetse litšebeletso tsa bongaka tsa tšohanyetso hang-hang haeba u e-s'o etse joalo.
17. Haeba Sebapali se le Teng, Ntlafatsa Phaposi kapa Sebelisa Mokhoa o Otlolohileng oa ho Hohella butle:
18. Nakong ea bronchospasm e matla, ho kenya letsoho ka ho toba molomong ntle le spacer deposit ho fihlela ** 80 lekholong ea meriana ka morao ea 'metso ** ho e-na le matšoafo.
19. Haeba u sena sepakapaka sa polasetiki sa khoebo, seha sekoti ka tlas'a senoelo se hloekileng sa pampiri se lahloang kapa botlolo ea metsi ea polasetiki ea 500-milliliter (16.9-fluid-ounce) ho theha kamore e ntlafalitsoeng ea ho ts'oara, kapa u etse hore motho a ntše moea ka botlalo, a koahele molomo oa hae molomong oa molomo oa inhaler, tobetsa hanngoe ha a ntse a hema ** butle butle le ho ts'oara butle. Metsotsoana e 10 haeba e mamelloa.
20. Rera bakeng sa Gridlock ea Ambulense 'me U Itokisetse Boithati kapa Pholoso ea Bo-rakhoebo Haeba Marang-rang a Hateletsoe:
21. Nakong ea seoa sa sealuma sa sealuma sa libaka, batho ba likete ba letsetsa litšebeletso tsa tšohanyetso ka nako e le 'ngoe,' me mela ea ho romela ambulense e ka feta ** 2 ho lihora tsa 4 **.
22. Ha u ntse u boloka mohala o bulehileng kapa oa ho romela molaetsa o sebetsang bakeng sa mokuli ea matla kapa ea behang bophelo kotsing, tsoela pele ho fana ka ** 4 puffs ea salbutamol (albuterol) metsotso e meng le e meng ea 4 ** (kapa ho fihlela ho 6 ho ea ho 8 ho phunya metsotso e meng le e meng ea 5 tlas'a tataiso ea dispatcher mahlomoleng a sokelang bophelo). Haeba li-ambulense li sa fumanehe ka ho feletseng 'me mokhanni ea inehetseng ea nang le koloi e koetsoeng (e behiloeng ho khutlisetsa moea) a ka fihla lefapheng la tšohanyetso la sepetlele kapa pharmacy ea tšohanyetso nakong ea ** 5 ho metsotso ea 10 **, hokahanya lipalangoang hafeela mokuli a ntse a tseba 'me a tsoela pele ho fumana li-spacer puffs tse tsoelang pele tseleng.

Sefate sa qeto: Thibelo ea asma ea lialuma, triage, le bronchodilation ea mahlatsipa a mangata¶

flowchart TD
    Start["HO ATAmela HO THUSOA HO TSAMAYA KA TŠEBELE KAPA HO TSAMAYA LEHLABULA - Ponelopele ea joang bo phahameng, lehola, kapa peō ea lifate + temoso ea ho tsoa ha metsi"] --> Location{"Na uena kapa batho ba kotsing e kholo - (hay fever, wheeze, kapa nalane ea asthma) kantle?"}

    Location -->|YES: Outdoors or Windows Open| SealUp["SHELTER BEFORE THE GUST FRONT HITS - 1. Kena ka tlung kapa ka koloing e koetsoeng metsotso e 20-30 pele pula e na - 2. Koala lifensetere tsohle, mamati le masoba a ka ntle - 3. Beha AC ho 100% INTERNAL RECIRCULATION & tsamaisa filthara ea HEPA"]

    Location -->|NO: Symptoms Already Starting| Triage["RAPID RESPIRATORY SEVERITY TRIAGE - Lekola puo, lebelo la ho phefumoloha, ho khutla, 'mala oa letlalo le melumo ea matšoafo"]
    SealUp --> SymptomsCheck{"A na ho na le motho ea ka ba le khohlela, ho thibana sefuba, - ho hema, kapa ho hema ka thata?"}
    SymptomsCheck -->|No Symptoms| Monitor["Lula ka tlung lihora tse 2 ho isa ho tse 4 ka mor'a hore sefefo se fete - Nka thibelo e behiloeng (ICS) le antihistamine ea molomo"]
    SymptomsCheck -->|Yes: Symptoms Present| Triage

