Pumu
Pumu | |
---|---|
Mwainisho na taarifa za nje | |
Kundi Maalumu | Pulmonology, immunology ![]() |
ICD-10 | J45. |
ICD-9 | 493 |
OMIM | 600807 |
DiseasesDB | 1006 |
MedlinePlus | 000141 |
eMedicine | article/806890 |
MeSH | D001249 |
Pumu (kwa Kiingereza asthma) ni ugonjwa wa kudumu wa uvimbe wa makoromeo ulio na sifa za dalili zinazobadilika na kujirudia, hewa kuzibwa na bronkospasimu.[1]
Dalili ni pamoja na kukoroma, kukohoa, kujikaza kwa kifua, na kukosa pumzi.[2]
Inashukiwa kusababishwa na jenetikia pamoja na hali ya mazingira.[3] Kwa kawaida huzingatia mtindo wa dalili, matokeo baada ya matibabu ya muda, na spirometri.[4] Imeainishwa kulingana na idadi ya dalili, wingi wa kupumua kwa nguvu (FEV1), na idadi ya juu ya kupumua.[5] Inaweza pia kuainishwa kama atopiki (ya nje) au isiyo ya atopiki (ya ndani)[6] ambapo atopi inarejelea maelekezo ya kuanzia type 1 hypersensitivity.[7]
Dalili kali hutibiwa na Beta2-adrenergic agonist ya kuvuta (kama vile salbutamol) na kotikosteroidi za mdomo.[8] Katika visa vikali kotikosteroidi za mishipa, salfeti ya magnesia na ulazwaji hospitalini unaweza kuhitajika.[9]
Dalili zinaweza kuzuiwa kwa kujiepusha na visababishi, kama vile alajeni[10] na vitu vinavyowasha, na kwa kutumia kotikosteroidi za kuvuta.[11] Beta-adrenoceptor agonist zinazofanya kazi kwa muda mrefu (LABA) au leukotriene antagonist inaweza kutumika kando ya kotikosteroidi iwapo dalili za ugonjwa hazitadhibitiwa.[12]
Uenezi umeongezeka tangu mwaka 1970. Kufikia 2011, watu milioni 235–300 walikuwa wameathiriwa ulimwenguni,[13][14] ikijumuisha takribani vifo 250,000.[14]
Ishara na dalili
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Ugonjwa huu huwa na visa vya kujirudia vya kukoroma, upungufu wa pumzi, kujikaza kwa kifua, na kukohoa.[15] Makohozi yanaweza kutoka mapafuni, lakini kwa kawaida huwa vigumu kuyatoa.[16] Ukiendelea kupata nafuu yanaweza kutokea uchafu kama usaha kwa sababu ya kiwango cha juu cha seli nyeupe za damu ziitwazo esinofili.[17] Dalili huwa mbaya zaidi usiku na mapema asubuhi au kwa athari ya mazoezi au baridi.[18] Baadhi ya watu wenye ugonjwa huu ni nadra kwa kawaida kuhisi dalili, kwa athari za visababishi, ilhali wengine wanaweza kuwa na dalili zinazotambulika na zinazoendelea.[19]
Hali zinazohusiana
[hariri | hariri chanzo]Hali kadhaa za afya hutokea mara nyingi kwa walio na pumu ikiwa ni pamoja na: ugonjwa wa ucheuaji wa astro-esophajeli (GERD), rhinosinusitisi, na apnea inayosumbua wakati wa kulala.[20] Matatizo ya kisaikolojia huwa ya kawaida[21] na wasiwasi unaotokea kati ya asilimia 16–52 na tatizo la sununu katika asilimia 14–41.[22] Hata hivyo, haijulikani iwapo ugonjwa huu husababisha matatizo ya kisaikolojia au iwapo matatizo ya kisaikolojia husababisha pumu.[23]
Visababishi
[hariri | hariri chanzo]Ugonjwa huu husababishwa na mchanganyiko wa mwingiliano mgumu na usioeleweka kikamilifu wa kimazingira na kijenetiki.[3][24] Masuala haya huathiri ukali wake na matokeo yake baada ya matibabu.[25] Inaaminika kuwa ongezeko la hivi karibuni la ugonjwa huu unasababishwa na kubadilika kwa masuala ya kiepijenetiki (kuridhika kando na yanayohusiana na Mfuatano wa DNA) na kubadilika kwa mazingira ya kuishi.[26]
Mazingira
[hariri | hariri chanzo]Masuala mengi ya kimazingira yamehusishwa na kutokea kwa pumu na maumivu ikiwa ni pamoja na: alejeni, kuchafuka kwa hewa na kemikali zingine za kimazingira.[27] Kuvuta sigara wakati wa ujauzito na baada ya kuzaa huhusishwa na hatari kuu za dalili zinazofanana na za pumu.[28] aina ya hewa, kutoka kwa magari barabarani au ngazi za juu za ozoni ,[29] zimehusishwa na kutokea kwa pumu na ongezeko la ukali wake.[30] Hatari ya mchanganyiko wa ogani fukivu inaweza kuchochea kutokea kwa pumu; uhatarisho wa fomadeidi, kwa mfano, huwa na ushirikiano halisi.[31] Pia, fithaleti katika PVC huhusishwa na ugonjwa huu kwa watoto na watu wazima[32][33] kama ilivyo kwa viwango vya juu vya hatari ya endotoksini.[34]
Pumu huhusishwa na uhatarisho wa alejeni za ndani ya nyumba.[35] Alejeni za kawaida za ndani ni pamoja na: wadudu wa vumbi, mende, magamba ya wanyama, na kuvu.[36][37] Juhudi za kupunguza wadudu wa vumbi zimepatikana kutofaa.[38] Maambukizi fulani yanayohusiana na upumuaji yanaweza kuongeza hatari ya kupata pumu yanapopatikana utotoni kama vile:[39]virusi vya sinksia vya upumuaji na virusi vya rhino.[40] Hata hivyo maambukizi mengine yanaweza kupunguza hatari.[40]
Nadharia ya usafi
[hariri | hariri chanzo]Nadharia ya usafi hujaribu kuelezea viwango vya kuongezeka kwa pumu kote ulimwenguni kama matokeo ya moja kwa moja na yasiyokusudiwa ya kupungua kwa hatari wakati wa utotoni, hadi kwa bakteria na virusi visivyo na maambukizi.[41][42] Imependekezwa kuwa kupungua kwa hatari ya bakteria na virusi sehemu yake ni kwa sababu ya kuongezeka kwa usafi na kupungua kwa ukubwa wa familia katika jamii za kisasa.[43] Ushahidi unaodhibitisha nadharia ya usafi ni pamoja na viwango vya chini vya pumu kwa mashamba na maboma yaliyo na wanyama vipenzi.[43]
Matumizi ya antibiotiki mapema maishani yamehusishwa na kutokea kwa pumu.[44] Pia, kuzaa kwa njia ya operesheni ya Siza huhusishwa na ongezeko la hatari (lililokadiriwa kwa asilimia 20–80) ya pumu—ongezeko hili la hatari linahusishwa na ukosefu wa kudhibiti bora wa bakteria ambao mtoto mchanga angepata kutoka kwa njia inayopitia kwenye njia ya uzazi.[45][46] Kuna uhusiano kati ya pumu na kiwango cha utajiri.[47]
Jenetikia
[hariri | hariri chanzo]Endotoxin levels | CC genotype | TT genotype |
---|---|---|
High exposure | Low risk | High risk |
Low exposure | High risk | Low risk |
Historia ya familia ni suala la hatari huku jeni nyingi tofauti zikihusishwa.[49] Iwapo mmoja wa mapacha ataathiriwa, uwezekano wa mwingine kuwa na ugonjwa ni takriban asilimia 25.[49] Kufikia mwisho wa 2005, jeni zilikuwa zimehusishwa na pumu katika idadi sita au zaidi za watu zilizotengana ikiwa ni pamoja na:GSTM1, IL10,CTLA-4, SPINK5,LTC4S, IL4R na ADAM33 kati ya zingine.[50] Nyingi za jeni hizi zinahusiana na mfumo wa kingamwili au urekebishaji wa inflamesheni. Hata kati ya orodha ya jeni zilizodhibitishwa na uchunguzi uliorudiwa, matokeo hayajawa sawa kati ya idadi zote za watu zilizotathminiwa.[50] Mwaka wa 2006 zaidi ya jeni 100 zilihusishwa na pumu katika uchunguzi wa muungano wa jeni moja pekee;[50] mengi yanaendelea kutambuliwa.[51]
Baadhi ya tofauti ya jenetikia unaweza kusababisha ugonjwa unapounganishwa na hatari ya kimazingira.[3] Kwa mfano upolimofi moja ya nunukliotaidi katika eneo la CD14 na hatari ya endotoksini (zao la bakteria). Hatari ya endotoksini unaweza kupatikana kutoka kwa vyanzo kadhaa vya kimazingira ikiwa ni pamoja na moshi wa tobako, mbwa na mashamba. Hatari ya pumu, kisha husababishwa na jenetiki ya mtu na kiwango cha hatari ya endotoksini.[48]
Hali ya tiba
