Isinyathelo seziguli, abahlinzeki, kanye nabenzi benqubomgomo

Ukubuka konke kokuqala

I-Corticosteroids inconywa ekwelapheni kwabaningi izifo, okuhlanganisa ukungezwani komzimba nezinto ezithile, isifuba somoya, i-atopic dermatitis (ebuye ibizwe ngokuthi i-eczema), isifo esingamahlalakhona sokuvimbela amaphaphu (COPD), i-eosinophilic esophagitis (EoE), nama-polyps amakhala (okuvame ukubizwa ngokuthi yizifo ze-T2). I-Corticosteroids yizidakamizwa ezinamandla zokulwa nokuvuvukala (ungacabanga ukuvuvukala njengokuvuvukala).

Ngokuya ngesifo okuhloswe ukuselapha, i-corticosteroids ingaba:

  • inikezwe intranasally (ekhaleni),
  • uphefumulelwe noma uphefumulelwe ngaphakathi,
  • ukugwinya,
  • Ijovwe,
  • noma inganikezwa ngesikhumba njengama-ointments noma ama-creams (topical).

I-Oral corticosteroids (OCS), lapho ithathwa ngomlomo, isetshenziswa ngokujwayelekile isikhathi esifushane (imvamisa izinsuku ezingama-3-7), yelapha ukuqubuka kwezifo noma ukuhlasela - noma isikhathi eside ukwelapha isifo esibi esingalawulwa ngezinye izindlela zokwelapha. Abantu abanezifo eziningana kungenzeka basebenzise ngaphezu kohlobo olulodwa lwe-corticosteroid (isb, i-corticosteroid eyodwa ehogelwe kanye ne-topical eyodwa).

Uma isetshenziswe kahle, i-corticosteroids iyindlela yokwelapha ebalulekile futhi ephumelelayo yokulwa nokuvuvukala. Nokho, njengezidakamizwa eziningi, i-corticosteroids ingaba nemiphumela engemihle. Eminye yale miphumela engemihle eyesikhathi esifushane kanti eminye eyesikhathi eside. Ama-corticosteroids akheka emzimbeni ngokuhamba kwesikhathi, futhi lapho umuntu ewasebenzisa kakhulu, kuba nengozi enkulu yemiphumela emibi yesikhathi eside.1,2

I-OCS, kokubili uma ithathwa isikhathi eside futhi ithathwa izikhathi ezimbalwa esikhathini esifushane, idlala indima enkulu kulezi zinhlobo zemiphumela emibi. Siyazi ukuthi ukuthatha ama-OCS amafushane izikhathi ezimbalwa izikhathi ezine empilweni yakho kungakhuphula ingcuphe yezimo eziningi ezifana nesifo sikashukela, ulwelwesi lwamehlo, ne-osteoperosis.1 Ezinye izinhlobo ze-corticosteroids, okuhlanganisa ukuhogela, intranasal, namafutha okugcoba, nazo zingangeza ekuhlanganiseni okuphelele kwe-corticosteroids emzimbeni. Lapho abantu besebenzisa izinhlobo eziningi ze-corticosteroids ukwelapha izifo ezimbalwa, amathuba abo okuba nemiphumela engemihle emibi ayanda.

Ukuphuza i-OCS izikhathi ezimbalwa izikhathi ezine ekuphileni kwakho kungandisa ingozi yokushaywa unhlangothi, ukwehluleka kwenhliziyo, uhlobo lwesifo sikashukela sohlobo 2, ulwelwesi lwamehlo, i-osteoporosis, ukuphuka kwamathambo, inyumoniya, ukucindezeleka/ukukhathazeka, nokukhubazeka kwezinso.1

Naphezu kwengozi yemiphumela emibi yesikhathi eside esizayo, i-OCS ivame ukusetshenziswa ngokweqile futhi inikezwe odokotela ngaphezu kwalokho okutuswayo.3-5 Ukuze kwehliswe lokhu kusetshenziswa okungase kube yingozi futhi okuvame ukungafaneleki, i-GAAPP iphromotha imfundo yokuphatha nge-steroid kanye nomkhankaso wokunika amandla ezigulini, abahlinzeki, kanye nabenzi bezinqubomgomo. Izinjongo zalolu hlelo yilezi:

  • Ukuqinisekisa ukuthi iziguli zithembele kuphela ku-OCS uma zonke ezinye izinketho zokwelashwa seziphelile (indlela yokugcina. 
  • Ukuqwashisa ngemiphumela emibi yesikhathi esifushane neyesikhathi eside ye-OCS
  • Ukuqinisekisa ukuthi isiguli ngasinye sithola ukwelashwa okufanele ngesikhathi esifanele nezithiyo ezimbalwa zokuthola umphumela omuhle kakhulu
  • Ukuqinisekisa ukuthi iziguli kanye nabahlinzeki bazo bazibandakanya ekuthathweni kwezinqumo okwabelwana ngazo, ikakhulukazi maqondana ne-corticosteroids
Indaba ka-Stacey

U-Stacey wabelana ngokukhululekile ngolwazi lwakhe ngezifo ezingamahlalakhona, ezifana nokungezwani komzimba nesifuba somoya, kanye nokuxilongwa okunzima kwesimila ebuchosheni. Uchaza nendima ye-corticosteroids ohambweni lwakhe kanye nomthelela wawo obalulekile ekusebenzeni kwakhe isikhathi eside. 

