Izingozi zezempilo ezisuka kumanzi kanye nesikhunta
Okungenani kunezimbangela ezintathu ezingase zibe yimbangela yempilo embi kubantu abanamasosha omzimba anempilo ajwayelekile ngemva kokuhlangana nokuswakama nezisikhunta: ukutheleleka, ukungezwani komzimba nezinto ezinobuthi.
Lapho isikhunta siphazamiseka, izinhlayiya zesikhunta (izinhlayiya nezinye izinsalela) namakhemikhali aguquguqukayo adedelwa kalula emoyeni futhi angaphefumulelwa kalula emaphashini nasezonweni zanoma ubani oseduze.
Lezi zinhlayiya namakhemikhali ngokuvamile abangela izifo (kuhlanganise ne-sinus allergies) futhi ngezinye izikhathi kubangele i-alveolitis eguquguqukayo (i-hypersensitivity pneumonia). Akuvamile ukuthi zikhule futhi zikhule ezindaweni ezincane njengama-sinuses - ngezinye izikhathi ngisho nasemaphashini ngokwawo.CPA, I-ABPA). Muva nje sekucacile ukuthi umswakama, futhi ngokunokwenzeka isikhunta, kungabangela futhi kubhebhethekise isifuba somoya.
Isikhunta esiningi singenza izinhlobo ezahlukene zobuthi ezinohlu lwemiphumela kubantu nasezilwaneni. Ama-Mycotoxins akhona kwezinye zezinto zesikhunta kunalokho ezingasakazwa emoyeni, ngakho-ke kungenzeka ukuthi lezi zingaphefumulelwa. Ezinye izinto ezingezwani nazo zaziwa ngokuthi zinobuthi. Ubufakazi bamanje buphakamisa ukuthi i-mycotoxin eyanele ingaphefumulelwa ukuze kubangele izinkinga ezihlobene ngokuqondile nobuthi bayo - kube nezigameko ezimbili kuphela noma ezintathu ezingaphikiswa ezake zabikwa futhi eyodwa kuphela ekhaya elinesikhunta. Amathuba okuba nemiphumela yezempilo enobuthi (okungukuthi hhayi ukungezwani komzimba nezinto ezithile) okubangwa ukuhogela izinto ezingezwani noshevu awakaqiniseki kakhulu.
Kunezinye izinto ezinobuthi eziphuma ezikhunjini ezisekhaya elimanzi:
- Amakhemikhali e-Volatile organic (VOCs) angamaphunga akhishwa amagciwane athile
- Ama-proteases, ama-glucans nezinye izinto ezicasulayo
- Futhi qaphela ukuthi kunohlu olukhulu lwezinye izinto (ezingezona isikhunta) ezicasulayo/VOC okufanele zibe khona ezindlini ezinomswakama.
Konke lokhu kungase kube nomthelela ebunzimeni bokuphefumula.
Ngaphezu kwalezo zifo eziphawulwe ngenhla singangeza lezi zifo ezilandelayo ezinobudlelwane obuqinile (isinyathelo esisodwa sokuthi kwaziwe ukuthi kubangelwa) izifo zokuphefumula, izimpawu zepheshana eliphezulu lokuphefumula, ukhwehlela, gxuma futhi ngobe. Kungase kube nezinkinga zempilo ezingakachazwa okwamanje ezibonakala zinqwabelana kusukela ekuchayekeni isikhathi eside 'esikhunjeni esinobuthi' ekhaya elimanzi, kodwa lezi kusekude nobufakazi obuhle bokuzisekela okwamanje.
Yibuphi ubufakazi bokuthi umswakama udala lezi zinkinga zempilo?
Kunohlu 'oluqondile' (bheka ngenhla) lwezifo okucatshangwa ukuthi zinokwesekwa okwanele okuvela emphakathini wocwaningo ukuze sibheke kabanzi, kodwa ezinye ezimbalwa azinakho ukwesekwa okwanele komphakathi wesayensi ukuze wenze isinqumo. Kungani sizikhathaza ngalokhu?
