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Ffiltvebis qronikuli obstuqciuli daavadeba da misi marTva lali miqiaSvili tfdc. 2 marti, 2010
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Ffiltvebis qronikuli obstuqciuli daavadeba (fqod) ( Chronic obstructive pulmonary disease- COPD) janmo-s 2005 wlis monacemebi: 80 mln adamiani daavadebulia fqod-s saSualo an mZime formiT. 3 mln adamiani gardaicvala fqod-iT, rac globaluri sikvdilianobis 5%-s Seadgens. sikvdilianobis 90% modis saSualo da dabalSemosavlian qveynebze.
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janmo-s monacemebi: 2002 wels fqod-m daikava V adgili sikdilianobis mxriv; 2030 wels savaraudod daiWers III adgils.
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Ffiltvebis qronikuli obstuqciuli daavadeba (fqod) : ( Chronic obstructive pulmonary disease- COPD) aSS-Si uWiravs me-4 adgili sikvdilianobis mxriv; aSS-Si sikvdilianobis 10 yvelaze xSirad gamomwvev daavadebas Soris, fqod aris erTaderTi, romlis sikvdilianobis maCvenebelic izrdeba.
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Ffqod-s gansazRvreba: ( ERS/ATS) Ffqod-s aris daavadeba, romlis mkurnaloba da prevencia SesaZlebelia da xasiaTdeba : ventilaciis darRveviT, romelic arasrulad Seqcevadia; Cveulebriv progresirebs; asocirebulia gamRizianebel agentze filtvebSi araadeqvaturi anTebadi pasuxis ganviTarebasTan; asocirebulia sistemur garTulebebTan.
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fqod aerTianebs : qr. obstruqciuli bronqiti; emfizema; 3.α-1 antitrifsinis deficiti.
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garTulebebi: filtvismieri guli; policitemia; sunTqvis ukmarisoba; Ramis hipoqsia; bronqogenuli karcinoma; motexilobebi; barZayis Zvlis mineralizaciis darRveva; kataraqta depresia
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saWiroa fqod-s adreuli gamovlena: klinicistebis ganswavla; fqod-s specifiuri skriningi; specialuri kiTxvaris roli pirveladi jandacvis qselSi
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spirometria
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Ffqod-s stadia Bbronqodilatatoris miRebis Semdeg tifnos indeqsi ( FEV 1 /FVC): bronqodilatatoris miRebis Semdeg FEV 1 %: I - msubuqi</= 0.7 >/= 80% II –saSualo simZimis </= 0.7 50-80% III -mZime</= 0.7 30-50% IV-Zalian mZime</= 0.7 < 30% spirometria: ( Global Strategy for Diagnosis, Management, and Prevention of COPD ).
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Ffqod-s mkurnaloba miznad isaxavs: respiratoruli Civilebis Seamcirebas; gamwvavebebis Semcirebas; filtvis funqciis gaumjobesebas; sicocxlis xangrZlivobis gazrdas.