    Triage -->|MILD TO MODERATE - Speaks in phrases, audible wheeze, sitting up| FourByFour["QALA 4x4x4 SALBUTAMOL / ALBUTEROL PROTOCOL - 1. Lula u otlolohile; le ka mohla u se ke ua li lumella ho robala li bataletse - 2. Fana ka puff e le 'ngoe ho SPACER -> mokuli o phefumoloha ha 4 - 3. Pheta makhetlo a 4 (kakaretso ea ho hema / 16 spacer breaths) - 4. Ema metsotso e 4 'me u hlahlobe puo le mosebetsi oa ho hema hape."]

    Triage -->|SEVERE OR LIFE-THREATENING - Single words only, blue lips, silent chest, exhaustion| CallEMS["LETSA LITŠEBELETSO TSA TŠEBELETSO HANG-HANG - (911 / 999 / 112 / 000) & bolela 'Sefuba se matla sa Sealuma'"]

    FourByFour --> ImproveCheck{"Na phefumoloho le puo li ile tsa fola ka botlalo - kamora metsotso e 4 ea pele?"}
    ImproveCheck -->|YES: Fully Relieved| PostCare["Beha leihlo ka hloko bakeng sa lihora tse 4 (kotsi ea biphasic rebound) - Fana ka likhahla tse ling tse 4 haeba moea o khutla; batla tlhahlobo ea bongaka"]
    ImproveCheck -->|NO: Still Breathless| CallEMS

    CallEMS --> ContinuousReliever["HO TSOELA PELE HO TSOELA PELE HO PHETHA LE LETHATLO LA HO PHAHAMA BRONCHODILATION & STEROIDS - 1. Fana ka li-puffs tse ling tse 4 ka spacer metsotso e meng le e meng ea 4 ha u ntse u emetse - 2. Haeba mokuli a laetse oral prednisolone/prednisone - kapa SMART (budesonide/formoterol) leano la ts'ebetso, tsamaisa hona joale - 3. Haeba anaphylling-exjections, matšoao a ho thothomela a hlabang, a hlahisa matšoao a ho tsieleha, ho hlahisa maikutlo a ho tsieleha, ho hlahisa matšoao a ho tsieleha. intramuscular Epinephrine (0.3-0.5 mg) ka har'a serope se ka ntle"]

Fisiks ea atmospheric le pathobiology ea asthma ea sefefo¶

Ho utloisisa hore na ke hobane'ng ha lifefo tse khethehileng feela tse bakang bronchospasm ho thusa batho ka bomong, likolo, bahlophisi ba liketsahalo tsa ka ntle le mafapha a tšohanyetso ho lebella lihora tsa seoa pele ho mohala oa pele oa 911 kapa 000.

1. Enjene ea Meteorological ea Methati e Mene¶

Seoa sa lefu la sealuma se hloka hore ho be le maemo a leholimo a leholimo a tšoanang hantle le maemo a leholimo:

1. Mohato oa 1 - Pula ea Pele ea Mariha/Semoea le Khōlo ea Joang: Lipula tse matla tsa morao-rao tsa mariha le tsa selemo li tsamaisa kholo e tlokomang ea joang bo itekanetseng (haholo-holo ryegrass ea perennial, Lolium perenne, Timothy grass, Phleum pratense, kapa Pariepwitaria/ragweed mefuta e mengata ea libaka tse futhumetseng, tse lateloang ke mefuta e mengata ea lehoatata) e etsang hore ho be le lipalesa tse ngata haholo le ho lokolloa ha lithollo tsa peo e phofo sepakapakeng (** peo e phofo e feteletseng e feta lithollo tse 100 ho isa ho tse 500 ka cubic meter ea moea**).
2. Mohato oa 2 - Convective Updraft sweep: Joalo ha tsela e batang e matla e ka pele, molapo o ommeng, kapa melapo e mengata e ntseng e tsoela pele ho haola le lithota tse nang le peō e ngata thapama, lintlafatso tse futhumetseng pele ho sefefo li koala libilione tsa lithollo tsa peo e phofshoana e tsoang moeeng ho tloha moeling o kaholimo ho fihla botlaaseng ba leru ho isa bohareng ba leru ho isa ho 3 metres. (3,300 ho 9,800 maoto)** bophahamo.
3. Mohato oa 3 - Osmotic Shock, Ho tjhaja Motlakase, le Karohano ya Metjhini: Ka hare ho maru a mongobo o phahameng (moo mongobo o fetang 95 ho isa ho 100 peresente) le kahara mabala a motlakase a matla a sefefo:
4. Peō e phofshoana e sa sebetseng e monya mongobo oa leru la hypotonic ka potlako ka li-apertures tsa tsona tsa likokoana-hloko (**osmotic turgor pressure surge **).
5. Khatello ea ka hare ea hydrostatic e feta matla a tsitsitseng a lebota la ka ntle la peo e phofshoana (exine le intine), ho etsa hore lijo-thollo li phatlohe joaloka balune ea metsi e nyenyane haholo (**osmotic lysis **).
6. Ka nako e le 'ngoe, masimo a matla a electrostatic (** 10,000 ho 100,000 volts ka mithara **) le ho kuta ka mechine pakeng tsa marotholi a supercooled le graupel fracture e feletsoe ke metsi kapa karolo e itseng ea peo e phofshoana e kolobisitsoeng le likokoana-hloko tsa fungal (*Alternaria , Cladosporium sub-5 * 5 . micrometer).
7. Mohato oa 4 - Cold Downdraft Concentration and Gust-Front Outflow Carpet-Bombing: Lithako tse pholileng tsa pula li jara litrilione tsena tsa granules tse sa bonahaleng tsa starch tse laetsoeng ke allergen ka potlako ho theohela holim'a Lefatše. Ha karolo e theohang ea moea o batang o teteaneng e otla fatše, e nama e tšekaletse ho ea pele 40 ho isa ho 100 km/h (25 ho 62 mph) e le botebo bo sa tebang, bo ferekaneng ka pele (moeli o tsoang) feela 100 ho isa ho 400 limithara (330 ho 1,300 maoto) botebo. Hobane ho tsoa ha serame ho koaletsoe ke ho fetoha ha mocheso, likaroloana tsa peo e phofo tse phatlohileng li ke ke tsa hasana ho ea holimo; ho e-na le hoo, li hatelloa hore e be leru le sa bonahaleng, le koahelang fatše la bioaerosol le bophahamo bo nepahetseng ba phefumoloho ea motho ** 10 ho isa metsotso e 30 pele pula e matla e fihla ho hlatsoa moea o hloekile **.

2. Papiso: Tloaelehileng Hay Fever vs. Lefu la Seoa la Sealuma¶

Tlhokomelo ea bongaka le tsamaiso ea mohato ka mohato pele ho sepetlele¶

1. Ho Lemoha Bronchospasm e Patehileng ho Bahlaseluoa ba Nako ea Pele¶

Hobane batho ba fetang halofo ea batho ba nang le lefu la asma ha ba e-s'o ka ba tšoaroa ke asthma pele, ke ka seoelo ba hlokomelang se etsahalang matšoafong a bona. Ba bangata ba lumela hore ba tšoeroe ke lefu la pelo, ba khangoa ke lerōle, kapa ba hlaseloa ke tšabo:

• Sekhohlela se sa Feleng, se Omileng, se Paroxysmal: Ho batho ba baholo le bana ba bangata, ho tsikitlana ha moea o monyane qalong ha se mololi oa 'mino oa khale, empa e le sekhohlela se omeletseng se sa khaotseng se mpefalang ka moea o mong le o mong oa moea o kantle.
• Ho Felloa ke Moea le ho Phefumoloha ha Nako e Telele: Hobane khatello ea intrathoracic e phahama nakong ea ho tsoa, ​​li-bronchioles tse ruruhileng le tse patehileng li ba tšesaane le ho feta ha mokuli a leka ho hema. Ho phefumoloha ho ikutloa ho le khuts'oane ebile ho sa teba, ha ho phefumoloha ho nka ** nako e telele ka makhetlo a mabeli ho isa ho a mararo ho feta tloaelo ** mme ho hlahisa molumo o phahameng oa 'mino oa mololi (wheeze).
• Dynamic Hyperinflation ("Air Trapping"): Hobane mohlaseluoa a ka hula moea o monyenyane nakong e fetileng ea bronchioles e patisaneng empa a sitoa ho o ntša ka ho feletseng pele phefumoloho e latelang e qala, moea oa khale o qabeletsoe ka har'a alveoli. Sefuba se fetoha se bōpehileng joaloka moqomo 'me se atolosoa haholo, se qobella mokuli hore a itšetlehe ka matsoho a otlolohileng (** tripod position**) 'me a sebelise mesifa ea molala le likhopo ho hula molumo o monyenyane oa moea o hloekileng holim'a matšoafo a bona a tletseng moea.
• Temoso e Lethal ea "Sefuba se Khutsitseng": Haeba moshebelli a beha tsebe ea hae sefubeng sa mohlaseluoa kapa mokokotlong 'me a utloa **ho lla kapa ho hema ho tloaelehileng ** ha mokuli a ntse a bonahala a sokola ho hema, bronchospasm e se e batla e le karolo ea 100 lekholong. Hoo e ka bang ha ho moea o kenang kapa o tsoa matšoafong; hypoxic bradycardia le ho tšoaroa ha pelo ho tla latela ka mor'a metsotso e seng mekae ntle le haeba bronchodilation e matla le thuso ea moea e qala hang-hang.

