Inyathelo lokuqala kwizigulana, ababoneleli, kunye nabenzi bomgaqo-nkqubo

Amagqabantshintshi enyathelo

I-Corticosteroids iyacetyiswa kunyango lwabaninzi izifo, kubandakanywa nokwaliwa, isifuba, i-atopic dermatitis (ekwabizwa ngokuba yi-eczema), isifo esingapheliyo se-pulmonary (COPD), i-eosinophilic esophagitis (EoE), kunye neempumlo zempumlo (ezidla ngokuba zizifo ze-T2). I-Corticosteroids ziziyobisi ezinamandla ezichasayo (unokucinga ngokudumba njengokudumba).

Ngokuxhomekeke kwisifo ekujoliswe kubo ukunyanga, i-corticosteroids ingaba:

  • ifakwe empumlweni (intranasally),
  • uphefumlele ngaphakathi okanye uphefumlele ngaphakathi,
  • ndiginye,
  • Itofwe,
  • okanye inokunikwa ngesikhumba njenge-ointments okanye i-creams (i-topical).

I-corticosteroids yomlomo (i-OCS), xa ithathwa ngomlomo, isetyenziswe ngokuqhelekileyo ixesha elifutshane (ngokuqhelekileyo iintsuku ze-3-7), ukuphatha izifo zesifo okanye ukuhlaselwa - okanye ixesha elide ukunyanga izifo ezinzima ezingalawulwayo kunye nolunye unyango. Abantu abanezifo ezininzi basenokusebenzisa ngaphezu kodidi olunye lwe-corticosteroid (umzekelo, i-corticosteroid enye e-inhaled kunye ne-topical enye).

Xa isetyenziswe ngokufanelekileyo, i-corticosteroids yonyango olubalulekileyo nolusebenzayo oluchasayo. Nangona kunjalo, njengamachiza amaninzi, i-corticosteroids ingaba nemiphumo emibi. Ezinye zezi ziphumo bezingalindelekanga zezexesha elifutshane kwaye ezinye zezexesha elide. IiCorticosteroids zakha emzimbeni ngokuhamba kwexesha, kwaye xa umntu ezisebenzisa ngakumbi, ingozi enkulu yeziphumo ebezingalindelekanga zexesha elide.1,2

I-OCS, zombini xa ithathwa ixesha elide kwaye ithathwa amatyeli amaninzi ngexesha elifutshane, idlala indima enkulu kwezi ntlobo zeziphumo ebezingalindelekanga. Siyazi ukuba ukuthatha ukuqhuma okufutshane kwe-OCS ngamaxesha ambalwa nje amane ebomini bakho kunokunyusa umngcipheko weemeko ezininzi ezifana nesifo sikashukela, i-cataracts, kunye ne-osteoperosis.1 Ezinye iintlobo ze-corticosteroids, ezibandakanya i-inhaled, intranasal, kunye ne-ointments, zinokongeza kwi-buildup yonke ye-corticosteroids emzimbeni. Xa abantu besebenzisa iindlela ezininzi ze-corticosteroids ukunyanga izifo ezininzi, amathuba abo okuba neziphumo ebezingalindelekanga ziyanda.

Ukuthatha ukuqhuma okufutshane kwe-OCS kangangezihlandlo ezine ebomini bakho kunokwandisa umngcipheko we-stroke, ukungaphumeleli kwentliziyo, i-Type 2 yeswekile, i-cataracts, i-osteoporosis, i-bone fractures, i-pneumonia, ukudandatheka / ukuxhalaba kunye nokukhubazeka kwezintso.1

Nangona umngcipheko weziphumo ebezingalindelekanga zexesha elide, i-OCS ihlala isetyenziswa kakhulu kwaye inikwe ngoogqirha ngaphaya koko kucetyiswayo.3-5 Ukunciphisa oku kusetyenziswa okunokuba yingozi kwaye kuhlala kungafanelekanga, i-GAAPP ikhuthaza imfundo yobugosa be-steroid kunye nenyathelo lokuxhobisa izigulana, ababoneleli, kunye nabenzi bomgaqo-nkqubo. Iinjongo zeli phulo zezi:

  • Ukuqinisekisa ukuba izigulane zixhomekeke kuphela kwi-OCS xa zonke ezinye iindlela zonyango ziphelile (into yokugqibela. 
  • Ukuphakamisa ulwazi malunga nemiphumo ye-OCS yexesha elifutshane kunye nexesha elide
  • Ukuqinisekisa ukuba isigulane ngasinye sifumana unyango oluchanekileyo ngexesha elifanelekileyo kunye nemiqobo embalwa yokufezekisa umphumo ongcono
  • Ukuqinisekisa ukuba izigulane kunye nababoneleli bazo babandakanyeka ekwenzeni izigqibo ekwabelwana ngazo, ngakumbi ngokubhekiselele kwi-corticosteroids
Ibali likaStacey

UStacey wabelana ngesisa ngamava akhe ngezigulo ezinganyangekiyo, ezinje nge-allergies kunye ne-asthma, kunye noxilongo olunzima lwethumba lobuchopho. Ukwachaza indima ye-corticosteroids kuhambo lwakhe kunye nefuthe labo elibalulekileyo ekusebenzeni kwakhe kwexesha elide. 

Education Patient
  • Yintoni i-corticosteroids kwaye isetyenziswa njani?

