Asthma

**Cukku** ko ñawu nguu heewi heɓtaade ko juuti, ngu ɓuuɓnata ƴiiƴam ɓalndu. Ina sikkaa ko maale mbayliigu e mbayliigu, e ustaare henndu mbayliigu, e ɓuuɓri gonndi e ɓuuɓri. Maandeeji ɗii ko : ɓuuɓri, ɓuuɓri, ɓuuɓri ɓernde, e ɓuuɓri foofaango. Bonannde maale asma ɗoon e ɗoon, sahaa e sahaa fof ina wiyee ‘’attaque asma’’ walla ‘’exacerbation asma’’ ina waawi waɗde so alerji, pollen, duƴƴe, walla geɗe goɗɗe, ina foofa e nder ƴiiƴam, ina addana ƴiiƴam ɗam ɓuuɓde e feewnude ƴiiƴam ɗam, ɗam restoraa tooksiliverik. Ɗee ina mbaawi waɗde laabi seeɗa e ñalawma walla laabi seeɗa e yontere. E fawaade e neɗɗo oo, maale asma ina mbaawi ɓeydaade bonde e jamma walla e fijirde.

Ina sikkaa ko jillondiral geɗe renndo e nokkuuji ngaddata asma. Geɗe weeyo ina njeyaa heen : ɓuuɓri henndu e alerji. Ko waawi heen wonde fof, ina jeyaa heen leɗɗe ko wayi no aspiriin e beta-bloqueurs. Ñawndugol ngol ina heewi tuugnaade e mbaadi maale ñawu nguu, no jaabawol ngol yahrata e nder sahaaji, e ƴeewndo golle ɓuuɓɗe (spirometrie) . Asma ina renndinee fawaade e keewal maale ɓuuɓri doole e nder leƴƴannde wootere (FEV1), e ɓuuɓri ɓurndi heewde. Ina waawi kadi renndineede e atopik walla ko wonaa atopik, ɗo atopik firtata ko mbaydi ƴellitgol mbaydi 1 ɓuuɓri ɓuuɓri.

Alaa safaara anndaaɗo e ñawu nguu, kono ina waawi safreede. Maale ɗee ina mbaawi haɗeede e rewrude e reentaade ko addata ɗum, ko wayi no alerji e ɓuuɓri fooftere, e suppiteede e huutoraade kortikosteroid foofoowo. Agonisteeji beta juutɗi (LABA) walla antileukotriyen ina mbaawi huutoreede e ko jiidaa e kortikosteroid foofaandu so tawii maale asma ina keddii e ɓuuɓde.Safaara maale bonɗe jaawɗe ina heewi huutoreede e agonist beta2 juutɗo baawɗo foofaade ko wayi no salbutasketmol e kortikosteroid motikosteroid. E nder caɗeele teeŋtuɗe, ina waawi ɗaɓɓude kortikosteroid e nder ƴiiƴam, sulfaat magnesium, e hopitaal.

E hitaande 2019, asma yanii ko ina tolnoo e 262 miliyoŋ neɗɗo, waɗii ko ina tolnoo e 461 000 maayɗo. Ko ɓuri heewde e maayɓe ɓee ko e leyɗeele ƴellitiiɗe ɗee. Asma ina heewi fuɗɗoraade e cukaagu, tee ina ɓeydoo heewde gila e kitaale 1960. Asma ina anndaa gila e Misra ɓooyɗo. Konngol asma ngol ummorii ko e ɗemngal Gerek ἆσθμα (âsthma), firti ko ‘ɓuuɓde’.