2. Mokhoa oa ho Sebelisa Mokhoa oa Pholoso oa 4x4x4 Spacer ka nepo¶

Lithuto tsa bongaka tse entsoeng ke National Asthma Council Australia, Global Initiative for Asthma (GINA), le British Thoracic Society li bonts'a hore **inhaler e hatelletsoeng ea metered-dose inhaler (pMDI) e khomaretsoeng ho valved spacer ** e sebetsa hantle joalo ka ('me e potlakile ho theha) ho feta) plug-in jet nebulizer ea sepetlele, ha e ntse e qoba ho hasana ha kokoana-hloko ea aerosol:

1. Beha Mokuli: Lulisa motho setulong a otlolohile kapa a tšehelitsoe leboteng ka mahetla a hae pele hanyane. Lokolla molala ofe kapa ofe o tiileng kapa leqhoele la sefuba.
2. ** Lokisetsa Inhaler le Spacer **:
3. Tlosa sekoahelo ho ** blue reliever pMDI (salbutamol 100 micrograms / albuterol 90 micrograms ka puff) **.
4. Shake sehatsela se otlolohile bakeng sa metsotsoana e 3 ho isa ho e 5 ebe u kenya molomo ka thata ka har'a selikalikoe se ka morao sa spacer e nang le valve.
5. Fana ka Puff 1 (Mokhoa oa ho Phefumoloha ka Tidal):
6. Beha molomo oa spacer pakeng tsa meno a mokuli ka melomo e tiisitsoeng ka thata ho e potoloha (kapa u hatelle maske a bana ka nkong le molomong oa ngoana ea ka tlase ho lilemo tse 4).
7. Tobetsa lekotikoti Hang ho chesa ** puff* e le 'ngoe ka har'a spacer, 'me mokuli a hema le ho tsoa butle ka melomo ea hae makhetlo a 4.
8. Fana ka Puffs 2, 3, le 4:
9. Hlohlelletsa hakhutšoanyane, mollo Puff 2 (4 phefumoloho butle), Puff 3 (4 butle hema), le Puff 4 (4 hema butle).
10. Sekala sa Tekolo Botjha sa Metsotso e 4:
11. Ema metsotso e 4 u ntse u shebile ho sisinyeha ha sefuba, bolelele ba puo le mmala oa molomo.
12. Haeba u ntse u hema, u khohlela, kapa u hema ka metsotso e 4, hang-hang u phete potoloho e 'ngoe ea ho hula ha 4 (ho hema ha 4 ka ho hula).
13. Maximum Pre-Hospital Dosing: Ha u ntse u emetse ambulense e liehang nakong ea ketsahalo ea sealuma sa sealuma, batho ba baholo le bana ba ka holimo ho lilemo tse 6 ba mahlomoleng a maholo ba ka fumana ka mokhoa o sireletsehileng ** metsu e 4 metsotso e meng le e meng ea 4 ** (kapa ** 6 ho 8 e hula metsotso e meng le e meng ea 5 ** bakeng sa motho e moholo ea mahlomoleng a sokelang bophelo tlas'a tataiso ea dispatcher). Litla-morao tsa nakoana tsa salbutamol / albuterol tse ngata, tse kang matsoho a thothomelang le ho otla ha pelo ka potlako, li lebeletsoe liphello tsa meriana 'me li ** li kotsi haholo ho feta ho tsuba ho sa phekoleheng **.