IiCorticosteroids (ikwabizwa ngokuba yiglucocorticoids) ngamachiza achasene nokudumba. Ezi ayizizo ii-steroids ezifanayo ezisetyenziselwa ukwakha izihlunu okanye ukwenza iimbaleki ziqhube ngcono. I-Corticosteroids isetyenziswa rhoqo ukulawula iimpawu kwaye ukuthintela amadangatye okanye uhlaselo lwe i-allergies,6 umbefu,7 COPD,8 Ewe,9 kunye nokucutha iipolyps ngeempumlo.10

I-topical corticosteroid ointments isetyenziselwa ixesha elifutshane ukunyanga i-eczema enzima kunye namaxesha athile (ngokuqhelekileyo 2-3 amaxesha ngeveki) ukukhusela ukuvutha.11,12 I-OCS okanye inaliti ye-corticosteroid ngamanye amaxesha inikezelwa ukunyanga ukuvutha kwezi zifo. I-OCS yexesha elide inconywa kuphela njengesigqibo sokugqibela kwisifo esibi esingaphenduliyo kunyango oluqhelekileyo.

  • I-corticosteroids inikwa njani izigulane?
  • Ngempumlo: i-intranasal, isetyenziswe imihla ngemihla kwi-allergies kunye ne-polyps yeempumlo
  • Ngomlomo:
    • Izihloko eziginyiweyo ezisetyenziswa yonke imihla kwi-EoE
    • Iipilisi okanye isiraphu esetyenziswa kwisiseko sexesha elifutshane sokuvutha kwaye njengonyango lwexesha elide lokunyanga isifo esinzima esingalawulwayo kunye nolunye unyango.
  • Ukuphefumlela ngaphakathi: i-inhalers esetyenziswa yonke imihla okanye njengoko ifuneka (ngethuba) kwi-asthma kunye neCOPD
  • Eluswini: Amafutha e-eczema
  • Ngolusu: iinaliti zingasetyenziselwa ukuvutha kokwaliwa, isifuba, iCOPD, iEoE, kunye nokucutha iipolyps zempumlo.
  • Ngemithambo (ngemithambo edla ngokuba sesandleni okanye engalweni) kwizigulana ezisesibhedlele
  • Isebenza njani i-corticosteroids?

I-Corticosteroids yi-hormone yendalo elawula imisebenzi emininzi emzimbeni, kuquka nokuvutha. Xa zinikezelwa njengonyango, zinciphisa iiseli ezivuthayo kunye neemolekyuli ezibangela iimpawu zesifo. Ukuba kunokwenzeka, oogqirha bahlala bejolise kwi-corticosteroids kwindawo yokuvuvukala, njengemiphunga ye-asthma kunye ne-COPD. I-OCS, kwelinye icala, isebenza kuwo wonke umzimba.

"Enoba zi-steroids, i-antihistamines, okanye i-biologics, izigulana zinenkxalabo malunga nemiphumo emfutshane kunye neyexesha elide-ingakumbi indlela unyango olunokubuchaphazela ngayo ubomi babo bemihla ngemihla, amandla, isimo sengqondo, ukulala kunye nempilo yabo yonke." - Karen S. Rance, DNP, CPNP

  • I-OCS inxulumene nemiphumo yecala elifutshane kwaye inokunyusa umngcipheko wemiphumo enokuba yingozi yexesha elide. Imiphumo emibi yezinye iifomyula ze-corticosteroid (i-inhaled, intranasal, iginywe, kunye ne-topical) ihluke kwi-OCS kwaye inobungozi obuncinane kwimiphumo yexesha elide. Iziphumo zexesha elifutshane ze-OCS
  • Uxinzelelo lwamehlo oluphakamileyo (iglaucoma)
  • Ukugcinwa kolwelo (okubangela ukudumba kwimilenze esezantsi)
  • Ukwandisa ukutya
  • Ukuphuthelwa/ukuphazamiseka kokulala
  • Igazi elonyukayo
  • Iingxaki zesimo sengqondo, inkumbulo, nokuziphatha
  • Ukunyuka kobunzima (isisu, ubuso kunye nentamo)
  • Iingozi zexesha elide ze-OCS
    • Urhatyazo (uguqulelo olunamafu)
    • Iswekile yegazi ephezulu (inokubangela okanye ibe mandundu iswekile)
    • Usulelo (ingakumbi ingozi yenyumoniya enokwenzeka kwizigulane zeCOPD)
    • iOsteoporosis
    • Cinga ulusu, ukugruzuka, ukuphola kancinci kwenxeba
    • Ukuhlaselwa yintliziyo kunye ne-stroke
    • ukutyeba
    • Ukukhubazeka kwezintso
    • Amathambo aphelile
    • Ukudakumba / ukuxhalaba
    • Ukukhubazeka kokukhula kwabantwana

