
01/12/2024
Habdhiska neefsashada iyo xanuunnada ku dhaca!
Casharka 18aad
Ballaarashada laanhungurida( Bronchiectasis ).
Waa marxalad laama hunguriga uu sameeyo kala bax raagga ee aan soo noqod lahayd, taasoo uu burbur ku yimaado kala jiidan iyo murqaha darbiyada laanhungurida. Waxa ka dhasha olol iyo marrinka hawada dhaawac soo gaadha.Caabuq malaxi gashato oo lagu arko dhuumaha hawo mareennada, waxaa badanaa cilladaan lagu arkaa dadka tiibishadu ka daawoobay laakiin dhaawacyo ku reebtay, Alle wuxuu dhuumaha hawada ku abuuray difaacyo u qaabilsan in wasakhda iyo hambaabuqa(Infection)kala dagaallamaan sambabada, sida qanjirro dheecaan jeermis dile ah soo daayo, wax sidii dhogorta camal ah oo qashinka soo saaro, qanjirro xab soo saara oo qashinka inuu gudaha usii gudbo ka ilaaliya, haddii marka dhuumuhu dhaawac gaaraan, barar ayay yeeshaan, difaaca ayaa meesha ka taga, wasakh ayaa fadhiisato, caabuq joogto ah ayaa ku dhasho, waxaana badanaa sabab u ah tiibishada qofka aan dhakhso laga daawayn.
Xanuunkan wuxuu ku bilowdaa dhaawac ama waxyeello ku timaadda darbiyada hunguri caddaha taas oo badanaa ka dhalata caabuqyo halis ah ama soo noqnoqda sida oofwareenka (pneumonia), qaaxo (tuberculosis), ama xiiq dheerta (pertussis). Arrimo kale oo sababi kara waxaa ka mid ah difaac-yarida jirka.
Marka darbiyada hunguri caddaha ay waxyeelloobaan, miiqanka kala jiidma iyo muruqyadooda taageera way burburaan, taasoo keenaysa kala bax raagga oo aan soo noqod lahayn(irreversible). Tani waxay sababtaa in dhuumaha hawadu ay lumiyaan awooddooda nadiifinta xabka(mucus), taasoo keenta in xaakadu ku ururto dhuumaha hawada. Xaakada urursan waxay si fudud u noqotaa deegaan ku habboon taranka bakteeriyada, taasoo keenta hambaabuq(infekshanno) soo noqnoqda.
Hambaabuqyadaasi joogtada ah waxay sababi karaan olol(infalamayshayn), taas oo sii dhaawacaysa darbiyada hunguriga cadka(bronchi-ga). Bararka joogtada ah wuxuu sii burburiyaa unugyada caafimaadka qaba, taasoo sababeysa miiqsan (fibrosis) iyo dhaawac darran. Sidaas darteed, darbiyada hunguri caddaha(bronchi-ga) way dhumuc weynaanayaan, wayna adkaadaan, taasoo dhaawac weyn u geysanaysa habka isku-baddelka ogsijiinta iyo kaarboon-daayoksaydhka ee sambabada.
Shaqada timaha, oo ah unugyo yaryar oo mas'uul ka ah dhaqaajinta xaakada iyo haraadiga, ayaa sidoo kale saameyn weyn ku yeelata. Marka timah ay waxyeelloobaan, xaakada way sii urursantaa taasoo sii hurinaysa caabuaa iyo ololka.
Waxaa loo qeybiyaa seddex nooc.
1. Cylindrical Bronchiectasis: marrinada hawada waxay noqdaan kuwa kala jiidma, sidii tubbada oo kale.
2. Varicose Bronchiectasis: marrinnada hawada kuwa barara oo ciriirsama, sida guntinka oo kale.
3. Cystic Bronchiectasis: waa marka marrinnada hawada dhaawac xooggan uu gaar ama uu daran yahay dhaawacooda, waxa uu noqdaa mid waynaada, sida buufin la buufiyay oo kale.
Maxaa keenna?
