Ffiltvebis qronikuli obstuqciuli daavadeba da misi marTva

lali miqiaSvilitfdc. 2 marti, 2010

Ffiltvebis qronikuli obstuqciuli daavadeba (fqod) (Chronic obstructive pulmonary disease- COPD)

janmo-s 2005 wlis monacemebi: 80 mln adamiani daavadebulia fqod-s

saSualo an mZime formiT. 3 mln adamiani gardaicvala fqod-iT,

rac globaluri sikvdilianobis 5%-s Seadgens.

sikvdilianobis 90% modis saSualo da dabalSemosavlian qveynebze.

janmo-s monacemebi:

2002 wels fqod-m daikava V adgili sikdilianobis mxriv;

2030 wels savaraudod daiWers III adgils.

Ffiltvebis qronikuli obstuqciuli daavadeba (fqod): (Chronic obstructive pulmonary disease- COPD)

aSS-Si uWiravs me-4 adgili sikvdilianobis mxriv;

aSS-Si sikvdilianobis 10 yvelaze xSirad gamomwvev daavadebas Soris, fqod aris erTaderTi, romlis sikvdilianobis maCvenebelic izrdeba.

Ffqod-s gansazRvreba:(ERS/ATS)

Ffqod-s aris daavadeba, romlis mkurnaloba da prevencia SesaZlebelia da xasiaTdeba:

ventilaciis darRveviT, romelic arasrulad Seqcevadia;

Cveulebriv progresirebs; asocirebulia gamRizianebel agentze

filtvebSi araadeqvaturi anTebadi pasuxis ganviTarebasTan;

asocirebulia sistemur garTulebebTan.

fqod aerTianebs :

1. qr. obstruqciuli bronqiti;2. emfizema;3. α-1 antitrifsinis deficiti.

garTulebebi:

filtvismieri guli; policitemia; sunTqvis ukmarisoba; Ramis hipoqsia; bronqogenuli karcinoma; motexilobebi; barZayis Zvlis mineralizaciis darRveva; kataraqta depresia

saWiroa fqod-s adreuli gamovlena:

klinicistebis ganswavla;

fqod-s specifiuri skriningi;

specialuri kiTxvaris roli pirveladi jandacvis qselSi

spirometria

Ffqod-s stadia

Bbronqodilatatoris miRebis Semdeg

tifnos indeqsi (FEV1/FVC):

bronqodilatatoris miRebis Semdeg

FEV1 %:

I - msubuqi </= 0.7 >/= 80%

II –saSualo simZimis

</= 0.7 50-80%

III -mZime </= 0.7 30-50%

IV-Zalian mZime

</= 0.7 < 30%

spirometria:(Global Strategy for Diagnosis, Management, and Prevention of

COPD).

Ffqod-s mkurnaloba miznad isaxavs:

respiratoruli Civilebis Seamcirebas;

gamwvavebebis Semcirebas;

filtvis funqciis gaumjobesebas;

sicocxlis xangrZlivobis gazrdas.

individualuri pacientisaTvis unda ganisazRvros ras vmkurnalobT :

sunTqvis ukmarisobas?

gamwvavebebs? – hospitalizaciis prevencia an misi vadis Semcireba?

aqtivobis gazrdas?

eqimsac da avadmyofsac naTlad unda esmodeT mkurnalobis mizani

Ffqod-s stadia

daxasiaTeba rekomendaciebi

yvela risk-faqtorebis moSoreba;

gripis sawinaaRmdego vaqcinacia

I msubuqi FEV1/FVC < 0.70; FEV1 >/= 80%

SA-BD saWiroebisas;

II saSualo FEV1/FVC < 0.70 FEV1-50-80%

samkurnalo sqema: orkomponentiani- BD;

reabilitaciaA

III mZime FEV1/FVC < 0.70 FEV1-30-50%

samkurnalo sqema:erT- an orkomponentiani-BD;+ sainhalacio kortikosteroidi;reabilitaciaA

IV Zalian mZime

FEV1/FVC < 0.70FEV1 < 30%

samkurnalo sqema: erT- an orkomponentiani-BD + sainhalacio kortikosteroidi;oqsigenoTerapia, qirurgia, reabilitaciaA