  • Unokunceda ukunciphisa ukuvutha kwezifo (uhlaselo) ngokuthatha amayeza kanye njengoko kumiselwe ngumboneleli wakho wezempilo.
    Qinisekisa ukuba usebenzisa amayeza kunye nezixhobo zakho ngokuchanekileyo; iividiyo ezifana la inokukunceda ukuba ucokise isixhobo sakho sokuphefumla kunye nobuchule besixhobo. Kuyanceda ukwazi ukuba i-OCS isetyenziselwa ukunyanga amadangatye ezifo. Nangona amadangatya engenzeka ngaphandle kwamayeza okulawula isifo, ukuthatha iidosi ezisezantsi okanye ukutsiba iidosi kunokwenza amayeza angasebenzi kakuhle. Thetha nomboneleli wakho wezempilo ukuba uvakalelwa kukuba isifo sakho silawulwa kakubi; ulawulo lwezifo ludla ngokumiselwa ngovavanyo lolawulo olufana ne-ACT okanye i-AIRQ® kwi-asthma.
  • Ufanele ukuphepha i-OCS engeyomfuneko14,15; xoxa ngezinye iindlela zonyango ezinokubakho kunye nomboneleli wakho wezempilo. Funda ngakumbi malunga nezinye iindlela ze-OCS apha. Usenokufumana iziganeko zeklinikhi kunye neemeko apho i-OCS yeyona ndlela ilungileyo.
  • Ukuba ubona ababoneleli bezempilo abaninzi, basenokungabinayo irekhodi yayo yonke imimiselo yakho ye-OCS. Kuluncedo ukuba unxibelelane nabo bonke ababoneleli bakho ukuba zingaphi iikhosi ze-OCS ozifumene kunyaka ophelileyo. Wena kunye nomboneleli wakho wezempilo unokuxoxa ngamayeza anokunyanga izifo ezininzi ezivuthayo ngexesha elifanayo, ezinokuthi zinciphise ukuvutha kwesifo ngasinye kunye nesidingo sezifundo ezininzi ze-OCS kwizifo zakho ezahlukeneyo.

Uvimba: U-SAM kunye nam, isixhobo sasimahla sedijithali ukukunceda ulandelele uhambo lwakho lwe-steroid.

Kukho iimeko zeklinikhi apho i-OCS yeyona ndlela ilungileyo. Nangona kunjalo, unyango nge-OCS kufuneka lube licebo lokugqibela xa kungekho ezinye iindlela ezikhoyo. Kulawulo lwezifo, kukho iindlela ezizezinye zamayeza. Thetha nogqirha wakho kwaye usebenzise ukwenza izigqibo ekwabelwana ngazo ukubona ukuba ezinye iindlela zinokuba nokwenzeka kuwe.

  • Utywala
    • Antihistamines
    • Abachasi beLeukotriene
    • Amayeza okukhupha isisu (kufuneka asetyenziswe iintsuku ezisi-7 okanye ngaphantsi)
    • IiCromones
    • I-corticosteroids yangaphakathi
    • I-Anti-IgE-unyango
    • Allergen immunotherapy
  • COPD
    • I-beta-agonist yexesha elide (LABA)
    • I-LABA kunye ne-corticosteroids ephefumleyo (ICS)
    • I-anti-muscarincs esebenza ixesha elide (LAMA)
    • LABA/ICS/ICS/LAMA
    • Theophylline
    • Mucolytic amayeza
    • Phosphodiesterase-4 i-enzyme inhibitors
    • Antibiotics
    • I-Anti IL-4 / IL-13
Iisteroids kunye nesixhobo seM
Ibali likaTeresa

UTeresa uthetha ngokuphandle ngokuphila ne-sarcoidosis kunye neCOPD. Ukwabelana ngemiphumo yexesha elide yokusetyenziswa ngokugqithiseleyo kwe-cortiscosteroids emiselweyo. “Kufuneka kubekho ezinye iindlela zonyango ngaphandle kwee-steroids,” utshilo.

IsiKhokelo soMboneleli wezempilo

Ubugosa be-Steroid luxanduva loluntu lonke lwezempilo. Njengabantu basekuhlaleni, besiya kuba senza ngobulumko ukuba sithobela izifundo esizifumene kulawulo lwamayeza okubulala iintsholongwane. Njengogqirha, ungasebenzisa ezona ndlela zilungileyo ezisekelwe kubungqina bokunciphisa ukuvezwa kwesigulane kwi-OCS.

  • Ukuphonononga kwakhona isicwangciso sonyango lwesigulane ukuba i-OCS rhoqo (ngaphezu kweekhosi ze-2 ngonyaka) yenzekile
  • Landela izikhokelo zonyango ezicetyiswayo ukuze ukwandise ulawulo lwezifo nokuthintela amadangatye
  • Ukuvavanya ukubambelela kwesigulane kunyango kunye nokubonelela ngenkxaso yokunciphisa imiqobo yokubambelela kunyango
  • Ukuba isifo asilawulwa kakuhle, thumela isigulane kwingcali ukuqinisekisa ukuxilongwa kunye nokulawula ngokufanelekileyo
  • Chaza ezinye iindlela ezisebenzayo nezikhuselekileyo kwi-OCS, xa zikhona
  • Qinisekisa nakuphi na ukuchasana kwe-OCS kunye nesikrini se-metabolic kunye neemeko ze-endocrine ezinokuthi zibe mandundu ngokusetyenziswa kwe-OCS.
  • Sebenzisa ukwenza izigqibo ekwabelwana ngazo ukubonelela izigulane ngolwazi malunga nemiphumo emibi kunye nobungozi bexesha elide le-OCS kunye nolunye unyango (oko kukuthi, amayeza kunye / okanye iindlela ezingezizo iziyobisi ezifana nokuvuselelwa kwemiphunga, ukutya kunye nokuzivocavoca)
  • Xa i-OCS iyimfuneko, nciphisa umthamo we-OCS okhulayo kwi-1 g ngonyaka (okulingana nezifundo ze-4 zexesha elifutshane kwi-dose eqhelekileyo yokunyanga ukunyanzeliswa kwe-asthma exacerbation).16 Imilinganiselo ye-OCS eqhelekileyo iyafumaneka Apha.
  • Sebenzisa ukuqulunqwa kwamandla aphantsi kunye nedosi ephantsi eyimfuneko kunyango olusebenzayo

