Izifo Zomkhuhlane We-Asthma: Kungani Imimoya Ephuma Isiphepho Ibangela Ukuhlasela Kwe-Asthma Okuningi Okusongela Impilo¶

Lapho isiphepho esinamandla sasentwasahlobo noma ekuqaleni kwehlobo sishanela ezindaweni ezinotshani, amathafa ezolimo, noma amaphaseji asemadolobheni anempova enkulu, ukwehla okubandayo kwesiphepho kanye ne-gust front kungabangela inkinga yezempilo yomphakathi esheshayo, eyinhlekelele eyaziwa ngokuthi ubhubhane lwesifuba somoya. Ngesikhathi somcimbi odume kabi wangoNovemba 2016 eMelbourne, e-Australia, iqhubu elilodwa ladala izethulo zokuphefumula zomnyango wezimo eziphuthumayo ezingaphezu kuka-3,300 nokufa kwabantu abayi-10 emahoreni ambalwa, okwaqeda amandla ama-ambulensi asemadolobheni amakhulu kanye nezikhungo zabagula kakhulu esibhedlela. Ngokungafani nokungezwani komzimba okuvamile kwesizini lapho i-ryegrass engaguquki noma izinhlamvu zempova yesihlahla ezikala ama-micrometer angu-20 kuye kwangama-60 (0.0008 kuya ku-0.0024 amayintshi) zivaleleke ngokungenabungozi emakhaleni, ukuduma kwezulu kuphakamisela izinhlamvu zempova eziphelele ezisekelweni zamafu eziswakeme lapho kubangelwa khona ukushaqeka* nokushaqeka kwamanzi. Uhlamvu ngalunye lwempova oluphukile luphahlazeka lube amakhulukhulu ezinhlamvana zesitashi ezimbozwe izinambuzane ezilingana no-*0.5 kuya ku-2.5 micrometers (0.00002 kuya ku-0.0001 amayintshi)**, abe eseqhunyiswa phansi aze afike ezingeni lomgwaqo emimoyeni ebandayo ephumayo egxilile bese ehogelwa aqonde ngqo ku-altheminal bronchiole.

Ngenxa yokuthi lawa ma-sub-micron bioaerosols adlula ikhala ngokuphelele, ngaphezu kwamaphesenti angu-40 kuya kwangu-60 ezisulu ezihlushwa i-bronchospasm esongela ukuphila phakathi nesenzakalo sesifuba somoya esihambisana nokuduma kwezulu azikaze kutholwe ukuthi zinesifuba somoya ngaphambi kokuba, njengoba ngaphambili zazike zaba nemfiva yesizini encane kuphela (i-allergenic rhinitis). Uma wena noma othile oseduze nawe eqala ukuhefuzela, ukushaywa umoya, noma ukuzabalaza ukukhuluma ngemisho egcwele njengesiphepho sasentwasahlobo, thintana ngokushesha nasendaweni yakini. izinombolo eziphuthumayo (911 e-United States naseCanada, 999 e-United Kingdom, 112 yonkana i-European Union, kanye 000 e-Australia) futhi baqale umthamo ophezulu we-bronchodilator usizo lokuqala. Kufanele futhi uqonde indlela yokuphatha isisekelo ukuhlasela kwesifuba somoya, qaphela uhlelo ukungezwani komzimba, kanye nendawo yokukhosela ngokuphepha ukuduma kwezulu nombani.

Yenza lokhu manje¶

Uma intwasahlobo enempova ephezulu noma ukuduma kwezulu kwasekuqaleni kwehlobo, noma uma othile eqala ukukhwehlela, ukuphefumula, noma ukuzwa ukuqina kwesifuba phakathi nesiphepho esingaphambili:

1. Ngena Endlini Ngokushesha Ngaphambi Kokuba I-Cold Outflow Gust Front Ifike:
2. Inani eliphakeme kakhulu lama-sub-micron pollen starch granules aphukayo ahamba ngaphakathi komoya ophumayo obandayo, onesiyaluyalu (gust front) ofika imizuzu eyi-10 kuye kwengama-30 ngaphambi kwemvula.
3. Hambisa ngaphakathi kwebhilidi elikhulu noma imoto ephezulu ngokushesha lapho ubona amafu amnyama akha i-convective noma uzwa ukwehla okungazelelwe kwezinga lokushisa kanye nokushintsha komoya ngosuku lwempova ephezulu.
4. Vala Wonke Ama-Windows futhi Ushintshe I-Air Conditioning ibe Ukujikeleza Kabusha Kwangaphakathi:
5. Vala wonke amafasitela angaphandle, umnyango we-balcony, kanye ne-passive trickle vent ngokuqinile.
6. Misa amasistimu e-HVAC asekhaya kanye nesistimu yokulawula isimo sezulu semoto ukuze kube amaphesenti angu-100 wokujikeleza komoya wangaphakathi ukuze umoya ophuma ngaphandle ungadonseleki kukhabethe noma endaweni yokuhlala, bese uvula I-HEPA (High-Efficiency Particulate Air) yokuhlanza elinganiselwe ukuze ithwebule izinhlayiya zehle ziye kokuthi 0.3 micrometer.
7. Hlola Ukuqina Kwendlela Yomoya Usebenzisa Ukuhlolwa Kwenkulumo Yokuphefumula Okukodwa:
8. Cela othintekile ukuthi akhulume umusho ogcwele ngokuzwakalayo.
9. Ukuhlasela okumaphakathi: Ingakwazi ukukhuluma ngamabinzana, ukuhefuzela okuzwakalayo, izinga lokuphefumula elingaphezu kokuphefumula okungu-20 ngomzuzu, ishayela amabhithi angu-100 kuya kwangu-120 ngomzuzu.
10. Ukuhlasela okunzima: Ingakhuluma kuphela igama elilodwa phakathi kokuphefumula, ihlezi imile njengesitayela se-tripod ibambe unqenqema lwesihlalo, ukuhlehla kwe-suprasternal noma kwangaphakathi (ukumunca isikhumba ngaphansi komphimbo naphakathi kwezimbambo), ukushaya kwenhliziyo okungaphezu kuka-120 ngomzuzu.
11. Ukuboshwa okusongela ukuphila okuseduze: Ukuphelelwa umoya kakhulu ukuthi ungakhuluma nhlobo, i-cyanosis (izindebe ezimpunga eziluhlaza noma izinzipho), ukudideka noma ukozela, i-bradycardia (inhliziyo eshaya kancane), noma "isifuba esithule" lapho ukugeleza komoya kuvinjwe kakhulu kangangokuthi akukho msindo ohefuzayo ongezwakali.
12. Lawula i-4x4x4 Reliever Protocol usebenzisa i-Pressurised Metered-Dose Inhaler (pMDI) kanye ne-Spacer:
13. Hlalisa lowo muntu eqonde (ungalinge uphoqe isiguli esiphethwe yisifuba somoya ukuthi silale sibheke phansi, okucindezela i-diaphragm futhi kube kubi nakakhulu ukuqunjelwa).
14. Nyakazisa i-beta-2 agonist (SABA) esebenza iDemo esiphefumulayo esifana ne-salbutamol (albuterol)* noma terbutaline ngamandla, yifake ekumbeni yokubamba ivalvu (spacer), bese uqondisa ukukhukhuma oku-1 ku-spacer, wenze umuntu adonse 4, aphefumule kancane, ajule lowo mlomo owodwa aphume emlonyeni.
15. Phinda lokhu kulandelana ngqo izikhathi ezi-4 sezizonke (amaphafu ahlukene angu-4, anokuphefumula okungu-4 ngokudonsa ngakunye).
16. Ima imizuzu emi-4. Uma ukuphefumula kungakabuyeli esimeni esijwayelekile ngokuphelele, sebenzisa okunye ukufutheka okungu-4 (ngokuphefumula oku-4 ngakunye) futhi ushayele izinsizakalo zezokwelapha eziphuthumayo ngokushesha uma ungakenzi kanjalo.
17. Uma Singekho Isikhala Esitholakalayo, Thuthukisa Igumbi noma Sebenzisa Indlela Eqondile Yokuhogela Kancane Kancane:
18. Phakathi ne-bronchospasm eqinile, ukuvuthwa kwe-inhaler okuqondile emlonyeni ngaphandle kwe-spacer kubeka kufikela ku-80 wamaphesenti omuthi ngemuva komphimbo kunamaphaphu.
19. Uma ungenayo i-spacer yepulasitiki yezentengiso, sika imbobo phansi enkomishini yephepha ehlanzekile eyomile elahlwayo noma ibhodlela lamanzi lepulasitiki elingu-500-milliliter (16.9-fluid-ounce) ukuze udale igumbi lokubamba elithuthukisiwe, noma wenze umuntu akhiphe umoya ngokugcwele, avale izindebe zakhe eduze komlomo we-inhaler, cindezela kanye ngenkathi uhogela kancane kancane futhi ubambe umoya kancane futhi ubambe umoya kancane* Imizuzwana engu-10 uma ibekezelelwa.
20. Hlela I-Ambulensi Gridlock futhi Uzilungiselele Ukuzivivinya noma Ukusindisa Kosokhemisi Uma Amanethiwekhi Ekhungathekile:
21. Phakathi nobhadane lwesifuba somoya wokuduma kwesifunda, izinkulungwane zabafonayo shayela izinsiza eziphuthumayo ngesikhathi esisodwa, futhi imigqa yokuthunyelwa kwe-ambulensi ingadlula amahora angu-2 kuya kwangu-4.
22. Ngenkathi ugcina ulayini ovulekile noma i-callback ye-dispatch isebenza esigulini esinzima noma esisongela ukuphila, qhubeka unikeza ama-4 amafu e-salbutamol (albuterol) njalo ngemizuzu emi-4 (noma kufika ku-6 kuya ku-8 ukukhukhumeza njalo ngemizuzu emi-5 ngaphansi kokuqondiswa kwe-dispatcher ekucindezelekeni okusongela ukuphila). Uma ama-ambulensi engatholakali ngokuphelele futhi umshayeli ozinikele onemoto evalekile (ehlelwe ukuthi ijikelezise umoya) angafinyelela umnyango wezimo eziphuthumayo esibhedlela noma ekhemisi eziphuthumayo phakathi** nemizuzu engu-5 kuya kweyi-10**, aqondise ezokuthutha kuphela uma isiguli sihlala siqaphile futhi siqhubeka nokuthola ukufutheka kwe-spacer okuqhubekayo endleleni.