1:Caabuqyada waxay leeyihiin doorka ugu muhiimsan ee ka qeyb qaata balaadhashada laamaha hunguriga caddaha (bronchiectasis) oo ah xaalad ku dhacda sambabbada taasoo keenta dillaac iyo burbur joogto ah oo ku yimaada hunguri laamo yarihiisa (bronchi). Marka caabuqyada ay dhaawacaan, waxay bilaabaan meerto aan dhammaanin oo ka kooban olol, caabuq, dhaawac, iyo caabuqyada soo noqnoqda. Bakteeriyada sida Pseudomonas aeruginosa iyo Haemophilus influenzae ayaa ah kuwa ugu badan ee lala xiriiriyo balaadhashadha laamaha hunguriga(bronchiectasis), laakiin fayras iyo fangas ayaa sidoo kale ka qaybqaadan kara, dhaawaca soo gaaraha hunguriga caddaha.
Hambaabuqyada waxay sababaan dhaawac ku yimaada derbiyada hunguriga caddaha(bronchi), iyadoo carqaladeynta shaqada timaha hawa mareenka (cilia) waa qayb ka mid ah nidaamka difaaca jirka oo ka caawiya nadiifinta marrinka hawada ay ka nadiifineyso xabka iyo waxyaabaha kale ee khatar gelin kara marrinka hawada, taasoo ay ku ururayaan hunguriga caddaha. Marka uu xabka ku ururo waxa fududaaneysa in bakteeriyada ay noqoto mid daagaameysata, iyo in ay ka curtaan caabuq. Caabuqa waxa uu ka sii darayaa xaalada balaadhashada laamaha hunguriga, waxay dhaawacayaan qaabdhiska hunguriga cadka, in ay noqdaan kuwa kala jiidma aan isku soo ururin, Tani waxay keeneysaa in ay adkaado neefsashada, nadiifinta xabka. Marka waliba uu caabuqa xawaarihiisa sii dheeraado, difaaca jirka waxa uu noqonayaa mid aan xakameyn karin, xaaladana waxay noqoneysaa mid ka sii dareysa.
2:Cystic fibrosis (CF) waa xauunnada hiddo-sida ah, kaas oo keenna in la soo saaro xab adag, taasoo keenta xannibaado iyo barar ku dhaca xubnaha kala duwan ee jirka, gaar ahaan sambabada. Cudurkan, waa isbedelada ku dhaca hidda-wadaha (Cystic Fibrosis Transmembrane Conductance Regulator) waxa uu carqaladeynayaa daabulitaanka caadiga ee curaarta( ions chloride iyo sodium )si ay ugu gudbaan ibisiiliyamta. Tani waxay keeneysaa in xabka uu noqdo mid adag, taasoo keeneysa in la nadiifin waayo cudur dhalliyayaasha.Sambabada, xabka adag ee ku soo ururay waxay sarre u qaadayaan caabuqa raaga, taaso keeneysa olol iyo inuu dhaawacmo marrinka hawada. Waqti badan kaddib xaaladani haddii ay sii jirto, waxay keenaysaa ballaadhinta laamaha hunguriga caddaha, iyo burburka ku yimaada darbiyada hunguriga cadka. Waxaana loo yaqaan Ballaarashada laanhungurida(bronchiectasis),marka derbiyada hawo-mareennada ay dhaawacmaan, waxay lumiyaan kala jiidanka, taasoo ka dhigaysa mid aad u adag in sambabada ay si wax ku ool ah u nadiifiyaan xaka (mucus-ka). Tani waxay keentaa hambaabuqyo dheeraad ah iyo hoos u dhac ku yimaada shaqada sambabada.
3:Difaacyarida:Cilladaha difaaca jirka ee la xiriira waxay sababi karaan Ballaarashada laanhungurida (bronchiectasis) sababtoo ah awoodda jirka ee looga hortago caabuqyada sambabada ayaa hoos u dhacda. Caabuqyada soo laba noqda waxay keenaan olol iyo dhaawac ku yimaada darbiyada marrinnada hawada, taasoo keenta ballaadhinta laamaha hunguriga taasoo astaan u ah Ballaarashada laanhungurida(bronchiectasis). Waxa keenna qofka xanuunnada difaaca jirka hoos u dhigga sida ay dhiska, ama kuwa ka dhasha daaweynta kiimoterapi lagu daweeyo kansarka. Taas ayaa keeneysa inuu difaaca jirka inuu hoos u dhaco, halkii difaaca in uu la dagaalamo bakteeriyada. Taasoo carineysa inuu soo labo noqdo caabuqa habdhiska neefsashada.
