asTmis marTvisa da prevenciis Tanamedrove rekomendaciebi

definicia - bronquli asTma sasunTqi gzebis qronikuli anTebiTi daavadebaa,

romelSic
mravali
ujredi
monawileobs.
viTardeba
sasunTqi
gzebis
hipermgrZnobeloba, rac iwvevs wheezing-is (wheezing maRali tembris mqone
mstvinavi xmianoba amosunTqvisas), sulxuTvis, gulmkerdis SeboWilobisa da
xvelis morecidive epizodebs, gansakuTrebiT RamiT da/an adre diliT. simptomebi
Cveulebriv dakavSirebulia haeris nakadis SezRudvasTan, romelic Seqcevadia
spontanurad an mkurnalobis Sedegad.
epidemiologia - sadReisod msoflioSi 300 milioni adamiania asTmiT
daavadebuli dasavluri cxovrebis damkvidrebisa da urbanizaciis sapasuxod
aRiniSneba asTmis sixSiris zrda. 2025 wlisTvis damatebiT 100 milioni adamiani
daavaddeba. sxvadasxva qveyanaSi asTmis gavrcelebis sixSire 1-dan-18 %-mde
meryeobs. msoflioSi weliwadSi 250 000 adamiani ki iRupeba am daavadebiT.
etiologia/paTogenezi - faqtorebi, romlebic gavlenas axdenen asTmis
ganviTarebasa da mis gamovlinebaze, iyofa or ZiriTad jgufad faqtorebi, romlebic
iwveven asTmas da faqtorebi, romlebic amwvaveben mis mimdinareobas. pirvel
jgufs miekuTvneba e.w. maspinZeli (ZiriTadad genetikuri) faqtorebi, meores ki
garemo faqtorebi.
maspinZeli faqtorebi
genetika - arsebobs genebi, romlebic
ganapirobeben atopiisadmi
winaswarganwyobas, sasunTqi gzebis hiperreaqtiulobas, imunur pasuxis tips,
pasuxs asTmis mkurnalobaze
simsuqne zogierTi mediatori (mag. leptini) arRvevs sasunTqi gzebis funqcias
da zrdis asTmis ganviTarebis risks. sxeulis masis indeqsis maRali maCvenebeli
asocirdeba asTmis sixSiris zrdasTan. msuqan pacientebSi asTmis mimdinareoba
umjobesdeba wonis klebis paralelurad (mtkicebuleba B).
sqesi mamrobiTi sqesi bavSvobis asakSi asTmis risk-faqtors warmoadgens. 14
wlamde asTma 2-jer ufro xSiria biWebSi, gogonebTan SedarebiT. asakis
matebasTan erTad gansxvaveba mcirdeba. mozrdil asakSi asTma ufro xSiria
qalebSi. aseTi gansxvavebis mizezi ucnobia, Tumca fiqroben, rom is SeiZleba
dakavSirebuli iyos sasunTqi gzebisa da filtvebis zomasTan (mamrobiT sqesSi
dabadebisas sasunTqi gzebis zoma ufro mcirea, magram mozrdil asakSi ufro
didia mdedrobiT sqesTan SedarebiT).
garemo faqtorebi
alergenebi
_ karSida: mtvris tkipa, bewviani cxovelebi, tarakanis alergeni, sokoebi,
safuara, obis soko,
_ kargareTa: mcenaris mtveri, obis, safuaras soko,
infeqcia (upiratesad virusuli) respiraciul sincitiuri, da rinovirusuli infeqcia
asocirdeba bronqul asTmasTan, gansakuTrebiT adreul asakSi.
haeris dabinZureba
Tambaqos moxmareba (pasiuri da aqtiuri mweveli) Tambaqos boli arRvevs
filtvis funqcias, amcirebs mgrZnobelobas inhalaciuri steroidebisadmi
(mtkicebuleba B) da xels uSlis asTmis kontrols. dedis mier Tambaqos
moxmareba zrdis bavSvSi asTmis ganviTarebis risks
kvebis xasiaTi - ZuZuTi kveba icavs asTmis ganviTarebisagan. kvebiTi alergia
asTmis gamwvavebas ZiriTadad adreul asakSi uwyobs xels. 6 cximovani
mJavebis (margarini, mcenareuli zeTi) Warbi da 3 cximovani mJavebis (Tevzis
qoni) mcire moxmareba zrdis asTmis ganviTarebis risks.