[hariri | hariri chanzo]Seti ya kizema ya atopi, aleji ya mafua na pumu huitwa atopi.[52] Suala la hatari kuu zaidi la kupata ugonjwa ni historia ya ugonjwa wa atopi;[39] huku pumu ikitokea kwa kiwango cha juu kwa walio na kizema au mafua ya mzio.[53] Ugonjwa huu umehusishwa na Churg–Strauss syndrome, ugonjwa wa kipekee wa kingamwili na vaskulitisi. Watu binafsi walio na aina fulani za utikaria pia wanaweza kuhisi dalili za pumu.[52]
Kuna uhusiano kati ya unene na hatari ya ugonjwa huku zikiwa zimeongezeka miaka iliyopita hivi karibuni.[54][55] Masuala kadhaa yanaweza kusababisha ikiwa ni pamoja na kupungua kwa utendakazi wa upumuo kwa sababu ya ongezeko la mafuta na hasa kwa kuwa tishu ya adiposi husababisha hali ya pro-inflamesheni.[56]
Dawa za Beta blocker kama vile propranolol zinaweza kusababisha ugonjwa kwa walio na uwepesi wa kuipata.[57] Cardioselective beta-blockers, hata hivyo, huonekana kuwa salama kwa walio na ugonjwa mdogo au wa kiasi.[58] Dawa zingine zinazoweza kusababisha matatizo ni ASA, NSAID, na vizuizi vya enzaimu anjiotensini-badilishi.[59]
Ongezeko
[hariri | hariri chanzo]Baadhi ya watu huwa na pumu tulivu kwa majuma au miezi kisha kuwa kali kwa ghafla. Watu tofauti huathirika kwa njia tofauti na masuala mbalimbali.[60] Watu wengi binafsi wanaweza kupata ongezeko kali kutokana na baadhi ya maajenti sababishi.[60]
Visababishi vya kinyumbani vya ugonjwa huu ni pamoja na vumbi, magamba ya mnyama (hasa manyoya ya paka na mbwa), mende alejeni na kuvu.[60] marashi ni kisababishi cha kawaida cha mashambulizi kali kwa kina mama na watoto. Ambukizo la virusi na bakteria la trakti ya juu ya kupumua unaweza kuongeza ugonjwa.[60] Mfadhaiko wa kisaikolojia mfadhaiko unaweza kuzidisha dalili—inakisiwa kuwa mfadhaiko hubadilisha mfumo wa kingamwili na hivyo huongeza athari ya inflamesheni ya njia ya hewa kutokana na alejeni na vitu ambavyo huwasha.[30][61]
Pathofisiolojia
[hariri | hariri chanzo]![Sehemu ya tishu ya njia ya hewa inayoonyesha ukuta ulio na doa la waridi na kamasi ya rangi nyeupe uliojaa upande wa ndani](http://upload.wikimedia.org/wikipedia/commons/thumb/6/6b/Asthma.jpg/220px-Asthma.jpg)
Pumu husababishwa na uvimbe kwa njia za hewa ikifuatiwa na mikazo katika eneo hilo msuli mdogo. Hii pamoja na visababishi vingine husababisha maumivu yanayotokana na njia ya hewa iliyonyembamba na dalili za hali ya juu za kukoroma. Uwembamba unaweza kurudi hali yake ya kawaida bila matibabu Mara kwa mara njia za hewa hujibadilisha.[15] Mabadiliko ya njia za hewa ni pamoja na ongezeko kwa esinofili na kunenepa kwa lamina lililofanana na neti. Msuli wa njia za hewa inaweza kuwa kubwa kwa ukali na kuongezeka kwa idadi ya tezi ya miukosi. Aina zingine za seli zilizohusika ni pamoja na: T lymphocytes, macrophages, na nutrofili. Pia kunaweza kuwa na vijenzi vya mfumo wa kinga pamoja na: cytokines, chemokines, histamine, na leukotrienes miongoni mwa zingine.[40]
Utambuzi
[hariri | hariri chanzo]Pumu umetambulika vizuri, ilhali hakuna ufafanuzi hata moja ulioidhinishwa.[40] Inafafanuliwa na Uvumbuzi wa Kidunia wa Pumu kama "ulemavu mkali wa inflamesheni katika njia za hewa ambapo seli mingi na elementi za seli huwa na jukumu. Inflamesheni kali inahusishwa na mwitikio uliozidi wa njia ya hewa zinazosababisha matukio ya kukoroma, kushindwa kupumua, mikazo kifuani na kukohoa hasa usiku au asubuhi na mapema. Matukio haya kwa kawaida yanahusiana na kutapakaa kwa hewa mwilini lakini mtiririko wa hewa uliozuiwa ambao unabadilika kwa pafu ambayo mara kwa mara inaweza kurudi kwa hali ya kawaida bila matibabu au na matibabu".[15]
Kwa sasa hakuna uchunguzi maalum na utambuzi unaofanana hasa uliokatika muundo wa dalili na mwitikio kwa tiba muda unapoendelea.[4][40] Utambuzi unapaswa kushukiwa ikiwa kuna: ukoromaji unaotokea mara kwa mara, kukohoa au kupumua kwa ugumu na hizi dalili hutokea au kuzidi kwa sababu ya mazoezi, maambukizi ya virusi, alejeni au hewa chafu.[62] Kisha Spirometry hutumika kuthibitisha utambuzi.[62] Utambuzi kwa watoto waliochini ya miaka sita ni vigumu kwa sababu ni wadogo kufanyiwa spirometry.[63]
Spirometry
[hariri | hariri chanzo]Spirometry inapendekezwa ili isaidie utambuzi na udhibiti.[64][65] Hii ndio uchunguzi bora wa pumu. Ikiwa FEV1 kilichopimwa na mbinu hii kitakuwa bora na zaidi ya asilimia 12 kufuatiliwa na utoaji wa kipanua bronkasi kama vile sabutamoli, husaidia kwa utambuzi. Hata hivyo inaweza kuwa sawa kwa walio na historia ya ugonjwa isiyokali, isiyojitokeza. Kiwango cha hewa mtu anaweza kuvuta kwa pumzi moja inaweza kusaidia kutofautisha pumu COPD.[40] Ni muhimu kufuatilia spirometry kila mwaka moja au mbili ili kufuatilia jinsi ugonjwa unavyodhibitiwa.[66]
Njia nyingine
[hariri | hariri chanzo]Kipimo cha tatizo la methacholine kinahusisha kuvuta hewa ya kuongeza viwango vya dutu vinavyosababisha njia ya hewa kuwa nyembamba katika eneo linalochangia kupata magonjwa. Ikiwa hakuna dalili inamaanisha hana ugonjwa; ikiwa ana dalili, hata hivyo, si ya ugonjwa hasa.[40]
Ushahidi mwingine unaochangia ni: tofauti ya asilimia ≥20 kwa kiwango cha mwisho cha kupumua angalau siku tatu kwa wiki kwa wiki mbili, uboreshaji kwa asilimia ≥20 ya kiwango cha kupumua ukifuatiliwa na matibabu ya sabutamoli, kotikosteroidi ya kuvuta au prinisoni, au upungufu wa asilimia ≥20 ya kifaa cha kupima hewa kutoka kwa mapafu ikifuatiliwa na hatari ya kisababishi.[67] Kipimo cha kiwango cha juu cha kupumua hubadilika zaidi kuliko ya spirometry, hata hivyo, haijakubaliwa kwa utambuzi wa mara kwa mara. Inaweza kuwa ya manufaa ya kujitathmini kila siku kwa wale walio na ugonjwa uliokali kiasi hadi kwa iliyokali na kutathmini matokeo yanayofaa kwa matibabu mapya. Inaweza pia kuwa ya manufaa ya kuongoza kwa matibabu kwa walio na hali ya kuongezeka kwa ukali wa ugonjwa.[68]
Uainishaji
[hariri | hariri chanzo]Severity | Symptom frequency | Night time symptoms | %FEV1 of predicted | FEV1 Variability | SABA use |
---|---|---|---|---|---|
Intermittent | ≤2/week | ≤2/month | ≥80% | <20% | ≤2 days/week |
Mild persistent | >2/week | 3–4/month | ≥80% | 20–30% | >2 days/week |
Moderate persistent | Daily | >1/week | 60–80% | >30% | daily |
Severe persistent | Continuously | Frequent (7×/week) | <60% | >30% | ≥twice/day |
Ugonjwa huu huainishwa kulingana na dalili inavyojitokeza mara kwa mara, kutoka kwa pumzi inayotolewa nje (FEV1), na kiwango cha mwisho cha kupumua.[5] Pumu inaweza kuainishwa kama atopi (iliyo ya nje) au isiyo ya atopi (iliyo ya ndani), kwa kuzingatia iwapo dalili zimechochewa na alejeni (atopi) au la (zisizo za atopi).[6] Pumu unapoainishwa kulingana na ukali, kwa sasa hakuna mbinu halisi ya kuainisha vikundi vidogo mbalimbali vya ugonjwa huu zaidi ya mfumo huu.[69] Kutafuta njia za kutambua vikundi vidogo vinavyoitikia vyema kwa aina tofauti za matibabu ni lengo muhimu la utafiti wa pumu.[69]
Ingawa pumu ni hali kali pingamizi, haichukuliwi kama sehemu ya ugonjwa kali unaopinga mapafu kwa kuwa jina hili linahusu mchanganyiko wa magonjwa zisizoweza kurudi katika hali iliyosawa kama vile bronkektasisi,bronkitisi kali, na emphysema.[70] Tofauti na magonjwa haya, kizuizi cha njia ya hewa huweza kurudi katika hali yake ya kawaida; hata hivyo, isipotibiwa, inflamesheni kali kutokana na pumu huweza kusababisha mapafu kuwa na kizuizi kisichorudi kwa hali yake ya kawaida kwa sababu ya njia ya hewa kupata muundo mwingine.[71] Tofauti na emphysema, ugonjwa huu huathiri bronkia, sio alveoli.[72]