Imfundo yeziguli
  • Yini i-corticosteroids futhi isetshenziswa kanjani?

I-Corticosteroids (ebizwa nangokuthi i-glucocorticoids) yizidakamizwa eziqeda ukuvuvukala. Lawa awawona ama-steroid afanayo asetshenziselwa ukwakha imisipha noma ukwenza abasubathi benze kangcono. I-Corticosteroids isetshenziswa njalo ukulawula izimpawu futhi ukuvimbela ukuvutha noma ukuhlaselwa i-allergies,6 isifuba somoya,7 I-COPD,8 EoE,9 kanye nokunciphisa ama-polyps akhala.10

Amafutha e-corticosteroid e-topical asetshenziswa isikhathi esifushane ukwelapha isiqephu esibucayi se-eczema futhi ngezikhathi ezithile (ngokuvamile izikhathi ezingu-2-3 ngesonto) ukuvimbela ukuvutha.11,12 Umjovo we-OCS noma we-corticosteroid ngezinye izikhathi unikezwa ukwelapha ukuqubuka kwalezi zifo. I-OCS yesikhathi eside inconywa kuphela njengendlela yokugcina yesifo esinzima esingaphenduli ekwelashweni okujwayelekile.

  • I-corticosteroids inikezwa kanjani iziguli?
  • Ekhaleni: intranasal, esetshenziswa nsuku zonke ukuze uthole ukungezwani komzimba kanye nama-polyps akhala
  • Ngomlomo:
    • Izihloko ezigwiniwe ezisetshenziswa nsuku zonke ku-EoE
    • Amaphilisi noma isiraphu esetshenziswa ngesikhathi esifushane ukuvutha futhi njengendlela yokugcina yokwelapha yesikhathi eside yesifo esibi kakhulu esingalawulwa nezinye izindlela zokwelapha.
  • Ukuphefumula: ama-inhalers asetshenziswa nsuku zonke noma njengoba kudingeka (ngezikhathi ezithile) ku-asthma ne-COPD
  • Esikhumbeni: amafutha okugcoba e-eczema
  • Ngesikhumba: imijovo ingasetshenziselwa ukuvutha kwe-allergies, isifuba somoya, i-COPD, i-EoE, kanye nokunciphisa ama-polyps emakhaleni.
  • Ngokufakwa emthanjeni (ngokusebenzisa umthambo ngokuvamile osesandleni noma engalweni) ezigulini ezilaliswe esibhedlela
  • I-corticosteroids isebenza kanjani?

I-Corticosteroids iyi-hormone yemvelo elawula imisebenzi eminingi emzimbeni, kuhlanganise nokuvuvukala. Uma zinikezwa njengokwelashwa, zinciphisa amangqamuzana okuvuvukala nama-molecule abangela izimpawu zesifo. Uma kungenzeka, odokotela bavame ukukhomba i-corticosteroids endaweni yokuvuvukala, njengamaphaphu e-asthma ne-COPD. I-OCS, ngakolunye uhlangothi, isebenza kuwo wonke umzimba.

“Kungakhathaliseki ukuthi ama-steroid, ama-antihistamine, noma i-biologics, iziguli zikhathazeka ngakho kokubili imiphumela yesikhathi esifushane neyesikhathi eside—ikakhulukazi ukuthi ukwelapha kungase kuthinte kanjani ukuphila kwazo kwansuku zonke, amandla, imizwa, ukulala nempilo yazo yonke.” - Karen S. Rance, DNP, CPNP

  • I-OCS ihlotshaniswa nemiphumela emibi yesikhathi esifushane futhi ingandisa ingozi yemiphumela engaba yingozi yesikhathi eside. Imiphumela engemihle yezinye izinhlobo ze-corticosteroid (ephefumulelwe, e-intranasal, egwinywe, kanye ne-topical) ihluke ku-OCS futhi inezingozi ezimbalwa kakhulu zemiphumela yesikhathi eside. Imiphumela emibi yesikhashana ye-OCS
  • Umfutho wamehlo ophakeme (i-glaucoma)
  • Ukugcina uketshezi (okubangela ukuvuvukala emilenzeni engezansi)
  • Ukwandisa ukudla
  • Ukuqwasha/ukuphazamiseka kokulala
  • Umfutho wegazi ophezulu
  • Izinkinga ngemizwa, inkumbulo, nokuziphatha
  • Ukukhula kwesisindo (isisu, ubuso, nentamo)
  • Izingozi zesikhathi eside ze-OCS
    • I-Cataracts (inguqulo ehlanganisiwe)
    • Ushukela wegazi ophakeme (ungadala noma ubhebhetheke sikashukela)
    • Ukutheleleka (ikakhulukazi ingozi ye-pneumonia engenzeka ezigulini ze-COPD)
    • Kwamathambo
    • Cabanga ngesikhumba, imihuzuko, ukuphola kancane kwesilonda
    • Ukuhlaselwa yinhliziyo nokushaywa unhlangothi
    • Ukukhuluphala
    • Ukukhubazeka kwezinso
    • I-Bone ihlukana
    • Ukudangala/ukukhathazeka
    • Ukukhubazeka kokukhula ezinganeni