"Ukuxhobisa izigulana ngolwazi malunga nemingcipheko ye-steroid kunye nezinye iindlela linyathelo lokuqala eliya kukhathalelo olukhuselekileyo, oluzinzileyo." - Karen S. Rance, DNP, CPNP

Ubugosa obuhle be-steroid bunokufezekiswa ngokumisela i-steroid ehlakaniphile (ungathembeli kuphela kwiingcamango zeendleko), usebenzisa i-corticosteroids ngokulumkisa kwizigulane ezinokuthi zichaphazeleke kakhulu kwimiphumo emibi, kunye nokunxibelelana nesigulane kunye nosapho. Ngaphezu koko, i-corticosteroids kufuneka imiselwe kuphela xa kuyimfuneko kwaye kwiimeko apho uncedo lwekliniki lubonakalisiwe.

  • Ukumiselwa kwe-steroid enobuchule

Ii-steroids ezahlukeneyo zinamandla ahlukeneyo. Ekubeni ukuvezwa kwe-steroid kuyanda ngokuhamba kwexesha, amandla aphantsi, umthamo, kunye nobude bexesha lokufezekisa impendulo esebenzayo kufuneka imiselwe ukunciphisa ukubonakaliswa.

  • Ukuqwalaselwa kwabemi abakhethekileyo

abantwana

  • I-corticosteroids ye-topical kufuneka isetyenziswe ngononophelo ebantwaneni ngenxa yendawo enkulu kumlinganiselo wobunzima bomzimba kunye nokusebenza kakubi komqobo wolusu.17 Cinga ngezinye iindlela ezinciphisa ukusetyenziswa kwemihla ngemihla kwe-topical corticosteroids.
    • I-Corticosteroids elawulwa yiyo nayiphi na indlela ibonakaliswe ukucinezela ukukhula kwexesha elide kubantwana. Inzuzo yeklinikhi ye-corticosteroids kufuneka ilinganiswe ngokuchasene namandla okunciphisa ukukhula kunye nokufumaneka kolunye unyango.
    • Ezinye izitofu [ziphila okanye ziphile, zincitshisiwe (imasisi, uqwilikana, kunye nerubella)] akufuneki zisetyenziswe ngelixa umntwana ephantsi kwe-immunosuppressive doses yonyango lwe-corticosteroid (umzekelo, > 20 mg/ngosuku ngaphezu kweeveki ezi-2). Irhashalala kunye nemasisi zinokumandundu ngakumbi kubantwana abasebenzisa i-corticosteroids kwaye ukuchanabeka kwezi zifo kufuneka kuthintelwe.

abadala

  • I-corticosteroid ye-topical kufuneka isetyenziswe ngononophelo kubantu abasele bekhulile ngenxa yendawo enkulu kumlinganiselo wobunzima bomzimba kunye nolusu olubuthathaka.17
    • Idosi ye-OCS kufuneka iqale phantsi xa kujongwa ukuxhaphaka okukhulu kwezintso, isibindi, intliziyo, kunye nokungasebenzi kakuhle kwempilo yengqondo, kubandakanya nokudakumba.
  • Ukunciphisa ukusetyenziswa kwe-steroid ngokungeyomfuneko

Ukuxhomekeka kwi-OCS okanye i-OCS rhoqo zizinto eziphambili zokuchonga izifo ezingalawulwayo. Izicwangciso zolawulo lwezifo kufuneka zixoxwe kunye nezigulane zokwandisa ulawulo lwezifo kunye nokunciphisa imfuno yokusetyenziswa kwe-OCS.

I-OCS ayifanele imiselwe iimeko (umzekelo, i-bronchitis enzima, i-sinusitis enzima) engenabo ubungqina bokuxhasa inzuzo.18 KwiCOPD, ukusetyenziswa kwe-ICS kufuneka kuncitshiswe ngaphandle kweentlobo ezithile zezigulane ezaziwa ngokuphendula kakuhle kwi-corticosteroids (umzekelo, i-eosinophilic phenotype).

