Cututtukan kirji

Pulmonology (/ˌpʌlməˈnɒlədʒi/, /ˌpʊlməˈ nɒlədʃi/, daga Latin *pulmō, -ōnis* "kurciya" da kuma Girkanci   "bincike na"), pneumology (/nʊˈmɒləd ʒi, njʊ-/, wanda aka gina a kan Girkanci πνεύμων  "lung") ko pneumonology  (/nɪmənˈɒləd Vesti, nj) ƙwararrun na kiwon lafiya wanda ke ba da cututtuka numfashi da ke ba da ke bautar numfashi. Har ila yau an san shi da **ilimin numfashi**, maganin numfashi, ko **maganin kirji** a wasu ƙasashe da yankuna.

Ana ɗaukar ilimin huhu reshe ne na maganin ciki, kuma yana da alaƙa da maganin kulawa mai tsanani. Pulmonology sau da yawa ya haɗa da sarrafa marasa lafiya waɗanda ke buƙatar tallafin rayuwa da iska ta inji. Ana horar da likitocin huhu musamman a cikin cututtuka da yanayin kirji, musamman cutar huhu, asma, tarin fuka, emphysema, da cututtukan kirji masu rikitarwa.

Sashen ilimin huhu / numfashi suna aiki musamman tare da wasu ƙwarewa: sassan tiyata ta zuciya da sassan ilimin zuciya.

## Jaridu na ilimin hu

* Ƙungiyar Amurka don Kula da Muho
* Kwalejin Likitocin Zuciya ta Amurka
* Ƙungiyar huhu ta Amurka
* Ƙungiyar Zuciya ta Amirka
* Ƙungiyar Zuciya ta Burtaniya
* Ƙungiyar numfashi ta Turai

## Tarihin ilimin huhu
Ɗaya daga cikin manyan binciken farko da suka dace da fannin ilimin huhu shine gano ƙwayar huhu.  Da farko, an yi tunanin cewa jinin da ke kaiwa gefen dama na zuciya ya ratsa ta cikin ƙananan 'pores' a cikin septum zuwa gefen hagu don samun iskar oxygen, kamar yadda Galen ya tsara;  duk da haka, gano bugun jini na huhu ya karyata wannan ka'idar, wacce a baya aka yarda da ita tun karni na 2.  Masanin ilimin halittar jiki na karni na goma sha uku Ibn Al-Nafis ya yi daidai da cewa babu wani nassi ‘kai tsaye’ tsakanin bangarorin biyu (ventricles) na zuciya.  Ya yi imani cewa dole ne jinin ya ratsa ta cikin jijiya na huhu, ta huhu, ya koma cikin zuciya don a zubar da shi a cikin jiki.  Mutane da yawa sun yi imani da wannan shine bayanin farko na kimiyya game da kewayawar huhu.

Kodayake maganin huhu kawai ya fara tasowa a matsayin ƙwarewar likita a cikin shekarun 1950, William Welch da William Osler sun kafa ƙungiyar 'mahaifiyar' ta American Thoracic Society,  Ƙungiyar Nazarin da Rigakafin Cutar Fuka.  Kulawa, magani, da nazarin tarin fuka na huhu an gane su a matsayin horo a cikin kansa, phthisiology. Lokacin da ƙwarewar ta fara canzawa, ana yin binciken da yawa da ke haɗa tsarin numfashi da ma'aunin iskar jini, yana jan hankalin ƙarin likitoci da masu bincike zuwa fagen ci gaba.