Ake sihlole kafushane inqubo lapho kwakhiwa khona ukuxhumana okuyimbangela phakathi kwesifo kanye nembangela yaso:
Imbangela nomphumela
Kunomlando omude wabacwaningi abahlukahlukene esikhathini esidlule ababecabanga ukuthi imbangela esobala yokugula kwakuyimbangela yangempela futhi lokhu kuye kwavimbela inqubekelaphambili ekwelapheni. Esinye isibonelo nge umalaleveva. Manje sesiyazi ukuthi umalaleveva ubangelwa isibungu esincane esisakazwa omiyane abamunca igazi (okutholwe ngu UCharles Louis Alphonse Laveran, lapho athola khona uMklomelo KaNobel ngo-1880). Ngaphambi kwalesi sikhathi kwakucatshangwa ukuthi, njengoba abantu bejwayele ukuthola umalaleveva ezingxenyeni zomhlaba ezinamaxhaphozi amaningi futhi ngokuvamile ezinuka kabi 'kwakuwumoya omubi' owawubangela ukugula. Iminyaka yamoshakala izama ukuvimbela umalaleveva ngokususa iphunga elibi!
Siwufakazela kanjani imbangela nomphumela? Lesi yisihloko esiyinkimbinkimbi esithole ukunakwa okuningi kusukela izingxabano zokuqala zokuthi ukubhema ugwayi udala umdlavuza noma cha - bheka ingxoxo enemininingwane yalokhu lapha. Lo mbango uholele ekushicilelweni kwe Imibandela ye-Bradford Hill ngobudlelwano obuyimbangela phakathi kwembangela yesifo kanye nesifo ngokwaso. Noma kunjalo, sisekhona isikhala senkulumompikiswano kanye nokwakhiwa kwemibono - imbangela engaba khona yokugula kuseyindaba yokwamukelwa komuntu ngamunye kanye neqembu emiphakathini yocwaningo lwezokwelapha.
Ngokuphathelene nokuswakama, i- World Health Organisation umbiko kanye nokubuyekezwa okulandelayo kusebenzise le mibandela elandelayo:
Ubufakazi be-Epidemiological (okungukuthi bala izinombolo zezigameko zokugula ozithola endaweni okusolwa ukuthi kuyona umsolwa (lapho abantu bechayeka esibangeni okusolekayo)): amathuba amahlanu acatshangelwa ngokulandelana kokuncipha kokubaluleka
- Ubudlelwano obuyimbangela
- Kukhona ukuxhumana phakathi kwembangela nesifo
- Ubufakazi obunomkhawulo noma obusikiselayo bokuhlotshaniswa
- Ubufakazi obanele noma obanele bokunquma ukuthi kukhona yini inhlangano
- Ubufakazi obunomkhawulo noma obusikiselayo bokungahlangani
Ubufakazi bemitholampilo
Ucwaningo olubandakanya amavolontiya angabantu noma izilwane zokuhlola ezivezwe ezimeni ezilawulwayo, amaqembu omsebenzi noma ngokomtholampilo. Eziningi zalezi zifundo zisekelwe emaqenjini amancane abantu ngabanye, kodwa kokubili ukuchayeka kanye nemiphumela yomtholampilo ibonakala kangcono kunokuba kunjalo ezifundweni ze-epidemiological. Ibonisa ukuthi yiziphi izimpawu ezingase zibe khona uma izimo zilungile.
Ubufakazi be-Toxicological
Isetshenziselwa ukusekela ubufakazi be-epidemiological. Akwanele ngokwako ukufakazela imbangela noma umphumela, kodwa kuyasiza ukukhombisa ukuthi izimpawu ezithile zingenzeka kanjani ngaphansi kwezimo ezithile. Uma bungekho ubufakazi be-epidemiological, ngakho-ke asikho isiphakamiso sokuthi izimo ezidingekayo zophawu oluthile zenzeka ngempela ngaphansi kwezimo 'zempilo yangempela'.
Yimiphi imiphumela yezempilo esiqinisekile ukuthi ibangelwa ukuswakama?