Ngelixa sele besazi malunga nobunzima bokulala, ukuziva ujittery, okanye ezinye iziphumo ezibi ezaziwayo, izigulane zihlala zimangaliswa ziimpembelelo zexesha elide zokusetyenziswa kwe-steroid. Abaninzi abalindelanga ukuva malunga nemiba efana ne-cataract, i-glaucoma, okanye iingxaki ze-adrenal gland, kodwa ezi zinokuchaphazela kakhulu impilo yabo ekuhambeni kwexesha. Bahlala bexhalabile xa befunda malunga nendlela i-steroids enokunyusa ngayo amanqanaba eswekile yegazi, yenza buthathaka amathambo kunye namalungu, kwaye iholele kwiinguqu eziphawulekayo eluswini lwabo, ezifana nokunciphisa okanye ukugruzuka ngokulula. Ezi ziphumo zinokuxhalabisa kwaye zihlala zishiya izigulana zinqwenela ukuba zinolwazi oluthe kratya ngaphambili. ” - UStephanie Williams, BS, RRT

Ulawulo lwe-Steroid lunokwenzeka kuphela xa ababoneleli bezempilo beqaphela umngcipheko wokusetyenziswa kakubi kwe-corticosteroid kunye nokusetyenziswa kakubi kwaye banenkqubo ecacileyo yendlela yokuphepha. Ngokufanayo, hlola inqanaba lolwazi olungelulo malunga nesigulana se-corticosteroids kunye nosapho olunokuthi lufunyenwe, ukongeza ekuthetheni ngokubaluleka kobugosa be-steroid kubo.

  • Imfundo yobugosa be-steroid kunye nenkxaso kumaqela okhathalelo lwempilo

    Amaqela okhathalelo lwempilo kufuneka abe nesicwangciso esibhaliweyo solawulo lwe-steroid. Esi sicwangciso kufuneka siquke uluhlu lokutshekisha kagqirha, amagama akhethiweyo e-steroid, iidosi kunye nendlela yokulawula, iiprothokholi ze-dose titration kunye ne-dose tapering, kunye nemiyalelo yokulandelwa.17 Ukuvezwa kwe-steroid ephantsi kwisigulane esixhomekeke kwi-OCS yokulawula isifo kunokufezekiswa ngendlela ehleliweyo yokunciphisa.19 Iinkqubo zokulumkisa ze-elektroniki ezibonisa izigulane ezinemimiselo emininzi ye-OCS zinokunceda ababoneleli bezempilo bachonge izigulane ezisengozini yokusetyenziswa ngokugqithiseleyo kwe-OCS.
  • Izixhobo zokuvavanya iimfuno zesigulane kunye nobungozi
  • Iindlela zokunxibelelana ngempumelelo nezigulana kunye neentsapho

    Iingxoxo zokwenza izigqibo ezikwabelwana ngazo - ngokuphindaphindiweyo ngokusetyenziswa kwezixhobo zokwenza izigqibo ezikwabelwana ngazo okanye izixhobo - kufuneka zisetyenziswe ukubonelela izigulane ngolwazi malunga neenzuzo ezinokubakho, imiphumo emibi, kunye nobungozi bexesha elide le-OCS. Ukubaluleka kokubambelela kunye neengxoxo zokhetho zonyango kufuneka kwakhona kube yinxalenye yezi ngxoxo. Amanyathelo acetyiswayo okuthathwa kwezigqibo ekwabelwana ngawo anokufunyanwa Apha. Isikhokelo kwizigulana ezinesifuba esiya kunceda ukuqalisa iincoko zababoneleli-zigulana malunga nokuthembela kakhulu kwi-OCS siyafumaneka. Apha.

Uphononongo olutshanje luye lwabalaselisa ukubaluleka kokwenza isigqibo ekwabelwana ngaso njengentsika ephambili ekuthinteleni usulelo oluqatha kwizigulane eziphathwa nge-steroids yexesha elide.

“Kwizigulane ezininzi, ukuhlala nesifo esingapheliyo akukhona nje ukulawula iimpawu-kumalunga nokuhamba kwindawo yemihla ngemihla yokungaqiniseki, ukudinwa, kunye nokukhungatheka. Izigulane zidla ngokuziva ngathi kwenziwa izigqibo malunga Bona, hayi kunye bona. Bafuna ukubona amazwi abo, amava, kunye neziphumo zibonakaliswa ngokunentsingiselo kuyilo lolingo, ukuleyibhelishwa kwemveliso, imfundo yesigulana, kunye nonxibelelwano lokhuseleko. - Karen S. Rance, DNP, CPNP

I-Glucocorticoids iyasebenza ekupheliseni ukuvuvukala kwaye isetyenziswa ngokubanzi ukulawula izifo ezivuthayo kunye ne-immune-mediated izifo ezibandakanya isifo sofuba, i-asthma kunye nezifo ze-rheumatic. Ukusetyenziswa kweglucocorticoids, nangona kunjalo, kunxulunyaniswa neziphumo ebezingalindelekanga ezibalulekileyo ezibandakanya i-osteoporosis, uxinzelelo lwe-adrenal kunye nosulelo olungenelelayo. Ngelixa ezi ziphumo zibi zithathwa ngokuba ziqhutywa yidosi, ubude bexesha, indlela yolawulo kunye nokuqina konyango lwe-steroid, ababhali bolu phononongo lwakutsha nje bakholelwa ukuba le modeli ixhomekeke kwidosi ayinakuxela lonke ibali xa kuqwalaselwa usulelo olungenelelayo.  