## Pulmonology da muhimmancinsa a wasu fannoni na kiwon lafiya
Kwararrun likitoci ne ke yin tiyata na hanyar numfashi  (ko tiyata ta kirji),  kodayake likitocin huhu na iya yin ƙananan hanyoyin. Ilimin huhu yana da alaƙa da maganin kulawa mai mahimmanci  lokacin da yake hulɗa da marasa lafiya waɗanda ke buƙatar iska ta inji. A sakamakon haka, yawancin likitocin huhu suna da takardar shaidar yin amfani da maganin kulawa mai mahimmanci ban da maganin huhu. Akwai shirye-shiryen zumunci waɗanda ke ba da damar likitoci su zama masu takardar shaidar kwamitin a cikin maganin huhu da na kulawa mai mahimmanci a lokaci guda. Ilimin huhu na yau da kullun sabon yanki ne a cikin maganin huhu  wanda ke hulɗa da amfani da hanyoyin kamar su bronchoscopy  da pleuroscopy don magance cututtukan huhu da yawa.  Ana karuwar gane ilimin huhu na yau da kullun a matsayin takamaiman ƙwarewar likita.

## Binciken ganewa
Masanin ilimin huhu ya fara aikin bincike tare da bita na gaba ɗaya yana mai da hankali kan:

* cututtukan gado da ke shafar huhu (Cystic fibrosis,  rashi na alpha 1-antitrypsin) 
* bayyanar abubuwa masu guba (hauka, asbestos, hayaki mai guba, hayaki na hakar kwal, hayaki ya-sigari) 
* bayyanar ga masu kamuwa da cuta (wasu nau'ikan tsuntsaye, sarrafa malt) 
* diathesis na autoimmune wanda zai iya haifar da wasu yanayi (Fibrosis na huhu, hauhawar jini na huhu) 

Binciken jiki  yana da mahimmanci kamar yadda yake a wasu fannoni na magani.

* Binciken hannaye don alamun cyanosis ko clubbing, bango na kirji, da kuma numfashi.
* Palpation na cervical lymph nodes, trachea da motsi na bango na kirji.
* Rashin ƙarfi na filayen huhu don rashin jin daɗi ko saurin sauti.
* Auscultation (tare da stethoscope) na filayen huhu don raguwa ko sautin numfashi mai ban mamaki. 
** Rales ko rhonchi da aka ji a kan filayen huhu tare da stethoscope.

Kamar yadda yawancin cututtukan zuciya zasu iya ba da alamun huhu,  yawanci ana haɗa cikakken binciken zuciya.

## Hanyar da ake yi
Hanyoyin asibiti na huhu sun haɗa da gwaje-gwaje da hanyoyin da ke biyowa: 

* Binciken dakin gwaje-gwaje na likita na jini (bincike na jini). Wani lokaci ana buƙatar gwajin iskar jini.
* Spirometry ƙaddamar da matsakaicin iska a cikin ƙarar huhu kamar yadda aka auna ta hanyar numfashi a cikin na'ura mai sadaukarwa; wannan shine mabuɗin gwajin don gano cikas ga iska.
* Gwajin aikin huhu ciki har da spirometry, kamar yadda yake a sama, tare da amsawa ga bronchodilators, ƙarar huhu, da ƙarfin watsawa, ƙarshen shine ma'auni na yankin ƙwayar oxygen na huhu
* Bronchoscopy  tare da wankewar bronchoalveolar (BAL), endobronchial da transbronchial biopsy da kuma gogewar epithelial
* X-ray na kirji
* CT scan
* Scintigraphy da sauran hanyoyin maganin nukiliyaMagungunan nukiliya
* Positron emission tomography  (musamman a cikin Ciwon daji na huhu) 
* Polysomnography (bincike na barci ) wanda aka saba amfani dashi don ganewar asali na apnea na bacciRashin bacci

### Hanyoyin tiyata
Babban hanyoyin tiyata a zuciya da huhu ana yin su ne ta hanyar Likitan kirji. Masana ilimin huhu galibi suna yin hanyoyin musamman don samun samfurori daga cikin kirji ko cikin huhu. Suna amfani da dabarun radiographic don duba vasculature na huhu da zuciya don taimakawa tare da ganewar asali.

