Tazama chanzo cha Pumu

{{Infobox disease
| Name            = Pumu
| Image           = AsthmaInhaler.jpg
| Alt             = Fluticasone metered dose inhaler
| Caption      = Peak flow meters are used to measure the [[peak expiratory flow]]rate, important in both monitoring and diagnosing asthma.<ref name=GINA_2011_page18>{{harvnb|GINA|2011|p=18}}</ref>
| DiseasesDB      = 1006
| ICD10           = {{ICD10|J|45||j|40}}
| ICD9            = {{ICD9|493}}
| ICDO            =
|  OMIM           = 600807
|  MedlinePlus    = 000141
|  eMedicineSubj  = article
|  eMedicineTopic = 806890
| MeshID          = D001249
| GeneReviewsID   =
| GeneReviewsName =
}}

'''Pumu''' (kwa [[Kiingereza]] ''[[w:Asthma|asthma]]'') ni [[ugonjwa]] wa kudumu wa [[uvimbe]] wa [[koromeo|makoromeo]] ulio na sifa za [[dalili]] zinazobadilika na kujirudia, [[hewa]] kuzibwa na [[bronkospasimu]].<ref name=NHLBI07p11-12>{{harvnb|NHLBI Guideline|2007|pp=11–12}}</ref> 

Dalili ni pamoja na [[kukoroma]], [[kukohoa]], kujikaza kwa [[kifua]], na [[kukosa pumzi]].<ref name=bts2009p4>{{harvnb|British Guideline|2009|p=4}}</ref>

Inashukiwa kusababishwa na [[jenetikia]] pamoja na hali ya [[mazingira]].<ref name=Martinez_geneenvir>{{cite journal |author=Martinez FD |title=Genes, environments, development and asthma: a reappraisal |journal=Eur Respir J |volume=29|issue=1 |pages=179–84 |year=2007 |pmid=17197483 |doi=10.1183/09031936.00087906}}</ref> Kwa kawaida huzingatia mtindo wa dalili, matokeo baada ya matibabu ya muda, na [[spirometri]].<ref name=lemanske>{{cite journal |author=Lemanske RF, Busse WW|title=Asthma: clinical expression and molecular mechanisms|journal=J. Allergy Clin. Immuno. |volume=125 |issue=2 Suppl 2 |pages=S95–102 |year=2010|month=February|pmid=20176271 |pmc=2853245 |doi=10.1016/j.jaci.2009.10.047 }}</ref> Imeainishwa kulingana na idadi ya dalili, wingi wa kupumua kwa nguvu ([[Spirometri|FEV1]]), na [[idadi ya juu ya kupumua]].<ref name=Yawn2008/> Inaweza pia kuainishwa kama [[Atopi|atopiki]] (ya nje) au isiyo ya atopiki (ya ndani)<ref name=RobbinsCotran2010/> ambapo atopi inarejelea maelekezo ya kuanzia type 1 hypersensitivity.<ref>{{cite book | title=Stedman's Medical Dictionary | publisher=Lippincott Williams and Wilkins | edition=28 | year=2005 |isbn=0-7817-3390-1 }}</ref>

Dalili kali hutibiwa na [[Beta2-adrenergic agonist]] ya kuvuta (kama vile [[salbutamol]]) na kotikosteroidi za [[mdomo]].<ref name=NHLBI07p214>{{harvnb|NHLBI Guideline|2007|p=214}}</ref> Katika visa vikali kotikosteroidi za mishipa, [[salfeti ya magnesia]] na ulazwaji [[hospitali|hospitalini]] unaweza kuhitajika.<ref name=NHLBI07p373>{{harvnb|NHLBI Guideline|2007|pp=373–375}}</ref> 