Kuzidi kwa pumu
[hariri | hariri chanzo]Near-fatal | High PaCO2 and/or requiring mechanical ventilation | |
---|---|---|
Life threatening (any one of) | ||
Clinical signs | Measurements | |
Altered level of consciousness | Peak flow< 33% | |
Exhaustion | Oxygen saturation< 92% | |
Arrhythmia | PaO2< 8 kPa | |
Low blood pressure | "Normal" PaCO2 | |
Cyanosis | ||
Silent chest | ||
Poor respiratory effort | ||
Acute severe (any one of) | ||
Peak flow 33–50% | ||
Respiratory rate ≥ 25 breaths per minute | ||
Heart rate ≥ 110 beats per minute | ||
Unable to complete sentences in one breath | ||
Moderate | Worsening symptoms | |
Peak flow 50–80% best or predicted | ||
No features of acute severe asthma |
Ugonjwa kali uliozidi huitwa shambulizi la pumu. Dalili zinazotambulika ni upungufu wa hewa, ukorotaji, na kujikaza kwa kifua.[40] Wakati hizi ni dalili za kwanza za ugonjwa,[74] baadhi ya watu huonyesha kwa kukohoa, na katika hali kali, mwendo wa kupumua unaweza kuwa umeharibika sana kiasi kwamba ukoromaji hausikiki.[73]
Dalili zinzazotokea wakati wa shambulizi la ugonjwa ni pamoja na matumizi zinazosaidia misuli za kupumua (sternocleidomastoid na misuli ya scalene za shingo), kunaweza kuwa na mpwito wa moyo wa kifumbo (mpwito uliodhaifu wakati wa kuvuta hewa na ulio na nguvu wakati wa kutoa hewa), na kuvimba kwa kifua.[75] rangi ya bluu ya ngozi na kucha inaweza kutokea kutokana na ukosefu wa oksijeni.[76]
Katika hali ya maumivu usio kali kiwango cha mwisho cha kupumua ni ≥200 ya lita moja kwa dakika au asilimia ≥50 ya utabiri uliobora.[77] Wastani wake unafasiliwa kama kati ya 80 na 200 ya lita moja kwa dakika au asilimia 20 na 50 ya utabiri uliobora bali iliokali inafasiliwa kama ≤ 80 ya lita kwa dakika au asilimia ≤25 ya utabiri uliobora.[77]
Pumu iliyo kali mno, ulioitwa hali ya kuwa na pumu kali mbeleni, na inayoendelea kwa muda mrefu, ni ugonjwa kali uliozidi ambao hautibii na matibabu ya kawaida ya kipanua koromeo na kotikosteroidi.[78] Nusu ya hali hizi zimesababishwa na maambukizi kutoka kwa mengine yaliyosababishwa na alejeni, hewa chafu, ukosefu wa dawa au kuzitumia kwa njia isiyofaa.[78]
Pumu ya brittle ni aina ya ugonjwa unaotambuliwa na mashambulizi makali yanayorudi.[73] Aina ya kwanza ya ugonjwa wa brittle ni ugonjwa ulio tofauti na mtiririko wa upeo mpana, licha ya makali ya dawa. Aina ya pili ya ugonjwa wa brittle ni ugonjwa ulio na usuli uliothibitiwa kwa njia inayofaa na ukali wa ghafla.[73]
Yanayosababisha na mazoezi
[hariri | hariri chanzo]Zoezi linaweza kusababisha kuminya bronkasi kwa wote walio na wasio kuwa na ugonjwa.[79] Hutokea kwa watu wengi walio na pumu na hadi asilimia 20 ya watu wasio kuwa na ugonjwa.[79] Hutokea mara nyingi kwa wanariadha wa tabaka la juu, kwa viwango vinavyobadilika kutoka asilimia 3 kwa wanaoshiriki katika mashindano ya bobsled hadi asilimia 50 kwa wanariadha wa baiskeli na asilimia 60 kwa cross-country skiing.[79] Ingawa inaweza kutokea katika hali yoyote ya hewa ni ya kawaida zaidi wakati hewa ni kavu na baridi.[80] Beta2-agonists ya kuvuta inaonekana kuwa haileti mabadiliko katika matokeo ya wanariadha wasiokuwa na pumu[81] hata hivyo dozi za kumeza zinaweza kuboresha uvumilivu na nguvu.[82][83]
Kazini
[hariri | hariri chanzo]Pumu unaotokea (au kuzidishwa na) mazingira ya kazini, hurejelewa kama magonjwa ya kazini.[84] Hata hivyo hali nyingi haziripotiwi au kutambuliwa.[85][86] Inakadiriwa kuwa asilimia 5-25 ya ugonjwa huu kwa watu wazima huhusiana na mahali pa kazi. Maajenti karibu mia moja wamehusishwa na ya kawaida ikiwa: isocyanates, nafaka na uchafu wa mbao, colophony, soldering flux, ulimbo wa mpira, wanyama, na aldehydes. Uajiri uliohusishwa na hatari kubwa ya matatizo inajumuisha: wale ambao wanajipaka rangi, waokaji na watengenezao chakula, wauguzi, wafanyikazi wa kemikali, wanaofanyakazi na wanyama, wati weko, watengenezaji nywele na wafanyikazi wa mabao.[84]
Utambuzi tofauti
[hariri | hariri chanzo]Hali zingine zinaweza kusababisha dalili zinazofanana na za pumu. Kwa watoto, magonjwa mengine ya njia ya hewa kama vile mzio wa pua na sinositisi zinapaswa kuangiliwa pia kama visababishi vinavyofunga njia ya hewa ikijumuisha: kitu kigeni mwilini, tracheal stenosis au laryngotracheomalacia, vizingo vya utomvu, hurefushwa Tezi au uzito wa shingo. Kwa watu wazima, COPD, kutofanya kazi kwa moyo, uzito wa hewa kupita, vile vile dawa za kukomesha athiri ya ACE zinapaswa kuangaliwa. Kwa watu wote kutofanya kazi kwa mshipi wa sauti inaweza kutokea pia.[87]
Pumu zibifu wa kudumu inaweza kuwa na ugonjwa huu na inaweza kutokea kama tatizo la kudumu. Katika umri wa miaka 65 watu wengi walio na ugonjwa wa njia ya hewa iliyofunganga watakuwa na pumu na COPD. Kati hali hii, COPD inaweza kutofautishwa kwa nutrofili nyingi katika njia ya hewa, inayoongezwa na ukubwa wa ukuta, na kuongezeka kwa msuli mdogo bronkia. Hata hivyo, kiwango hiki cha kuchunguza haiwezi kutekelezwa kwa sababu COPD na pumu huwa na kanuni sawa za usimamizi: kotikosteroidi, kuwepo kwa beta agonists, na hatua za kuacha kuvuta sigara.[88] Hukaribiana na pumu kwa dalili, huhusiana na uvutaji wa sigara, umri mkubwa, kutobadilika kwa dalili baada ya kuweka kipanua bronkasi, na upungufu wa kuwepo kwa atopi katika familia.[89][90]
Uzuiaji
[hariri | hariri chanzo]Ushahidi wa kufanya kazi kwa mikakati ya kuzuia kutokea kwa ugonjwa ni finyu.[91] Baadhi huonyesha matumaini ikijumuisha: kuepekuna na sehemu zilizo na moshi katika uterasi na baada ya kuzaa, unyonyeshaji, na ongezeko la utunzaji au familia kubwa lakini hakuna hata moja inayopendekezwa kwa dalili hii.[91] Kufichuliwa kwa mnyama mapema inaweza kusaidia.[92] Matokeo ya ufichuzi kwa wanyma wakati mwingine inashida[93] na inapendekezwa tu wanyma watolewe nyumbani ikiwa binadamu ana dalili za aleji ya mnyama huyo.[94] Upangaji mlo wakati wa ujauzito au unyonyeshaji haibainishi kama njia nzuri na hivyo haipendekezwi.[94] Utoaji au upunguzaji wa vitu vilivyo hatari kwa watu kazini inaweza kuwa salama.[84]
Udhibiti
[hariri | hariri chanzo]Ilhali hakuna matibabu ya pumu, dalili zinaweza kuboreshwa.[95] Mpango maalum, ulioboreshwa kwa kufuatilia na kudhibiti dalili inapaswa kutengenezwa. Mpango huu unapaswa kujumuisha upunguzaji wa alejeni, kwa uchunguzi wa kutathmini ukali, na matumizi ya dawa. Mpango wa matibabu unapaswa kuandikwa chini na kuwashauri kuhusu marekebisho ya matibabu kulingana na mabadiliko ya dalili.[96]
Njia mwafaka ya kutibu ni kutambua visababishi, kama vile uvutaji wa sigara, wanyama, au aspirin, na kuepukana nao. Ikiwa haiwezekani, matumizi ya dawa utahitajika. Dawa ya matibabu yanachaguliwa kwa kuzingatia, vitu vingi, ukali wa ugonjwa na marudio ya dalili. Matibabu maalum ya pumu huanishwa kwa jumla katika kategoria zinazojitokeza na zinazochukua muda.[97][98]