Balungiselela ukuba:

  • Qonda umngcipheko wosulelo olungenelelayo kwizigulana ezithatha iglucocorticoids ngoku:
  • Ukuvavanya imiphumo yeselula kunye neklinikhi ye-steroids
  • Ukuqonda unxibelelwano kunye nezinto ezibambekayo zebhayoloji ezifana ne-comorbidities kunye namayeza ahambelanayo
  • Xoxa ngemingeni yokulinganisa ukwanda komngcipheko wosulelo olungenelelayo
  • Cebisa izicwangciso zokuthintela usulelo olubukhali okanye ukuphinda kusebenze usulelo olufihlakeleyo

Uphononongo lubandakanye izifundo kuzo zonke izigulana ezahlukeneyo (kubandakanya izifo zamathambo, isifo sokukrala kwamathumbu kunye ne-systemic lupus erythematosus), kunye ne-heterogeneous co-morbidities kunye neeprofayili zamayeza ahambelanayo. Ababhali baphonononga ubungakanani kunye nekhwalithi yeziphumo ze-immunosuppressive ze-steroids, kunye nefuthe lokuba sesichengeni se-steroid ixesha elide kumngcipheko wosulelo olungenelelayo.  

Iziphumo zibonise iindlela eziyinkimbinkimbi apho i-glucocorticoids idlulisela ngayo umphumo wabo, ukuguqula ukuqeshwa kunye nomsebenzi weentlobo ezininzi zeeseli zomzimba ezibandakanya i-eosinophils, i-T- kunye ne-B-cell. Ukulinganisa ifuthe le-steroids kumngcipheko wosulelo olungenelelayo kwantsonkothwa zezi zinto zilandelayo:

  • Ukunqongophala kokungaguquguquki kwindlela izifundo ezichaze ngayo idosi ye-steroid, ubude kunye nolawulo
  • Uluhlu olubanzi lwee-glucocorticoids ezisetyenziswa kwizifundo ezahlukeneyo, ezinamaqondo ahlukeneyo okugonywa
  • Inqaku elilinganayo le-prednisone elisetyenziselwa ukwenza oku kuguquguquka kwe-immunosuppression, engayibambi ngokupheleleyo imiphumo eyahlukileyo yonyango olwahlukileyo lwe-steroid, okwenza kube nzima ukulinganisa ngokuchanekileyo naluphi na unxulumano phakathi kwe-steroids kunye nosulelo olungenelelayo.
  • Idatha ephikisanayo kunxibelelwano phakathi kwedosi yeglucocorticoid kunye nomngcipheko wosulelo olungenelelayo
  • Izigulana ezineenkcazo ezahlukeneyo nezintsonkothileyo ezinokuthi zibe negalelo kumngcipheko wosulelo kuquka:
  • Ukubandakanyeka kwezifo, umzekelo, ukungasebenzi kwe-immunologic kwizigulane
  • I-Comorbidities, umz, i-immunodeficiencies ekhoyo

Amayeza ahambelanayo ne-immunosuppressive, umz, i-methotrexate, i-anti-TNFs kunye ne-antirheumatic yokuguqula izifo eziphazamisa uhlalutyo lomngcipheko wosulelo oluvela kwi-glucocorticoids.

Ungenelelo lokuthintela usulelo okanye ukuqhubela phambili kwezifo ezibangelwa zizifo ezithatha amathuba kwizigulane ezifumana unyango lweglucocorticoid zibalulekile. Nangona kunjalo, ukuphunyezwa kunzima ngaphandle kokukwazi ukuchonga ukuba zeziphi izigulana eziza kuxhamla kungenelelo olunjalo. Ukungabikho kwezixhobo zokumisela “imeko eshiyekileyo” yesigulana yokuthomalalisa amajoni omzimba, oogqirha banyanzelwa ukuba baxhomekeke kwindlela exhomekeke kwithamo, elinganayo ne-prednisone ukuchonga izigulane ezisemngciphekweni wosulelo.

Ukukwazi ukumisela ngokufanelekileyo umngcipheko wosulelo olungenelelayo kwixesha elizayo kuya kuxhamla kulwazi oluthe kratya malunga nokuba iindlela ezahlukeneyo zonyango lwe-steroid ziwuchaphazela njani umsebenzi wokuzivikela komzimba. Izibali zeklinikhi eziqwalasela zonke iinkalo zonyango lwe-steroid (i-dose, amandla, ubude be-exposure) kunye nokubandakanya izinto ezithile zesigulane (umz., i-comorbidities, i-immunodeficiencies ekhoyo kunye ne-concomitant immunosuppressive therapies) nayo kufuneka iphuhliswe. Itekhnoloji entsha enokulinganisa ukhuseleko olungena kwiseli nayo inokubonelela ngengqikelelo echane ngakumbi yengozi yesigulana sosulelo olungenelelayo.

Ngelixa iimodeli zokuxela kwangaphambili ziphuhliswa, abaphandi bacebisa indlela ye-multifactorial ebandakanya ukunciphisa ukusetyenziswa kwe-steroid, ukuhlolwa kosulelo lwe-asymptomatic, i-antimicrobial prophylaxis kunye nokugonywa.

Sicebisa ngamandla ukuba kuphunyezwe ukuthathwa kwezigqibo ekwabelwanayo ngako okubandakanya ingxoxo eqhubekayo nevulelekileyo phakathi kwezigulane kunye noogqirha malunga neempawu zesifo, izifo ezixhaphakileyo, amayeza angaphambili kunye nobungozi bomntu kunye nokusingqongileyo kwesigulane ukuqinisekisa ukuba izigulana zinokunciphisa imingcipheko yokufumana izifo ezithatha amathuba.