## Maandeeji e maandeeji
Asma ina maantiniri ɓuuɓri keewndi, maale ɓuuɓri, ɓuuɓri foofaango, ɓuuɓri ɓalndu, e ɓuuɓri ɓuuɓri. Ɓuuɓri ina waawi yaltude e ɓuuɓri e ɓuuɓri kono ina heewi saɗtude addude. E nder cellal e ñawu asma (exacerbation), ɓuuɓri ina waawi feeñde no ɓuuɓri nii, sabu ɓeydagol ƴiiƴam ɓalejam biyeteeɗam eosinophiles. Maale ɗee ina keewi bonde e jamma e subaka law walla e jaabawol fijirde walla henndu ngulndu. Won e yimɓe wonduɓe e asma ina famɗi ɗo keɓata maale, ko heewi heen ko jaabawol gonngol e ɓuuɓri, won heen ina mbaawi jaabaade ko heewi e ko yaawi, ina keɓa maale duumotooɗe.

## Sarɗiiji jokkondirɗi
Ko heewi e ngonkaaji cellal goɗɗi ina keewi feeñde e yimɓe wonduɓe e asma, ina jeyaa heen ñawu nguu (GERD), ñawu nguu ina wiyee « rhinosinusitis » e « apnée obstructive du sommeil ». Rafiiji hakkille kadi ɓuri heewde, rafiiji kulɓiniiɗi ina keɓa hakkunde 16 e 52% e rafiiji ɓernde ina tawee e 14–41%. Anndaaka so tawii asma ina addana neɗɗo caɗeele hakkille walla caɗeele hakkille ina ngadda asma. Asma jooni oo, kono wonaa asma ɓooyɗo oo, ina jokkondiri e ɓeydagol maayɗeele e nder safaaraaji kala, maayɗeele e ñawuuji ɓernde, e maayɗeele e ñawuuji gonɗi e nder reedu les.

Asma, haa teeŋti noon e asma bonɗo, ina jokkondiri no feewi e ƴellitaare ñawu nguu (COPD). Ɓeen wonduɓe e asma, haa teeŋti noon so tawii ko ko ŋakki e reentaade, ina ɓeydoo heewde baasal e rafiiji raajo-kontrast.

Caɗeele ɓuri heewde feeñde ko e yimɓe wonduɓe e asma.Ɗum ina waawi jokkondirde e batte agonisteeji beta2-adrenergik ustude ƴiiƴam. Ɗeeɗoo leɗɗe ina mbaawi kadi ustude baasal dental.

## Sabaabuuji
Asma ina safra jokkondire hakkunde nokkuuji e renndo, caɗtuɗe, ɗe nganndaaka no feewi. Ɗee ina mbaawi battinde e tiiɗnaare maggal e jaabawol maggal e safaara. Ina sikkaa wonde ɓeydagol nguleeki weeyo ko ɓooyaani koo, ko waylude epigenetik (geɗe ndonaandi ko wonaa ɗe jowitiiɗe e jokkondire ADN) e waylude nokku nguurndam. Asma fuɗɗotooɗo ko adii duuɓi 12 ɓuri waawde arde ko e batte renndo, tawi noon fuɗɗoraade caggal duuɓi 12 ɓuri waawde arde ko e batte nokku.

### Ko fayti e nokkuuji
Ƴeew kadi: Mikroobiiji jowitiiɗi e asma

Geɗe keewɗe e nder weeyo ina njokkondiri e ƴellitaare e ɓeydagol asma, ina jeyaa heen alerji, pollugol henndu, e kemikaaji goɗɗi e nder weeyo. Won geɗe ɗe nganndu-ɗaa ina mbaawi saabaade asma e nder yimɓe wonduɓe e rafi o, ɗe mbiyetee ko asmagens. Won e asmaaji ɓurɗi heewde ina mbaɗi amoniak, lateks, pesticides, cumu solder e wellitaare, ɓuuɓri njamndi walla leɗɗe, ɓuuɓri pentiir isosiyanaat e peewnugol otooji, formaldehiid, glutaraldehiid, anidriid, kolaaɗe, ɗaɗi, ndiyam gollorɗam njamndi, ɓuuɓri nebam, e moul. Sikke alaa, e nder reedu e caggal jibinannde ina addana neɗɗo ɓeydaade saabaade maale nannduɗe e asma.Lowre henndu ummoraade e geɗe weeyo ko wayi no pollugol jolngo walla tolno ozone toowɗo. ina jokkondiri e ƴellitaare asma e ɓeydagol tiiɗgol asma. Ko ɓuri feccere e ñawɓe sukaaɓe e nder leyɗeele dentuɗe Amerik ina tawee e nokkuuji ɗo henndu nduu woni les tolnooji EPA. Lowre henndu ɓuri heewde ko e renndooji ɗi ngalaa kaalis e ɗi ngalaa kaalis.