Ubufakazi be-Epidemiological (Ukubaluleka Okuyinhloko)
Ukubuyekezwa kwakamuva kokubuyekezwa kwe-Institute of Medicines kokuchayeka kwemvelo kwangaphakathi kushilo lokho ufuba ukuthuthukiswa, ukukhushulwa kwesifuba somoya (asthma), isifuba somoya (isifuba somoya okwenzeka manje), kukhona okubangelwa izimo ezimanzi, cishe kuhlanganise nezibungu. Icaphuna umbiko wangaphambili we-WHO, “kunobufakazi obanele bokuhlobana phakathi kwezinto ezihlobene nokuswakama kwasendlini kanye nenqwaba yemiphumela yezempilo yokuphefumula, okuhlanganisa izifo zokuphefumula, izimpawu zepheshana eliphezulu lokuphefumula, ukhwehlela, gxuma futhi ngobe“. Singengeza i-hypersensitivity pneumonia kulolu hlu ngemuva UMendell (2011).
Ubufakazi be-Toxicological (Ukubaluleka okusekela okwesibili)
Izindlela lapho ukuchayeka kwe-microbial okungatheleleki kube nomthelela emiphumeleni yezempilo engemihle ehambisana nokuswakama komoya endlini kanye nesikhunta awaziwa kakhulu.
Ucwaningo lwe-in vitro kanye ne-in vivo lubonise ukusabela okuhlukahlukene kokuvuvukala, i-cytotoxic kanye ne-immunosuppressive ngemva kokuchayeka ezinhlamvu, ama-metabolite kanye nezingxenye zezinhlobo ze-microbial ezitholakala ezakhiweni ezinomswakama, okwenza kube nokwenzeka kokutholwe yi-epidemiological.
I-asthma ehambisana nomswakama, ukuzwela komzimba kanye nezimpawu zokuphefumula ezihambisanayo kungase kubangele ukusebenza ngokuphindaphindiwe kwezivikelo zokuzivikela komzimba, ukuphendula okweqile kwe-immune, ukukhiqizwa isikhathi eside kwabalamuli bokuvuvukala nokulimala kwezicubu, okuholela ekuvuvukeni okungapheli kanye nezifo ezihlobene nokuvuvukala, njenge-asthma.
Ukwanda okuphawuliwe kwemvamisa yezifo zokuphefumula ezihambisana nezakhiwo ezinomswakama kungase kuchazwe imiphumela yokuzivikela komzimba yamagciwane ahlobene nesakhiwo esimanzi ezilwaneni ezihlolwayo, okuthikameza ukuzivikela komzimba futhi ngaleyo ndlela andise ukungenwa yizifo. Enye incazelo ingase ibe ukuthi izicubu ze-mucosal ezivuthayo zinikeza umgoqo ongasebenzi kahle, okwandisa ingozi yokutheleleka.
Ama-microbial agents ahlukahlukene anamandla ahlukahlukene, aguquguqukayo okuvuvukala kanye nobuthi akhona kanyekanye nezinye izinhlanganisela zomoya, okuphumela ekusebenzisaneni emoyeni ongaphakathi. Ukusebenzisana okunjalo kungase kuholele ekuphenduleni okungalindelekile, ngisho nasekugxilweni okuphansi. Ekusesheni izakhi eziyimbangela, izifundo ze-toxicological kufanele zihlanganiswe nokuhlaziywa okuphelele kwe-microbiological kanye namakhemikhali kwamasampuli angaphakathi.
Ukusebenzisana kwamagciwane kufanele kucatshangelwe ngokucophelela lapho kuhlolwa imiphumela yezempilo engaba khona yokuchayeka ezakhiweni ezinomswakama. Umehluko ekugxilweni okusetshenziswe ezifundweni zamasiko amangqamuzana noma izilwane ezihlolwayo kanye nalezo ezingafinyelelwa abantu kufanele nazo zikhunjulwe lapho kuchazwa okutholakele.
Ekuhumusheni imiphumela yocwaningo ezilwaneni ezihlolwayo ngokuhlobene nokuchayeka kwabantu, kubalulekile ukucabangela umehluko kumithamo ehlobene kanye neqiniso lokuthi ukuchayeka okusetshenziselwa izilwane ezihlolwayo kungase kube ukuhleleka kobukhulu obuphezulu kunalezo ezitholakala ezindaweni zasendlini.
Umswakama wendawo yokuhlala uhlotshaniswa nokwenyuka okungama-50% kwesifuba somoya samanje kanye nokwenyuka okukhulu kweminye imiphumela yezempilo yokuphefumula, okuphakamisa ukuthi u-21% wesifuba somoya samanje e-United States ungase ubangelwe ukumanzi nokukhunta kwendawo yokuhlala.