Izigulane ezifuna i-OCS yexesha elide zifuna uvavanyo olusisiseko lwe-metabolic kunye neemeko ze-endocrine ezinokuthi zibe zibi ngakumbi nge-OCS. Ukongeza, isicwangciso sokubeka iliso kunye nokulawula iziphumo ebezingalindelekanga kwizigulane kwi-OCS yexesha elide.

  • Isiseko kunye novavanyo lomngcipheko
    • ubunzima
    • ukuphakama
    • BMI
    • Ifuthe legazi
    • Iimpawu zesikhumba
    • I-Pedal edema
    • IGlucose (FPG, A1C, 2-hour OGTT)
    • Iprofayile ye-lipid
    • I-DEXA yoxinaniso lwamathambo amaminerali
    • Uvavanyo lokuphazamiseka kwemizwelo
  • Ukubeka esweni impendulo engathandekiyo yesigulana kunyango
    • Ukutyeba kwakho
    • Ukutshintsha kobude
    • Uxinzelelo lwegazi luyatshintsha
    • Utshintsho lokukhula (kubantwana)
    • Utshintsho lweGlucose (FPG, A1C, 2-hour OGTT)
    • Utshintsho kwiprofayile ye-lipid
    • Impilo yeThambo
    • X-reyi yomqolo
    • Umqolo obuhlungu
    • Ukukhawulela
    • Amanqaku e-FRAX kunye novavanyo lomngcipheko wengozi ye-vertebral fracture
    • Uvavanyo lwe-Ophthalmological for cataracts kunye neglaucoma
    • Utshintsho kwimo, kuquka ukudakumba
    • Infections
  • Ubuchule bokunciphisa iziphumo ebezingalindelekanga ezingafunekiyo

Esona sicwangciso sisebenzayo sokunciphisa iziphumo zexesha elide yi-judicious steroid dosing kunye nokupheliswa kokusetyenziswa kwe-OCS engeyomfuneko. Nangona kunjalo, kukho imilinganiselo ethile enokunciphisa iziphumo ebezingalindelekanga zexesha elifutshane kunye nemingcipheko yexesha elide.

              Ukunciphisa umngcipheko wexesha elide

  • I-taper dosing xa uyeka unyango lwexesha elide ukunqanda ukucinezelwa kwe-hypothalamic-pituitary adrenal axis
  • Ukuguqulwa kwendlela yokuphila (umzekelo, ukuyeka ukutshaya, ukunciphisa utywala, ukuthatha inxaxheba kwimithambo yemihla ngemihla) ukunciphisa umngcipheko we-osteoporosis.
  • I-calcium kunye ne-vitamin D supplementation kunye neprogram yokuzivocavoca umzimba obunzima kunokunceda impilo yamathambo
  • Ukuthintelwa kwetyuwa yokutya kunye ne-potassium supplementation kunokunceda ekugcineni amanzi kunye noxinzelelo lwegazi
  • Thatha kunye nokutya okanye ubisi ukunciphisa ukucaphuka kwesisu
  • Kwidosi enkulu ye-OCS, ii-antacids okanye i-proton pump inhibitors (PPDs) zinokunceda ukuthintela izilonda ze-peptic.
  • Enye idosi yosuku kabini kwidosi yesiqhelo yemihla ngemihla ukunciphisa uxinzelelo kunye neempawu zokurhoxa

Ukunciphisa umphumo wexesha elifutshane

  • Ukuthintelwa kwetyuwa ekutyeni kunokunceda ekugcineni amanzi
  • Thatha kunye nokutya okanye ubisi ukunciphisa ukucaphuka kwesisu

Iidosi zexeshana elifutshane akufuneki ukuba zicocwe

Uvimba: I-SAM kunye nam sisixhobo sasimahla sedijithali esinokunceda izigulane zakho zilandelele uhambo lwazo lwe-steroid.  

Ibali likaHilary
I-Asma kunye ne-OCS Ubugosa
IziBonelelo zoMhlawuli kunye noMenzi wePolisi

Iindleko zokwenyani zokusetyenziswa kwe-OCS azikachazwa kakuhle. Ukusuka kwi-cataract ukuya kwiingxaki ze-cardiovascular, iziganeko ezimbi ezinxulumene nokusetyenziswa kwexesha elide le-glucocorticoids zibanzi, zithatha ubunzima obunzima kwizigulana kunye neenkqubo zempilo.

Ukulinganisa impembelelo yezoqoqosho yokusetyenziswa kweglucocorticoid sisenzo esiphambili sokwenza ukhathalelo olusekwe kwixabiso kwizigidi zezigulana ezithwaxwa ziimeko zokuvuvukala ezifana ne-asthma, COPD & eczema.

Ukusukela oko zafunyanwa, ii-steroids ziye zaba lunyango olungundoqo lwezifo ezizimelayo kunye nezifo ezivuthayo, njengoko ukukwazi kwabo ukuzisa ngokukhawuleza nangempumelelo iimpawu phantsi kolawulo kuhlala kubenza babaluleke kakhulu. Nangona kunjalo, ukuzingisa kwezi meko rhoqo kufuna ukusetyenziswa kwexesha elide, ukonyusa umngcipheko we-steroid-toxicities.