Feññinde mborosaaji gonɗi e nder galle ina waawi addande asma ; yeru, ɓuuɓri formaldehyde ina jogii jokkondire moƴƴe. Ftalat e nder won e mbaydiiji PVC ina jokkondiri e asma e nder sukaaɓe e mawɓe. So tawii noon udditgol ñawu nguu ina jokkondiri e ƴellitaare asma, jokkondire hakkunde sabaabu e batte ina njogori tabitineede tawo. Meta-analyse hollitii wonde ƴulɓe gaas ko huunde mawnde e baasal asma, tawi ko ina wona gooto e 8 ñawɓe e nder U.S. ina waawi tawa ko ɗeen ngoni.

### Reedu
Ɓooygol hakkille yumma e nder reedu ina addana cukalel ngel heɓde asma.

### Alerji
Asma ina jokkondiri e ɓuuɓri alerji nder suudu. Alerji ɓurɗi heewde e nder galleeji ko mborosaaji, mborosaaji, mborosaaji daabaaji (pecce ƴiye walla ƴiye), e mborosaaji. Eɓɓooje ngam ustude mboros oo tawaama ina ŋakki e maale ñawu nguu e nder yimɓe senngooji. Seedeeji ŋakkuɗi ina kollita wonde darnde ngam ustude mborosaaji e feewnude mahaaɗe ina waawi wallitde moƴƴinde maale asma e nder mawɓe. Won e ñawuuji foofaango viral, ko wayi no mboros sinsitiyal foofaango e mboros rhinovirus, ina mbaawi ɓeydude baasal e ñawu nguu so tawii ko e sukaaɓe tokosɓe. Kono won e ñawuuji goɗɗi ina mbaawi ustude baasal.

### Teskagol cellal
Teskagol hipoene ina etoo faamninde ɓeydagol keewal asma e nder winndere ndee kala, ko ɗum huunde nde alaa ɗo haaɗi, nde nganndu-ɗaa ko batte ustaare, e nder cukaagu, e bakteriiji e mborosaaji ɗi ngonaa pathogenic. Ina sikkaa wonde ustaare ɓuuɓri bakteriiji e mborosaaji ina foti, e nder heen, e ɓeydagol laaɓal e ustude mawnugol galleeji e nder renndooji hannde ɗii. So en ƴeewii endotoksin bakteriiji e nder cukaagu mum ina waawi haɗde ƴellitaare asma, kono feeñninde e nder duuɓi mawɗi ina waawi saabaade ɓuuɓri bronkokonstriction. Seedeeji ballitooji miijo cellal ina waɗi ŋakkeende asma e nder gese e nder galleeji jogiiɗi jawdi.

Huutoraade antibiotik e nder nguurndam gadanal ina jokkondiri e ƴellitaare asma.[68] Rewindaade caggal ɗuum hollitii wonde wiɗtooji ɓennuɗi ɗii ngarii e ciimtol ngol aldaa e nanondiral e jokkondire hakkunde kuutoragol antibiotik e ƴellitaare asma, tee heewɓe mbaawaano safrude wonde ñawuuji foofaandu ina mbaawi wonde sabaabu jiiɓru.