  • Ungasiza ekwehliseni ukuqubuka kwezifo (ukuhlaselwa) ngokuthatha imithi njengoba kunqunywe umhlinzeki wakho wezempilo.
    Qinisekisa ukuthi usebenzisa imithi yakho kanye nemishini ngendlela efanele; amavidiyo anjenge lezi ingakusiza ukuthi ucwenge i-inhaler yakho kanye nezindlela zedivayisi. Kuyasiza ukwazi ukuthi i-OCS isetshenziswa ngokuyinhloko ukwelapha ukuqubuka kwezifo. Nakuba ukuvutha kungase kwenzeke naphezu kwemithi yokulawula izifo, ukuthatha imithamo ephansi noma ukweqa imithamo kungenza imithi ingasebenzi kahle. Khuluma nomhlinzeki wakho wokunakekelwa kwezempilo uma unomuzwa wokuthi isifo sakho sisalawuleka kahle; ukulawulwa kwezifo ngokuvamile kunganqunywa ukuhlolwa kokulawula okufana ne-ACT noma i-AIRQ® ku-asthma.
  • Ufanelwe ukugwema i-OCS engadingekile14,15; xoxa ngezinye izindlela zokwelapha ezingase zibe khona nomhlinzeki wakho wokunakekelwa kwezempilo. Funda kabanzi mayelana nezinye izindlela ze-OCS lapha. Usengathola izehlakalo zomtholampilo nezimo lapho i-OCS iyindlela engcono kakhulu yazo.
  • Uma ubona abahlinzeki bezempilo abaningi, bangase bangabi nalo irekhodi layo yonke imiyalelo yakho ye-OCS. Kuwusizo kuwe ukuxhumana nabo bonke abahlinzeki bakho ukuthi zingaki izifundo ze-OCS ozitholile phakathi nonyaka odlule. Wena kanye nomhlinzeki wakho wokunakekelwa kwezempilo ningaxoxa ngemithi engakwazi ukwelapha izifo eziningi ezivuvukalayo ngesikhathi esisodwa, okungase kunciphise ukuqubuka kwesifo ngasinye kanye nesidingo sezifundo eziningi ze-OCS zezifo zakho ezahlukene.

Imithombo: SAM kanye nami, ithuluzi digital mahhala ukukusiza ukulandelela uhambo lwakho steroid.

Kunezimo zomtholampilo i-OCS eyindlela engcono kakhulu yazo. Nokho, ukwelashwa nge-OCS kufanele kube yindlela yokugcina lapho kungekho ezinye izinketho ezitholakalayo. Ukuze ulawule izifo, kunezinye izindlela zokwelashwa. Khuluma nodokotela wakho futhi usebenzise izinqumo ezabiwe ukuze ubone ukuthi ezinye izindlela zingase zibe khona yini kuwe.

  • Amagciwane
    • Ama-Antihistamine
    • Abamelene neLeukotriene
    • Ama-decongestants (kufanele asetshenziswe izinsuku eziyi-7 noma ngaphansi)
    • Ama-Cromones
    • I-corticosteroids ye-intranasal
    • I-Anti-IgE-ukwelashwa
    • I-Allergen immunotherapy
  • COPD
    • I-beta-agonist yesikhathi eside (LABA)
    • I-LABA plus inhaled corticosteroids (ICS)
    • I-anti-muscarincs esebenza isikhathi eside (LAMA)
    • LABA/ICS/ICS/LAMA
    • Theophylline
    • Izidakamizwa ze-mucolytic
    • I-Phosphodiesterase-4 ama-enzyme inhibitors
    • Nemithi Elwa Namagciwane
    • I-Anti IL-4/IL-13
I-Steroids kanye Nethuluzi Lami
Indaba kaTeresa

U-Teresa ukhuluma ngokungagunci ngokuphila ne-sarcoidosis kanye ne-COPD. Wabelana ngemiphumela yesikhathi eside yokusebenzisa ngokweqile i-cortiscosteroids enqunyiwe. “Kufanele kube nezinye izinhlobo zokwelapha ngaphandle kwama-steroid,” usho kanje.

Isiqondiso Somhlinzeki Wezempilo

Ukuphathwa kwe-steroid kungumsebenzi wawo wonke umphakathi wokunakekelwa kwezempilo. Njengomphakathi, siyobe senza ukuhlakanipha ukulalela izifundo esizitholile ekuphathweni kwama-antibiotic. Njengodokotela, ungasebenzisa izinqubo ezihamba phambili ezisekelwe ebufakazini ukuze unciphise ukuchayeka kwesiguli ku-OCS.