4:Xannuunada isweeearka difaaca(autoimmune diseases) waxay keeni karaan Ballaarashada laanhungurida(bronchiectasis) iyada oo ku keeni karaan siyaabo kala duwan, kuwaas oo inta badan lala xiriirsho ololka joogto ah iyo shaqo xumo nidaamka difaaca jirka. Xanuunnadani waxay sababi karaan in nidaamka difaaca jirka uu si khaldan u weeraro unugyada jirka, gaar ahaan dhuumaha neef-mareenka ee sambabbada. Tani waxay keentaa olol joogto ah iyo dhaawac ku yimaada darbiyada dhuumaha neef-mareenka, taasoo keenta ballaarashada hunguriga cadka(bronchiectasis).
Tusaale ahaan, xanuunnada sida arthritis rheumatoid, lupus, iyo xanuunka Sjögren waxay sababi karaan in difaaca jirka uu weerar qaado ama waa xanuunnada sababa is weerarka difaaca, markaas ayaa la soo daayaa maadooyinka ololka kuwaasoo ku ururaya sambabada, taasoo keeneysaa dhaawaca laamaha hunguriga caddaha,ololka joogtada ee darbiyada hawo mareenka waxay keeneysaa in timaha nadiifiya xabka(cillia) iyo waxyaabaha cudur dhaliyayaayasha keenna taasoo shaqadeeda xumaato, taasoo keeneysa in uu xabka ku ururo hunguriga caddaha laamihiisa, taasina waxay keeneysaa in bakteeriyada ay u noqoneyso bar ay dagto. Tanina waxay xoojineysaa dhaawaca soo gaadha hunguriga cadka. Taasina waxa loo yaqaan Ballaarashada laanhungurida.
5:Qaaxada (TB) waxay keeni kartaa balaarashada laamaha hunguriga caddaha (bronchiectasis, iyadoo ay ku imaneyso hannaanka raagga ee ololka iyo dhaawaca nuddaha sambabbada soo gaadha. TB-du, oo ay sababto jeermiska Mycobacterium tuberculosis, waxay ku dhacdaa nuddaha sanbabada, taas oo keenta jawaab celin uu sameeyo difaaca jirka, taasoo ka dhallaneysa in liqaha iyo unugyada cad cad in ay isku ururaan(granulomas),dhaawaca nuddaha samababka.Caabuqa joogtada ah wuxuu dhaawacaa darbiyada hunguriga caddaha(bronchial walls), taas oo daciifisa marrinnada hawada isla markaana carqaladaysa shaqada caadiga ah ee neefsashada.
Ololka raagga ee ka dhasha nabarrada TB-da waxay keeni karaa ballaadhin hawo-mareen (bronchial dilation), miiqsan (fibrosis), iyo burburka nuddaha dabacsan ee sanbabada. Mudda kaddib waxa imaneysa in balaadhashada laama hunguriga caddaha uu yimaado( bronchiectasis). Balaadhitaankaas uu balaartay waxay abuureysaa in xabka meesha ku ururo aan laga saarin, taasina waxay keeneysaa in noolaha jeermis dhalliya uu ku ururo meesha, isla durbadiiba waxay xumeynayaan shaqada hawo mareenka.
6:Primary Ciliary Dyskinesia .
Waa xanuunnada la iska dhaxlo kuna yimaada isbeddelka ku dhaca hidda sidaha, waxa uu keenaa cilad ama isbeddel ku yimaada qaabdhiska timaha ka nadiifiya marrinka hawada, xabka iyo waxyaabaha qalaad soo gala, waxay ka hawl galaan hawo mareenka. Dadka qaba xaaladan timaha wax nadiifiya ee hawo mareenka ayaa shaqo gaba, oo uma shaqeeyaan sidii loogu tala galay,taasoo keeneysa in xabka uu ku ururo marrinka hawo mareenka. Ku ururka xabka waxa uu dhalinayaa deegaan ay ku bulaalaan jeermisyada, taasoo dhalineysa caabuq soo laba noqda, iyo ilol raagga. Caabuqyada iyo ololka raagga waxa ay burburinayaan darbiyada laamaha hunguriga caddaha, taasoo keeneysa balaaraashada laamaha hunguriga, taasoo isbeddel ku keeneysa qaabdhiska laamahunguriga. Xaaladaasi waxa loo yaqaan Ballaarashada laanhungurida(bronchiectasis).