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individualuri pacientisaTvis unda ganisazRvros ras vmkurnalobT : sunTqvis ukmarisobas? gamwvavebebs? – hospitalizaciis prevencia an misi vadis Semcireba? aqtivobis gazrdas? eqimsac da avadmyofsac naTlad unda esmodeT mkurnalobis mizani
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Ffqod-s stadia daxasiaTebarekomendaciebi yvela risk-faqtorebis moSoreba; gripis sawinaaRmdego vaqcinacia I msubuqi FEV1/FVC < 0.70; FEV1 >/= 80% SA-BD saWiroebisas; II saSualo FEV1/FVC < 0.70 FEV1-50-80% samkurnalo sqema: orkomponentiani- BD ; reabilitaciaA III mZime FEV1/FVC < 0.70 FEV1-30-50% samkurnalo sqema: erT- an orkomponentiani- BD ; + sainhalacio kortikosteroidi; reabilitaciaA IV Zalian mZime FEV1/FVC < 0.70 FEV1 < 30% samkurnalo sqema: erT- an orkomponentiani- BD + sainhalacio kortikosteroidi; oqsigenoTerapia, qirurgia, reabilitaciaA
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Ffqod-s samkurnalo preparatebi: antiqolinerguli bronqodilatatorebi; xangrZlivi moqmedebis β-agonistebi; sainhalacio kortikosteroidebi (kombinaciaSi);
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asTmisa da fqod-s samkurnalo medikamentebi gansxvavdeba erTmaneTisagan fqod-s dros ar gamoiyeneba: qromolini; leikotrinebis antagonistebi; sainhalacioKkortikosteroidebis monoTerapia
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miRwevebi fqod-s mkurnalobaSi: or- da samkomponentiani reJimi: bronqodilatatorebis sxvadasxva klasis kombinacia β 2 -agonistebi: a. xanmokle moqmedebis ( Albuterol) b. gaxangrZlivebuli moqmedebis (salmeteroli, formeteroli) antiqolinerguli saS-bebi: a. xanmokle moqmedebis (I pratropium bromide) ; b. gaxangrZlivebuli moqmedebis ( Tiotropium) mag. Tiotropium+ formeterol; Tiotropium+salmeterol. kortikosteroidebi bronqodilatatorebTan kombinaciaSi.
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iotropium
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Ppnevmoniis signali Psainhalacio kortikosteroidebi pnevmoniis signali: maRali dozis kortikosteroidebis gamoyeneba asocirebulia pnevmoniasTan; ar arsebobs sarwmuno cnobebi sikvdilianobis matebaze; sikvdilianobis maCvenebeli klebulobs kombinirebuli Terapiisas. kvlevebi: TORCH, INSPIRE, SMART, UPLIFT, Registry Study in America, Erst and Suisa
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reabilitacia: fizikuri varjiSi zeda da qveda kidurebis aqtiuri datvirTviT; sasunTqi kunTebis varjiSi; fizioTerapia; fsiqosocialuri daxmareba (depresia); ganaTleba.
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oqsigenoTerapia PCvenebebi: P PaO 2 < 7,3 kPa ; SaO 2 < 80% Aan PaO 2 = 7,3 - 7,8 kPa + filtvismieri guli, policitemia. Ooqsigenaciis mizani: P PaO 2 > 8kPa, SaO 2 > 90%
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qirurgia: National Emphysema Treatment Trial (NETT)
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qirurgia: National Emphysema Treatment Trial (NETT)2 Patient s 90 Day Mortality LVRS 90 Day Mortality Medical Therapy P Value 29,2mos Mortality LVRS 29,2mos Mortality Medical Therapy Risk Ratio P Value Group A 20/70 (28,6) 0/70(0)<.00142/7030/701,82.06 Group B 4/139(2,9)5/151(3,3)1.0026/13951/1510,47.005 Group C 6/206(2.9)2/213(0,9)0.1734/20639/2130,98.70 Group D 7/84(8,3)0/65(0)0,0228/8426/650,81.49 Group E 11/109 (10,1) 1/111(0,9)0,00327/10914/1112,06.02
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sicocxlis xangrZlivoba : Ffam 1 (FEV 1) sicocxlis xangrZlivoba >/= 1,2L10 weli =1L5 weli <700 ml2 welze naklebi
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janmo-s prevenciuli RonisZiebebi Seiqmna: GARD(Global Alliance against Chronic Respiratory Disease) Mmisi erTerTi nawilia GOLD (Global Initiative for Chronic Obstructive Disease)
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Tambaqos mowevaze kontroli
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sabinao pirobebSi haeris dabinZureba
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daskvna aucilebelia fqod-s adreuli gamovlena; gasaumjobesebelia fqod-s gamovlenis strategia; prevenciuli RonisZiebebis aqtiuri Catareba; aucilebelia kombinirebuli Terapiis Catareba fqod-s gamosavlis gasaumjobeseblad; pacientis mkurnalobaze damyolobis gaumjobeseba; axali, efeqturi Terapiis aucilebloba.
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gmadlobT yuradRebisaTvis
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