medikamentebi aspirini da anTebis sawinaaRmdego sxva arasteroiduli

saSualebebi iwveven asTmis gamwvavebas. blokatorebi (peroraluri, Tu
intraokularuli) iwvevs bronqospazms.
emociuri stresi Warbma emociam (sicili, tirili, SiSi) SeiZleba gamoiwvios
hiperventilacia da hipokapnia, rac Tavis mxriv iwvevs sasunTqi gzebis
Seviwrovebas.
sxva faqtorebi riniti, sinusiti da polipozi xSirad asocirebulia asTmasTan,
gastroezofaguri
refluqsi
gansakuTrebiT
bavSvebSi
iwvevs
asTmis
gamwvavebas, asTmis mimdinareoba SeiZleba gaumjobesdes an gauaresdes
orsulobis dros.

klinikuri gamovlineba

asTmaze miuTiTebs iseTi simptomebi, rogoricaa periodulad sunTqvis

gaZneleba, mstvinavi sunTqva, xvela da gulmkerdis SeboWiloba. asTmis
simptomebi xangamoSvebiT viTardeba, ris gamoc SeiZleba moxdes misi
ugulvebelyofa (rogorc pacientis, ise eqimis mxridan) an daisvas araswori diagnozi.
asTmis sadiagnostikod pacients Semdegi kiTxvebi unda daesvas
hqonda pacients wheezing-is Seteva an morecidive wheezing?
pacients aqvs Semawuxebeli xvela RamiT?
varjiSis Semdeg pacients aReniSneba wheezing an xvela?
sxvadasxva aeroalergeni an polutantis moqmedebis sapasuxod pacients
aReniSneba wheezing, gulmkerdis SeboWva an xvela?
gacieba mudmivad xom ar Cadis gulmkerdSi an gamojanmrTelebas xom ar
sWirdeba 10 dReze meti?
simptomebi umjobesdeba asTmis medikamentebis gamoyenebisas?
obieqturi gasinjva
Setevis dros mstvinavi sunTqva ismis Soridan. avadmyofs aqvs Sewuxebuli
gamometyveleba, zogjer iZulebiTi mjdomare mdebareoba, gulmkerdis Seberiloba
- emfizematozuri
forma, palpaciiT aRiniSneba gulmkerdis kedlis rigidoba,
gulmkerdis bgeriTi xmianoba daqveiTebulia. Setevis dros vlindeba tqaipnoe,
cianozi, Zilianoba, taqikardia, sunTqvaSi damxmare kunTebis monawileoba. perkusiiT vlindeba kolofiseburi xmianoba, auskultaciiT gaxangrZlivebuli amosunTqvis
fonze mravlobiTi mstvinavi da mogugune xasiaTis mSrali da sxvadasxva kalibris
sveli xixini.

diagnostikuri testebi

filtvis funqciis SeswavliT fasdeba haeris nakadis SezRudva, misi Seqcevadoba

da cvalebadoba, rac adasturebs asTmis diagnozs. haeris nakadis SezRudvis
Sefasebis sxvadasxva meTodi arsebobs maT Soris upiratesoba eniWeba
spirometriasa da pikfloumetrias. orive meTodi gamoiyeneba 5 welze meti asakis
pacientebTan.
spirometriiT fasdeba FEV1 (forsirebuli amosunTqvis moculoba 1 wm-Si) da FVC
(forsirebuli sasicocxlo tevadoba). spirometriis gamoyenebisas asTmis sasargeblod
metyvelebs FEV1-is (forsirebuli amosunTqvis moculoba 1 wm-Si) 12%-iT da metiT
mateba bronqodilatatoris gamoyenebis Semdeg.
pik-floumetriiT
fasdeba
PEF
haeris
nakadis
maqsimaluri
siswrafe
amosunTqvisas. PEF maCveneblis monitoringi gamoiyeneba:
asTmis diagnozis dasadastureblad - asTmis sasargeblod metyvelebs PEF
maCveneblis mateba 20%-ze metad swrafi moqmedebis 2agonistis
gamoyenebidan 15-20 wuTSi, an diliT gaRviZebisas da 12 saaTis Semdeg
PEF maCveneblebis cvalebadoba 20%-ze metad im pacientebSi, romlebic
iReben bronqodilatatorebs