Vipanua bronkasi vinapendekezwa kwa dalili za muda mfupi. Matibabu mengine hayahitajiki, kwa wanaokuwa na maumivu kila mara. Ikiwa ugonjwa itaendelea kudumu (kuwa mgonjwa zaidi ya mara mbili kwa wiki moja), dozi ndogo ya kuvuta ya kotikosteroidi au nyingine, ya kunywa leukotriene antagonist au mast cell stabilizer inapendekezwa. Kwa walio na maumivu kila siku, dozi kubwa ya kotikosteroidi ya kuvuta inatumiwa. Wakati wa maumivu, kotikosteroidi ya kumeza zinaongezwa kwa matibau haya.[8]
Ubadilishaji wa mtindo wa maisha
[hariri | hariri chanzo]Uepaji wa visababishi ni sehemu kuu ya kuboresha udhibiti na kuzuia kupatwa na ugonjwa. Visababishi vya kawaida sana ni pamoja na alejeni, moshi (tobako na vingine), uchafuzi wa hewa, vizuizi beta visivyo chaguzi, na chakula kilicho na salfeti.[99][100] Uvutaji sigara na uvutaji moshi kutoka kwa anayevuta sigara(moshi wa mtu mwingine) unaweza kupunguza utendakazi wa dawa kama vile kotikosteroidi.[101] Juhudi za kudhibiti wadudu wa vumbi, pamoja na kuchunja hewa, kemikali za kuua wadudu, kutumia kivuta vumbi, vitu vya kufunika godoro na njia zingine hazikuwa na mabadiliko kwa dalili za ugonjwa.[38]
Dawa
[hariri | hariri chanzo]Dawa zinazotumika kutibu pumu zimegawanywa mara mbili: zinazotuliza maumivu haraka kwa kutibu dalili kali; na za kudhibiti maumivu kwa muda mrefu ambazo huzuia ongezeko la ugonjwa.[97]
- Zinazofanya kazi haraka
- beta2-adrenajiki agonistibeta2-adrenosepta agonistsi (SABA), kama vile sabutamoli (albuterol USAN) ni matibabu ya kwanza ya dalili za ugonjwa.[8]
- Dawa za Anticholinergic kama vile bromidi ya ipratropiamu, hupeana faida zinapotumika pamoja na SABA kwa walio na dalili.[8] Vipanuzi vya bronkasi visivyo na anticholinergic inaweza pia hutumika iwapo mtu hawezi kustahimili SABA.[70]
- Kipokezi cha adrenaji cha zamani, kisichochaguliwa sana adrenajiki agonistsi, kama vile epinephrine ya kuvuta huwa na matokeo sawa na yale ya SABA.[102] Hazipendekezwi kwa sababu ya tatizo la kuchangamsha moyo.[103]
- Udhibiti wa muda mrefu
- Kotikosteroidi huchukuliwa kama matibabu yanayofaa kwa udhibiti wa muda mrefu.[97] Aina zinazovutwa hutumika isipokuwa kwa ugonjwa kali unaoendelea, ambapo kotikosteroidi za kumeza zitahitajika.[97] Hupendekezwa kuwa aina za kuvutwa zitumike mara moja au mbili kwa siku, kulingana na ukali wa dalili.[104]
- Adrenosepta agonisti beta zinazofanya kazi kwa muda mrefu (LABA) kama vile salmeterol na formoterol zinaweza kuboresha udhibiti wa ugonjwa, angalau kwa watu wazima, zinapopeanwa pamoja na kotikosteroidi za kuvuta.[105] Kwa watoto faida hii si hakika.[105][106] Zinapotumika bila steroidi huongeza hatari ya athari[107] na hata zikitumiwa na kotikosteroidi zinaweza kuongeza hatari kidogo.[108][109]
- Leukotriene antagonist (kama vile montelukast na zafirlukast) zinaweza kutumika kando na kotikosteroidi za kuvuta, pia pamoja na LABA.[97] Dhibitisho hairuhusu matumizi katika ongezeko la ugonjwa.[110][111] Kwa watoto chini ya umri wa miaka mitano, therapi ya kuongeza baada ya kuvuta kotikosteroidi inapendekezwa.[112]
- Mast cell stabilizer (kama vile sodiamu kromolini) haitumiki badala ya kotokosteroidi.[97]
- Njia za kupeana
Dawa hupeanwa kama kifaa cha kuvutia dawa (KKD) pamoja na kifaa cha kupeana dawa ya pumu au kama kivutia dawa cha poda. Kifaa kinachopeana dawa ni silinda ya plastiki ambayo huchanganya dawa na hewa, na kurahisisha kupata dozi kamili ya dawa. Nebulaiza inaweza kutumiwa. Nebulaiza na kifaa cha kutoa nafasi hufaa kwa walio na dalili, hata hivyo hakuna thibitisho kuamua iwapo kuna au hakuna tofauti kwa dalili kali.[113]
- Athari
Matumizi ya muda mrefu ya kotikosteroidi ya kuvuta huwa na hatari ndogo ya athari.[114] Hatari ni pamoja na kutokea kwa cataract na kurudi nyuma kidogo kwa akili.[114][115]
Dawa nyingine
[hariri | hariri chanzo]Pumu isipobadilika na dawa za kawaida, kuna aina zingine za chaguo zinazopatikana kwa udhibiti wa dharura na uzuizi wa milipuko. Kwa udhibiti wa dharura aina zingine za chaguo ni:
- Oksijeni ili kutuliza haipoksia ikiwa viwango vya juu iko chini ya asilimia 92.[116]
- Salfeti ya magnesia matibabu ya mishipa ya ndani yameonyeshwa kusababisha athari ya kupanua bronkasi inapotumika pamoja na matibabu mengine katika mashambulizi makali ya ugonjwa.[9][117]
- Helioksi, mchanganyiko wa heli na oksijeni, unaweza kutumiwa kwa visa vikali visivyoonyesha mabadiliko kwa kutumia dawa.[9]
- Sabutamoli ya mishipa ya ndani haitetewi na dhibitisho linalopatikana na hivyo hutumika tu kwa visa vikali zaidi.[116]
- Methylxanthines (kama vile theophylline) wakati mmoja ilitumika kwa wingi, lakini haiongezi athari za beta-agonistsi.[116] Matumizi yake kwa maumivu makali huwa na pingamizi.[118]
- Kitiaganzi kinachojitenga ketamini inaweza kutumiwa kinadharia iwapo intubesheni na uingizaji wa hewa utahitajika kwa watu wanaokaribia kuwa na tatizo la upumuo; hata hivyo, hakuna dibitisho kutoka kwa majaribio ya kliniki ili kudhibitisha hili.[119]
Kwa walio na ugonjwa kali unaoendelea usiodhibitiwa na kotikosteroidi za kuvuta na LABAS themoplasti ya bronkasi inaweza kutumiwa.[120] Huhusisha hupeanaji wa nishati joto kwa njia za hewa wakati wa mifululizo ya bronkoskopi.[120] Ingawa inaweza kuongeza idadi ya maumivu katika miezi michache ya kwanza huonekana kupunguza idadi ambayo hufuata.Athari za kupita mwaka mmoja hazijulikani.[121]
Dawa mbadala
[hariri | hariri chanzo]Watu wengi, kama wale walio na matatizo ya muda mrefu, hutumia matibabu mbadala; uchunguzi unaonyesha kuwa takribani asilimia 50 hutumia baadhi ya therapi isiyo ya kawaida.[122][123] Kuna data chache ya kudhibitisha utendakazi wa therapi hizi. Ushahidi hautoshi kudhibitisha matumizi ya vitamini C.[124] Acupuncture haipendekezwi kwa matibabu maana hakuna ushahidi wa kudhibitisha matumizi yake.[125][126] Kutia aioni kwa hewa haionyeshi ushahidi wa mabadiliko ya dalili au kusaidia utendakazi wa mapafu; hii ikitumika sawa kwa jenereta hasi na zisizo hasi.[127]
"Therapi za mikono", ikiwa ni pamoja na osteopathi, kiropraktiki, fiziotherapi na therapi ya pumzi washawishi, wasio na ushahidi wa kudhibitisha matumizi kwa kutibu pumu.[128] Mbinu ya Butyko ya kupumua ya kudhibiti upitishaji wa hewa nyingi inaweza kusababisha upungufu wa matumizi ya dawa hata hivyo haina athari yoyote kwa pafu.[98] Hivyo kamati ya wastadi ilihisi kuwa ushahidi haukutosha kudhibitisha matumizi yake.[125]
Prognosisi
[hariri | hariri chanzo]![Ramani ya ulimwengu Ulaya ukiwa umepakwa rangi ya manjano, sehemu nyingi za Amerika ukiwa na rangi ya chungwa na Kusini mwa Afrika ukiwa na rangi nyekundu nzito](http://upload.wikimedia.org/wikipedia/commons/thumb/8/8f/Asthma_world_map_-_DALY_-_WHO2004.svg/220px-Asthma_world_map_-_DALY_-_WHO2004.svg.png)
no data <100 100–150 150–200 200–250 250–300 300–350 | 350–400 400–450 450–500 500–550 550–600 >600 |