Jibingol e laawol seernaaɓe ina jokkondiri e ɓeydagol baasal (ina hiisa ko 20–80%) e asma – ngol ɓeydagol baasal ina jokkondiri e ŋakkeende koloñaal bakteriiji celluɗi ɗi jibinaaɗo keso oo heɓatnoo e rewrude e ɓuuɓri jibinannde. Won jokkondire hakkunde asma e tolno jawdi, ina waawi tawa ina jokkondiri e miijo laaɓal, sibu yimɓe ɓe ngalaa jawdi ina keewi heɓde bakteriiji e mborosaaji.

### Genetik
Jokkondiral CD14 e endotoksin tuugingal e CD14 SNP C-159T

Toɓɓe endotoksin CC *genotype* TT *genotype*

Feññinde toownde *Risk* tokooso Risk toowɗo

*Low exposure Risk* mawɗo Risk tokooso

Daartol ɓesngu ko huunde hulɓiniinde wonande asma, tawa ina waɗi taƴe keewɗe ceertuɗe. So tawii ɓiɗɗo gooto nannduɗo e ɓiɗɗo oo ina wondi e ñawu nguu, ina gasa tawa goɗɗo o ina heɓa ñawu nguu ko ina tolnoo e 25%. E darorɗe hitaande 2005, taƴe 25 ina njokkondiri e asma e nder yimɓe jeegom walla ko ɓuri ɗum ceertuɗi, ina heen GSTM1, IL10, CTLA-4, SPINK5, LTC4S, IL4R e ADAM33, e woɗɓe. Heewɓe e ɗeen taƴe ina njokkondiri e reenngo ɓalndu walla e modulaasiyoŋ ɓuuɓri. Hay e nder ndee doggol taƴe ballitooje wiɗtooji baɗaaɗi no feewi, njeñtudi ndii hawraani e nder denndaangal yimɓe jarribaama. E hitaande 2006 ko ina ɓura 100 taƴre ina njokkondiri e asma e nder wiɗto fedde taƴre wootere tan ; ko ɓuri ɗum ina jokki e yiyeede.

Won e mbaydiiji taariindi ina mbaawi saabaade asma tan so ɗi kawrii e mbaydiiji keertiiɗi e nder nokkuuji. Yeru mum ko polimorfiis nukleotiid gooto keeriiɗo e nder diiwaan CD14 e jokkondire e endotoksin (geɗe bakteriiji). Feññinde endotoksin ina waawi ummoraade e nokkuuji keewɗi, ko wayi no cumu tuubaako, kulle, e gese. Ndeen noon, baasal asma ina anndiree e nder renndo neɗɗo kam e tolno gonɗo e nder endotoksin.

### Sarɗiiji safaara
Tato eksema atopik, rinitis alerji e asma ina wiyee atopi. Ko ɓuri tiiɗde e ko addanta asma heɓde ko daartol ñawu atopik;[63] tawi asma ina heewi feeñde e wonduɓe e eksema walla hay fever. Asma ina jokkondiri e mboros eosinofilik (granulomatose) e polianjitis (anndiraaɗo ko adii fof ko sindrom Churg-Strauss), ñawu nguu ina waawi reentaade ɓalndu, e vaskulitis. Yimɓe wonduɓe e won e mbaydiiji urtikaaji ina mbaawi kadi heɓde maale asma.

Won jokkondire hakkunde ŋakkere teddeendi e baasal asma, tawi kamɓe ɗiɗo fof ɓe ɓeydiima e ɗii duuɓi cakkitiiɗi.Geɗe keewɗe ina mbaawi wonde heen, ina jeyaa heen ustaare golle fooftere sabu mooftude ƴiiƴam e no ƴiiƴam ɗam addanta neɗɗo ngonka ɓuuɓka.