 asTmaze kontrolis gasaumjobeseblad asTmis marTvis gegma moicavs

asTmis simptomebisa da PEF maCveneblis TviT-monitorings, rac mkurnalobis
efeqtirobis Sefasebis saSualebas iZleva.
damatebiTi diagnostikuri testebi
amosunTqul haerSi azotis Jangis (NO)Semcvelobis gansazRvra
sasunTqi gzebis reaqtiulobis Seswavla metaqolinis, histaminis zemoqmedebis
an fizikuri datvirTvis sapasuxod (gansakuTrebiT im pacientebSi romelTac aqvT
asTmis mdgradi simptomebi, magram filtvis normaluri funqcia)
kanis testebi alergenebze an SratSi specifikuri IgE-s gansazRvra (saerTo IgE
arainformatiulia)
rentgenologiurad aRiniSneba filtvis qsovilis gamWvirvalobis momateba,
diafragmis dabla dgoma, sisxlZarRvovani surTis gaZliereba.

diagnostikuri SesaZleblobebi da diferenciuli diagnozi

daavadebebi, romlebTanac unda gatardes diferenciuli diagnozi, icvleba

asakTan erTad.
5 wlamde asakis bavSvebi
adreul asakSi asTmis diagnozi ZiriTadad klinikur gamovlinebas eyrdnoba. 3
wlamde mstvinavi sunTqva da xvela sakmaod xSiria da yovelTvis ar aris
asTmasTan dakavSirebuli.
5 wlamde bavSvebSi gamoyofen 3 kategorias:
tranzitoruli adreuli wheezing (3 wlamde) - xSirad dakavSirebulia
dRenaklulobasTan an mSoblebis mier Tambaqos mowevasTan;
persistiuli adreuli wheezing (ZiriTadad 3 wlamde) xSirad asocirebulia virusul
infeqciebTan (2 wlamde rsv, 2-5 weli sxva virusebi), bavSvs ar aqvs atopiis
niSnebi, ar aRiniSneba atopiis ojaxuri anamnezi niSnebi. SeiZleba klinikuri
gamovlineba SenarCundes skolis asakSic;
mogvianebiTi wheezing/asTma asTmis damaxasiaTebeli klinika vlindeba
aramarto bavSobisas, aramed mozrdil asakSic, pacientebsi xSirad vlindeba
atopia, egzema.
adreul asakSi asTmis sasargeblod metyvelebs Semdegi niSnebi - wheezing-is
xSiri epizodebi (TveSi erTze meti), datvirTvasTan dakavSirebuli xvela an
wheezing, Ramis xvela virusuli infeqciis ararsebobisas, simptomebi persistireba 3
wlis asakis Semdeg. 3 wlamde wheezing-is paralelurad erTi didi risk-faqtoris
(mSoblis asTma an ekzema) an 2-3 mcire risk-faqtoris (eozinofilia, wheezing
gaciebis gareSe da alergiuli riniti) arseboba mogvianebiT asakSi asTmis arsebobis
prediqtoria.
am asakSi morecidive wheezing-is alternatiuli mizezebia
qronikuli rinosinusiti
gastroezofaguri refluqsi
morecidive respiraciuli virusuli infeqcia
mukoviscidozi
bronqopulmonuri displazia
tuberkulozi
Tandayolili anomalia, romelic iwvevs sasunTqi gzebis Seviwrovebas
ucxo sxeulis aspiracia
pirveladi ciliaruli diskineziis sindromi
imunodeficiti
gulis Tandayolili manki/gulis ukmarisoba
5 wlamde asTmis diagnozis dadasturebis meTodia swrafi moqmedebis
bronqodilatatorebisa da inhalaciuri steroidebiT sacdeli mkurnaloba. klinikuri

