Kosulio gydymas fenspiridu

Kosulio gydymas fenspiridu

Santrauka

Kosulys – vienas dažniausių kvėpavimo sistemos ligų simptomų. Neretai jį lemia ūminis ar lėtinis kvėpavimo takų uždegimas. Sergant kvėpavimo takų infekcija, pacientai dažniausiai rūpinasi būtent dėl kosulio ir visuomet siekia kuo greičiau nustoti kosėti. Tačiau reikia nepamiršti, kad kosulys – svarbus apsauginis refleksas, apsaugantis nuo aspiracijos ir užtikrinantis kvėpavimo takų išsivalymą. Šis simptomas gali nurodyti kvėpavimo takuose esantį uždegimą. Gydytojo uždavinys – išaiškinti pacientui kosulio svarbą ir paskirti tinkamą uždegimą slopinantį ir kosulį lengvinantį gydymą. Fenspiridas – pasaulyje plačiai naudojamas, o Lietuvoje tik dabar pasirodęs preparatas simptominiam kosulio bei sekrecijos kvėpavimo takuose gydyti sergant uždegiminėmis bronchų ir plaučių ligomis. Tyrimai su fenspiridu ne tik plačiai aprašo jo antiuždegiminį veikimą, bet įrodo ir jo bronchus plečiantį, antioksidacinį, antihistamininį poveikius. Dėl šių savybių preparatas gali būti skiriamas tiek esant sausam, neproduktyviam kosuliui su bronchų spazmu, tiek ir lėtiniam apatinių kvėpavimo takų uždegimui su gausiu skrepliavimu, ligos paūmėjimo metu ir prevencijai – esant remisijai. Gydymas fenspiridu nepakeičia gydymo antibiotikais, tačiau gali būti su jais derinamas ir skiriamas gydant ūmines bei lėtines apatinių kvėpavimo takų infekcijas tiek vaikams, tiek ir suaugusiesiems.

 

Raktažodžiai: kosulys, kvėpavimo takų uždegimas, bronchitas, vaikai, fenspiridas.

 

Kosulys – dažniausias kvėpavimo sistemos ligų simptomas

 

Vienas dažniausių kvėpavimo takų ligų simptomų, su kuriuo susiduria šeimos gydytojai ir gydytojai specialistai, yra kosulys. Jį lemia uždegimas viršutiniuose ar apatiniuose kvėpavimo takuose. Tiek vaikams, tiek ir suaugusiesiems dažniausiai pasitaiko ūminis kosulys – staiga prasidėjęs ir trunkantis mažiau nei 3 savaites.

Labai dažnai tokio kosulio priežastis yra viršutinių kvėpavimo takų virusinės infekcijos – ūminis nosiaryklės uždegimas, ūminis ryklės migdolų (adenoidų) ar veidinių ančių uždegimas (sinusitas), laringitas, tracheitas. Uždegimui apėmus ir apatinius kvėpavimo takus, susergama bronchitu ar plaučių uždegimu. Įprastai pasveikstama per 2–3 savaites.

Ūminis kosulys pradžioje dažniausiai būna sausas, dirginantis, priepuolinis, neproduktyvus, t. y. neatkosima sekreto, nes uždegimo pradžioje kvėpavimo takų gleivinė dar nepradėjo jo gaminti. Po kelių dienų kosulys dažniausiai tampa drėgnas, produktyvus – atkosima sekreto, skreplių. Tai natūrali ūminių kvėpavimo takų infekcijų eiga [1].

Užsitęsęs ar lėtinis kosulys esti retesnis, ypač vaikams, tačiau sukelia daug daugiau problemų. Yra daugybė priežasčių, sukeliančių užsitęsusį (3–8 savaites) ar lėtinį kosulį, trunkantį daugiau nei 8 savaites. Vaikams tokius simptomus dažniausiai sukelia alerginės viršutinių bei apatinių kvėpavimo takų ligos (alerginis rinitas, bronchų astma) ar užsitęsę infekciniai procesai (adenoiditai, sinusitai, bakteriniai bronchitai). Suaugusiesiems, be minėtų ligų, reikia nepamiršti lėtinių bronchitų ir lėtinės obstrukcinės plaučių ligos (LOPL). Visas šias ligas lemia lėtinis kvėpavimo takų uždegimas, kuris ir yra nuolatinių simptomų, visų pirma kosulio, priežastis.