  • Phinda uhlole uhlelo lokwelapha lwesiguli uma i-OCS evamile (izifundo ezingaphezu kwezingu-2 ngonyaka) yenzekile
  • Landela imihlahlandlela yokwelashwa enconyiwe ukuze ulawule kahle izifo futhi uvimbele ukuqubuka
  • Hlola ukubambelela kwesiguli ekwelashweni futhi unikeze ukwesekwa ukuze kuncishiswe izithiyo zokubambelela
  • Uma isifo singalawuleki kahle, dlulisela isiguli kuchwepheshe ukuze uqinisekise ukuxilonga nokuphathwa kahle
  • Nikeza ezinye izindlela ezisebenzayo neziphephile ze-OCS , uma zikhona
  • Thola noma yikuphi ukuphikisana ne-OCS kanye nesikrini sezimo ze-metabolic kanye ne-endocrine ezingase zibe zimbi kakhulu ngokusetshenziswa kwe-OCS.
  • Sebenzisa izinqumo ezabiwe ukuze unikeze iziguli ulwazi mayelana nemiphumela engemihle kanye nezingozi zesikhathi eside ze-OCS kanye nezinye izindlela zokwelapha (okungukuthi, imithi kanye/noma izindlela ezingezona izidakamizwa ezifana nokuvuselelwa kwamaphaphu, ukudla, nokuzivocavoca)
  • Uma i-OCS idingeka, nciphisa umthamo we-OCS oqongelelwayo ube ngu-1 g ngonyaka (okulingana nezifundo zesikhashana ezi-4 ngedosi evamile yokwelapha ukubhebhetheka kwesifuba somoya).16 Imithamo ye-OCS evamile iyatholakala lapha.
  • Sebenzisa ukwakheka kwamandla aphansi kanye nethamo eliphansi elidingekayo ukuze uthole ukwelashwa okuphumelelayo

"Ukunika iziguli amandla ngolwazi mayelana nezingozi ze-steroid nezinye izindlela kuyisinyathelo sokuqala sokunakekelwa okuphephile, okusimeme." - Karen S. Rance, DNP, CPNP

Ubuphathi obuhle be-steroid bungafinyelelwa ngokunikezwa kwe-steroid ehlakaniphile (hhayi ukuncika kuphela ekucabangeleni izindleko), ngokusebenzisa i-corticosteroids ngokuqapha ezigulini ezingase zibe lula emiphumeleni emibi, kanye nokukhulumisana nesiguli nomndeni. Ngaphezu kwalokho, i-corticosteroids kufanele inqunywe kuphela uma kunesidingo futhi ezimweni lapho inzuzo yomtholampilo iboniswe khona.

  • Ukunikezwa kwe-steroid ehlakaniphile

Ama-steroid ahlukahlukene anamandla ahlukene. Njengoba ukuchayeka kwe-steroid kukhula ngokuhamba kwesikhathi, amandla aphansi kakhulu, umthamo, kanye nobude bokuthola impendulo ephumelelayo kufanele kunqunywe ukuze kuncishiswe ukuchayeka.

  • Ukucatshangelwa kwabantu abakhethekile

Izingane

  • I-corticosteroids yama-topical kufanele isetshenziswe ngokuqapha ezinganeni ngenxa yendawo enkulu nesilinganiso sesisindo somzimba kanye nokusebenza kabi kokuvimbela isikhumba.17 Cabangela ezinye izindlela ezinciphisa ukusetshenziswa kwansuku zonke kwe-topical corticosteroids.
    • I-Corticosteroids elawulwa yinoma yimuphi umzila ikhonjiswe ukuthi icindezela ukukhula kwesikhathi eside kwezingane. Inzuzo yomtholampilo ye-corticosteroids idinga ukukalwa ngokumelene namandla okucindezela ukukhula kanye nokuba khona kwezinye izindlela zokwelapha.
    • Eminye imigomo [ephilayo noma ephilayo, encishisiwe (isimungumungwane, umvukuzane, nerubella)] akufanele inikezwe lapho ingane ithola imithamo ye-immunosuppressive yokwelashwa kwe-corticosteroid (isb., >20 mg/ngosuku isikhathi esingaphezu kwamasonto amabili). I-chicken pox kanye nesimungumungwane ingaba yingozi kakhulu ezinganeni ezithatha i-corticosteroids futhi ukuchayeka kulezi zifo kufanele kugwenywe.

Asebekhulile

  • I-Topical corticosteroid kufanele isetshenziswe ngokuqapha kubantu asebekhulile ngenxa yendawo enkulu nesisindo somzimba kanye nesikhumba esintekenteke.17
    • Umthamo we-OCS kufanele uqale uphansi uma kubhekwa imvamisa enkulu yokungasebenzi kahle kwezinso, isibindi, inhliziyo, nempilo yengqondo, okuhlanganisa ukucindezeleka.
  • Ukunciphisa ukusetshenziswa kwama-steroid okungadingekile

Ukuthembela ku-OCS noma i-OCS evamile kuyizici ezibalulekile zokuhlonza izifo ezingalawuleki. Izinhlelo zokuphatha izifo kufanele kuxoxwe ngazo neziguli ukuze kwandiswe ukulawula kwezifo futhi kuncishiswe isidingo sokusetshenziswa kwe-OCS.

I-OCS akufanele imiselwe izimo (isb., i-acute bronchitis, i-acute sinusitis) ezingenabo ubufakazi bokusekela inzuzo.18 Ku-COPD, ukusetshenziswa kwe-ICS kufanele kuncishiswe ngaphandle kwezinhlobo ezithile zeziguli ezaziwa ngokusabela kahle kuma-corticosteroids (isb, i-eosinophilic phenotype).