Leɗɗe *beta-blocker* ko wayi no propranolol ina mbaawi saabaade asma e ɓeen wonduɓe e rafi o. Kono tan, *beta-bloqueurs cardioselectives*  ina peeña e wonduɓe e ñawu nguu, tawa ina moƴƴi e wonduɓe e ñawu nguu.Leɗɗe goɗɗe baawɗe saabaade caɗeele e asma ko : reennooɓe enzim baylotooɗo anjiyotensin, aspiriin, e AINE. Huutoraade leɗɗe cemmbinɗe asid (inhibiteurs de pompe *proton* et bloqueurs H2) e nder reedu ina jokkondiri e ɓeydagol nguleeki e nder cukalel ngel.

### Ko ɓuri heewde e golle
Won e yimɓe maa njogo asma dartiiɗo fotde jonte walla lebbi, caggal ɗuum ɗoon e ɗoon ƴellito episod asma ɓuuɓɗo. Yimɓe ceertuɓe ina njaaboo e geɗe ceertuɗe e laabi ceertuɗi.[88] Ko ɓuri heewde e yimɓe ina mbaawi heɓde ɓuuɓri tiiɗndi e nder geɗe keewɗe ɗe o dañi.

Geɗe cuuɗiiɗe baawɗe addande asma ɓeydaade heewde ko wayi no duƴƴe, dander daabaaji (haa teeŋti e gaasa cat e puccu), alerjiiji cokaaɗo e ɓuuɓri.Perfumes ko huunde huuɓtodinnde e njanguuji ɓuuɓɗi e nder rewɓe e sukaaɓe. Infections viral e bakteriiji e nder ƴiiƴam toowɗam fof ina mbaawi bonnude ñawu nguu. Teskagol hakkille ina waawi bonnude maale – ina sikkaa wonde stres ina wayla reenngo ɓalndu, ɗum noon ina ɓeyda jaabawol ɓuuɓngol e nder weeyo wonande alerji e ɓuuɓri.

Asma ina ɓeydoo heewde e sukaaɓe yahrooɓe e duuɓi jaŋde, e nder ndunngu, fotde jonte 8, ko juuti caggal nde sukaaɓe ɓee ngarti e jaŋde. Ɗum ina waawi hollirde geɗe keewɗe, ko wayi no ŋakkeende jokkondiral e safaara, ɓeydagol alerji e mborosaaji, e waylude muñal ɓalndu. Hujjaaji seeɗa ina ngoodi ngam ardude e laabi potɗi huutoreede ngam ustude ŋakkeende nguura e nder ndunngu, kono so tawii ko huunde nde alaa ko nafata, safaara omalizumab mo sahaa kala ina waawi huutoreede gila e yontereeji nay haa jeegom hade mum artude e duɗal ina waawi ustude ŋakkeende nguura e nder ndunngu.

## Patofisiyoloji
Asma ko batte ɓuuɓri gonndi e nokku ɗo ƴiiƴam ɗam woni ɗoo (ko ɓuri teeŋtude e ƴiiƴam ɗam e ƴiiƴam ɗam), ko ɗum addanta caggal ɗuum ɓeydaade ɓuuɓde e ƴiiƴam ɗam. *Narrowing* ina heewi wayleede e safaara walla tawa alaa. Sahaa e sahaa fof, laabi henndu ɗii e koye mum en ina mbayla. Waylooji keewɗi e nder laabi henndu ina njeyaa heen ɓeydagol eosinofiiluuji e teddeendi lamina retikulaar. E nder dumunna juutɗo, ƴiiƴam ɗam ina waawi ɓeydaade mawnude wondude e ɓeydagol limoore ƴiiƴam ɗam. Ko wayi no limfositteeji T, makrofaaji, e neutrofiiluuji, sifaaji cellal goɗɗi gonɗi heen ɗii. Ina waawi kadi tawa ina waɗi heen geɗe goɗɗe gonɗe e nder ɓalndu, ko wayi no sitokineeji, kemikineeji, histamin, e leukotriyen e ko nanndi heen.