Isihlahla sesinqumo: ukuvimbela isifuba somoya esivunguzayo, ukulinganisa, kanye ne-bronchodilation yokulimala okukhulu¶

flowchart TD
    Start["KUSONDELA ENTSAPHOYA NOMA EKUQALENI KWEHLOBO - Utshani obuphezulu, ukhula, noma impova yesihlahla + isexwayiso sokuphuma kokugeleza kwangaphambili"] --> Location{"Ingabe wena noma abantu abasengozini enkulu - (i-hay fever, wheeze, noma umlando wesifuba somoya) ngaphandle?"}

    Location -->|YES: Outdoors or Windows Open| SealUp["UKUKHOSELELA NGAPHAMBI KOKUSHAYA PHAMBI KOKUSHAYA - 1. Ngena endlini noma emotweni evalekile imizuzu engu-20-30 ngaphambi kwemvula - 2. Vala wonke amafasitela, izicabha, nezimbobo zokuphuma ngaphandle - 3. Misa i-AC ibe ngu-100% UKUVUKA KWANGAKAPHAKATHI & ugijime isihlungi se-HEPA"]

    Location -->|NO: Symptoms Already Starting| Triage["I-RAPID RESPIRATORY SEVERITY TRIAGE - Hlola inkulumo, izinga lokuphefumula, ukuhlehla, umbala wesikhumba, nemisindo yamaphaphu"]
    SealUp --> SymptomsCheck{"Ingabe ukhona oqala ukukhwehlela, ukucinana kwesifuba, - ukushaywa umoya, noma ukuphelelwa umoya?"}
    SymptomsCheck -->|No Symptoms| Monitor["Hlala endlini amahora angu-2 kuya kwangu-4 ngemva kokudlula kwesiphepho - Thatha isivimbeli esinqunyiwe (ICS) kanye ne-antihistamine yomlomo"]
    SymptomsCheck -->|Yes: Symptoms Present| Triage

    Triage -->|MILD TO MODERATE - Speaks in phrases, audible wheeze, sitting up| FourByFour["QALA 4x4x4 SALBUTAMOL / ALBUTEROL PROTOCOL - 1. Hlala nesineke uqonde; ungalokothi uzivumele zilale phansi - 2. Nika ukufutha oku-1 ku-SPACER -> isiguli siphefumula ka-4 - 3. Phinda izikhathi ezi-4 (inani lokuphefumulela okungu-4 / ukuphefumula okungu-16 kwesikhala) - 4. Linda imizuzu emi-4 bese uhlola kabusha inkulumo nomsebenzi wokuphefumula"]

    Triage -->|SEVERE OR LIFE-THREATENING - Single words only, blue lips, silent chest, exhaustion| CallEMS["SHAYELA IZINKONZO EZISIPHUTHUMAYO NGOKUSHESHA - (911 / 999 / 112 / 000) & usho 'Isifuba Somoya Esinamandla Okuduma Kwezulu'"]

    FourByFour --> ImproveCheck{"Ingabe ukuphefumula nokukhuluma kwalulama ngokugcwele - ngemva kwemizuzu emi-4 yokuqala?"}
    ImproveCheck -->|YES: Fully Relieved| PostCare["Gada eduze amahora angu-4 (ingozi ye-biphasic rebound) - Nikeza okunye ukufutheka okungu-4 uma ukuhefuzela kubuya; funa ukubuyekezwa kwezokwelapha"]
    ImproveCheck -->|NO: Still Breathless| CallEMS

    CallEMS --> ContinuousReliever["OKUQHUBEKAYO KWE-BRRONCHODILATION YOMTHAMO OPHEZULU KANYE NE-STEROIDS - 1. Nikeza amanye ama-4 ngaphezulu nge-spacer njalo emizuzwini emi-4 ngesikhathi ulindile - 2. Uma isiguli sinikeze i-oral prednisolone/prednisone - noma i-SMART (budesonide/formoterol) uhlelo lokusebenza, sebenzisa manje - 3. Uma i-anaphylling, izimpawu zokushaqeka, i-hijections ikhombisa ukushaqeka I-Epinephrine emithanjeni yemisipha (0.3-0.5 mg) ethangeni elingaphandle"]

I-Atmospheric physics kanye ne-pathobiology ye-thunderstorm asthma¶

Ukuqonda ukuthi kungani kuphela iziphepho ezithile eziguquguqukayo zidala i-bronchospasm enkulu kusiza abantu ngabanye, izikole, abahleli bemicimbi yangaphandle, kanye neminyango yezimo eziphuthumayo ukuthi balindele amahora obhubhane ngaphambi kokuba kufakwe ucingo lokuqala lwe-911 noma 000.

1. Injini ye-Meteorological Enezigaba Ezine¶

Umqedazwe wesifuba somoya wokuduma kwezulu udinga ukuqondana okunembile kwezimo zezulu ze-aerobiological kanye ne-convective sezulu:

1. Isigaba 1 - Imvula Yangaphambili Yasebusika/Entwasahlobo kanye Nokukhula Kotshani: Izimvula ezinamandla zasekupheleni kobusika nentwasahlobo zibangela ukukhula kotshani obupholile (ikakhulukazi i-ryegrass ehlala isikhathi eside, Lolium perenne, utshani be-Timothy, Phleum pratense, noma amadolobha e-Pariepwita/ragweed, amadolobha afudumele, nezinhlobo ezimbalwa ze-podium, ezilandelwa yi-podium efudumele) lokho kubangela ukuqhakaza kwezimbali okuphakeme kanye nokukhululwa okukhulu komoya komoya kwezinhlamvu zempova ezingaguquki (impova enkulu ibala izinhlamvu ezingaphezu kuka-100 kuya ku-500 ku-cubic meter ngayinye yomoya).
2. Isigaba 2 - Ukushanela Okuthuthukisiwe Kwe-Convective: Njengomugqa obandayo oqinile ngaphambili, umugqa owomile, noma umugqa we-multicell squall udlula emathafeni anempova ntambama ntambama, ukuvuselelwa okufudumele ngaphambi kwesiphepho kugenca izigidigidi zezinhlamvu zempova ezitholakala emoyeni zisuka phezulu emngceleni wogqinsi ukuya kumamitha angu-0000000000000000m kuya ku-hum00000 metres (3,300 kuya ku-9,800 amafidi)* ukuphakama.
3. Isigaba 3 - Ukushaqeka kwe-Osmotic, Ukushaja Ugesi, Nokuhlukana Kwemishini: Ngaphakathi kwesisekelo samafu esinomswakama ophezulu (lapho umswakama ohlobene udlula amaphesenti angu-95 ukuya kwangu-100) nangaphakathi kwezinkundla zikagesi ezinamandla zeseli yesiphepho:
4. Izinhlamvu zempova ezingaguquki zimunca ngokushesha umswakama wamafu we-hypotonic ngokusebenzisa izimbobo zazo zamagciwane (osmotic turgor pressure surge).
5. Ingcindezi ye-hydrostatic yangaphakathi idlula amandla aqinile odonga lwempova olungaphandle (i-exine ne-intine), okubangela ukuthi okusanhlamvu kuqhume kuvuleke njengebhaluni lamanzi elincane (osmotic lysis).
6. Ngesikhathi esifanayo, amasimu kagesi aqinile (10,000 kuya ku-100,000 volts imitha) kanye nokusheya komshini phakathi kwamaconsi apholile kakhulu kanye nokuphuka kwegraupel kuphelelwe amanzi noma okumanziswe kancane okusanhlamvu kwempova kanye nezinhlamvu zesikhunta (Alternaria, Cladosporium sub--5 . ama-micrometer **).
7. Isigaba 4 - Ukugxiliswa Kwe-Cold Downdraft Concentration kanye Ne-Gust-Front Outflow Carpet-Bombing: Izinto ezingaphansi ezipholiswe yimvula zithwala lezi zigidigidi zezinhlamvana zesitashi ezigcwele ukungezwani komzimba zehle ngokushesha emhlabeni. Lapho ikholomu eyehlayo yomoya obandayo ominyene ishaya phansi, isakazeka iye phambili ngokuvundlile ku-40 kuya ku-100 km/h (25 kuya ku-62 mph)* njengendawo engashoni, enesiphithiphithi isifudumezi esingaphambili (umngcele ophumayo) kuphela 100 kuya ku-400 amamitha (330 kuya ku-1,300 amafidi) ukujula. Ngenxa yokuthi ukuphuma okubandayo kuhlanganiswe ukuguqulwa kwezinga lokushisa, izinhlayiya ze-pollen eziphukile azikwazi ukuhlakazeka phezulu; esikhundleni salokho, acindezelwa abe yifu le-bioaerosol elingabonakali, eligoqe phansi elisezingeni eliqondile lokuphefumula komuntu imizuzu eyi-10 kuye kwengama-30 ngaphambi kokuba kufike imvula enkulu ezogeza umoya uhlanzeke.

2. Ukuqhathanisa: I-Hay Fever Evamile Yesizini vs. Ubhubhane lwe-Asthma¶

Ukuqashelwa komtholampilo kanye nokuphathwa kwesinyathelo ngesinyathelo ngaphambi kwesibhedlela¶

1. Ukubona I-Bronchospasm Efihliwe Ezisulu Zesikhathi Sokuqala¶

Ngenxa yokuthi abantu abangaphezu kwesigamu abaphethwe isifuba somoya abakaze bahlaselwe yisifuba somoya ngaphambili, abaqapheli ukuthi kwenzekani emaphashini abo. Abaningi bakholelwa ukuthi banesifo senhliziyo, babamba uthuli, noma bahlaselwa yi-panic attack:

• Ukukhwehlela Okuphikelelayo, Komile, Okuphazamisekile: Kubantu abadala abaningi kanye nezingane, ukuminyana komzila womoya omncane obuhlungu ekuqaleni akuvezi njengekhwela lomculo wakudala, kodwa njengokungathi **ukukhwehlela okomile okungapheli, okuba kubi kakhulu ngawo wonke umoya wangaphandle.
• Ukuphefumula Kokuphefumula Nokuphefumula Isikhathi Eside: Ngenxa yokuthi ukucindezela kwe-intrathoracic kuyenyuka lapho kukhishwa umoya, ama-bronchioles avuvukele futhi aminyene abe mancane nakakhulu lapho isiguli sizama ukuphefumula. Ukuphefumula kuzwakala kufushane futhi kungashoni, kuyilapho ukuphefumula kuthatha isikhathi esiphindwe kabili ukuya kathathu kunokuvamile futhi kukhiqiza umsindo ophakeme womculo wekhwela (wheeze).
• I-Dynamic Hyperinflation ("I-Air Trapping"): Ngenxa yokuthi isisulu singadonsa umoya omncane ngaphambi kwama-bronchioles aminyene kodwa angakwazi ukuwukhipha ngokugcwele ngaphambi kokuba kuqale ukuphefumula okulandelayo, umoya omdala uvaleleka ngaphakathi kwe-alveoli. Isifuba siba njengomphongolo futhi sinwetshwe ngokweqile, okuphoqa isiguli ukuthi sincike phambili ezandleni ezeluliwe (i-tripod position) futhi sisebenzise imisipha yentamo nesezimbambo ukuze nje sidonse umoya omncane womoya omusha phezu kwamaphaphu aso afutheke kakhulu.
• Isixwayiso "Sesifuba Esithule" Esibulalayo: Uma isibukeli sibeka indlebe yaso esifubeni noma emhlane womuntu ohlukunyezwayo futhi ezwa noma umsindo ohefuzayo noma ovamile wokuphefumula kuyilapho isiguli sibonakala sidonsa kanzima ukuphefumula, i-bronchospasm manje isicishe iphelele ngamaphesenti angu-100. Cishe awukho umoya ongena noma ophuma emaphashini; i-hypoxic bradycardia kanye nokuboshwa kwenhliziyo kuzolandela kungakapheli imizuzu ngaphandle kwalapho i-bronchodilation enamandla kanye nokuphuma komoya okusizwayo kuqala ngokushesha.