Dalili zinaweza kuzuiwa kwa kujiepusha na visababishi, kama vile [[alajeni]]<ref name="NHLBI07p169">{{harvnb|NHLBI Guideline|2007|pp=169–172}}</ref> na [[mwasho|vitu vinavyowasha]], na kwa kutumia kotikosteroidi za kuvuta.<ref name=GINA_2011_page71>{{harvnb|GINA|2011|p=71}}</ref> [[Beta-adrenoceptor agonist zinazofanya kazi kwa muda mrefu]] (LABA) au [[leukotriene antagonist]] inaweza kutumika kando ya kotikosteroidi iwapo dalili za ugonjwa hazitadhibitiwa.<ref name=GINA_2011_page33>{{harvnb|GINA|2011|p=33}}</ref> 

Uenezi umeongezeka tangu mwaka [[1970]]. Kufikia [[2011]], watu [[milioni]] 235–300 walikuwa wameathiriwa ulimwenguni,<ref name=WHO2011/><ref name=GINA_2011_page3/> ikijumuisha takribani [[Kifo|vifo]] 250,000.<ref name=GINA_2011_page3>{{harvnb|GINA|2011|p=3}}</ref>
{{TOC limit|limit=3}}

==Ishara na dalili==
{{listen
| filename     =
Wheeze2O noise reduced.ogg   | title        = Wheezing
| maelezo  = Sauti ya kukoroma kama inavyosikika kwa stethoskopu.
| format       = [[Ogg]]
}}

Ugonjwa huu huwa na visa vya kujirudia vya [[kukoroma]], [[upungufu wa pumzi]], kujikaza kwa kifua, na [[kukohoa]].<ref name=GINA2011p2>{{harvnb|GINA|2011|pp=2–5}}</ref> [[Makohozi]] yanaweza kutoka mapafuni, lakini kwa kawaida huwa vigumu kuyatoa.<ref>{{cite book|last=Jindal|first=editor-in-chief SK|title=Textbook of pulmonary and critical care medicine|publisher=Jaypee Brothers Medical Publishers|location=New Delhi|isbn=978-93-5025-073-0|page=242|url=http://books.google.ca/books?id=EvGTw3wn-zEC&pg=PA242}}</ref> Ukiendelea kupata nafuu yanaweza kutokea uchafu kama [[usaha]] kwa sababu ya kiwango cha juu cha [[seli nyeupe]] za [[damu]] ziitwazo [[esinofili]].<ref>{{cite book|last=George|first=Ronald B.|title=Chest medicine : essentials of pulmonary and critical care medicine|year=2005|publisher=Lippincott Williams & Wilkins|location=Philadelphia, PA|isbn=978-0-7817-5273-2|page=62|url=http://books.google.ca/books?id=ZzlX2zJMbdgC&pg=PA62|edition=5th ed.}}</ref> Dalili huwa mbaya zaidi [[usiku]] na mapema [[asubuhi]] au kwa athari ya mazoezi au [[baridi]].<ref name=bts2009p14>{{harvnb|British Guideline|2009|p=14}}</ref> Baadhi ya watu wenye ugonjwa huu ni nadra kwa kawaida kuhisi dalili, kwa athari za visababishi, ilhali wengine wanaweza kuwa na dalili zinazotambulika na zinazoendelea.<ref name=GINA2011_p8-9>{{harvnb|GINA|2011|pp=8–9}}</ref>