Nakuba kungenzeka ukuthi kakade zazi mayelana nobunzima bokulala, ukuzwa jittery, noma eminye imiphumela emibi eyaziwayo, iziguli zivame ukumangala imithelela yesikhathi eside yokusetshenziswa kwe-steroid. Abaningi abalindele ukuzwa ngezinkinga ezifana ne-cataract, i-glaucoma, noma izinkinga ze-adrenal gland, kodwa lezi zingathinta kakhulu impilo yabo ngokuhamba kwesikhathi. Baphinde bakhathazeke kakhulu lapho befunda ngokuthi ama-steroids angakhuphula kanjani amazinga kashukela egazini, enze amathambo namalunga abe buthaka, futhi aholele ezinguqukweni eziphawulekayo esikhumbeni sabo, njengokuncipha noma ukulimaza kalula. Le miphumela ingakhathaza futhi ivame ukushiya iziguli zifisa sengathi ngabe zinolwazi olwengeziwe kusenesikhathi.” - UStephanie Williams, BS, RRT

Ukuphatha i-steroid kungenzeka kuphela lapho abahlinzeki bezokunakekelwa kwezempilo beqaphela ubungozi bokusetshenziswa ngokweqile kwe-corticosteroid nokusetshenziswa kabi futhi benenkambo ecacile yesenzo sokuthi ungazigwema kanjani. Ngokufanayo, hlola izinga lokwaziswa okungelona iqiniso ngokuphathelene nesiguli kanye nomndeni okungenzeka balitholile, ngaphezu kokukhuluma ngokubaluleka kokuphatha kwe-steroid kubo.

  • Imfundo yobuphathi be-steroid nokwesekwa kwamathimba okunakekelwa kwezempilo

    Amaqembu okunakekelwa kwezempilo kufanele abe nohlelo olubhaliwe lokuphatha ama-steroid. Lolu hlelo kufanele lufake uhlu lokuhlola olunqunywe udokotela, amagama athandwayo e-steroid, imithamo kanye nomzila wokuphatha, izivumelwano zokulinganisa umthamo kanye nokunciphisa umthamo, kanye nemiyalelo yokulandelela.17 Ukuchayeka kwe-steroid ephansi kwesiguli esithembele ku-OCS ekulawuleni izifo kungase kuzuzwe ngendlela ehlelekile yokunciphisa.19 Amasistimu ezixwayiso zama-elekthronikhi ahlaba umkhosi iziguli ezinemiyalelo ye-OCS eminingi angasiza abahlinzeki bezempilo ukuthi bakhombe iziguli ezisengozini yokusebenzisa ngokweqile i-OCS.
  • Amathuluzi okuhlola izidingo zesiguli kanye nezingozi
  • Amasu okuxhumana ngempumelelo neziguli nemindeni

    Izingxoxo zokwenza izinqumo ezabiwe - ngokuvamile kusetshenziswa izinsiza zokwenza izinqumo ezabiwe noma amathuluzi - kufanele zisetshenziselwe ukunikeza iziguli ulwazi mayelana nezinzuzo ezingaba khona, imiphumela engemihle, nobungozi besikhathi eside be-OCS. Ukubaluleka kokubambelela kanye nokuxoxisana ngezinketho zokwelashwa kufanele futhi kube yingxenye yalezi zingxoxo. Izinyathelo ezinconyiwe zokwenza izinqumo ezabiwe zingatholakala lapha. Umhlahlandlela weziguli ezinesifuba somoya ozosiza ukuqala izingxoxo zabahlinzeki besiguli mayelana nokuthembela ngokweqile ku-OCS uyatholakala lapha.

Ukubuyekezwa kwakamuva kuye kwagqamisa ukubaluleka kokuthatha izinqumo okwabelwana ngazo njengensika eyinhloko ekuvimbeleni ukutheleleka okunamandla ezigulini ezilashwa ngama-steroid esikhathi eside.

“Ezigulini eziningi, ukuphila nesifo esingamahlalakhona akukhona nje ukulawula izimpawu—kumayelana nokuzulazula endaweni yansuku zonke yokungaqiniseki, ukukhathala, nokukhungatheka. Iziguli zivame ukuzwa sengathi kwenziwa izinqumo mayelana labo, hhayi nge bona. Bafuna ukubona amazwi abo, okuhlangenwe nakho, kanye nemiphumela kukhonjiswa ngendlela ephusile ekwakhiweni kwesilingo, ukulebula komkhiqizo, imfundo yesiguli, nokuxhumana nokuphepha. - Karen S. Rance, DNP, CPNP

Ama-Glucocorticoids asebenza kahle ekuqedeni ukuvuvukala futhi asetshenziswa kabanzi ukuphatha izifo ezivuvukalayo kanye ne-immune-mediated kuhlanganise nesifo samathumbu esivuvukalayo, isifuba somoya kanye nezifo zamathambo. Ukusetshenziswa kwe-glucocorticoids, nokho, kuhlotshaniswa nemiphumela emibi ebalulekile ehlanganisa ukukhumuzeka kwamathambo, ukucindezelwa kwezindlala ze-adrenal kanye nezifo ezingosomathuba. Nakuba le miphumela emibi ngokuvamile ibhekwa njengeqhutshwa umthamo, ubude besikhathi, umzila wokuphatha kanye nokuqina kokwelashwa kwe-steroid, ababhali balokhu kubuyekezwa kwakamuva bakholelwa ukuthi le modeli encike kumthamo ingase ingakhulumi indaba yonke lapho icabangela ukutheleleka okungosomathuba.  