3. Litokiso tsa Tšohanyetso Ha ho se Setsi sa Asthma se Teng Sebakeng¶

Hobane karolo ea 40 ho ea ho karolo ea 60 lekholong ea bahlaseluoa ba asthma ea sefefo ha ba na sesebelisoa sa ho inhaler ha sefefo se otla, batho ba emeng haufi le litho tsa malapa hangata ba tobana le lekhalo le tšosang ha liambulense li lieha:

• Kalima Setsi sa ho Phomola Hang-hang (Ho arolelana Bronchodilator ea Mosamaria e Molemo):
• Ka tlhaselo ea asthma ea sefefo se sokelang bophelo, **u seke oa tsilatsila ho botsa baahelani, basebetsi-'moho, matichere, kapa ba fetang ka tsela hore na ho na le motho ea nkileng salbutamol/albuterol inhaler e putsoa kapa budesonide/formoterol inhaler **.
• Hlakola molomo ka sesepa sa joala kapa lesela le hloekileng, kapa u chese inhaler e alimiloeng ka kopi ea pampiri e ntlafalitsoeng e ntlafalitsoeng kapa u sehe sepakapaka sa botlolo ea metsi e le hore ho se ke ha kopana le molomo, 'me u tsamaise 4x4x4 protocol.
• Lekola hore na K'hemik'hale e Haufi le ho Tsamaea Hang-hang kapa Sebaka sa Metsotso e Meli ea ho Khanna:
• Libakeng tse kang Australia (Shedule 3 Pharmacist-Only Medicine), United Kingdom (Emergency Supply melaoana), Canada, le likarolo tsa European Union, litsebi tsa meriana ea sechaba li lumelloa ka molao ho fana ka ** emergency salbutamol (albuterol) inhaler le spacer ntle le lengolo la ngaka ** nakong ea tšohanyetso e matla ea ho hema.
• Nako ea ho Sebelisa Epinephrine Auto-Injector (EpiPen / Jext / Emerade / Auvi-Q):
• Batho ba bangata ba nang le litlama tse matla tsa joang kapa lijo tse hananang le lijo ba na le intramuscular epinephrine (adrenaline) auto-injector le haeba ba sa nke salbutamol inhaler.
• Epinephrine ke e matla e sa khetheng alpha le beta-2 adrenergic agonist e khathollang ka potlako mesifa e boreleli ea bronchial le ho fokotsa edema ea mucosal edema ea moea.
• Ho ea ka tataiso ea ho tsosolosa le ea anaphylaxis, haeba mokuli a utloa bohloko ** bronchospasm e behang bophelo kotsing ** (ha a khone ho bua, cyanotic, sefuba se khutsitseng, kapa ho putlama) le ** ebang ** e bontša tšobotsi leha e le efe ea systemic anaphylaxis ** kapa ** e na le ** zero phihlello ho beta-2 agonist inhaler ha a ntse a tobane le anpint e haufi-ufi ea tsamaiso * auto-injector (0.3 mg bakeng sa batho ba baholo le bana ba fetang 30 kg [66 lb]; 0.15 mg bakeng sa bana ba 15 ho 30 kg [33 ho 66 lb])** ho kena bohareng ba serope se ka ntle (vastus lateralis) e ka pholosa bophelo ha litšebeletso tsa tšohanyetso li arabela.
• Ho Bea Maemo, Ho Phefumoloha ka Molomo o Khutsitseng, le Seo U sa lokelang ho se Etsa:
• O SE KE UA kenya mokuli ka shaoareng e nang le mouoane kapa u mo kope ho hema mouoane o chesang: Mongobo o phahameng le mouoane o futhumetseng li ka qholotsa reflex bronchoconstriction litseleng tsa moea tse sa sebetseng hantle 'me tsa baka peō ea phofo e eketsehileng.
• U SE KE UA re mokuli a hema ka mokotleng oa pampiri: Ho phefumoloha ha mokotla oa pampiri ke tšōmo e siiloeng ke nako ea hyperventilation e theolang kapele oksijene e bululetsoeng (\(FiO_2\)) mme e ka bolaea mokuli oa asthma ea hypoxic.
• Koetlisa mokuli hore a hema butle ka linko tsa bona (tse futhumatsang, tse mongobo, le ho hloekisa likaroloana leha e le life tse setseng tsa ka tlung) 'me u ntše moea butle-butle ka ** melomo e phunyeletsoeng ** (joaloka ho butsoela ka bonolo ka sopho e chesang), e etsang ** 5 ho 10 centimeters ea metsi a intrinsic positive end-expiratory pressure (auto-PEEP the airoles during the airoles small.