===Hali zinazohusiana===
Hali kadhaa za afya hutokea mara nyingi kwa walio na pumu ikiwa ni pamoja na: [[ugonjwa wa ucheuaji wa astro-esophajeli]] (GERD), [[rhinosinusitisi]], na [[apnea inayosumbua wakati wa kulala]].<ref name=Boulet2009>{{cite journal |author=Boulet LP |title=Influence of comorbid conditions on asthma |journal=Eur Respir J |volume=33 |issue=4 |pages=897–906 |year=2009|month=April |pmid=19336592 |doi=10.1183/09031936.00121308 }}</ref> Matatizo ya kisaikolojia huwa ya kawaida<ref name=Boulay2011>{{cite journal|last=Boulet|first=LP|coauthors=Boulay, MÈ|title=Asthma-related comorbidities.|journal=Expert review of respiratory medicine|date=2011 Jun|volume=5|issue=3|pages=377–93|pmid=21702660}}</ref> na [[wasiwasi]] unaotokea kati ya asilimia 16–52 na [[tatizo la sununu]] katika [[asilimia]] 14–41.<ref name=Andrew2010>{{cite book|last=editors|first=Andrew Harver, Harry Kotses,| title=Asthma, health and society a public health perspective|year =2010|publisher=Springer|location=New York|isbn=978-0-387-78285-0|page=315|url=http://books.google.ca/books?id=nkP8_h_ewLMC&pg=PA315}}</ref> Hata hivyo, haijulikani iwapo ugonjwa huu husababisha matatizo ya kisaikolojia au iwapo matatizo ya kisaikolojia husababisha pumu.<ref>{{cite journal|last=Thomas|first=M|coauthors=Bruton, A; Moffat, M; Cleland, J|title=Asthma and psychological dysfunction.|journal=Primary care respiratory journal : journal of the General Practice Airways Group|date=2011 Sep|volume=20|issue=3|pages=250–6|pmid=21674122}}</ref>

==Visababishi==
Ugonjwa huu husababishwa na mchanganyiko wa mwingiliano mgumu na usioeleweka kikamilifu wa kimazingira na kijenetiki.<ref name=Martinez_geneenvir/><ref>{{cite journal | last=Miller |first=RL | coauthors=Ho SM|title=Environmental epigenetics and asthma: current concepts and call for studies | journal=American Journal of Respiratory and Critical Care Medicine| volume=177 | issue=6 | pages=567–573 | year=2008 | month=March | pmid=18187692|doi=10.1164/rccm.200710-1511PP | pmc=2267336 }}</ref> Masuala haya huathiri ukali wake na matokeo yake baada ya matibabu.<ref>{{cite journal |author=Choudhry S, Seibold MA, Borrell LN "et al." |title=Dissecting complex diseases in complex populations: asthma in latino americans |journal=Proc Am Thorac Soc |volume=4 |issue=3 |pages=226–33|year=2007 |pmid=17607004 |doi=10.1513/pats.200701-029AW |pmc=2647623}}</ref> Inaaminika kuwa ongezeko la hivi karibuni la ugonjwa huu unasababishwa na kubadilika kwa masuala ya [[kiepijenetiki]] ([[kuridhika]] kando na yanayohusiana na [[Mfuatano wa DNA]]) na kubadilika kwa mazingira ya kuishi.<ref>{{cite journal|last=Dietert|first=RR|title=Maternal and childhood asthma: risk factors, interactions, and ramifications.|journal=Reproductive toxicology (Elmsford, N.Y.)|date=2011 Sep|volume=32|issue=2|pages=198–204|pmid=21575714}}</ref>