Prognosi ya pumu ni nzuri, hasa kwa watoto walio na ugonjwa usio mkali.[131] Vifo vimepungua katika miongo michache iliyopita kwa sababu ya utambuzi na uboreshaji wa utunzaji.[132]
Ulimwenguni umesababisha ulemavu wa watu milioni 19.4 kufikia mwaka wa 2004 (milioni 16 wakiwa katika hali ya chini na ya kawaida katika nchi zinazoendelea).[133] Kwa pumu uliotambuliwa wakati wa utotoni, nusu ya hali hizi hazitafanyiwa utambuzi baada ya mwongo mmoja.[49] Upitishaji wa hewa hutengenezwa upya, lakini haijulikani ikiwa italeta faida au madhara.[134] Matibabu ya mapema kwa kutumia kotikosteroidi inaonekana kuzuia au kusaidia kupunguza matumizi kwa pafu.[135]
Epidemiolojia
[hariri | hariri chanzo]![Ramani ya dunia ikiwa na Ulaya, Marekani Kaskazini, Australia na sehemu nyingi za Marekani Kusini yakichorwa nyekundu, sehemu nyingi za Asia yakiwa manjano, na sehemu nyingi za Afrika yakiwa kijivu](http://upload.wikimedia.org/wikipedia/commons/thumb/9/99/Prevalence_of_Clinical_Asthma_world_map_-_GINA2004.svg/220px-Prevalence_of_Clinical_Asthma_world_map_-_GINA2004.svg.png)
no data <1% 1-2% 2-3% 3-4% 4-5% 5-6% | 6-7% 7-8% 8-10% 10-12.5% 12.5–15% >15% |
Kufikia mwaka wa 2011, watu milioni 235–300 ulimwenguni walikuwa wameathiriwa na ugonjwa huu,[13][14] na karibu watu 250,000 hufa kila mwaka.[15] Viwango vyao hutofautiana kati ya nchi zilizo na maambukizi kati ya asilimia 1 hadi 18.[15] Zinapatikana sana katika zilizoendelea kuliko nchi zinazokuwa.[15] Kuna viwango vya chini barani Asia, Ulaya Mashariki na Afrika.[40] Katika nchi zilizoendelea ni kawaida kwa wale walio na shida ya kifedha unapolinganisha na nchi zinazokuwa inapatikana sana kwa walio na fedha.[15] Sababu ya tofauti hizi haijulikani.[15] Nchi zilizo na pato la chini wanajumulisha asilimia 80 ya vifo.[136]
Ilhali ugonjwa huu unapatikana kwa wavulana mara mbili zaidi ya wasichana,[15] ukali wa ugonjwa hutokea kwa viwango sawa.[137] Katika utofautishaji, wanawake wana viwango vikubwa vya pumu kuliko wanaume[15] na hupatikana sana kwa wachanga kuliko wakubwa.[40]
Viwango vya ugonjwa huu ulimwenguni viliongezeka kwa kasi kati ya miaka ya 1960 na 2008[138][139] ikipitishwa kama shida kubwa katika afya ya umma kwanzia miaka ya 1970.[40] Viwango vya ugonjwa havijabadilika tangu katikati ya miaka ya 1990 kukiwa na ongezeko katika nchi zinazoendelea.[140] Pumu huathiri takriban asilimia 7 ya watu nchini Marekani[107] na asilimia 5 nchini Uingereza.[141] Kanada, Australia and Nyuzelandi vina viwango vya kati ya asilimia 14-15.[142]
Historia
[hariri | hariri chanzo]Pumu uligunduliwa kitambo nchini Misri na ulitibiwa kwa kunywa ubani mchanganyiko unaoitwa kyphi.[143] Ulitajwa rasmi kama tatizo la upumuaji na Hippocrates mwaka 450 KK hivi, kutoka kwa neno la Kigriki kumaanisha "kuhema" ikiunda asili ya neno la kisasa.[40] Mnamo 200 KK uliaminika kuhusiana kidogo na hisia.[22]
Mwaka wa 1873, mmoja kati ya karatasi za kwanza za dawa za kisasa kuhusu taarifa zilijaribu kuelezea ugonjwa wa pathofisiolojia ilhali nyingine mwaka wa 1872 ilihitimisha kuwa ugonjwa huu unaweza kutibiwa kwa kupanguza kifua na chloroform liniment.[144][145] Matibabu ya afya mwaka wa 1880, ilijumuisha matumizi ya sindano ya vena inayoitwa pilocarpin.[146] Mnamo mwaka wa 1886, F.H. Bosworth alieleza uhusiano kati ya pumu na mafua ya mzio.[147] epinefrini ulirejelewa mara ya kwanza mwaka wa 1905 katika matibabu ya pumu.[148] Kotikosteroidi za kunywa zilianza kutumiwa miaka ya 1950 ilhali kotikosteroidi za kuvuta na beta agonist za kuchagua zilianza kutumika miaka ya 1960.[149][150]
Kati ya miaka ya 1930–1950, ugonjwa huu ulijulikana kama "takatifu saba" maradhi ya saikosomatiki. Kisababishi chake kilichukuliwa kama saikolojia, na matibabu kuangaliwa kwa uchunguzi nafsia na matibabu mengine ya kuzungumza.[151] Walivyofafanua wachanganuzi ukoromaji wa pumu jinsi mtoto alivyolilia mama yake, walibaini kuwa matibabu ya masumbuko ni muhimu kwa walio na pumu.[151]
Tanbihi
[hariri | hariri chanzo]- ↑ NHLBI Guideline 2007, pp. 11–12
- ↑ British Guideline 2009, p. 4
- ↑ 3.0 3.1 3.2 Martinez FD (2007). "Genes, environments, development and asthma: a reappraisal". Eur Respir J. 29 (1): 179–84. doi:10.1183/09031936.00087906. PMID 17197483.
- ↑ 4.0 4.1 Lemanske RF, Busse WW (2010). "Asthma: clinical expression and molecular mechanisms". J. Allergy Clin. Immuno. 125 (2 Suppl 2): S95–102. doi:10.1016/j.jaci.2009.10.047. PMC 2853245. PMID 20176271.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ 5.0 5.1 5.2 Yawn BP (2008). "Factors accounting for asthma variability: achieving optimal symptom control for individual patients" (PDF). Primary Care Respiratory Journal. 17 (3): 138–147. doi:10.3132/pcrj.2008.00004. PMID 18264646. Ilihifadhiwa kwenye nyaraka kutoka chanzo (PDF) mnamo 2010-03-04. Iliwekwa mnamo 2014-01-09.
{{cite journal}}
: Unknown parameter|dead-url=
ignored (|url-status=
suggested) (help); Unknown parameter|month=
ignored (help) - ↑ 6.0 6.1 Kumar, Vinay; Abbas, Abul K; Fausto, Nelson; Aster, Jon, whr. (2010). Robbins and Cotran pathologic basis of disease (toleo la 8th). Saunders. uk. 688. ISBN 978-1-4160-3121-5. OCLC 643462931.
- ↑ Stedman's Medical Dictionary (toleo la 28). Lippincott Williams and Wilkins. 2005. ISBN 0-7817-3390-1.
- ↑ 8.0 8.1 8.2 8.3 NHLBI Guideline 2007, p. 214 Hitilafu ya kutaja: Invalid
<ref>
tag; name "NHLBI07p214" defined multiple times with different content - ↑ 9.0 9.1 9.2 NHLBI Guideline 2007, pp. 373–375 Hitilafu ya kutaja: Invalid
<ref>
tag; name "NHLBI07p373" defined multiple times with different content - ↑ NHLBI Guideline 2007, pp. 169–172
- ↑ GINA 2011, p. 71
- ↑ GINA 2011, p. 33
- ↑ 13.0 13.1 "World Health Organization Fact Sheet Fact sheet No 307: Asthma". 2011. Ilihifadhiwa kwenye nyaraka kutoka chanzo mnamo 2011-06-29. Iliwekwa mnamo Jan 17th,2013.
{{cite web}}
: Check date values in:|accessdate=
(help) - ↑ 14.0 14.1 14.2 GINA 2011, p. 3
- ↑ 15.00 15.01 15.02 15.03 15.04 15.05 15.06 15.07 15.08 15.09 GINA 2011, pp. 2–5
- ↑ Jindal, editor-in-chief SK. Textbook of pulmonary and critical care medicine. New Delhi: Jaypee Brothers Medical Publishers. uk. 242. ISBN 978-93-5025-073-0.
{{cite book}}
:|first=
has generic name (help) - ↑ George, Ronald B. (2005). Chest medicine : essentials of pulmonary and critical care medicine (toleo la 5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. uk. 62. ISBN 978-0-7817-5273-2.
{{cite book}}
:|edition=
has extra text (help) - ↑ British Guideline 2009, p. 14
- ↑ GINA 2011, pp. 8–9
- ↑ Boulet LP (2009). "Influence of comorbid conditions on asthma". Eur Respir J. 33 (4): 897–906. doi:10.1183/09031936.00121308. PMID 19336592.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ Boulet, LP (2011 Jun). "Asthma-related comorbidities". Expert review of respiratory medicine. 5 (3): 377–93. PMID 21702660.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ 22.0 22.1 editors, Andrew Harver, Harry Kotses, (2010). Asthma, health and society a public health perspective. New York: Springer. uk. 315. ISBN 978-0-387-78285-0.