2. Uyenza Kanjani Isu Lokuhlenga I-4x4x4 Spacer Kahle¶

Ucwaningo lwezokwelapha olwenziwe yiNational Asthma Council Australia, iGlobal Initiative for Asthma (GINA), kanye neBritish Thoracic Society lukhombisa ukuthi i-pressurized metered-dose inhaler (pMDI) exhunywe ku-valve spacer iyasebenza njengokuthi (futhi ishesha ukusethwa kuno) ipulaki yejet nebulizer yasesibhedlela, kuyilapho igwema ukuhlakazwa kwegciwane le-aerosol:

1. Misa Isiguli: Hlalisa umuntu aqonde esihlalweni noma ancike odongeni amahlombe akhe aya phambili kancane. Khulula noma iyiphi ikhola eqinile noma ibhande lesifuba.
2. Lungiselela i-Inhaler ne-Spacer:
3. Susa ikepisi ku-blue reliever pMDI (salbutamol 100 micrograms / albuterol 90 micrograms puff).
4. Nyakazisa i-inhaler ibheke phezulu imizuzwana emi-3 ukuya kwemi-5 bese ufaka umlomo uqinile eringini yangemuva yesikhala esivalekile.
5. Letha i-Puff 1 (Indlela Yokuphefumula Ngamanzi):
6. Faka umlomo womkhathi phakathi kwamazinyo esiguli ngezindebe ezivalwe ngokuqinile nxazonke (noma cindezela imaski yezingane emakhaleni nasemlonyeni wengane engaphansi kweminyaka engu-4 ubudala).
7. Cindezela ithini elithi kanye ukuze udubule pufu elingu-1 ku-spacer, futhi wenze isiguli siphefumule siphefumule kancane ngomlomo waso izikhathi ezi-4.
8. Letha i-Puffs 2, 3, kanye ne-4:
9. Nyakazisa kafushane, umlilo Ukukhukhumeza 2 (ukuphefumula kancane oku-4), Ukudonsa 3 (ukuphefumula kancane oku-4), kanye Ukukhukhumeza 4 (ukuphefumula kancane okungu-4).
10. Umjikelezo Wokuhlola kabusha wemizuzu emi-4:
11. Linda imizuzu emi-4 ngesikhathi ubuka ukunyakaza kwesifuba, ubude benkulumo, nombala wezindebe.
12. Uma usahefuzela, ukhwehlela, noma uphefumula ngemizuzu emi-4, phinda ngokushesha omunye umjikelezo wokudonsa okungu-4 (ukuphefumula oku-4 ngakunye).
13. Umthamo Ophakeme Wangaphambi Kwesibhedlela: Ngenkathi ulinde i-ambulensi ebambezelekile ngesikhathi somcimbi omkhulu wesifuba somoya wokuduma kwezulu, abantu abadala kanye nezingane ezingaphezu kweminyaka engu-6 abacindezeleke kakhulu bangathola ngokuphepha ukukhukhumala okungu-4 njalo ngemizuzu emi-4 (noma 6 kuya ku-8 ukukhukhumeza njalo emizuzwini emi-5 kumuntu omdala ososizini olusongela ukuphila ngaphansi kokuqondisa komthumeli). Imiphumela emibi yesikhashana yedosi ephezulu ye-salbutamol/albuterol, njengezandla eziqhaqhazelayo nokushaya kwenhliziyo okusheshayo, ilindeleke imiphumela yezemithi futhi iyingozi kakhulu kunokuphelelwa umoya okungalashwa.

3. Izindlela Zokusebenza Eziphuthumayo Uma Ingekho I-Asthma Inhaler Ekhona Esigcawini¶

Ngenxa yokuthi amaphesenti angu-40 kuya kwangu-60 ezisulu zesifuba somoya wokuduma kwezulu awanawo amandla okudonsa umoya lapho isiphepho sihlasela, ababukele namalungu omndeni bavame ukubhekana negebe elesabekayo kuyilapho ama-ambulensi ebambezeleka:

• Boleka I-Reliever Inhaler Ngokushesha (Ukwabelana Nge-Bronchodilator Enhle YamaSamariya):
• Ekuhlaselweni kwesifuba sokuduma kwezulu esisongela ukuphila, ungangabazi ukubuza omakhelwane, osebenza nabo, othisha, noma abadlulayo ukuthi ingabe kukhona ophethe i-salbutamol/albuterol inhaler eluhlaza okwesibhakabhaka noma i-budesonide/formoterol inhaler.
• Sula umlomo nge-swab yotshwala noma ngendwangu ehlanzekile, noma ushise i-inhaler oyibolekile ngenkomishi yephepha ethuthukisiwe ehlanzekile noma usike isikhala sebhodlela lamanzi lepulasitiki ukuze kungabikho ukuthintana komlomo ngokuqondile, bese uphatha 4x4x4 protocol.
• Hlola ukuthi Ikhemisi Iphakathi Kokuhamba Ngokushesha Noma Ibanga Eliyimizuzu emi-2 Lokushayela:
• Ezindaweni ezifana ne-Australia (Shejuli 3 Pharmacist-Only Medicine), e-United Kingdom (Imithetho Yezimo Eziphuthumayo), e-Canada, kanye nezingxenye ze-European Union, osokhemisi bomphakathi bagunyazwe ngokusemthethweni ukuthi bakhiphe isimo esiphuthumayo se-salbutamol (albuterol) inhaler kanye ne-spacer ngaphandle kwencwadi kadokotela ngesikhathi esiphuthumayo sokuphefumula.
• Usetshenziswa Nini I-Epinephrine Auto-Injector (EpiPen / Jext / Emerade / Auvi-Q):
• Abantu abaningi abangezwani kahle ngotshani noma abangezwani nokudla okuthile baphatha i-epinephrine (adrenaline) auto-injector e-*intramuscularly ngisho noma bengawuphathi i-salbutamol inhaler.
• I-epinephrine inamandla i-alpha engakhethi kanye ne-beta-2 adrenergic agonist ekhulula ngokushesha imisipha ebushelelezi ye-bronchi futhi yehlise i-mucosal edema yomoya.
• Ngokusho kwemihlahlandlela yokuvuselela kanye ne-anaphylaxis, uma isiguli sihlupheka ** i-bronchospasm esongela ukuphila ** (engakwazi ukukhuluma, i-cyanotic, isifuba esithulile, noma ukugoqa) futhi ** noma ** ibonisa noma yisiphi isici se-systemic anaphylaxis ** noma ** inokufinyelela ** zero ku-beta-2 i-agonist inhaler ngenkathi ibhekene ne-inminent ephethwe * i-auto-injector (0.3 mg yabantu abadala kanye nezingane ezingaphezu kuka-30 kg [66 lb]; 0.15 mg ezinganeni ezingu-15 kuya ku-30 kg [33 kuya ku-66 lb])** phakathi nethanga elingaphandle (vastus lateralis) lingasindisa ukuphila kuyilapho abezimo eziphuthumayo besabela.
• Ukuma, Ukuphefumula Izindebe Ezipholile, nokuthi OKUNGAMELE Ukwenze:
• Ungasifaki isiguli eshaweni eshisayo noma usihogele isitimu esishisayo: Umswakama ophezulu nesitimu esifudumele kungase kubangele i-reflex bronchoconstriction emigwaqweni yomoya esabela kakhulu futhi kubangele ukuhlukana kwempova okwengeziwe.
• UNGAMBE isiguli siphefumula esikhwameni sephepha: Ukuphefumula kabusha kwesikhwama sephepha kuyinganekwane ephelelwe yisikhathi ye-hyperventilation eyehlisa ngokushesha umoya-mpilo ophefumulelwe (\(FiO_2\)) futhi kungabulala isiguli sesifuba somoya esingaphili.
• Qeqesha isiguli ukuthi sihogele kancane ngamakhala aso (afudumeza, afudumale, futhi ahlunge noma yiziphi izinhlayiya ezisele zasendlini) futhi akhiphe kancane kancane ngokusebenzisa izindebe ezigobekile (njengokuphephezela ngobumnene isobho elishisayo), okudala *amasentimitha angu-5 kuya kwangu-10 amanzi okucindezela kokuphela kokuphefumula okungaphakathi (okuzenzakalelayo kwe-PEEP ikhipha umoya ngaphakathi kokuphefumula okuncane)

Ukuvimbela abaphethwe i-hay fever entwasahlobo nasekuqaleni kwehlobo¶

Uma uba nokuthimula ngezikhathi ezithile zonyaka, amehlo alume amanzi, noma ukuminyana kwamakhala ngesikhathi sotshani noma inkathi yempova yezihlahla, iziphathimandla zezokwelapha zikubeka njengengcuphe enkulu yobhubhane lwesifuba somoya esiwubhubhane ngisho noma amaphaphu akho ehlale ezizwa ephile saka:

1. Qala I-Daily Intranasal Corticosteroid Spray kanye Ne-Preventer Inhaler Ekuqaleni Kwesizini Yempova:
2. Qala ukusebenzisa isifutho se-intranasal corticosteroid* (i-fluticasone, i-mometasone, noma i-budesonide) amasonto angu-2 kuya kwangu-4 ngaphambi kwenkathi yempova yotshani ephakeme kakhulu, ehambisana ne-antihistamine yomlomo yansuku zonke.
3. Uma wake waba nokushaywa umoya okuncane, ukukhwehlela ebusuku, noma ukucinana kwesifuba ngesikhathi sasentwasahlobo noma ukujima, thola isivimbeli se-corticosteroid (ICS) esihogelwa nsuku zonke (noma budesonide/formoterol anti-inflammatory reliever). Kubhubhane lwango-2016 lwase-Melbourne, cishe amaphesenti angu-90 eziguli zesifuba somoya e-ICU zazingathathi isivimbeli esivamile se-ICS.
4. Ungalokothi Udlule Entwasahlobo Ngaphandle Kokuthwala I-Blue Reliever Inhaler + Spacer:
5. Gcina i-salbutamol (albuterol) pMDI esesikhathini samanje kanye ne-valve spacer* elingana nephakethe esikhwameni sakho kanye nekhithi yosizo lokuqala yasekhaya entwasahlobo nasekuqaleni kwehlobo.
6. Qapha Impova Esemthethweni Nezinhlelo Zokuduma Kwesifuba Sesifuba Sezulu:
7. Ngezinsuku ezilinganiselwe Eziphezulu noma Ezidlulele kukho kokubili impova yotshani kanye nokuduma kwezulu okukhulu, khansela imikhuba yezemidlalo yangaphandle, ukugijima, nohambo lwangaphandle phakathi newindi le-convective lantambama nakusihlwa.
8. Gqoka I-Tight-Fitting N95 / P2 / FFP2 Respirator Uma Ubanjwe Ngaphandle Phakathi KweGust Front:
9. Uma uphoqeleka ukuba uhambe ngaphandle ngesikhathi somoya ophumayo onempova ephezulu, gqoka okukulingana kahle NIOSH N95, Australian/NZ P2, noma isiphefumula saseYurophu se-FFP2 (ukuhlunga okungenani amaphesenti angu-94 kuya kwangu-95 ezinhlayiya ezincane ze-micron) futhi uphefumule ngokuqinile ngekhala lakho uze ungene endlini.
10. Ukukhipha Ukungcola Kwangemva Kwesiphepho Ngaphakathi:
11. Uma usungaphakathi ngemva kokuchayeka, khipha izingubo zangaphandle ngokushesha, ugeze ubuso bakho nezinwele, futhi wenze i-saline ehlanzekile yokuwasha emakhaleni.