===Mazingira===
Masuala mengi ya kimazingira yamehusishwa na kutokea kwa pumu na maumivu ikiwa ni pamoja na: alejeni, kuchafuka kwa hewa na kemikali zingine za kimazingira.<ref>{{cite journal|last=Kelly|first=FJ|coauthors=Fussell, JC|title=Air pollution and airway disease.|journal=Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology|date=2011 Aug|volume=41|issue=8|pages=1059–71|pmid=21623970}}</ref> [[Uvutaji sigara na ujauzito|Kuvuta sigara wakati wa ujauzito]] na baada ya kuzaa huhusishwa na hatari kuu za dalili zinazofanana na za pumu.<ref name=GINA2011_p6>{{harvnb|GINA|2011|p=6}}</ref> [[alama ya kiwango cha chini cha ubora wa hewa|aina ya hewa]], kutoka kwa magari barabarani au ngazi za juu za [[ozoni]] ,<ref name=GINA2011_p61>{{harvnb|GINA|2011|p=61}}</ref> zimehusishwa na kutokea kwa pumu na ongezeko la ukali wake.<ref name=Gold>{{cite journal |author=Gold DR, Wright R |title=Population disparities in asthma |journal=Annu Rev Public Health|volume=26 |pages=89–113|year=2005 |pmid=15760282|doi=10.1146/annurev.publhealth.26.021304.144528 }}</ref> Hatari ya [[mchanganyiko wa ogani fukivu]] inaweza kuchochea kutokea kwa pumu; [[uhatarisho wa fomadeidi]], kwa mfano, huwa na ushirikiano halisi.<ref>{{cite journal|last=McGwin|first=G|coauthors=Lienert, J; Kennedy, JI|title=Formaldehyde exposure and asthma in children: a systematic review.|journal=Environmental health perspectives|date=2010 Mar|volume=118|issue=3|pages=313–7|pmid=20064771}}</ref> Pia, [[fithaleti]] katika [[PVC]] huhusishwa na ugonjwa huu kwa watoto na watu wazima<ref>{{cite journal |author= Jaakkola JJ, Knight TL. |title= The role of exposure to phthalates from polyvinyl chloride products in the development of asthma and allergies: a systematic review and meta-analysis|url= https://archive.org/details/sim_environmental-health-perspectives_2008-07_116_7/page/845 |journal= Environ Health Perspect |volume=116 |issue=7 |pages=845–53 |year=2008 |month=July |pmid= 18629304 |pmc= 2453150 |doi= 10.1289/ehp.10846 }}</ref><ref>{{cite journal|last=Bornehag|first=CG|coauthors=Nanberg, E|title=Phthalate exposure and asthma in children.|journal=International journal of andrology|date=2010 Apr|volume=33|issue=2|pages=333–45|pmid=20059582}}</ref> kama ilivyo kwa viwango vya juu vya [[hatari ya endotoksini]].<ref>{{cite journal |author=Liu AH|title=Something old, something new: indoor endotoxin, allergens and asthma |journal=Paediatr Respir Rev|volume=5|issue=Suppl A |pages=S65–71 |year=2004 |pmid=14980246|doi=10.1016/S1526-0542(04)90013-9 }}</ref>

<!--Alejeni-->
Pumu huhusishwa na uhatarisho wa alejeni za ndani ya nyumba.<ref>{{cite journal|last=Ahluwalia|first=SK|coauthors=Matsui, EC|title=Mazingira ya ndani ya nyumba na athari zake kwa athma ya utotoni.|journal=Current opinion in allergy and clinical immunology|date=2011 Apr|volume=11|issue=2|pages=137–43|pmid=21301330}}</ref> Alejeni za kawaida za ndani ni pamoja na: [[wadudu wa vumbi]], [[mende]], magamba ya wanyama, na kuvu.<ref name=Arshad>{{cite journal|last=Arshad|first=SH|title=Does exposure to indoor allergens contribute to the development of asthma and allergy?|journal=Current allergy and asthma reports|date=2010 Jan|volume=10|issue=1|pages=49–55|pmid=20425514}}</ref><ref>{{cite journal|last=Custovic|first=A|coauthors=Simpson, A|title=The role of inhalant allergens in allergic airways disease.|journal=Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunologia|year=2012|volume=22|issue=6|pages=393–401; qiuz follow 401|pmid=23101182}}</ref> Juhudi za kupunguza wadudu wa vumbi zimepatikana kutofaa.<ref name=Gotzsche2008/> Maambukizi fulani yanayohusiana na upumuaji yanaweza kuongeza hatari ya kupata pumu yanapopatikana utotoni kama vile:<ref name=NHLBI07p11>{{harvnb|NHLBI Guideline|2007|p=11}}</ref>''[[virusi vya sinksia vya upumuaji]]'' na ''[[virusi vya rhino]]''.<ref name=M38/> Hata hivyo maambukizi mengine yanaweza kupunguza hatari.<ref name=M38/>