{{cite book}}
:|last=
has generic name (help)CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link) - ↑ Thomas, M (2011 Sep). "Asthma and psychological dysfunction". Primary care respiratory journal : journal of the General Practice Airways Group. 20 (3): 250–6. PMID 21674122.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Miller, RL (2008). "Environmental epigenetics and asthma: current concepts and call for studies". American Journal of Respiratory and Critical Care Medicine. 177 (6): 567–573. doi:10.1164/rccm.200710-1511PP. PMC 2267336. PMID 18187692.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help); Unknown parameter|month=
ignored (help) - ↑ Choudhry S, Seibold MA, Borrell LN; na wenz. (2007). "Dissecting complex diseases in complex populations: asthma in latino americans". Proc Am Thorac Soc. 4 (3): 226–33. doi:10.1513/pats.200701-029AW. PMC 2647623. PMID 17607004.
{{cite journal}}
: Explicit use of et al. in:|author=
(help)CS1 maint: multiple names: authors list (link) - ↑ Dietert, RR (2011 Sep). "Maternal and childhood asthma: risk factors, interactions, and ramifications". Reproductive toxicology (Elmsford, N.Y.). 32 (2): 198–204. PMID 21575714.
{{cite journal}}
: Check date values in:|date=
(help) - ↑ Kelly, FJ (2011 Aug). "Air pollution and airway disease". Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology. 41 (8): 1059–71. PMID 21623970.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ GINA 2011, p. 6
- ↑ GINA 2011, p. 61
- ↑ 30.0 30.1 Gold DR, Wright R (2005). "Population disparities in asthma". Annu Rev Public Health. 26: 89–113. doi:10.1146/annurev.publhealth.26.021304.144528. PMID 15760282.
- ↑ McGwin, G (2010 Mar). "Formaldehyde exposure and asthma in children: a systematic review". Environmental health perspectives. 118 (3): 313–7. PMID 20064771.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Jaakkola JJ, Knight TL. (2008). "The role of exposure to phthalates from polyvinyl chloride products in the development of asthma and allergies: a systematic review and meta-analysis". Environ Health Perspect. 116 (7): 845–53. doi:10.1289/ehp.10846. PMC 2453150. PMID 18629304.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ Bornehag, CG (2010 Apr). "Phthalate exposure and asthma in children". International journal of andrology. 33 (2): 333–45. PMID 20059582.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Liu AH (2004). "Something old, something new: indoor endotoxin, allergens and asthma". Paediatr Respir Rev. 5 (Suppl A): S65–71. doi:10.1016/S1526-0542(04)90013-9. PMID 14980246.
- ↑ Ahluwalia, SK (2011 Apr). "Mazingira ya ndani ya nyumba na athari zake kwa athma ya utotoni". Current opinion in allergy and clinical immunology. 11 (2): 137–43. PMID 21301330.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Arshad, SH (2010 Jan). "Does exposure to indoor allergens contribute to the development of asthma and allergy?". Current allergy and asthma reports. 10 (1): 49–55. PMID 20425514.
{{cite journal}}
: Check date values in:|date=
(help) - ↑ Custovic, A (2012). "The role of inhalant allergens in allergic airways disease". Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunologia. 22 (6): 393–401, qiuz follow 401. PMID 23101182.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ 38.0 38.1 PC Gøtzsche, HK Johansen (2008). Gøtzsche, Peter C (mhr.). "House dust mite control measures for asthma". Cochrane Database Syst Rev (2): CD001187. doi:10.1002/14651858.CD001187.pub3. PMID 18425868.
- ↑ 39.0 39.1 NHLBI Guideline 2007, p. 11
- ↑ 40.00 40.01 40.02 40.03 40.04 40.05 40.06 40.07 40.08 40.09 40.10 40.11 Murray and Nadel's textbook of respiratory medicine (toleo la 5th ed.). Philadelphia, PA: Saunders/Elsevier. 2010. ku. Chapter 38. ISBN 1-4160-4710-7.
{{cite book}}
:|edition=
has extra text (help);|first=
missing|last=
(help) - ↑ Ramsey, CD (2005). "The hygiene hypothesis and asthma". Current Opinion in Pulmonary Medicine. 11 (1): 14–20. doi:10.1097/01.mcp.0000145791.13714.ae. PMID 15591883.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help); Unknown parameter|month=
ignored (help) - ↑ Bufford, JD (2005). "The hygiene hypothesis revisited". Immunology and Allergy Clinics of North America. 25 (2): 247–262. doi:10.1016/j.iac.2005.03.005. PMID 15878454.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help); Unknown parameter|month=
ignored (help) - ↑ 43.0 43.1 Brooks, C (2013 Feb). "The hygiene hypothesis in allergy and asthma: an update". Current opinion in allergy and clinical immunology. 13 (1): 70–7. PMID 23103806.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Murk, W (2011 Jun). "Prenatal or early-life exposure to antibiotics and risk of childhood asthma: a systematic review". Pediatrics. 127 (6): 1125–38. doi:10.1542/peds.2010-2092. PMID 21606151.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ British Guideline 2009, p. 72
- ↑ Neu, J (2011 Jun). "Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis". Clinics in perinatology. 38 (2): 321–31. PMID 21645799.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Von Hertzen, LC (2004 Feb). "Asthma and atopy -the price of affluence?". Allergy. 59 (2): 124–37. PMID 14763924.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ 48.0 48.1 Martinez FD (2007). "CD14, endotoxin, and asthma risk: actions and interactions". Proc Am Thorac Soc. 4 (3): 221–5. doi:10.1513/pats.200702-035AW. PMC 2647622. PMID 17607003.
- ↑ 49.0 49.1 49.2 Elward, Graham Douglas, Kurtis S. (2010). Asthma. London: Manson Pub. ku. 27–29. ISBN 978-1-84076-513-7.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - ↑ 50.0 50.1 50.2 Ober C, Hoffjan S (2006). "Asthma genetics 2006: the long and winding road to gene discovery". Genes Immun. 7 (2): 95–100. doi:10.1038/sj.gene.6364284. PMID 16395390.
- ↑ Halapi, E (2009 Jan). "Overview on the current status of asthma genetics". The clinical respiratory journal. 3 (1): 2–7. PMID 20298365.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ 52.0 52.1 Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
{{cite book}}
: CS1 maint: multiple names: authors list (link) - ↑ GINA 2011, p. 4
- ↑ Beuther DA (2010). "Recent insight into obesity and asthma". Curr Opin Pulm Med. 16 (1): 64–70. doi:10.1097/MCP.0b013e3283338fa7. PMID 19844182.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ Holguin F, Fitzpatrick A (2010). "Obesity, asthma, and oxidative stress". J. Appl. Physiol. 108 (3): 754–9. doi:10.1152/japplphysiol.00702.2009. PMID 19926826.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ Wood LG, Gibson PG (2009). "Masuala ya chakula husababisha innate immune activation katikia athma". Pharmacol. Ther. 123 (1): 37–53. doi:10.1016/j.pharmthera.2009.03.015. PMID 19375453.
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: Unknown parameter|month=
ignored (help) - ↑ O'Rourke ST (2007). "Antianginal actions of beta-adrenoceptor antagonists". Am J Pharm Educ. 71 (5): 95. PMC 2064893. PMID 17998992.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ Salpeter, S (2001). "Cardioselective beta-blocker use in patients with reversible airway disease". Cochrane database of systematic reviews (Online) (2): CD002992. PMID 11406056.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Covar, RA (2005 Feb). "Medications as asthma trigers". Immunology and allergy clinics of North America. 25 (1): 169–90. PMID 15579370.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ 60.0 60.1 60.2 60.3 Baxi SN, Phipatanakul W (2010). "The role of allergen exposure and avoidance in asthma". Adolesc Med State Art Rev. 21 (1): 57–71, viii–ix. PMC 2975603. PMID 20568555.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ Chen E, Miller GE (2007). "Stress and inflammation in exacerbations of asthma". Brain Behav Immun. 21 (8): 993–9. doi:10.1016/j.bbi.2007.03.009. PMC 2077080. PMID 17493786.
- ↑ 62.0 62.1 NHLBI Guideline 2007, p. 42
- ↑ GINA 2011, p. 20
- ↑ American Academy of Allergy, Asthma, and Immunology, "Five things physicians and patients should question" (PDF), Choosing wisely: an initiative of the ABIM Foundation, American Academy of Allergy, Asthma, and Immunology, ilihifadhiwa kwenye nyaraka kutoka chanzo (PDF) mnamo 2012-11-03, iliwekwa mnamo Agosti 14, 2012
{{citation}}
: Unknown parameter|dead-url=
ignored (|url-status=
suggested) (help)CS1 maint: date auto-translated (link) CS1 maint: multiple names: authors list (link) - ↑ Third Expert Panel on the Diagnosis and Management of Asthma (2007). Guidelines for the diagnosis and management of asthma. National Heart, Lung, and Blood Institute (US).
- ↑ NHLBI Guideline 2007, p. 58
- ↑ Pinnock H, Shah R (2007). "Asthma". BMJ. 334 (7598): 847–50. doi:10.1136/bmj.39140.634896.BE. PMC 1853223. PMID 17446617.
- ↑ NHLBI Guideline 2007, p. 59
- ↑ 69.0 69.1 Moore WC, Pascual RM (2010). "Update in asthma 2009". American Journal of Respiratory and Critical Care Medicine. 181 (11): 1181–7. doi:10.1164/rccm.201003-0321UP. PMID 20516492.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ 70.0 70.1 Self, Timothy; Chrisman, Cary; Finch, Christopher (2009). "22.
Asthma". Katika Mary Anne Koda-Kimble, Brian K Alldredge; na wenz. (whr.). Applied therapeutics: the clinical use of drugs (toleo la 9th). Philadelphia: Lippincott Williams & Wilkins. OCLC 230848069.