Basuka bathi:

  • Qonda ubungozi bezifo ezingosomathuba ezigulini ezithatha i-glucocorticoids ngokwenza lokhu:
  • Ukuhlola imiphumela yamaselula neyomtholampilo ye-steroids
  • Ukuqonda ukusebenzisana nezici ze-biological host ezifana ne-comorbidities kanye nemithi ehambisanayo
  • Xoxa ngezinselelo zokulinganisa ukwanda kwengozi yokutheleleka ngentuba
  • Phakamisa amasu okuvimbela izifo eziyingozi noma ukuphinda kusebenze izifo ezicashile

Ukubuyekezwa kufake izifundo kuwo wonke amaqoqo eziguli ahlukahlukene (okuhlanganisa izifo zamathambo, isifo samathumbu esivuvukalayo kanye ne-systemic lupus erythematosus), okuhambisana nokugula okuhlukahlukene kanye namaphrofayili emithi ahambisanayo. Ababhali bahlole imiphumela ye-steroids yokuzivikela engakanani kanye nekhwalithi, kanye nomthelela ukuthi ukuchayeka kwe-steroid isikhathi eside okuba nawo engcupheni yokutheleleka ngentuba.  

Imiphumela yaqokomisa izindlela eziyinkimbinkimbi lapho i-glucocorticoid idlulisela khona umphumela wayo, iguqule ukubuthwa kanye nomsebenzi wezinhlobo eziningi zamaseli omzimba ahlanganisa i-eosinophils, T- kanye nama-B-cell. Ukulinganisa umthelela wama-steroid engcupheni yezifo ezingosomathuba kwaba nzima ngalezi zinto ezilandelayo:

  • Ukushoda kokungaguquguquki kokuthi izifundo zibike kanjani umthamo we-steroid, ubude besikhathi nokuphatha
  • Uhlu olubanzi lwama-glucocorticoids asetshenziswa ezifundweni ezahlukahlukene, ezinamadigri ahlukene e-immunosuppression
  • Isilinganiso esilinganayo se-prednisone esisetshenziselwa ukwenza kube kujwayelekile lokhu kuvinjelwa kokuzivikela komzimba okuguquguqukayo, okungathwebuli ngokugcwele imiphumela ehlukahlukene yemithi ehlukene ye-steroid, okwenza kube nzima ukulinganisa ngokunembile noma yikuphi ukuhlobana phakathi kwe-steroids kanye nezifo ezingosomathuba.
  • Idatha eshayisanayo ngokuhlobana phakathi kwethamo le-glucocorticoid kanye nengozi yezifo ezingosomathuba
  • Iziguli ezinezethulo ezihlukahlukene neziyinkimbinkimbi ezingase zibe nomthelela engcupheni yokutheleleka okuhlanganisa:
  • Ukubandakanyeka kwezifo, isb, ukungasebenzi kahle kwe-immunologic ezigulini
  • I-Comorbidities, isb, ama-immunodeficiencies akhona

Imithi ehambisana ne-immunosuppressive, isb, i-methotrexate, i-anti-TNFs kanye nemithi elwa namagciwane eguqula izifo edida ukuhlaziywa kwengozi yokutheleleka nge-glucocorticoids.

Ukungenelela ukuvimbela izifo noma ukuqhubeka kwezifo okubangelwa amagciwane angosomathuba ezigulini ezithola ukwelashwa nge-glucocorticoid kubalulekile. Kodwa-ke, ukuqaliswa kunzima ngaphandle kokukwazi ukuhlonza ukuthi yiziphi iziguli ezingazuza kulokho kungenelela. Uma engekho amathuluzi okunquma “isimo esiphelele” seziguli sokucindezelwa kwamasosha omzimba, odokotela bayaphoqeleka ukuthi bathembele endleleni encike kumthamo, elingana ne-prednisone ukuze bahlonze iziguli ezisengozini yokutheleleka.

Ikhono lokunquma ngempumelelo ubungozi bezifo ezingosomathuba esikhathini esizayo lingazuza olwazini olunemininingwane yokuthi izindlela zokwelapha ezihlukene ze-steroid ziwuthinta kanjani umsebenzi wokuzivikela komzimba. Izibalo zemitholampilo ezicabangela zonke izici zokwelapha nge-steroid (umthamo, amandla, ubude bokuchayeka) futhi zihlanganise izakhi eziqondile zesiguli (isb, izifo ezihlangene, ukuzivikela komzimba okukhona kanye nemithi yokwelapha ehambisanayo yokuzivikela komzimba) nazo zidinga ukuthuthukiswa. Ubuchwepheshe obusha obungakwazi ukukala ukuvikeleka kwe-cell-mediated bunganikeza nokubikezela okunembe kakhudlwana kwengozi yesiguli ngasinye sokutheleleka ngentuba.

Nakuba kwakhiwa amamodeli abikezelayo, abacwaningi batusa indlela yokwenza izinto eziningi ezihlanganisa ukukhawulela ukusetshenziswa kwe-steroid, ukuhlolwa kwezifo ezingenazimpawu, i-antimicrobial prophylaxis kanye nokugonywa.

Sincoma kakhulu ukusebenzisa izinqumo ezabiwe ezihilela ingxoxo eqhubekayo nevulekile phakathi kweziguli kanye nodokotela mayelana nezimpawu zesifo, ukugula okugulayo, ukugula kwangaphambilini kanye nezingozi zesiguli zomuntu siqu nezendawo ukuze kuqinisekiswe ukuthi iziguli zingakwazi ukunciphisa ubungozi bokuthola izifo ezingosomathuba.