gaumjobeseba mkurnalobis dros da gauareseba misi Sewyvetis Semdeg asTmis

sasargeblod metyvelebs.
5 welze meti asakis bavSvebi da mozrdilebi
anamnezuri da obieqturi gasinjvis monacemebi haeris nakadis cvalebadi da
Seqcevadi SezRudvis (upiratesoba eniWeba spirometrias) arsebobasTan erTad
adasturebs diagnozs.
alternatiuli diagnozia:
hiperventilaciis sindromi da panikis Seteva
seda sasunTqi gzebis obstruqcia da ucxo sxeulis aspiracia
xmovani iogebis disfunqcia
filtvis obstruqciuli daavadebis sxva formebi, kerZod fqod
filtvis araobstruqciuli daavadebebi (mag.: filtvis difuzuri parenqimuli
dazianeba)
ararsepiraciuli mizezebi (mag.: marcxena parkuWis ukmarisoba)

asTmis klasifikacia
GINA-s wina wlebis rekomendaciebiT asTmis klasifikacia efuZneboda mis
simZimes (intermisiuli, msubuqi, saSualo da mZime persistiuli). GINA-s
Tanamedrove rekomendaciebiT asTmis simZime fasdeba masze kontrolis xarisxiT
da mkurnalobac swored am monacemebs efuZneba.
asTmis kontrolis done
kontrolirebuli
(yvela saxezea)

dRis simptomebi ar aris (kviraSi 2)

aqtivobis
ar aris
SezRudva
Ramis
ar aris
simptomebi/
gaRviZeba
Setevis
ar aris
mosaxsneli wamlis (kviraSi 2)
gamoyenebis
saWiroeba
filtvis funqcia
normaluri
(PEF /FEV1)
gamwvaveba

ar aris

nawilobriv
arakontrolireb
kontrolirebuli
uli
(romelime aRiniSneba
nebismier kviraSi)
kviraSi > 2
aris
aris
kviraSi > 2

nawilobriv
kontrolirebuli
asTmis 3 an
meti niSnis
arseboba
nebismier
kviraSi

mosalodneli an saukeTeso
maCveneblis 80%-ze
naklebi
erTi an meti weliwadSi
kviraSi erTi

asTmis samkurnalo medikamentebi

asTmis mkurnalobis mizania asTmaze kontrolis miRweva da misi

SenarCuneba. medikamentebi, romlebic asTmis samkurnalod gamoiyeneba iyofa
or did jgufad - Setevis mosaxsneli da kontrolis (prevenciuli) medikamentebi.
asTmis kontrolis (prevenciuli) medikamentebi gamoiyeneba
xangrZlivi mkurnalobisaTvis da aucilebelia asTmaze kontrolis mosapoveblad.
sainhalacio glukokortikosteroidebi (gks) - flutikazoni, mometazoni,
budezonidi, beklametazoni
leikotrienebis modifikatorebi _ montelukasti, zafirlukasti, zileutoni
gaxangrZlivebuli moqmedebis sainhalacio 2 agonistebi _ salmeteroli,
formoteroli (ar gamoiyeneba sainhalacio glukokortikosteroidebis gareSe)
4

kombinirebuli
preparati
sainhalacio
glukokortikosteroidi
da
gaxangrZlivebuli moqmedebis sainhalacio 2 agonisti _ seretidi
gaxangrZlivebuli moqmedebis Teofilini
qromonebi - natriumi qromoglikati, nedokromili (araefeqturia)
gaxangrZlivebuli moqmedebis oraluri 2 agonistebi _ salbutamoli,
terbutalini (iSviaTad gamoiyeneba)
anti IgE omalizumabi
sistemuri gks prednizoloni, meTilprednizoloni
alergen specifiuri imunoTerapia

