Læknablaðið - 01.07.2015, Page 21

Y F i R l i T S G R E i n
Önnur meðferð en lyfjameðferð
Reykleysisráðgjöf og reykbindindi er það inngrip sem mestan þátt
getur átt í að hægja á versnun lungnastarfsemi hjá sjúklingum með
LLT. Ef vel er að slíku staðið má fá allt að 25% langtíma reykleys-
isáhrif.54 Reykbindindi fækkar BVLLT og áhættuminnkunin er í
beinu hlutfalli við lengd reykleysisins hjá LLT-sjúklingnum.55
Lungnaendurhæfing er mikilvæg fyrir alla sjúklinga með lang-
vinna lungnateppu.2 Ekki hefur verið sýnt fram á að lungnaendur-
hæfing fljótt eftir sjúkrahúslegu flýti fyrir bata eða fækki versn-
unum.56 Þannig getur verið betra að láta nokkurn tíma líða áður en
sjúklingur byrjar í lungnaendurhæfingu eftir sjúkrahúsinnlögn.
Hins vegar hefur líkamsþjálfun í sjúkrahúslegu vegna BVLLT sýnt
sig að flýta fyrir bata og lungnaendurhæfing eftir að sjúklingur
hefur náð sér eftir bráða versnun fækkar sjúkrahúsinnlögnum og
lækkar dánartíðni.2,57
Það er aukin dánartíðni við lækkaðan líkamsþyngdarstuðul og
vannæring er mikilvægur áhættuþáttur fyrir slæmar horfur hjá
LLT-sjúklingum.58,59
Eftirlit
Rannsóknir hafa sýnt fram á að minni líkur eru á endurinnlögn ef
sjúklingur hittir lækni innan 30 daga frá útskrift.60 Eftirlit hjúkr-
unarfræðinga fljótt eftir útskrift getur einnig verið hjálplegt. Mis-
vísandi niðurstöður hafa fengist við rannsóknir á sjálfshjálparúr-
ræðum fyrir sjúklinga eftir útskrift og beðið er frekari rannsókna
til að skera úr um virkni þeirra.2,3
Lokaorð
Langvinn lungnateppa er algengur sjúkdómur með mikilli
sjúkdómsbyrði og hárri dánartíðni. Þar skipta bráðar versnanir
höfuðmáli. Markviss meðferð þeirra er mikilvæg og ekki er síður
mikilvægt að reyna með öllum ráðum að fyrirbyggja endurteknar
versnanir því þær skerða mjög lífsgæði sjúklinga og auka dánar-
tíðni. Þessir sjúklingar koma víða við í heilbrigðisþjónustunni og
því nauðsynlegt fyrir íslenska lækna að þekkja vel til þessa vanda-
máls. Þá er rökvíst val sýklalyfja mikilvægt til að minnka líkur á
sýklalyfjaónæmi með tilheyrandi þjáningum og kostnaði fyrir ís-
lenska þjóð.
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