Iziguli ezidinga i-OCS yesikhathi eside zidinga ukuhlolwa okuyisisekelo kwezimo ze-metabolic kanye ne-endocrine ezingase zibe zimbi kakhulu nge-OCS. Ngaphezu kwalokho, uhlelo lokuqapha nokuphatha imiphumela engemihle yeziguli ku-OCS yesikhathi eside.

  • Isisekelo kanye nokuhlolwa kwezinto ezinobungozi
    • Isisindo
    • Ukuphakama
    • BMI
    • Ukushaya kwegazi
    • Amathegi esikhumba
    • I-Pedal edema
    • IGlucose (FPG, A1C, 2-hour OGTT)
    • Iphrofayela ye-Lipid
    • I-DEXA bone mineral density
    • Ukuhlolwa kokuphazamiseka kwemizwelo
  • Ukuqapha impendulo engathandeki yesiguli ekwelashweni
    • Inzuzo yesisindo
    • Ukushintsha ubude
    • Umfutho wegazi uyashintsha
    • Izinguquko zokukhula (ezinganeni)
    • Izinguquko zeGlucose (FPG, A1C, 2-hour OGTT)
    • Iphrofayili ye-lipid iyashintsha
    • I-Bone impilo
    • I-X ray yomgogodla
    • Ukuhlungu obusemhlane
    • Ukulinganisa
    • Ukulinganisa kwe-FRAX kanye nokuhlolwa kwengozi yengozi yokuphuka kwe-vertebral
    • Ukuhlolwa kwe-Ophthalmological for cataracts kanye ne-glaucoma
    • Ukushintsha kwemizwa, kuhlanganise nokucindezeleka
    • Izifo
  • Amasu okunciphisa imiphumela emibi engathandeki

Isu elisebenza kahle kakhulu lokunciphisa imiphumela yesikhathi eside ukudotshwa kwe-steroid okuhlakaniphile nokuqedwa kokusetshenziswa kwe-OCS okungadingekile. Kodwa-ke, kunezinyathelo ezithile ezinganciphisa imiphumela emibi yesikhashana kanye nezingozi zesikhathi eside.

              Ukunciphisa ingozi yesikhathi eside

  • I-taper dosing lapho uyeka ukwelashwa isikhathi eside ukugwema ukucindezelwa kwe-hypothalamic-pituitary adrenal axis.
  • Ukuguqulwa kwendlela yokuphila (isb., ukuyeka ukubhema, ukunciphisa utshwala, ukuhlanganyela ekuvivinyeni umzimba nsuku zonke) ukuze kwehliswe ingcuphe ye-osteoporosis
  • Ukwengezwa kwe-calcium ne-vitamin D kanye nohlelo lokuzivocavoca oluthwala isisindo lungasiza empilweni yamathambo
  • Ukuvinjelwa kosawoti wokudla kanye ne-potassium supplementation kungasiza ekugcineni amanzi kanye nomfutho wegazi ophezulu
  • Thatha nokudla noma ubisi ukunciphisa ukucasuka kwesisu
  • Ngomthamo omkhulu we-OCS, ama-antacid noma ama-proton pump inhibitors (PPD) angasiza ukuvimbela izilonda ze-peptic.
  • Enye idosi yosuku kabili kunomthamo ojwayelekile wansuku zonke ukuze unciphise ukucindezelwa kwezindlala ze-adrenal kanye nezimpawu zokuhoxa

Ukunciphisa umphumela omubi wesikhashana

  • Ukukhawulelwa kukasawoti wokudla kungasiza ekugcineni amanzi
  • Thatha nokudla noma ubisi ukunciphisa ukucasuka kwesisu

Imithamo yesikhathi esifushane ayidingi ukuncishiswa

Imithombo: I-SAM kanye nami iyithuluzi lamahhala ledijithali elingasiza iziguli zakho zilandelele uhambo lwazo lwe-steroid.  

Indaba kaHilary
I-asthma ne-OCS Stewardship
Izinsiza Zomkhokhi kanye Nomenzi Wenqubomgomo

Izindleko zangempela zokusetshenziswa kwe-OCS namanje azikachazwa kahle. Kusukela ekuguleni kwamehlo kuya ezinkingeni zenhliziyo nemithambo yegazi, izehlakalo ezimbi ezihlobene nokusetshenziswa isikhathi eside kwe-glucocorticoids zibanzi, zilimaza iziguli nezinhlelo zokunakekelwa kwempilo.

Ukulinganisa umthelela wezomnotho wokusetshenziswa kwe-glucocorticoid kuwumsebenzi obalulekile wokunika amandla ukunakekelwa okusekelwe kubaluleka ezigidini zeziguli ezihlushwa izimo ezivuvukalayo njengesifuba somoya, i-COPD kanye ne-eczema.

Selokhu atholakala, ama-steroids abe yindlela yokwelapha eyisihluthulelo yezifo ezizimele kanye nezifo ezivuvukalayo, njengoba ikhono lawo lokulawula ngokushesha nangempumelelo izimpawu ngokuvamile lizenza zibaluleke kakhulu. Kodwa-ke, ukuphikelela kwalezi zimo kuvame ukudinga ukusetshenziswa isikhathi eside, okwandisa ingozi ye-steroid-toxicities.