Setevis mosaxsneli medikamentebi

swrafi moqmedebis sainhalacio 2 agonistebi (salbutamoili, fenoteroli,
albuteroli)
sistemuri gks
antiqolinerguli preparatebi (ipratropium bromidi)
Teofilini
swrafi moqmedebis oraluri 2 agonistebi

asTmis marTva da prevencia

asTmis marTvis mizania asTmis simptomebze kontrolis miRweva da SenarCuneba,

SeuzRudavi fizikuri aqtivobis miRweva, normasTan miaxloebuli filtvis funqciis
SenarCuneba, asTmis Setevebis prevencia, medikamentebis gverdiTi moqmedebis
Tavidan acileba, asTmiT gamowveuli sikvdilobis prevencia.
asTmis
kontrolis
misaRwevad
mniSvnelovanis
pacientis/ojaxis/eqimis
partniorobis Camoyalibeba. am partniorobis misaRwevad mniSvnelovania
pacientis/ojaxis ganaTleba (risk-faqtorebis Tavidan acileba, medikamentebis
sworad gamoyeneba, asTmis kontrolis da Setevis mosaxsnel medikaments
Soris gansxvaveba, asTmis gamwvavebis niSnebi da saWiro qmedebebi,
samedicino daxmarebisTvis mimarTvis Cvenebebi). miznis erTad dasaxva asTmis
samoqmedo individualuri gegmis SemuSaveba.
risk-faqtorebis identifikacia da maTi Tavidan acileba
risk-faqtori
oTaxis mtvris tkipis
alergenebi
(mcire
zomis
gamo
SeuiaraRebeli
TvaliT
maTi
danaxva
SeuZlebelia)

misi Tavidan acilebis gzebi'

loginis TeTreuli da gadasafarebeli kviraSi erTxel unda
gairecxos cxeli wyliT da gaSres cxel saSrobSi an mzeze.
leibi da baliSi moTavsdes haergaumtar SaliTaSi. xaliCa
da rbili iataki Seicvalos linoleumiT an parketiT,
gansakuTrebiT saZilebelSi. rbili aveji SeiCvalos vinilis,
tyavis an sada xis avejiT. dalagebisas sasurvelia filtris
mqone mtversasrutis gamoyeneba.
boli pacienti unda moeridos Tambaqos bols. bavSvi da misi
pasiuri ojaxis wevrebi ar unda eweodnen.

Tambaqos
(aqtiuri
an
moweva)
bewviani
cxovelis cxovelebi unda moacilon saxlidan (saZineblidan mainc).
alergenebi
taraknis alergeni
saxli
xSirad
da
saguldagulod
unda
dalagdes.
gamoiyeneba mwerebis sawinaaRmdego aerozoli,
rodesac pacienti Sin ar aris.
yvavilis mtveri da mcenareTa yvavilobisa da obis sokoebis gamravlebis
obis
sokoebi periodSi minimumamde unda davides gareT yofnis dro.
Senobis gareT
obis soko SenobaSi
unda Semcirdes nesti binaSi. xSirad dalagdes nestiani

adgilebi.
datvirTviT gamowveuli simptomebis Tavidan acileba
SeiZleba intensiuri fizikuri datvirTvis win xanmokle
moqmedebis
2 agonistis.
glukokortikosteroidebiT
xangrZlivi
mkurnaloba
mniSvnelovnad
amcirebs
datvirTviT gamowveuli asTmis ganviTarebis albaTobas.
Tu 2 blokatorebi da aspirini iwvevs asTmis Setevas,
pacientma Tavi unda Seikavos misi gamoyenebisgan

fizikuri aqtivoba

wamlebi

mkurnaloba asTmis kontrolis misaRwevad damokidebulia asTmis kontrolis

xarisxze - kontrolirebuli, nawilobriv kontrolirebuli da arakontrolirebuli.

kontrolirebuli

gazarde
T

nawilobriv
kontrolirebuli

Seamcir
eT

kontrolis done

mkurnalobis taqtika
ipoveT da SeinarCuneT kontrolis yvelaze dabali
safexuri
adiT erTi safexuriT zemoT kontrolis misaRwevad