Ffqod-s samkurnalo preparatebi:

antiqolinerguli bronqodilatatorebi;

xangrZlivi moqmedebis β-agonistebi;

sainhalacio kortikosteroidebi (kombinaciaSi);

asTmisa da fqod-s samkurnalo medikamentebi gansxvavdeba erTmaneTisagan

fqod-s dros ar gamoiyeneba:

qromolini; leikotrinebis antagonistebi; sainhalacioKkortikosteroidebis

monoTerapia

miRwevebi fqod-s mkurnalobaSi:

or- da samkomponentiani reJimi: bronqodilatatorebis sxvadasxva klasis kombinacia β2-agonistebi: a. xanmokle moqmedebis (Albuterol) b. gaxangrZlivebuli moqmedebis (salmeteroli,

formeteroli) antiqolinerguli saS-bebi: a. xanmokle moqmedebis (Ipratropium bromide) ; b. gaxangrZlivebuli moqmedebis (Tiotropium)mag. Tiotropium+ formeterol; Tiotropium+salmeterol.

kortikosteroidebi bronqodilatatorebTan kombinaciaSi.

iotropium

Ppnevmoniis signali

Psainhalacio kortikosteroidebi

pnevmoniis signali: maRali dozis kortikosteroidebis gamoyeneba asocirebulia pnevmoniasTan;

ar arsebobs sarwmuno cnobebi sikvdilianobis matebaze;

sikvdilianobis maCvenebeli klebulobs kombinirebuli Terapiisas.

kvlevebi: TORCH, INSPIRE, SMART, UPLIFT, Registry Study in America, Erst and Suisa

reabilitacia:

fizikuri varjiSi zeda da qveda kidurebis aqtiuri datvirTviT;

sasunTqi kunTebis varjiSi; fizioTerapia; fsiqosocialuri daxmareba (depresia); ganaTleba.

oqsigenoTerapia

PCvenebebi:

1. PPaO2 < 7,3 kPa ; SaO2 < 80%

2. Aan PaO2 = 7,3 - 7,8 kPa

+ filtvismieri guli, policitemia. Ooqsigenaciis mizani: PPaO2 > 8kPa, SaO2 > 90%

qirurgia: National Emphysema Treatment Trial (NETT)

qirurgia: National Emphysema Treatment Trial (NETT)2

Patients

90 Day Mortality

LVRS

90 Day Mortality Medical Therapy

P Value

29,2mos Mortality

LVRS

29,2mos MortalityMedical Therapy

Risk Ratio

P Value

Group A

20/70(28,6)

0/70(0) <.001 42/70 30/70 1,82 .06

Group B

4/139(2,9) 5/151(3,3) 1.00 26/139 51/151 0,47 .005

Group C

6/206(2.9) 2/213(0,9) 0.17 34/206 39/213 0,98 .70

Group D

7/84(8,3) 0/65(0) 0,02 28/84 26/65 0,81 .49

Group E

11/109 (10,1)

1/111(0,9) 0,003 27/109 14/111 2,06 .02

sicocxlis xangrZlivoba:

Ffam1

(FEV1)sicocxlis

xangrZlivoba

>/= 1,2L 10 weli

=1L 5 weli

<700 ml 2 welze naklebi

janmo-s prevenciuli RonisZiebebi

Seiqmna: GARD(Global Alliance against Chronic

Respiratory Disease)Mmisi erTerTi nawilia GOLD (Global Initiative for Chronic

Obstructive Disease)

Tambaqos mowevaze kontroli

sabinao pirobebSi haeris dabinZureba

daskvna

aucilebelia fqod-s adreuli gamovlena; gasaumjobesebelia fqod-s gamovlenis

strategia; prevenciuli RonisZiebebis aqtiuri Catareba; aucilebelia kombinirebuli Terapiis Catareba

fqod-s gamosavlis gasaumjobeseblad; pacientis mkurnalobaze damyolobis

gaumjobeseba; axali, efeqturi Terapiis aucilebloba.

gmadlobT

yuradRebisaTvis