Imiphumela emibi yokuqala ye-steroids yaqashelwa ngemva nje kokwethulwa komtholampilo. Iziguli ezelashwa ngama-glucocorticoid ngawo-1950 zabonisa izehlakalo ezimbi kakhulu, ezihlanganisa ukubukeka kwe-cushingoid kanye nesifo sengqondo. Ngokuhamba kwesikhathi, ezinye izinto ezimbi kakhulu ze-steroid-toxicity ziye zabhalwa kahle, kuhlanganise ne-osteoporosis, izinkinga zenhliziyo kanye nezingozi zokutheleleka. Naphezu kwalezi zingozi, izinkombandlela ezisemthethweni zokuphatha le miphumela zavela kuphela emashumini eminyaka kamuva, okubonisa ukubukelwa phansi komlando kobunzima bazo.

Ababhali bacaphuna ucwaningo lwakamuva2 eyahlola izazi ze-neuromuscular neurologists zaseCanada ukuze zihlole imikhuba yazo yokuphatha ukwelashwa okungapheli kwe-glucocorticoid. Okutholakele kuveze ukuhluka okukhulu ekuhlolweni, ekuqaphelweni nasekuvimbeleni ubuthi be-steroid. Nakuba odokotela abaningi bexoxa ngezingozi ezifana ne-osteoporosis kanye ne-hyperglycemia neziguli zabo, kwakukhona ukungahambisani kwezincomo zokugoma nezinye izinyathelo zokuvimbela.

Ukubhekana nezenzakalo ezimbi ze-glucocorticoids kudinga imizamo ehlanganisiwe kuzo zonke izici. Ukucaciswa okucacile kwezibopho phakathi kwabelaphi, abahlinzeki bokunakekelwa okuyinhloko kanye nochwepheshe kubalulekile. Ukusebenzisa amarekhodi ezempilo e-elekthronikhi anezikhumbuzo ezizenzakalelayo namathuluzi okusekela izinqumo zomtholampilo kungathuthukisa ukuqapha nokuphathwa kobuthi be-steroid. Ababhali baphinde baphakamise ukuthi kuthathwe amathuluzi aqinisekisiwe afana ne-Steritas Glucocorticoid Toxicity Index (GTI) ukulandelela nokunciphisa imiphumela emtholampilo.

Ngokusho kwababhali, izehlakalo ezimbi kakhulu ezibangelwa ama-glucocorticoids zenza kube nengxoxo-mpikiswano ngokuthi zizophumelela yini ekuhlolweni kokulawula kwesimanje. Izivivinyo zamanje zomtholampilo zizofaka umbuzo ukuthi ingabe isilinganiso sengozi nenzuzo yale mithi enamandla singenza ukuthuthukiswa kwayo kusebenze. Uma umuthi wakamuva ubungase ubangele izehlakalo ezimbi kangako, ingabe ungahoxiswa emakethe?

Nakuba ama-glucocorticoids ehlala eyinsika ekwelapheni izifo ezizimele nezivuvukalayo, ukusetshenziswa kwawo namuhla kudinga indlela ecophelelayo, enolwazi. Ukufaka imihlahlandlela evela kochwepheshe obuhlobene, ukusebenzisa amathuluzi okuqapha athuthukile, kanye nokukhuthaza ukusebenzisana kwezinhlanga ezihlukahlukene kuyizinyathelo ezibalulekile zokuthuthukisa ukwelashwa kwe-glucocorticoid.

Ababhali bagcizelela ukuthi, uma kubhekwa izingozi ezihlobene nama-glucocorticoids, ukusetshenziswa kwawo kufanele kusondele ngokuqapha. Imfundo yesiguli ephelele kanye nokuqapha okuqinile kufanele kuqinisekiswe ukulinganisa izinzuzo zaso ngokumelene nokulimala.

  1. U-Habib AA, uNarayanaswami P. Ingabe ama-glucocorticoid angavunyelwa ukuthi asetshenziswe emtholampilo uma etholakala namuhla? Inzwa Yemisipha. 2024 Jul;70(1):9-11. https://doi.org/10.1002/mus.28111 Epub 2024 May 8. PMID: 38720486.
  2. UStepanian L, Laughlin R, Bacher C, et al. Ukuphathwa kwe-glucocorticoid okungapheli ku-neuromuscular disease: inhlolovo ye-neuromuscular neurologists. Inzwa Yemisipha. 2024;70(1):52-59. https://doi.org/10.1002/mus.28069

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“Kumelwe kube nokulinganisela okuqinile phakathi kokuhlonipha isidingo sama-steroid nokunikeza iziguli amandla okubuza ngezinye izindlela.  futhi singasebenza ndawonye ukuze sinciphise ukuthembela kwakho kuzo ngokuhamba kwesikhathi.’” — Karen S Rance, DNP, CPNP

Ukubonga

Sibonga u-Erin Scott, PhD kanye noDkt. Don Bukstein ngegalelo labo kulo msebenzi.

Sibonga i-AstraZeneca, i-Novartis, ne-Sanofi ngokuseseka kwabo kwe-GAAPP's Steroid Stewardship Educational Initiative.

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