I-ABPA I-Aspergillosis ye-Alergic Bronchopulmonary (Aspergillosis) yisifo esibi esibangelwa ukutheleleka kwefungal kwemigudu yomoya. Abantu abane-ABPA bavame ukuba nesifuba somoya esibi kakhulu kanye nokuqubuka okuvamile okuvame ukudinga ukusetshenziswa kwesikhathi eside kwe-oral steroids kanye nama-antibiotics ukwelapha izifo zesibili zamagciwane.
Izindlela zokwelapha ezimbili eziyinhloko ze-ABPA ziyi umuthi we-antifungal nangomlomo i-steroids. Imithi ye-Antifungal isebenza ngokukhomba isikhunta esibangela ukutheleleka, sinciphise ukukhula nokusabalala kwayo. Lokhu kungasiza ukwehlisa imvamisa yokuqubuka komlilo futhi kusimamise isimo kodwa kungase futhi kubangele imiphumela engemihle efana nesicanucanu, futhi, okungajwayelekile, nokulimala kwesibindi. I-Oral steroids isebenza ngokunciphisa ukuvuvukala nokucindezela impendulo yamasosha omzimba ku-allergen, engasiza ukulawula izimpawu ze-ABPA. Kodwa-ke, ukusetshenziswa isikhathi eside kungabangela imiphumela emibi ebalulekile, okuhlanganisa ukuzuza isisindo, ukushintshashintsha kwemizwelo, nokungasebenzi kahle kwezindlala ze-adrenal.
Le miphumela engemihle ingaba nomthelela omkhulu eqophelweni lempilo, kodwa kokubili ukwelashwa kungase kudingeke ukuvimbela isifo ukuba singabi sibi. Ngakho-ke, ukwelashwa okusha noma okuthuthukisiwe kuyadingeka.
Ngenhlanhla, kube nentuthuko yakamuva ekulawuleni i-ABPA, futhi ukubuyekezwa kukaRichard Moss (2023) kugqamisa izinhlobo ezimbili zokwelashwa ezithembisayo:
- Umuthi we-antifungal ophefumulelwe phatha izifo zamaphaphu zokukhunta ngokuletha umuthi ngqo endaweni yegciwane. Lokhu kuvumela ukuthi umthamo ophezulu womuthi ulethwe endaweni ethintekile ngenkathi ukhawulela ukuchayeka komzimba wonke futhi ngenxa yalokho kunciphisa imiphumela emibi. Isibonelo, i-itraconazole ehogeliwe iboniswe ukuthi ifinyelela ekugxiliseni okuphezulu ngokwanele ukubulala noma ukuvimbela ukukhula kwesikhunta. Ezinye izivivinyo zizophothulwa kulo nyaka (2023) ukuze kuhlolwe ukuphepha nokusebenza kwayo. Nakuba isathuthukiswa, le mithi inikeza ithemba ngezinketho zokwelapha eziphumelela kakhulu nezibekezelelwa kangcono ezigulini ezine-ABPA.
- I-Biological imithi wuhlobo olusha ngokuphelele lokwelapha olusebenzisa amasosha omzimba okwenziwa ukuze luqondise amaseli athile noma amaprotheni esistimu yethu yokuzivikela komzimba esikhundleni sokusebenzisa inhlanganisela yamakhemikhali. I-Omalizumab, uhlobo lwe-biologic, ibophezela ku-immunoglobulin IgE futhi iyenze ingasebenzi. I-IgE ibandakanyeka ekuphenduleni kokungezwani nemizimba yethu ekwethulwa ngabahlaseli bakwamanye amazwe futhi idlala indima enkulu ezimpawini ze-ABPA. Ukuvalwa kwe-IgE kukhonjiswe ukunciphisa izimpawu zokungezwani komzimba. Ezivivinyweni zomtholampilo i-omalizumab ikhonjiswe ukuthi (a) yehlise kakhulu inani lokuqubuka uma kuqhathaniswa nokwelashwa kwangaphambili, (b) yehlisa isidingo sokusetshenziswa kwe-oral steroid futhi yehlisa umthamo wayo odingekayo, (c) ukwanda kwe-wean off steroids, d) ngcono ukusebenza kwamaphaphu kanye (e) nokulawulwa kwesifuba somoya okuthuthukisiwe. Ukwengeza, amanye amasosha omzimba e-Monoclonal (ama-Mabs) afana ne-mepolizumab, i-benralizumab, ne-dupilumab abonise ukuncipha kokuqubuka, i-IgE ephelele kanye nomphumela we-steroid-sparing.
NgokukaMoss (2023), lezi zindlela zokwelapha ezintsha zisebenza kahle kakhulu ekwehliseni ukuvakashelwa ezibhedlela. I-Biologics ibonakala iphumelela kakhulu, ngokunciphisa kuze kufike ku-90% ekuqubukeni kweziguli ze-ABPA kanye nokusebenza kahle okungafika ku-98% ekunciphiseni inani le-oral steroid elidingwa isiguli. Uma lokhu kwelashwa okusha kuqhubeka nokusebenza kahle, kungase kunikeze ikhwalithi yempilo entsha, ephakeme kakhulu kubantu abane-ABPA . Sekukonke, lokhu okutholakele kuyethembisa, kodwa ucwaningo olwengeziwe luyadingeka ukuze kuqinisekiswe ukusebenza kwalezi zindlela zokwelapha eziqondene ngqo ne-ABPA.
Iphepha langempela: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9861760/