Izinombolo zezimo eziphuthumayo zesifunda kanye nezinqubomgomo ze-ejensi¶

Imibuzo evame ukubuzwa¶

Kungani ukuhlasela kwesifuba somoya kokuduma kwezulu kwenzeka emizuzwini engu-20 NGAPHAMBI kokuba liqale ukuna kunokuba kube phakathi nemvula?¶

Inani eliphakeme kakhulu lama-microscopic ruptured pollen starch granules lihamba ngaphakathi komoya obandayo ophumayo wesiphepho (i-gust front), ogijima amakhilomitha angu-10 kuya kwangu-30 (amamayela angu-6 kuya kwangu-19) ngaphambi komgodi wemvula wangempela. Ngaphakathi kwesisekelo samafu, izinhlamvu zempova zigcwala umswakama futhi ziqhume zibe izingcezwana ezingu-0.5-to-2.5-micrometer, ezibese zidudulwa phansi phansi ngamakhaza abandayo bese ziphephezelwa ngaphandle emhlabathini ngaphambi kwesiphepho. Imvula enamandla eshaya phansi kamuva isiza ukugeza nokukhuhla impova emisiwe emkhathini ophansi, yingakho iwindi eliyingozi kakhulu kuwukuvunguza komoya owomile noma onenkungu kancane ngaphambi nje kokuba imvula ifike.

Ingabe umuntu ongakaze abe nesifuba somoya empilweni yakhe yonke angayidinga ngempela i-ambulensi noma afe ngesikhathi somcimbi wesifuba somoya wokuduma kwezulu?¶

Yebo: izifundo ze-post-dister epidemiological ezivela enhlekeleleni yase-Melbourne ka-2016 kanye nobhubhane olufanayo eLondon, eNaples, eWagga Wagga, nase-Ahvaz lubonise ukuthi amaphesenti angu-40 kuya kwangu-60 abantu abethula eminyangweni yezimo eziphuthumayo ayengakaze axilongwe ngaphambili, futhi abaningi babengazi ukuthi i-reliever inhaler ibukeka kanjani. Nokho, amaphesenti angu-95 kuya kwangu-99 alezo zisulu ayene-hay fever (i-allergenic rhinitis) ngezikhathi ezithile zonyaka futhi ayengezwa ngokuzivikela komzimba (ephethe amasosha omzimba e-IgE) e-ryegrass noma ezintweni ezingezwani nesikhunta. Ngenxa yokuthi impova engaguquki ayifinyeleli emaphashini aphansi ngezinsuku ezivamile, imigudu yawo yomoya ephansi yayingakaze ihlolwe kwaze kwaba yilapho isiphepho sokuduma siphahlaza impova yaba izinhlayiya ezingama-2-micrometer ezikwazi ukungena zijule kuma-bronchioles azo.

Uma ngithatha ithebhulethi ye-antihistamine yomlomo efana ne-cetirizine, i-loratadine, noma i-fexofenadine lapho ngiqala ukuphefumula phakathi nesiphepho, ingabe lokho kuzomisa ukuhlasela kwesifuba somoya?¶

Cha: ngenkathi uthatha i-antihistamine yomlomo engathuli ngaphambi kwesiphepho kusiza ekunciphiseni ukuthimula kwendlela yokuphefumula ephezulu kanye nokubonisa i-histamine encane, ama-antihistamine omlomo athatha imizuzu engu-30 kuya kwengu-60 ukuze afinyelele amazinga aphezulu egazi futhi awakwazi ukuhlehlisa ukuvinjelwa okunamandla kwe-bronchial smooth-muscle constriction (okuqhutshwa kakhulu yi-cysteinesyl cysteine, lestaukoglansyl cysteine, lestaukoglansyl cysteines, lestaukoglansyl cysteine, lestaukoglan ngaphezu kwe-histamine). Ukuhlasela kwesifuba somoya esinamandla okuduma kudinga i-bronchodilator ehogeliwe (salbutamol/albuterol nge-spacer noma budesonide/formoterol) ukuze kukhululeke ngokushesha imisipha yomoya, kanye ne-corticosteroids ukuze kwehlise ukuvuvukala kwendlela yomoya ephansi.