Iziphumo zecala zokuqala ze-steroids zaqatshelwa kungekudala emva kokwaziswa kwazo kweklinikhi. Izigulane eziphathwe ngeglucocorticoids ngeminyaka yee-1950 zibonise iziganeko ezibalulekileyo ezingathandekiyo, kuquka ukubonakala kwe-cushingoid kunye nengqondo. Ngokuhamba kwexesha, ezinye izinto ezinobungozi ze-steroid zibhalwe kakuhle, kubandakanya i-osteoporosis, iingxaki zentliziyo kunye neengozi zosulelo. Ngaphandle kwale mingcipheko, izikhokelo ezisesikweni zokulawula ezi ziphumo zavela kuphela kumashumi eminyaka kamva, zibonisa ukujongelwa phantsi kobungqongqo bembali.

Ababhali bacaphula uphononongo lwakutsha nje2 ukuba uphando lwe-neuromuscular neurologists yaseCanada ukuvavanya izenzo zabo ekulawuleni unyango olungapheliyo lweglucocorticoid. Iziphumo zibonise ukuguquguquka okukhulu ekuhlolweni, ukubeka iliso kunye ne-prophylaxis ngokuchasene ne-steroid-toxicity. Ngelixa uninzi lweekliniki zaxoxa ngemingcipheko efana ne-osteoporosis kunye ne-hyperglycemia kunye nezigulana zabo, bekukho ukungahambelani kwiingcebiso zokugonya kunye namanye amanyathelo okuthintela.

Ukujongana neziganeko ezimbi zeglucocorticoids kufuna iinzame ezilungelelanisiweyo kuzo zonke iingcali. Ukuchazwa ngokucacileyo koxanduva phakathi koogqirha abachazayo, abo banikezela ngokhathalelo lokuqala kunye neengcali zibalulekile. Ukusebenzisa iirekhodi zempilo zombane ezinezikhumbuzi ezizenzekelayo kunye nezixhobo zenkxaso yesigqibo seklinikhi kunokuphucula ukubeka iliso kunye nokulawulwa kwe-steroid-toxicities. Ababhali bacebisa ukuba bamkele izixhobo eziqinisekisiweyo ezifana ne-Steritas Glucocorticoid Toxicity Index (GTI) ukulandelela kunye nokunciphisa iziphumo kwikliniki.

Ngokutsho kwababhali, iziganeko ezimbi kakhulu ezibangelwa yi-glucocorticoids zenza ukuba kuxoxwe ngazo ukuba ziya kudlula kuphononongo lolawulo lwangoku. Ulingo lwangoku lwezonyango luya kubuza ukuba ingaba umlinganiselo wenzuzo yomngcipheko wala machiza anamandla ungenza uphuhliso lwawo lusebenze. Ukuba iyeza lamva nje belinokubangela iziganeko ezibalulekileyo ezinje, ngaba linokurhoxiswa kwintengiso?

Ngelixa i-glucocorticoids ihlala ilitye lembombo ekunyangeni izifo ezizimelayo kunye nezifo ezivuthayo, ukusetyenziswa kwazo namhlanje kufuna indlela enononophelo, enolwazi. Ukubandakanya izikhokelo ezivela kwiingcali ezinxulumeneyo, ukusebenzisa izixhobo zokubeka iliso ezikwinqanaba eliphezulu, kunye nokukhuthaza intsebenziswano phakathi kwamacandelo ngamanyathelo ayimfuneko ekwandiseni unyango lweglucocorticoid.

Ababhali bagxininisa ukuba, ngenxa yeengozi ezinxulumene ne-glucocorticoids, ukusetyenziswa kwabo kufuneka kuhanjiswe ngokuqaphela. Imfundo yesigulana ngokucokisekileyo kunye nokubekw'esweni okungqongqo kufuneka kuqinisekiswe ukulungelelanisa iinzuzo zabo ngokuchasene nokwenzakala.

  1. Habib AA, Narayanaswami P. Ngaba iglucocorticoids ingavunywa ukuba isetyenziswe ekliniki ukuba ifunyenwe namhlanje? I-Muscle Nerve. 2024 Jul;70(1):9-11. https://doi.org/10.1002/mus.28111 Epub 2024 May 8. PMID: 38720486.
  2. UStepanian L, uLaughlin R, uBacher C, et al. Ulawulo olungapheliyo lweglucocorticoid kwisifo se-neuromuscular: uphando lwe-neuromuscular neurologists. I-Muscle Nerve. 2024;70(1):52-59. https://doi.org/10.1002/mus.28069

Resources

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I-Chung LP, i-Upham JW, i-Bardin PG, i-Hew M. Ukusetyenziswa kwe-corticosteroid yomlomo kwi-asthma enzima yabantu abadala: Uphononongo olubalisayo. I-Respirology. 2020;25(2):161-172.

“Kumele kubekho ulungelelwano phakathi kokuhlonipha imfuneko yesteroids nokuxhobisa abaguli ukuba babuze ngezinye iindlela.” Imfundo ifanele ingabi nakugweba yaye iquke: ‘Iisteroids zinokusindisa ubomi.  kwaye singasebenzisana ukunciphisa ukuthembela kwakho kubo ekuhambeni kwexesha.’” — Karen S Rance, DNP, CPNP

Imibulelo

Ndiyabulela ku-Erin Scott, PhD kunye noGqr. Don Bukstein ngegalelo labo kule projekthi.

Siyayibulela i-AstraZeneca, i-Novartis, kunye ne-Sanofi ngenkxaso yabo ye-GAAPP's Steroid Stewardship Educational Initiative.

Ucaphulo

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