Ukuhlaziywa kwe-meta okushicilelwe ku-Internal Medicine kukhombisa ukuthi ama-antibiotics kanye ne-systemic glucocorticoids ahlotshaniswa nokwehluleka kokwelashwa okumbalwa kubantu abadalaI-COPDama-exacerbations uma kuqhathaniswa ne-placebo noma akukho ukungenelela kokwelapha.

Ukuze kwenziwe ukubuyekezwa okuhlelekile nokuhlaziywa kwe-meta, uClaudia C. Dobler, MD, Bond University, Australia, nabanye bahlola izivivinyo ezilawulwa ngokungahleliwe ze-68, kuhlanganise neziguli ezikhulile ze-10,758 ezine-acute exacerbations.I-COPDabelashwa esibhedlela noma esibhedlela.Ucwaningo luqhathanise ukungenelela kwemithi ne-placebo, ukunakekelwa okujwayelekile noma okunye ukungenelela kwemithi.

Izinzuzo zama-antibiotics kanye ne-systemic glucocorticoids

Ocwaningweni oluqhathanisayo lwezinsuku eziyi-7-10 zemithi elwa namagciwane kanye ne-placebo noma ukunakekelwa okuvamile kweziguli ezilaliswe esibhedlela noma ezilaliswa ngaphandle, ekupheleni kokwelashwa, ama-antibiotic ahlobene nokukhululwa kokubhebhetheka kwesifo esibi kakhulu, kodwa akuhlangene nhlobo ukuqina kokukhushulwa kanye nemvelo yokwelapha (NOMA = 2.03; 95% CI, 1.47- -2.8; ikhwalithi elinganiselwe yobufakazi).Ngemuva kokuphela kokungenelela kokwelashwa, ocwaningweni lweziguli eziphuma ngaphandle ezinokukhushulwa okunamandla okuncane, ukwelashwa kwe-systemic antibiotic kunganciphisa izinga lokwehluleka kokwelashwa (NOMA = 0.54; 95% CI, 0.34-0.86; amandla obufakazi obulingene).Iziguli ezilaliswayo kanye neziguli ezilaliswayo ezinokweqisa okumaphakathi noma okumaphakathi kuya kokuqina, ama-antibiotics angakwazi futhi ukunciphisa ubunzima bokuphefumula, ukukhwehlela nezinye izimpawu.

Ngokufanayo, ezigulini ezilaliswayo kanye neziguli ezingaphandle, i-systemic glucocorticoids iqhathaniswa ne-placebo noma ukunakekelwa okuvamile.Ngemuva kwezinsuku ze-9-56 zokwelashwa, i-glucocorticoids ye-systemic ayinamathuba amancane okuhluleka (NOMA = 0.01; 95% CI, 0- 0.13; ikhwalithi yobufakazi iphansi), kungakhathaliseki ukuthi imvelo yokwelashwa noma izinga lokukhushulwa okukhulu.Ekupheleni kwezinsuku ezingu-7-9 zokwelashwa, iziguli ezinobunzima obuncane ukuya kobunzima emtholampilo weziguli ezingalaliswa esibhedlela kanye ne-dyspnea yazo yakhululeka.Kodwa-ke, i-systemic glucocorticoids ihlotshaniswa nokwanda kwenani lezehlakalo ezimbi ezihlobene ne-endocrine.

Abacwaningi bakholelwa ukuthi ngokusekelwe kulokho abakutholile, odokotela kanye nozakwabo kufanele baqinisekiswe ukuthi ama-antibiotics kanye ne-systemic glucocorticoids kufanele isetshenziswe kunoma yikuphi ukwanda okukhulu kwesifo.I-COPD(noma ngabe imnene).Ngokuzayo, bangakwazi ukunquma kangcono ukuthi yiziphi iziguli ezizozuza kakhulu kulokhu kwelashwa nokuthi iziphi iziguli ezingase zingazuzi (ngokusekelwe kuma-biomarker, okuhlanganisa amaprotheni e-C-reactive noma i-procalcitonin, i-eosinophils yegazi).

Udinga ubufakazi obengeziwe

Ngokusho kwabaphenyi, alukho ulwazi olubalulekile mayelana nokuthandwa kwama-antibiotics noma i-glucocorticoid therapy, kanye nobufakazi bokusetshenziswa kweminye imithi, kuhlanganise ne-aminophylline, i-magnesium sulfate, izidakamizwa ezilwa nokuvuvukala, i-corticosteroids ephefumulayo, nama-bronchodilators asebenza isikhathi esifushane.

Umcwaningi uthe uzongabakhuthazi odokotela ukuthi basebenzise izindlela zokwelapha ezingenabufakazi, njenge-aminophylline ne-magnesium sulfate.Abacwaningi bakholelwa ukuthi nakuba kunezifundo eziningi nge-COPD, imithi eminingi yokwelapha ukukhushulwa kwe-COPD ayinabo ubufakazi obanele.Isibonelo, ekusebenzeni komtholampilo, ngokuvamile sisebenzisa ama-bronchodilator abamba isikhathi esifushane ukuze akhulule i-dyspnea ngesikhathi sokwanda okukhulu kwe-COPD.Lokhu kufaka phakathi abaphikisi be-muscarinic receptor abenza isikhathi esifushane (ipratropium bromide) kanye nama-agonists ama-beta receptor abamba isikhathi esifushane (salbutamol).

Ngaphezu kocwaningo lwekhwalithi ephezulu, ucwaningo oluthembekile ekwelashweni kwezidakamizwa, abacwaningi baphinde baveza ukuthi ezinye izinhlobo zokungenelela zingahle zifundwe.

“Ubufakazi obukhulayo bubonisa ukuthi izindlela zokwelapha ezithile ezingezona ezemithi, ikakhulukazi lezo eziqala ukuzivocavoca ekuqaleni kwesigaba sokubhebhetheka, zingase zithuthukise ukushuba okumaphakathi kuya kokunzima kweziguli zeCOPD esibhedlela.I-American Thoracic Society/European Respiratory Conference ngo-2017 Iziqondiso ezikhishiwe zihlanganisa izincomo ezinemibandela (ikhwalithi ephansi kakhulu yobufakazi) ngesikhathi sokulaliswa esibhedlela sokukhushulwa okukhulu kwe-COPD, ungaqali ukuvuselelwa kwamaphaphu, kodwa kuye kwavela ubufakazi obusha kusukela ngaleso sikhathi ukuthi sidinga ubufakazi obuningi bekhwalithi ephezulu bokuvivinya umzimba kusenesikhathi ngesikhathi sokwanda okukhulu kwe-COPD Ukuqinisekisa ukusebenza kahle kokuvivinya umzimba kusenesikhathi ukuze kubhebhetheke kakhulu kwe-COPD.