Mangaki ama-puff we-salbutamol (albuterol) inhaler eluhlaza okwesibhakabhaka amaningi kakhulu uma i-ambulensi ilibaziseka isikhathi esingaphezu kwehora ngesikhathi kunesimo esiphuthumayo?¶

Esimeni esiphuthumayo sesifuba somoya esinzima noma esisongela ukuphila lapho amanethiwekhi e-ambulensi egcwele khona, izazi ze-toxicologists zezokwelapha neziqondiso zokuphefumula zigcizelela ukuthi i-hypoxia (ukuntuleka komoya-mpilo emigwaqweni yomoya evaliwe) iyabulala phakathi nemizuzu, kanti i-salbutamol/albuterol ehogeliwe inomkhawulo obanzi wokuphepha. Ukulandela umthetho olandelwayo we-4x4x4 (ukuphefumula okungu-4 nge-spacer njalo ngemizuzu emi-4) ngokuqhubekayo kuze kube yilapho ukuphefumula kuba ngcono noma kufike abezimo eziphuthumayo kuphephile futhi kusindisa ukuphila. Ngisho nangemva kokukhukhumala okungama-20 kuya kwangu-40 esikhathini esingangehora, imiphumela engemihle eyinhloko izandla ezinyakazayo, ukungahlaliseki, nokushaya kwenhliziyo okusheshayo, odokotela abakwazi ukukulawula kalula lapho imigudu yokuphefumula yesiguli isivuliwe.

Kungani ukusebenzisa i-spacer yepulasitiki kubaluleke kangaka ngesikhathi sokuhlasela kwesifuba somoya okunzima kunokuba uvele ufafaze i-inhaler ngqo emlonyeni?¶

Lapho umuntu ehefuzela ephefumula okungu-30 kuye kwangama-40 ngomzuzu phakathi ne-bronchospasm enzima, akakwazi ukuxhumanisa ukucindezela i-inhaler canister ngokuhogela kancane okuyimizuzwana emi-4, futhi abakwazi ukubamba umoya wabo imizuzwana eyi-10. Ukudubula i-inhaler enomfutho ngokuqondile emlonyeni ngesikhathi sokuqhuma okusheshayo amaphesenti angu-80 kuya kwangu-90 amaconsi e-aerosol ebangeni elingu-100 km/h (62 mph) aqonde ngqo olimini nangemuva komphimbo, lapho egwinywa ngokungenabungozi esiswini. Ukudubula ukufutha okukodwa ku-spacer esivalekile kumisa inkungu yezidakamizwa engabonakali egunjini ukuze isiguli sikwazi ukuphefumula nokuphuma izikhathi ezi-4 ngejubane laso lemvelo, siletha imithi ephindwe izikhathi ezi-3 kuya kwezi-4 ekujuleni kwamaphaphu aminyene.

Lo mhlahlandlela ngowezinjongo zokwaziswa futhi awuthathi indawo yokuhlolwa kwezokwelapha okuqeqeshiwe noma ukuqeqeshwa kosizo lokuqala. Sincoma ngokuqinile ukuthatha izifundo ezigunyaziwe Zosizo Lokuqala, I-Asthma Management, ne-CPR nge-International Federation of Red Cross and Red Crescent Societies (IFRC), umphakathi wakho kazwelonke we-Red Cross, i-St John Ambulance, noma isisekelo sakho se-asthma sikazwelonke.

Iziqondiso ezihlobene¶

• I-asthma ihlasela usizo lokuqala kanye ne-inhaler protocols
• Ukungezwani komzimba nokunakekelwa okuphuthumayo kwe-anaphylaxis
• Ukuduma kwezulu nokuphepha kombani
• I-Derecho, umoya womugqa oqondile, nokusinda kwe-microburst
• Izinombolo zesimo esiphuthumayo ngezwe

Imithombo neziqondiso ezisemthethweni¶

• UMkhandlu Kazwelonke We-Asthma Australia: Incwadi Ye-Asthma Yase-Australia - I-Epidemic Thunderstorm Isiqondiso Somtholampilo Wesifuba Somoya kanye ne-4x4x4 First Aid Protocol.
• Umnyango Wezempilo We-Victorian & Bureau of Meteorology (Australia): Uhlelo Lokubikezela I-Asthma Ewubhubhane kanye Nemihlahlandlela Yempendulo Yezempilo Yomphakathi (Ukubuyekezwa Kwe-Melbourne Kwangemva kuka-2016).
• I-Global Initiative ye-Asthma (GINA): Isu Lomhlaba Lonke Lokulawulwa Nokuvimbela I-Asthma - Ukuphathwa Kwesifuba Sesifuba Esiba Sibi kakhulu kanye Nokwenyuka Okubukhali.
• I-World Health Organization (WHO) & World Allergy Organization (WAO): Ukuguquguquka Kwesimo Sezulu, I-Aerobiology, Ukuphuka Kwempova Ye-Osmotic, kanye Nezifo Ezihlobene Nokuduma Kwemimoya Yokuphefumula.
• I-British Thoracic Society (BTS), i-NICE, ne-Scottish Intercollegiate Guidelines Network (SIGN): Umhlahlandlela WaseBrithani Wokuphathwa Kwe-Asthma.
• Centers for Disease Control and Prevention (CDC, United States) & American Academy of Allergy, Asthma & Immunology (AAAAI): Izindlela Ze-Asthma Yesivunguvungu, I-Sub-Pollen Bioaerosols, kanye Nokulungiselela I-Emergency Bronchodilator Preparedness.