====Nadharia ya usafi====
[[Nadharia ya usafi]] hujaribu kuelezea viwango vya kuongezeka kwa pumu kote ulimwenguni kama matokeo ya moja kwa moja na yasiyokusudiwa ya kupungua kwa hatari wakati wa utotoni, hadi kwa bakteria na virusi visivyo na maambukizi.<ref>{{cite journal| last=Ramsey | first=CD |coauthors=Celedón JC | title=The hygiene hypothesis and asthma | journal=Current Opinion in Pulmonary Medicine| volume=11 | issue=1 | pages=14–20 | month=January | year=2005 |pmid=15591883 | doi=10.1097/01.mcp.0000145791.13714.ae }}</ref><ref>{{cite journal |last=Bufford | first=JD | coauthors=Gern JE | title=The hygiene hypothesis revisited |url=https://archive.org/details/sim_immunology-and-allergy-clinics-of-north-america_2005-05_25_2/page/247 |journal=Immunology and Allergy Clinics of North America | volume=25 | issue=2 |pages=247–262 | month=May |year=2005 | pmid=15878454 | doi=10.1016/j.iac.2005.03.005}}</ref> Imependekezwa kuwa kupungua kwa hatari ya bakteria na virusi sehemu yake ni kwa sababu ya kuongezeka kwa usafi na kupungua kwa ukubwa wa familia katika jamii za kisasa.<ref name=Brook2013>{{cite journal|last=Brooks|first=C|coauthors=Pearce, N; Douwes, J|title=The hygiene hypothesis in allergy and asthma: an update.|journal=Current opinion in allergy and clinical immunology|date=2013 Feb|volume=13|issue=1|pages=70–7|pmid=23103806}}</ref> Ushahidi unaodhibitisha nadharia ya usafi ni pamoja na viwango vya chini vya pumu kwa mashamba na maboma yaliyo na wanyama vipenzi.<ref name=Brook2013/>

Matumizi ya [[antibiotiki]] mapema maishani yamehusishwa na kutokea kwa pumu.<ref>{{cite journal|last=Murk|first=W|coauthors=Risnes, KR, Bracken, MB|title=Prenatal or early-life exposure to antibiotics and risk of childhood asthma: a systematic review.|journal=Pediatrics|date=2011 Jun|volume=127|issue=6|pages=1125–38|pmid=21606151|doi=10.1542/peds.2010-2092}}</ref> Pia, kuzaa kwa njia ya [[operesheni ya Siza]] huhusishwa na ongezeko la hatari (lililokadiriwa kwa asilimia 20–80) ya pumu—ongezeko hili la hatari linahusishwa na ukosefu wa kudhibiti bora wa bakteria ambao mtoto mchanga angepata kutoka kwa njia inayopitia kwenye njia ya uzazi.<ref>{{harvnb|British Guideline|2009|p=72}}</ref><ref>{{cite journal|last=Neu|first=J|coauthors=Rushing, J|title=Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis.|url=https://archive.org/details/sim_clinics-in-perinatology_2011-06_38_2/page/321|journal=Clinics in perinatology|date=2011 Jun|volume=38|issue=2|pages=321–31|pmid=21645799}}</ref> Kuna uhusiano kati ya pumu na kiwango cha utajiri.<ref>{{cite journal|last=Von Hertzen|first=LC|coauthors=Haahtela, T|title=Asthma and atopy -the price of affluence?|journal=Allergy|date=2004 Feb|volume=59|issue=2|pages=124–37|pmid=14763924}}</ref>

===Jenetikia===
{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"
|+ CD14-endotoxin interaction based on CD14 SNP C-159T<ref name=Martinez_CD14 />
|-
! Endotoxin levels !! CC genotype !! TT genotype
|-
! High exposure
| Low risk || High risk
|-
! Low exposure
|High risk || Low risk
|}