Thibelo bakeng sa batho ba nang le hay fever nakong ea selemo le mathoasong a lehlabula¶

Haeba u e-ba le ho thimola ka nako ea selemo, mahlo a nang le metsi a hlabang, kapa tšubuhlellano ea nko nakong ea joang kapa peō ea limela ea lifate, litsebi tsa bongaka li u beha kotsing e kholo ea lefu la seoa la sealuma le haeba matšoafo a hau esale a ikutloa a phetse hantle:

1. Qala Sefafatsi sa Letsatsi le Letsatsi sa Corticosteroid ea Intranasal le Preventer Inhaler Mathoasong a Sehla sa Peō:
2. Qala ho sebelisa sesepa sa letsatsi le letsatsi intranasal corticosteroid spray (fluticasone, mometasone, kapa budesonide) libeke tse 2 ho isa ho tse 4 pele ho nako ea peō ea joang bo phahameng, e kopantsoeng le antihistamine ea molomo ea letsatsi le letsatsi.
3. Haeba ** kile** u kile ua ba le ho hema hanyenyane, ho khohlela bosiu, kapa ho tlama ha sefuba nakong ea selemo kapa boikoetliso, fumana dayly inhaled corticosteroid (ICS) preventer (kapa budesonide/formoterol anti-inflammatory reliever). Ka lefu la seoa la Melbourne la 2016, hoo e ka bang ** liperesente tse 90 tsa bakuli ba asthma ea ICU ba ne ba sa nke sethibela se tloaelehileng sa ICS **.
4. Le ka mohla U se ke Ua Tsamaea ka Selemo U sa Tšoare Inhaler ea Blue Reliever + Spacer:
5. Boloka salbutamol (albuterol) pMDI ea morao-rao le sepakapaka se lekaneng sa pokothong ka mokotleng oa hao le khiti ea thuso ea pele ea lapeng nakong eohle ea selemo le mathoasong a lehlabula.
6. Lekola Melao ea Semmuso ea Peō e Phoofolo le Sealuma sa Sefefo sa Sefefo sa Lealuma:
7. Ka matsatsi a lekantsoeng Ho holimo kapa Ho fetelletseng bakeng sa peō ea joang ea joang le lifefo tse matla tsa lialuma, hlakola lipapali tsa ka ntle, ho matha, le ho etela ka ntle nakong ea thapama le ea mantsiboea.
8. Apara Setsi se Phefumolohang se Tight-Fitting N95 / P2 / FFP2 Haeba u ka tšoaroa ka ntle nakong ea Gust Front:
9. Haeba u qobelleha ho tsamaea ka ntle nakong ea moea o tsoang ka peō e ngata, apara seaparo se lekaneng NIOSH N95, Australian/NZ P2, kapa European FFP2 respirator (sefa ** bonyane karolo ea 94 ho ea ho 95 lekholong ea likaroloana tse nyenyane tse nyenyane **) 'me u hema ka thata ka nko ea hau ho fihlela ka tlung.
10. Tlhahiso ea Ka mor'a Sefefo Ka Hare:
11. Hang ha u le ka hare ka mor'a ho pepeseha, tlosa liaparo tsa ka ntle hang-hang, hlatsoa sefahleho sa hao le moriri oa hau, 'me u etse sesebelisoa se sa hloekang sa nasal saline.