 

Kvėpavimo takų uždegimas

 

Uždegimas – tai nespecifinis organizmo atsakas į infekciją, alergeną ar kitą dirgiklį. Sergant kvėpavimo takų uždegimu, į pažeistos srities kvėpavimo takų gleivinės kraujagysles priteka daugiau kraujo, padidėja kraujagyslių pralaidumas ir dėl išsiskyrusių mediatorių prasideda uždegimas. Uždegiminiai audiniai paburkta, juose pradeda kauptis granuliocitai (neutrofilai, eozinofilai), o vėliau mononuklearai – fagocitai. Jų migraciją į audinius skatina įvairūs uždegimo mediatoriai – interleukinai, chemokinai, eotaksinas, kt. [2].

 Vienas svarbiausių ankstyvosios uždegimo fazės mediatorių yra histaminas ir įvairūs eikosanoidai (arachidono rūgšties metabolizmo produktai). Tarp jų gerai žinomi prostaglandinai – PGE2 ir PGI2, kurie skatina kraujagyslių pralaidumą ir dar stimuliuoja chemotaktinius faktorius. Kiti arachidono rūgšties metabolizmo produktai – tromboksanas A2 ir PGD– turi bronchokontrikcinių savybių ir dažnai dominuoja esant bronchų alerginiam uždegimui. Leukocitų patekimą į uždegimo vietą reguliuoja leukocitų endotelio ląstelių adhezijos molekulės, kurios atsakingos už leukocitų adheziją ir migraciją per kraujagyslės endotelį į audinius [2].

Nors uždegimas yra gynybinė, apsauginė organizmo reakcija, tačiau jis gali pažeisti audinius, pavyzdžiui, plaučius. Sergant uždegimu, neutrofilai, eozinofilai, monocitai ir limfocitai gamina oksidantus – deguonies radikalus ir įvairias medžiagas tiems oksidantams neutralizuoti: enzimus (superoksido dismutazė, katalazė, gliutationo peroksidazė) ir neenzimines medžiagas, kurios ne visada spėja susitvarkyti su dideliu laisvųjų radikalų kiekiu. Granuliocitų membranoje esantis fermentas nikotinamido adenino dinukleotido fosfato oksidazė generuoja įvairias aktyvias oksiduojančias medžiagas – superoksido radikalus, vandenilio peroksidą, hidroksilo radikalus. Šios medžiagos gali pažeisti nervines galūnėles kvėpavimo takuose ir padidinti jų jautrumą cholinerginiams dirgikliams. Taip pat nustatytas ryšys tarp agresyvių deguonies atmainų ir eikosanoidų biosintezės stimuliacijos [1, 2]. Taigi uždegimo metu organizmas gali nukentėti dėl oksidacinio streso.

Neutrofilų ir eozinofilų granulėse taip pat esama mikrobicidinių medžiagų ir virškinimo fermentų. Pavyzdžiui, eozinofilų granulėse yra uždegimo žymenų – eozinofilų katijoninis proteinas, eozinofilų proteinas X ir didysis proteinas. Jie gali ne tik apsaugoti organizmą, bet ir pažeisti kvėpavimo takų epitelį [2].

Yra daug žinoma apie nespecifinių dirgiklių, alergenų ir infekcijų sukeliamus antigenui specifinius ir nespecifinius uždegimo mechanizmus, tačiau daug mažiau suvokiamas šių veiksnių nuslopinimas ir pasveikimas… 
Daugiau skaitykite Žurnale „Pediatrija“, 2017 m. Nr.3.

Laimutė Vaidelienė

Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų Vaikų ligų klinika


383 mintys apie “Kosulio gydymas fenspiridu

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