arakontrolirebuli

adiT erTi safexuriT zemoT sanam ar miaRwevT kontrols

gamwvaveba

umkurnaleT rogorc gamwvavebas

safexuri 1
6

Tu asTma kontrolirebulia mkurnaloba tardeba pirveli safexuris mixedviT. es

gulisxmobs pacientis/ojaxis ganaTlebas, garemos kontrols (risk-faqtorebis Tavidan
acileba) da swrafi moqmedebis sainhalacio 2 agonistebis gamoyenebas
saWiroebis mixedviT.
safexuri 2
Tu asTma nawilobriv kontrolirebuli da arakontrolirebulia mkurnaloba iwyeba
me-2 safexuridan. pacientis/ojaxis ganaTlebas, garemos kontrols (risk-faqtorebis
Tavidan acileba) da swrafi moqmedebis sainhalacio 2 agonistebis saWiroebis
mixedviT gamoyenebas emateba erTi kontrolis (prevenciuli) medikamenti.
asTmis kontrolis misaRwevi mkurnaloba nebismier asakSi iwyeba inhalaciuri
kortikosteroidiT (iks) (dabali doza). kontrolis alternatiuli medikamentia leikotrienis
modifikatori, romelic gamoiyeneba im pacientebSi romlebsac an ar surT iks
gamoyeneba an misi gamoyenebisas aReniSnebaT gverdiTi efeqtebi (mudmivi
disfonia).
safexuri 3 - Setevis mosaxsnel preparats emateba erTi an ori kontrolis
medikamenti.
mozardebisa da mozrdilebisTvis rekomendebulia inhalaciuri kortikosteroidisa
(dabali doza) da xangrZlivi moqmedebis 2 agonistis kombinaciis gamoyeneba.
bavSvebSi rekomendebulia iks dozis gazrda. kombinirebuli da alternatiuli
Terapiis efeqturoba bavSvebSi ar aris Seswavlili.
Tu mesame safexurze ver moxerxda aTmis kontrolis miRweva
saWiroa pacientis referali specialistTan. unda gamoiricxos alternatiuli
diagnozis arseboba an Sefasdes Znelad samkurnalo asTmis mizezebi.
asTmis kontrolis SenarCunebaze monitoringi - kontrolis medikamentis
dawyebidan gaumjobeseba Cveulebriv ramdenime dReSi iwyeba, magram sruli
efeqtis misaRebad saWiroa 3-4 Tve. mZime qronikuli aranamkurnalebi daavadebis
dros es periodi xangrZlivdeba. asTmaze kontrolis miRwevis Semdeg saWiroa
mudmivi monitoringi. monitoringi tardeba rogorc eqimis, ise pacientis/mSoblis
mier. monitoringis sixSire damokidebulia asTmis sawyis simZimeze. eqimTan
meore viziti tardeba 1-3 TveSi, Semdegi vizitebi ki 3 TveSi erTxel. gamwvavebis
Semdeg viziti tardeba 2-4 kviraSi (mtkicebuleba D).
mkurnalobis safexureobrivi Semcireba kontrolis miRwevis Semdeg
monacemebi imis Sesaxeb, Tu rodis unda daiwyos mkurnalobis safexureobrivi
Semcireba, arasakmarisia. mkurnalobis Semcireba SesaZlebelia 3 Tvis Semdeg.
mkurnaloba SeiZleba Sewydes, Tu kontrolis preparatis umcires
dozaze narCundeba asTmaze kontroli da ar viTardeba simptomebi 1 wlis
ganmavlobaSi.
mkurnalobis safexureobrivi gazrda simptomebis mcire gauaresebisas,
gamoiyeneba swrafi moqmedebis 2 agonisti. magram Tu swrafi moqmedebis 2
agonistis gamoyeneba saWiro xdeba 2 dReze met xans, unda gadaixedos kontrolis
Terapia.
asTmis gamwvavebis marTva
asTmis gamwvavebis samkurnalod gamoiyeneba:
oqsigenoTerapia (SaO2 unda iyos >95%)
swrafi moqmedebis sainhalacio 2 agonistebi (salbutamoli, fenoteroli,
albuteroli) I rigis preparati asTmis Setevis mosaxsnelad.
oraluri/parenteruli gks (prednizoloni, deqsametazomi)
meTilqsantini - gamoiyeneba mxolod im SemTxvevaSi Tu sainhalacio 2
agonistebi ar aris xelmisawvdomi (saWiroa SratSi koncentraciis
gansazRvra)
sainhalacio 2 agonistebis da antiqolinergulebis (atroventi) kombinacia beroduali
7