Calaamadaha
1. Qufac joogto ah uu la socdo xaako.
2. Xaako badan oo mararka qaar leh ur.
3. Caabuqa oo ku soo laalaabta habdhiska neefsashada.
4. Qofka oo dhiig qufaca (hemoptysis).
5. Neefsashada oo adkaata (dyspnea).
6. Daal ama tabar yari
7. Laab xanuun (pleuritic chest pain).
8. Cod qallaf laga maqlo qofka(wheezing)
9. Faraha wareegooda oo ballaarta
(digital clubbing).
10. Qandho.
Baadhitaanka.
1. Chest X-ray: waa hubbinta ugu horreysa lagu baadho xaaladan iyada wax gaar ah innama tuseyso, kaliya haddii marrinnada hawada ay weynaadeen, ama inuu sambabaka yeeshay nabar.
2. High-Resolution CT Scan (HRCT):
Waa midka ugu muhiimsan xaaladan go'aanka looga gaari karro, haddii ay jirran balaadhasho marrinnada hawada, adkaanshaha darbiyada. Waxaas oo dhami ayaa lagu ogaan karaa.
3. Pulmonary Function Tests (PFTs):
Waxa lagu qiimeynayaa shaqada sambabada, waxay innaga caawineysaa haddii uu jirro xirranka hawo mareenka.
4. Sputum Culture and Microbiological Tests: qofka waxa laga qaadayaa xaako si markaasi loo cadeeyo noolaha keenay caabuqa, nooca uu doonna ha noqdo.
5. Blood Tests: hubbinta dhiiggan waxa lagu hubbinayaa waxyaabaha kale ee keenay(Cystic Fibrosis, immune deficiency).
Daaweynta.
1:Dawooyinka Kala bixiyiyaasha (Bronchodilators:)kuwa wakhtiga kooban hawl gala (short acting beta-2 agonist inhalers) sida Albuterol sidoo kalena loo yaqaan Salbutamol iyo Terbutaline. Iyo kuwa waqtiga dheer hawl gala(long-acting beta-agonists (e.g., salmeterol). Waxay sameynayaan in ay dabciyaan marrinka hawada iyagoo qabsanaya qaabilaha(beta-2 adrenergic receptors) si markaasi ay u yareeyaan iska caabinta hawo mareenkam
2:Waxa la siinayaa lidiga dawooyinka ololka(Anti-inflammatory Agents:) waxay joojinayaan ololka iyo madooyinka ololka la soo daayo, waxa ka mid ah: corticosteroid. Iyo macrolides sida:azithromycin
3:Antibiotics: waxa la siinayaa jeermis dile iyadoo lagu saleynaayo baaritaanka soo baxay, iyadoo afka laga qaadanaayo ama xiddidka, waxa ka mid ah: amoxicillin-clavulanate ama ciprofloxacin.
4:Waxa la siinayaa dawooyinka xabka yareeya(Mucolytics), u jeeda aan u siineyno waa in ay innaga yareeyaan xabka, si markaasi loo wanaajiyo nadiifinta laamaha huguricad.
5:Waxaa loo sameynayaa in xabka laga soo saaro, bukaankana loo sameeyo jimicsiga neefshado, taasina waxay wanaajineysaa hannaanka neefshada inuu sidiisa ku soo laabto.
6:Ugu dambeyn haddii xaaladani sii xoogeysato waxaa loo baahanayaa qaliin.
Tixraaca.
Principles of Pulmonary Medicine (by Steven E. Weinberger) Pulmonary Pathophysiology: The Essentials (by John B. West) Manual of Clinical Problems in Pulmonary Medicine Chest Radiology: Patterns and Differential Diagnoses
Websites for Pulmonology:
1. American Thoracic Society (ATS) - www.thoracic.org
2. European Respiratory Society (ERS) - www.ersnet.org
3. Pulmonary Fibrosis Foundation (PFF) - www.pulmonaryfibrosis.org
4. National Heart, Lung, and Blood Institute (NHLBI) - www.nhlbi.nih.gov
5. CHEST Foundation - www.chestnet.org
6. Medscape Pulmonology - www.medscape.com
7. Amboss Pulmonology Section - www.amboss.com
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The American Thoracic Society is the world's leading medical society dedicated to accelerating the advancement of global respiratory health through…