Linomoro tsa libaka tsa tšohanyetso le liprothokholo tsa mekhatlo¶

Lipotso tse botsoang khafetsa¶

Hobaneng ha tlhaselo ea asma ea lialuma e etsahetse metsotso e 20 PELE pula e qala ho na ho e-na le nakong ea lipula tsa litloebelele?¶

Karolo e phahameng ka ho fetisisa ea li-microscopic ruptured pollen starch granules e tsamaea ka har'a moea o batang oa sefefo (the gust front), o mathang lik'hilomithara tse 10 ho isa ho tse 30 (6 ho isa ho 19 miles) ka pele ho molamu oa sebele oa pula. Ka har'a maru, lithollo tsa peō e phofshoana li kokomoha ka mongobo 'me li phatlohile likotoana tsa 0.5-to-2.5-micrometer, tse ntan'o sutumelletsoa fatše ke metsi a batang a theoha' me a bululeloa ka ntle fatše pele ho sefefo. Pula ea litloebelele e otlang fatše hamorao e thusa ho hlatsoa le ho hohla peō e phofshoana e leketlileng ho tsoa sepakapakeng, ke kahoo fensetere e kotsi ka ho fetisisa e leng moea o fokang o omileng kapa o fokang hanyenyane pele pula e fihla.

Na motho ea e-s'o be le asthma bophelong bohle ba hae a ka hloka ambulense kapa a shoa nakong ea ketsahalo ea sealuma?¶

E: Liphuputso tsa ka mor'a likoluoa ​​​​tsa koluoa ​​​​ea Melbourne ea 2016 le mafu a seoa a tšoanang London, Naples, Wagga Wagga, le Ahvaz li bontšitse hore karolo ea 40 ho ea ho 60 lekholong ea batho ba neng ba itlhahisa mafapheng a tšohanyetso ha ba e-s'o fumane hore na ba na le asthma, 'me ba bangata ba ne ba sa tsebe hore na "inhaler inhaler" e shebahala joang. Leha ho le joalo, karolo ea 95 ho ea ho ea 99 lekholong ea bahlaseluoa bao e ne e e-na le hay fever ( allergic rhinitis ) ka linako tse itseng tsa selemo ’me ba ne ba e-na le matla a ho itšireletsa mafung (ba jereng li-antibodies tsa IgE) ho ryegrass kapa allergens ea fungal. Kaha peō e phofshoana e sa bonahaleng ha e fihle matšoafong a ka tlaase matsatsing a tloaelehileng, litsela tsa tsona tse ka tlaase tsa moea li ne li e-s’o ka li lekoa ho fihlela leholiotsoana le pshatla peō e phofshoana ka likaroloana tse 2-micrometer tse khonang ho kenella ka hare ho li-bronchioles tsa tsona.

Haeba ke nka letlapa la antihistamine la molomo joaloka cetirizine, loratadine, kapa fexofenadine ha ke qala ho hema nakong ea sefefo, na seo se tla emisa tlhaselo ea asthma?¶

Che: ha u ntse u noa antihistamine ea molomo e sa khutsiseng pele sefefo se thusa ho fokotsa ho thimola holimo-ea moea le pontšo e bonolo ea histamine, li-antihistamine tsa molomo li nka metsotso e 30 ho isa ho e 60 ho fihla tlhōrōng ea methapo ea mali 'me ha li khone ho khutlisa khatello e matla ea "bronchial smooth-muscle constriction" (e tsamaisoang haholo ke cysteinesyl cysteine le protheine le cysteine le protheine le cysteine le protheine ea protheine ea cysteine le protheine ea cysteine le protheine ea cysteine le protheine ea cysteine le protheine. tlatsetso ho histamine). Tlhaselo e matla ea asma ea sealuma e hloka "bronchodilator" e hemang (salbutamol/albuterol ka spacer kapa budesonide/formoterol) hore hang-hang e phomotse mesifa ea moea, hammoho le corticosteroids ho kokobetsa ho ruruha ha moea o tlase.

Ke likhahla tse kae tsa salbutamol (albuterol) inhaler e putsoa e ngata haholo haeba ambulense e lieha ho feta hora nakong ea tšohanyetso ea boima?¶

Boemong ba tšohanyetso ba asthma e matla kapa e behang bophelo kotsing moo marang-rang a ambulense a sithabetsang, litsebi tsa toxicologists tsa bongaka le tataiso ea ho phefumoloha li hatisa hore hypoxia (ho hloka oksijene ho tloha litseleng tsa moea tse koetsoeng) e bolaea ka mor'a metsotso e seng mekae, athe salbutamol / albuterol e hemang e na le moeli o pharaletseng oa tšireletso. Ho latela protocol ea 4x4x4 (ho ikhohomosa ha 4 ka spacer metsotso e meng le e meng e 4) ho fihlela phefumoloho e ntlafala kapa baoki ba liphallelo ba fihla ho bolokehile ebile ho pholosa bophelo. Esita le ka mor'a ho hula ka makhetlo a 20 ho isa ho a 40 ka mor'a hora, litla-morao tse ka sehloohong ke matsoho a thothomelang, ho se phomole le ho otla ha pelo ka potlako, tseo lingaka li ka li laolang habonolo hang ha litsela tsa moea tsa mokuli li bulehile.