{{cite book}}
: Explicit use of et al. in:|editor=
(help); line feed character in|chapter=
at position 4 (help) - ↑ Delacourt, C (2004). "Conséquencesbronchiques de l'asthme non traité". Archives de Pédiatrie. 11 (Suppl. 2): 71s–73s. PMID 15301800.
{{cite journal}}
: Unknown parameter|month=
ignored (help); Unknown parameter|trans_title=
ignored (|trans-title=
suggested) (help) - ↑ Schiffman, George (18 Desemba 2009). "Chronic obstructive pulmonary disease". MedicineNet. Ilihifadhiwa kwenye nyaraka kutoka chanzo mnamo 2010-08-28. Iliwekwa mnamo 2 Septemba 2010.
{{cite web}}
: Unknown parameter|deadurl=
ignored (|url-status=
suggested) (help)CS1 maint: date auto-translated (link) - ↑ 73.0 73.1 73.2 73.3 British Guideline 2009, p. 54
- ↑ Barnes, PJ (2008). "Asthma". Katika Fauci, Anthony S; Braunwald, E,; Kasper, DL (whr.). Harrison's Principles of Internal Medicine (toleo la 17th). New York: McGraw-Hill. ku. 1596–1607. ISBN 978-0-07-146633-2.
{{cite book}}
: CS1 maint: extra punctuation (link) CS1 maint: multiple names: editors list (link) - ↑ Maitre B, Similowski T, Derenne JP (1995). "Physical examination of the adult patient with respiratory diseases: inspection and palpation". Eur. Respir. J. 8 (9): 1584–93. PMID 8575588.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ↑ Werner, HA (2001). "Status asthmaticus in children: a review". Chest. 119 (6): 1596–1607. doi:10.1378/chest.119.6.1913. PMID 11399724.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ 77.0 77.1 Shiber JR, Santana J (2006). "Dyspnea". Med. Clin. North Am. 90 (3): 453–79. doi:10.1016/j.mcna.2005.11.006. PMID 16473100.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ 78.0 78.1 Shah, R (2012 May–Jun). "Chapter 14: Athma uliokali mno (hali ya kuwa na athma kali, na inayoendelea kwa muda mrefu)". Allergy and asthma proceedings : the official journal of regional and state allergy societies. 33 Suppl 1: S47-50. PMID 22794687.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ 79.0 79.1 79.2 Khan, DA (2012 Jan–Feb). "Exercise-induced bronchoconstriction: burden and prevalence". Allergy and asthma proceedings : the official journal of regional and state allergy societies. 33 (1): 1–6. PMID 22370526.
{{cite journal}}
: Check date values in:|date=
(help) - ↑ GINA 2011, p. 17
- ↑ Carlsen, KH (2008 May). "Treatment of exercise-induced asthma, respiratory and allergic disorders in sports and the relationship to doping: Part II of the report from the Joint Task Force of European Respiratory Society (ERS) and European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA(2)LEN". Allergy. 63 (5): 492–505. PMID 18394123.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help)CS1 maint: extra punctuation (link) - ↑ Kindermann, W (2007). "Do inhaled beta(2)-agonists have an ergogenic potential in non-asthmatic competitive athletes?". Sports medicine (Auckland, N.Z.). 37 (2): 95–102. PMID 17241101.
- ↑ Pluim, BM (2011 Jan 1). "β₂-Agonists and physical performance: a systematic review and meta-analysis of randomized controlled trials". Sports medicine (Auckland, N.Z.). 41 (1): 39–57. PMID 21142283.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ 84.0 84.1 84.2 Baur, X (2012 Jun 1). "The management of work-related asthma guidelines: a broader perspective". European respiratory review : an official journal of the European Respiratory Society. 21 (124): 125–39. PMID 22654084.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Kunnamo, ed.-in-chief: Ilkka (2005). Evidence-based medicine guidelines. Chichester: Wiley. uk. 214. ISBN 978-0-470-01184-3.
{{cite book}}
:|first=
has generic name (help) - ↑ Kraft, editors, Mario Castro, Monica (2008). Clinical asthma. Philadelphia: Mosby / Elsevier. ku. Chapter 42. ISBN 978-0-323-07081-2.
{{cite book}}
:|first=
has generic name (help)CS1 maint: multiple names: authors list (link) - ↑ NHLBI Guideline 2007, p. 46
- ↑ Gibson PG, McDonald VM, Marks GB (2010). "Asthma in older adults". Lancet. 376 (9743): 803–13. doi:10.1016/S0140-6736(10)61087-2. PMID 20816547.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ↑ Hargreave FE; Parameswaran K (2006). "Asthma, COPD and bronchitis are just components of airway disease". European Respiratory Journal. 28 (2): 264–267. doi:10.1183/09031936.06.00056106. PMID 16880365.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ Diaz, P. Knoell (2009). "23. ugonjwa sugu wa mapafu zibifu". Applied therapeutics: the clinical use of drugs (toleo la 9th). Philadelphia: Lippincott Williams & Wilkins.
- ↑ 91.0 91.1 NHLBI Guideline 2007, pp. 184–5
- ↑ Lodge, CJ (2012). "Perinatal cat and dog exposure and the risk of asthma and allergy in the urban environment: a systematic review of longitudinal studies". Clinical & developmental immunology. 2012: 176484. PMID 22235226.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Chen, CM (2010 Jan). "The role of cats and dogs in asthma and allergy—a systematic review". International journal of hygiene and environmental health. 213 (1): 1–31. PMID 20053584.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ 94.0 94.1 Prescott, SL (2005 May 2). "The Australasian Society of Clinical Immunology and Allergy position statement: Muhtasari wa uzuiaji wa aleji kwa watoto". The Medical journal of Australia. 182 (9): 464–7. PMID 15865590.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Ripoll, Brian C. Leutholtz, Ignacio. Exercise and disease management (toleo la 2nd ed.). Boca Raton: CRC Press. uk. 100. ISBN 978-1-4398-2759-8.
{{cite book}}
:|edition=
has extra text (help)CS1 maint: multiple names: authors list (link) - ↑ GINA 2011, p. 56
- ↑ 97.0 97.1 97.2 97.3 97.4 97.5 NHLBI Guideline 2007, p. 213 Hitilafu ya kutaja: Invalid
<ref>
tag; name "NHLBI07p213" defined multiple times with different content - ↑ 98.0 98.1 "British Guideline on the Management of Asthma" (PDF). Scottish Intercollegiate Guidelines Network. 2008. Ilihifadhiwa kwenye nyaraka kutoka chanzo (PDF) mnamo 2008-08-19. Iliwekwa mnamo 2008-08-04.
{{cite web}}
: Unknown parameter|deadurl=
ignored (|url-status=
suggested) (help) - ↑ NHLBI Guideline 2007, p. 69
- ↑ Thomson NC, Spears M (2005). "Athari ya kuvuta sigara kwa matokeo ya matibabu kwa wagonjwa walio na pumu". Curr Opin Allergy Clin Immunol. 5 (1): 57–63. doi:10.1097/00130832-200502000-00011. PMID 15643345.
- ↑ Stapleton M, Howard-Thompson A, George C, Hoover RM, Self TH (2011). "Smoking and asthma". J Am Board Fam Med. 24 (3): 313–22. doi:10.3122/jabfm.2011.03.100180. PMID 21551404.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ↑ Rodrigo GJ, Nannini LJ (2006). "Comparison between nebulized adrenaline and beta2 agonists for the treatment of acute asthma. Uchunguzi wa meta wa majaribio tofauti meta-analysis of randomized trials". Am J Emerg Med. 24 (2): 217–22. doi:10.1016/j.ajem.2005.10.008. PMID 16490653.
- ↑ NHLBI Guideline 2007, p. 351
- ↑ NHLBI Guideline 2007, p. 218
- ↑ 105.0 105.1 Ducharme, FM (2010 May 12). "Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children". Cochrane database of systematic reviews (Online) (5): CD005535. PMID 20464739.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Ducharme, FM (2010 Apr 14). "Addition of long-acting beta2-agonists to inhaled steroids versus higher dose inhaled corticosteroids in adults and children with persistent asthma". Cochrane database of systematic reviews (Online) (4): CD005533. PMID 20393943.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ 107.0 107.1 Fanta CH (2009). "Asthma". New England Journal of Medicine. 360 (10): 1002–14. doi:10.1056/NEJMra0804579. PMID 19264689.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ Cates, CJ (2012 Apr 18). "Regular treatment with formoterol for chronic asthma: serious adverse events". Cochrane database of systematic reviews (Online). 4: CD006923. PMID 22513944.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Cates, CJ (2008 Jul 16). "Regular treatment with salmeterol for chronic asthma: serious adverse events". Cochrane database of systematic reviews (Online) (3): CD006363. PMID 18646149.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ GINA 2011, p. 74
- ↑ Watts, K (2012 May 16). "Leukotriene receptor antagonists in addition to usual care for acute asthma in adults and children". Cochrane database of systematic reviews (Online). 5: CD006100. PMID 22592708.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ British Guideline 2009, p. 43
- ↑ NHLBI Guideline 2007, p. 250
- ↑ 114.0 114.1 Rachelefsky, G (2009 Jan). "Inhaled corticosteroids and asthma control in children: assessing impairment and risk". Pediatrics. 123 (1): 353–66. doi:10.1542/peds.2007-3273. PMID 19117903.
