Alergijska astma i rinitis komorbiditet
Sažetak
Alergijske respiratorne bolesti, astma i rinitis, se na osnovu savremenih saznanja smatraju epidemijom dvadeset prvog veka i bolestima savremene dobi. Svetska zdravstvena organizacija procenjuje da u svetu ima oko 300 miliona obolelih od astme, a 500 miliona od rinitisa. Procenjuje se dalji porast broja obolelih u budućnosti, naročito među decom i adolescentima i u visoko- i niskorazvijenim zemljama
Veoma često astma i rinitis postoje zajedno kod istog pacijenta. Brojne savremene studije, vodeći se konceptom „jedan disajni put-jedna bolest“, su pokazale epidemiološku, patofiziološku i kliničku povezanost astme i rinitsa.
Obe bolesti su često nedijagnostikovane, pogotovo kada istovremeno postoje kod istog pacijenta. Koegzistiranje rinitisa i astme nije novo otkriće. Povezanost gornjih i donjih disajnih puteva je empirijski davno uočeno . U drugom veku je Galen savetovao svojim pacijentima da “često čiste nos da bi zaštitili pluća”. Začuđujuće je, ipak, da su bili potrebni vekovi da se ova povezanost i značaj argumentovano potvrde.
Koncept “istovremene bolesti disajnih puteva” ima značajne implikacije za obe bolesti, posebno u dijagnostičkom i terapijskom smislu. Neprepoznat i nelečen rinitis kod obolelih od astme je značajan propust i problem, zbog loše kontrole astme i značajnog uticaja na kvalitet života ovakvih pacijenata. Potvrda dijagnoze i adekvatno lečenje rinitisa je sastavni deo tretmana obolelog od astme. Nelečen rinitis uzrokuje česte egzacerbacije astme, njenu otežanu kontrolu i lečenje, kao i lošu prognozu. Obe bolesti su hronične inflamatorne, zahtevaju dugotrajan i kontinuirani tretman. Savremeni vodiči za lečenje konkurentne astme i rinitisa preporučuju kombinovani, stepenast, farmakološki pristup i strategiju. Adekvatan dijagnostički pristup i kombinovan tretman omogućava obolelima dobar kvalitet života i obavljanje svakodnevnih ličnih, socijalnih i profesionalnih aktivnosti.
U radu je dat pregled postojece literature i rezultata ispitivanja povezanosti izmedju astme i rinitisa koja su sprovedena i u nasoj zemlji, na osnovu kojih je utvrdjena veoma vazna činjenica da pridruzeni rinitis ima znacajan klinicki uticaj na astmu.
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