Ke hobane'ng ha ho sebelisa spacer ea polasetiki ho le bohlokoa hakaale nakong ea tlhaselo e matla ea asthma ho e-na le ho fafatsa sehatsetsi ka ho toba molomong?¶

Ha motho a ntse a phefumoloha ka makhetlo a 30 ho isa ho a 40 ka motsotso nakong ea bronchospasm e matla, ha a khone ho hokahanya ho hatelloa ha inhaler canister ka ho hema butle-butle ka metsotsoana e 4, kapa hona ho tšoara phefumoloho ea bona metsotsoana e 10. Ho thunyetsa sehatsetsi se hatelletsoeng ka ho toba ka hanong nakong ea ho phatloha ho potlakileng ha 80 ho isa ho 90 lekholong ea marotholi a aerosol ka lebelo la lik'hilomithara tse 100 ka hora (62 mph) ka ho toba le leleme le ka morao 'metso, moo e metsoang ntle le kotsi ho kena ka mpeng. Ho thunya sepakapaka se le seng ho emisa moholi oa sethethefatsi o ka har'a phaposi e le hore mokuli a khone ho hema le ho tsoa ka makhetlo a 4 ka lebelo la hae la tlhaho, a fana ka meriana e fetang makhetlo a 3 ho isa ho a 4 matšoafong a koalehileng.

• Tataiso ena ke ea merero ea tlhahisoleseling 'me ha e nke sebaka sa tlhahlobo ea bongaka ea litsebi kapa koetliso ea thuso ea pele. Re khothaletsa ka matla ho nka thupelo e ngolisitsoeng ka molao ea First Aid, Asthma Management, le CPR ka International Federation of Red Cross le Red Crescent Societies (IFRC), sechaba sa hau sa naha sa Red Cross, St John Ambulance, kapa setsi sa hau sa naha sa asthma.*

Litataiso tse amanang¶

• Asma e hlasela thuso ea pele le liprothokholo tsa inhaler
• Matšoao a ho kula le tlhokomelo ea tšohanyetso ea anaphylaxis
• Diaduma le polokeho ya lehadima
• Derecho, moea o otlolohileng, le ho pholoha ha microburst
• Linomoro tsa maemo a tshohanyetso ho ea ka linaha

Mehloli le tataiso ea semmuso¶

• Lekhotla la Naha la Asthma Australia: Buka ea Asthma ea Australia - Seoa sa Sealuma Tataiso ea Kliniki ea Asthma le 4x4x4 First Aid Protocol.
• Lefapha la Bophelo bo Botle la Victorian & Bureau of Meteorology (Australia): Seoa sa Seoa sa Lealuma la Asthma le Tataiso ea Karabelo ea Bophelo bo Botle ba Sechaba (Tlhahlobo ea Ka morao-2016 Melbourne).
• Global Initiative for Asthma (GINA): Leano la Lefatshe Lohle bakeng sa Taolo le Thibelo ya Asthma - Taolo ya Asthma e mpefalang le ho Eketsa ha Acute.
• Mokhatlo oa Lefatše oa Bophelo (WHO) le Mokhatlo oa Lefatše oa Allergy (WAO): Phetoho ea Tlelaemete, Aerobiology, Ho Pharoha ha Peō ea Osmotic, le Mafu a Seoa a Phefumolohang a Amanang le Sealuma.
• British Thoracic Society (BTS), NICE, and Scottish Intercollegiate Guidelines Network (SIGN): Tlhahiso ea Borithane ka Tsamaiso ea Asthma.
• Litsi tsa Taolo le Thibelo ea Mafu (CDC, United States) & American Academy of Allergy, Asthma & Immunology (AAAAI): Thunderstorm Asthma Mechanisms, Sub-Pollen Bioaerosols, le Emergency Bronchodilator Preparedness.