{{cite journal}}
: Check date values in:|date=
(help) - ↑ Dahl R (2006). "Systemic side effects of inhaled corticosteroids in patients with asthma". Respir Med. 100 (8): 1307–17. doi:10.1016/j.rmed.2005.11.020. PMID 16412623.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ 116.0 116.1 116.2 Rodrigo GJ, Rodrigo C, Hall JB (2004). "Acute asthma in adults: a review". Chest. 125 (3): 1081–102. doi:10.1378/chest.125.3.1081. PMID 15006973.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ↑ Noppen, M. (Agosti 2002). "Magnesium Treatment for Asthma : Where Do We Stand?". Chest. 122 (2): 396–8. doi:10.1378/chest.122.2.396. PMID 12171805.
{{cite journal}}
: CS1 maint: date auto-translated (link) - ↑ GINA 2011, p. 37
- ↑ NHLBI Guideline 2007, p. 399
- ↑ 120.0 120.1 Castro, M (2010 Apr). "Bronchial thermoplasty: a novel technique in the treatment of severe asthma". Therapeutic advances in respiratory disease. 4 (2): 101–16. doi:10.1177/1753465810367505. PMID 20435668.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ GINA 2011, p. 70
- ↑ Blanc PD, Trupin L, Earnest G, Katz PP, Yelin EH, Eisner MD (2001). "Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis : data from a population-based survey". Chest. 120 (5): 1461–7. doi:10.1378/chest.120.5.1461. PMID 11713120.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ↑ Shenfield G, Lim E, Allen H (2002). "Survey of the use of complementary medicines and therapies in children with asthma". J Paediatr Child Health. 38 (3): 252–7. doi:10.1046/j.1440-1754.2002.00770.x. PMID 12047692.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ↑ Kaur, B (2009). Arnold, Elizabeth (mhr.). "Vitamin C supplementation for asthma". Cochrane Database Syst Rev (1): CD000993. doi:10.1002/14651858.CD000993.pub3. PMID 19160185.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help); Unknown parameter|unused_data=
ignored (help) - ↑ 125.0 125.1 NHLBI Guideline 2007, p. 240
- ↑ McCarney RW, Brinkhaus B, Lasserson TJ, Linde K (2004). McCarney, Robert W (mhr.). "Acupuncture for chronic asthma". Cochrane Database Syst Rev (1): CD000008. doi:10.1002/14651858.CD000008.pub2. PMID 14973944.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ↑ Blackhall, K (2012 Sep 12). "Ionisers for chronic asthma". Cochrane database of systematic reviews (Online). 9: CD002986. PMID 22972060.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Hondras MA, Linde K, Jones AP (2005). Hondras, Maria A (mhr.). "Manual therapy for asthma". Cochrane Database Syst Rev (2): CD001002. doi:10.1002/14651858.CD001002.pub2. PMID 15846609.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ↑ "WHO Disease and injury country estimates". World Health Organization. 2009. Iliwekwa mnamo Nov. 11, 2009.
{{cite web}}
: Check date values in:|accessdate=
(help) - ↑ |archiveurl=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html%7Carchivedate%3D 11 November 2009 | deadurl= no}}
- ↑ Sergel, Michelle J.; Cydulka, Rita K. (Septemba 2009). "Ch. 75: Asthma". Katika Wolfson, Allan B.; Harwood-Nuss, Ann (whr.). Harwood-Nuss' Clinical Practice of Emergency Medicine (toleo la 5th). Lippincott Williams & Wilkins. ku. 432–. ISBN 978-0-7817-8943-1.
{{cite book}}
: External link in
(help); Unknown parameter|chapterurl=
|chapterurl=
ignored (|chapter-url=
suggested) (help)CS1 maint: date auto-translated (link) - ↑ NHLBI Guideline 2007, p. 1
- ↑ Organization, World Health (2008). The global burden of disease : 2004 update (toleo la [Online-Ausg.]). Geneva, Switzerland: World Health Organization. uk. 35. ISBN 978-92-4-156371-0.
- ↑ Maddox L, Schwartz DA (2002). "The pathophysiology of asthma". Annu. Rev. Med. 53: 477–98. doi:10.1146/annurev.med.53.082901.103921. PMID 11818486.
- ↑ Beckett PA, Howarth PH (2003). "Pharmacotherapy and airway remodelling in asthma?". Thorax. 58 (2): 163–74. doi:10.1136/thorax.58.2.163. PMC 1746582. PMID 12554904.
- ↑ World Health Organization. "WHO: Asthma". Ilihifadhiwa kwenye nyaraka kutoka chanzo mnamo 2007-12-15. Iliwekwa mnamo 2007-12-29.
{{cite web}}
: Unknown parameter|deadurl=
ignored (|url-status=
suggested) (help) - ↑ Bush A, Menzies-Gow A (2009). "Phenotypic differences between pediatric and adult asthma". Proc Am Thorac Soc. 6 (8): 712–9. doi:10.1513/pats.200906-046DP. PMID 20008882.
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: Unknown parameter|month=
ignored (help) - ↑ Grant EN, Wagner R, Weiss KB (1999). "Observations on emerging patterns of asthma in our society". J Allergy Clin Immunol. 104 (2 Pt 2): S1–S9. doi:10.1016/S0091-6749(99)70268-X. PMID 10452783.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ↑ Anandan C, Nurmatov U, van Schayck OC, Sheikh A (2010). "Is the prevalence of asthma declining? Systematic review of epidemiological studies". Allergy. 65 (2): 152–67. doi:10.1111/j.1398-9995.2009.02244.x. PMID 19912154.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ↑ Bousquet, J (2005 Jul). "The public health implications of asthma". Bulletin of the World Health Organization. 83 (7): 548–54. PMID 16175830.
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: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Anderson, HR (2007). "50 years of asthma: UK trends from 1955 to 2004". Thorax. 62 (1): 85–90. doi:10.1136/thx.2006.066407. PMC 2111282. PMID 17189533.
{{cite journal}}
: Unknown parameter|coauthors=
ignored (|author=
suggested) (help); Unknown parameter|month=
ignored (help) - ↑ Masoli, Matthew (2004). Global Burden of Asthma (PDF). uk. 9. Ilihifadhiwa kwenye nyaraka kutoka chanzo (PDF) mnamo 2013-05-02. Iliwekwa mnamo 2014-01-09.
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: Unknown parameter|=
ignored (help); Unknown parameter|dead-url=
ignored (|url-status=
suggested) (help) - ↑ Manniche L (1999). Sacred luxuries: fragrance, aromatherapy, and cosmetics in ancient Egypt. Cornell University Press. ku. 49. ISBN 978-0-8014-3720-5.
- ↑ Thorowgood JC (1873). "On bronchial asthma". British Medical Journal. 2 (673): 600. doi:10.1136/bmj.2.673.600. PMC 2294647. PMID 20747287.
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: Unknown parameter|month=
ignored (help) - ↑ Gaskoin G (1872). "On the treatment of asthma". British Medical Journal. 1 (587): 339. doi:10.1136/bmj.1.587.339. PMC 2297349. PMID 20746575.
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: Unknown parameter|month=
ignored (help) - ↑ Berkart JB (1880). "The treatment of asthma". British Medical Journal. 1 (1016): 917–8. doi:10.1136/bmj.1.1016.917. PMC 2240555. PMID 20749537.
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: Unknown parameter|month=
ignored (help)
Berkart JB (1880). "The treatment of asthma". British Medical Journal. 1 (1017): 960–2. doi:10.1136/bmj.1.1017.960. PMC 2240530. PMID 20749546.{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ Bosworth FH (1886). "Hay fever, asthma, and allied affections". Transactions of the Annual Meeting of the American Climatological Association. 2: 151–70. PMC 2526599. PMID 21407325.
- ↑ Doig RL (1905). "Epinephrin; especially in asthma". California State Journal of Medicine. 3 (2): 54–5. PMC 1650334. PMID 18733372.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ↑ von Mutius, E (2012 Mar 1). "A patient with asthma seeks medical advice in 1828, 1928, and 2012". New England Journal of Medicine. 366 (9): 827–34. PMID 22375974.
{{cite journal}}
: Check date values in:|date=
(help); Unknown parameter|coauthors=
ignored (|author=
suggested) (help) - ↑ Crompton G (2006 Dec). "A brief history of inhaled asthma therapy over the last fifty years". Primary care respiratory journal : journal of the General Practice Airways Group. 15 (6): 326–31. PMID 17092772.
{{cite journal}}
: Check date values in:|date=
(help) - ↑ 151.0 151.1 Opolski M, Wilson I (2005). "Asthma and depression: a pragmatic review of the literature and recommendations for future research". Clin Pract Epidemol Ment Health. 1: 18. doi:10.1186/1745-0179-1-18. PMC 1253523. PMID 16185365.
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[hariri | hariri chanzo]- Pumu katika Open Directory Project
- National Asthma Education and Prevention Program (NAEPP) (2007). "Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma" (PDF). National Heart Lung and Blood Institute.
- "British Guideline on the Management of Asthma" (PDF). British Thoracic Society. 2008 - revised 2012. Ilihifadhiwa kwenye nyaraka kutoka chanzo (PDF) mnamo 2008-08-19. Iliwekwa mnamo 2014-01-09.
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(help) - "Global Strategy for Asthma Management and Prevention" (PDF). Global Initiative for Asthma. 2011. Ilihifadhiwa kwenye nyaraka kutoka chanzo (PDF) mnamo 2012-11-20. Iliwekwa mnamo 2014-01-09.
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