## Ñawu nguu
So tawii asma ko ñawu anndaangu, alaa fof firo wooto, ngo nanondiraa. Ko ɗum siforii e *Global Initiative for Asthma* ko "rafi ɓuuɓɗo gonɗo e laabi henndu ɗo cellal keewngal e geɗe cellal mbaɗata darnde. Ɓuuɓri gonndi e laabi henndu ina jokkondiri e hiper-responsiveness laabi henndu addanoowo ɓuuɓri gonndi e ɓuuɓri, ɓuuɓri foofaango, ɓuuɓri ɓalndu teeŋti noon e cough ina heewi jokkondirde e ustaare henndu yaajndu kono waylotoondu e nder ɓuuɓri ndi heewi wayleede ko e hoore mum walla e safaara".

Alaa hannde jarribo laaɓtungo ngam anndude ñawu nguu, ko ɓuri heewde tuugnaade ko e mbaadi maale ɗee e jaabawol safaara e nder sahaaji.Asma ina waawi sikkeede so tawii won daartol ɓuuɓngol, ɓuuɓri, walla caɗeele fooftere, tawa ɗeen maale ina peeña walla ina ɓeydoo bonde sabu ekkorse, alerji, walla mborosaaji. Ndeen spirometri huutortee ngam tabitinde ñawu nguu. E sukaaɓe ɓe duuɓi mum en njahrata e jeegom, ñawu nguu ɓuri saɗtude sibu ko ɓe sukaaɓe no feewi ngam waɗde spirometrie.

### Spirometiri
*Spirometry* ina wasiyee ngam wallitde e ƴeewndo e njuɓɓudi. Ko ɗum ƴeewndo gooto ɓurngo moƴƴude ngam ƴeewde asma. So tawii FEV1 fotnooɗo e ngalɗoo karallaagal ina moƴƴi ko ɓuri 12%, ina ɓeydoo ko famɗi fof 200 mililiter caggal nde neɗɗo waɗanaa mboros korona (bronchodilateur) ko wayi no salbutamol, ɗuum ina wallita e ƴeewndo ngoo. Kono ina waawi wonde ko woowaa e ɓeen wonduɓe e daartol asma ɓuuɓɗo, tawa ina ngolloo jooni. No kafeyin woniri ɓuuɓnoowo ƴiiƴam e yimɓe wonduɓe e asma nii, huutoraade kafeyin ko adii ƴeewndo golle ƴiiƴam ina waawi haɗude ƴeewndorɗe ɗee. Capaato diffusion fooftere wootere ina waawi wallude e seerndude asma e COPD. Ina moƴƴi waɗde spirometrie hitaande kala walla ɗiɗi ngam ƴeewde no asma neɗɗo oo jogori reentoreede.

### Woɗɓe
Caɗeele metakolin ina njogii fooftere ɓeydotoonde e ɓuuɓri huunde addannde ɓuuɓri ƴiiƴam e nder ɓeen wonduɓe e ɓuuɓri. So tawii ko negatif firti ko neɗɗo alaa asma ; so tawii ko moƴƴo, kono, ɗum wonaa keeriiɗo e ñawu nguu.

Seedeeji goɗɗi ballitooji ina njeyaa heen : ≥20% e ɓuuɓri ɓuuɓri ɓuuɓri ko famɗi fof balɗe tati e nder yontere ko famɗi fof jonte ɗiɗi, ≥20% ɓeydagol ɓuuɓri caggal safaara salbutasuremol, kortikosteroid ina foofaa walla prednison, walla ≥pecreak in0 memmugo. Teskuyaaji ɓuuɓɗi (peak expiratory flow) ɓuri waylaade e spirometry, kono, ɗum noon, ɗum noon, wasiyaaka ngam ƴeewndaade ko woowaa. Ina waawi naftoreede ngam ƴeewde hoore mum ñalnde kala e wonduɓe e ñawu nguu, kam e ƴeewde no leɗɗe kese ɗee njahri. Ina waawi kadi wallitde e ardude safaara e wonduɓe e mboros oo.