## Magani da warkewa
Magunguna shine mafi mahimmancin magani ga mafi yawan cututtukan huhu, ko dai ta hanyar numfashi (Bronchodilators da Steroids) ko kuma a cikin hanyar baki (antibiotics, leukotriene antagonists). Misali na yau da kullun shine amfani da inhalers a cikin maganin yanayin kumburi na huhu kamar asma ko cututtukan huhu na yau da kullum. Magungunan oxygen  sau da yawa ana buƙatar su a cikin cututtukan numfashi masu tsanani (emphysema da Fibrosis na huhu). Lokacin da wannan bai isa ba, mai haƙuri na iya buƙatar iska ta inji.

An bayyana gyaran huhu  an ayyana shi azaman ci gaba na ayyuka da yawa da ake gudanarwa ga masu fama da cutar huhu da danginsu, yawanci ta ƙungiyar kwararru ta tsaka-tsaki, tare da manufar cimmawa da kiyaye matsakaicin matakin yancin kai da aiki na mutum a cikin al'umma.  Gyaran huhu[1] an yi niyya ne don ilmantar da majiyyaci, dangi, da inganta yanayin rayuwa gaba ɗaya da tsinkaye ga majiyyaci.  Matsalolin na iya haɗawa da motsa jiki, ilimi, goyon bayan motsin rai, oxygen, iskar injin da ba ta da hankali, inganta haɓakar ɓoyewar iska, inganta yarda da kulawar likita don rage yawan abubuwan da ke faruwa da kuma asibitoci, da kuma komawa aiki da / ko rayuwa mai gamsarwa da jin dadi.  Waɗannan burin sun dace da kowane majiyyata da ke da raguwar ajiyar numfashi ko dai saboda cututtuka na huhu ko na ciki (rashin iskar oxygen) ko raunin neuromuscular (lalacewar iska).  Ƙungiyar gyaran huhu  na iya haɗawa da likitan gyaran gyare-gyare, ƙwararren likitan huhu, mataimakiyar likita da ƙwararrun likitocin kiwon lafiya waɗanda suka haɗa da ma'aikacin jinya, mai kwantar da hankali na numfashi, masanin ilimin harshe, mai ilimin likitancin jiki, mai ilimin motsa jiki, masanin ilimin halayyar kwakwalwa, da ma'aikacin zamantakewa da sauransu.  Bugu da ƙari, ana amfani da wasanni na numfashi don motsa yara don yin gyaran huhu.

## Ilimi da horo

### Masanin huhu
 
A cikin Amurka, likitocin huhu likitoci ne waɗanda, bayan sun sami digiri na likita (MD ko DO), sun kammala horar da zama a cikin likitancin ciki, sannan aƙalla ƙarin ƙarin shekaru biyu na horarwar haɗin gwiwa a cikin ilimin huhu.  Bayan gamsuwa da kammala haɗin gwiwa a cikin maganin huhu, an ba da izinin likita don ɗaukar gwajin takaddun shaida na hukumar a cikin maganin huhu.  Bayan cin nasarar wannan jarrabawar, sai an ba da takardar shaidar likita a matsayin likitan huhu.  Yawancin likitocin huhu sun cika shekaru uku na haɗin gwiwar haɗin gwiwa na musamman a cikin likitan huhu da magungunan kulawa mai mahimmanci.

### Likitan huhu na yara
A Amurka, likitoci huhu na yara  su ne likitocin da, bayan sun sami digiri na likita (MD, DO, MBBS, MBBCh, da dai sauransu), sun kammala horon zama a cikin ilimin yara, sannan aƙalla ƙarin ƙarin shekaru uku na horarwar haɗin gwiwa a cikin ilimin huhu.  Likitocin yara kanana suna kula da cututtuka na hanyoyin iska, huhu, injiniyoyin numfashi da tsarin iska.

## Binciken kimiyya
Masana ilimin huhu suna da hannu a cikin bincike na asibiti da na asali na tsarin numfashi, daga jikin mutum na epithelium na numfashi zuwa mafi inganci na maganin hauhawar huhu. Binciken kimiyya kuma yana faruwa don neman dalilai da yiwuwar magani a cikin cututtuka kamar tarin fuka da ciwon huhu.