[[Historia]] ya [[familia]] ni suala la hatari huku [[jeni]] nyingi tofauti zikihusishwa.<ref name=El2010>{{cite book|last=Elward|first=Graham Douglas, Kurtis S.|title=Asthma|year=2010|publisher=Manson Pub.|location=London|isbn=978-1-84076-513-7|pages=27–29|url=http://books.google.ca/books?id=gS4BsugTBvoC&pg=PA27}}</ref> Iwapo mmoja wa [[pacha|mapacha]] ataathiriwa, uwezekano wa mwingine kuwa na ugonjwa ni takriban asilimia 25.<ref name=El2010/> Kufikia mwisho wa [[2005]], jeni zilikuwa zimehusishwa na pumu katika idadi sita au zaidi za watu zilizotengana ikiwa ni pamoja na:''[[Glutathione S-transferase Mu 1|GSTM1]]'', ''[[Interleukin 10|IL10]]'',''[[CTLA-4]]'', ''[[SPINK5]]'',''[[Leukotriene C4 synthase|LTC4S]]'', ''[[Interleukin-4 receptor|IL4R]]'' na ''[[ADAM33]]'' kati ya zingine.<ref name=Hoffjan/> Nyingi za jeni hizi zinahusiana na [[mfumo wa kingamwili]] au urekebishaji wa [[inflamesheni]]. Hata kati ya orodha ya jeni zilizodhibitishwa na uchunguzi uliorudiwa, matokeo hayajawa sawa kati ya idadi zote za watu zilizotathminiwa.<ref name=Hoffjan /> Mwaka wa 2006 zaidi ya [[jeni]] 100 zilihusishwa na pumu katika uchunguzi wa [[muungano wa jeni]] moja pekee;<ref name=Hoffjan>{{cite journal|author=Ober C, Hoffjan S |title=Asthma genetics 2006: the long and winding road to gene discovery |journal=Genes Immun |volume=7 |issue=2 |pages=95–100 |year=2006 |pmid=16395390|doi=10.1038/sj.gene.6364284 }}</ref> mengi yanaendelea kutambuliwa.<ref>{{cite journal|last=Halapi|first=E|coauthors=Bjornsdottir, US|title=Overview on the current status of asthma genetics.|journal=The clinical respiratory journal|date=2009 Jan|volume=3|issue=1|pages=2–7|pmid=20298365}}</ref>

Baadhi ya tofauti ya jenetikia unaweza kusababisha ugonjwa unapounganishwa na hatari ya kimazingira.<ref name=Martinez_geneenvir /> Kwa mfano [[upolimofi moja ya nunukliotaidi]] katika eneo la [[CD14]] na hatari ya [[endotoksini]] (zao la bakteria). Hatari ya endotoksini unaweza kupatikana kutoka kwa vyanzo kadhaa vya kimazingira ikiwa ni pamoja na moshi wa tobako, mbwa na mashamba. Hatari ya pumu, kisha husababishwa na jenetiki ya mtu na kiwango cha hatari ya endotoksini.<ref name=Martinez_CD14>{{cite journal |author=Martinez FD |title=CD14, endotoxin, and asthma risk: actions and interactions |journal=Proc Am Thorac Soc |volume=4 |issue=3 |pages=221–5 |year=2007|pmid=17607003 |doi=10.1513/pats.200702-035AW |pmc=2647622}}</ref>

===Hali ya tiba===
Seti ya [[kizema ya atopi]], [[aleji ya mafua]] na pumu huitwa atopi.<ref name="Bolognia"/> Suala la hatari kuu zaidi la kupata ugonjwa ni historia ya [[atopi|ugonjwa wa atopi]];<ref name=NHLBI07p11/> huku pumu ikitokea kwa kiwango cha juu kwa walio na [[kizema]] au [[mafua|mafua ya mzio]].<ref name=GINA2011_p4>{{harvnb|GINA|2011|p=4}}</ref> Ugonjwa huu umehusishwa na [[Churg–Strauss syndrome]], ugonjwa wa kipekee wa kingamwili na [[vaskulitisi]]. Watu binafsi walio na aina fulani za [[utikaria]] pia wanaweza kuhisi dalili za pumu.<ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L.|title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007|isbn=1-4160-2999-0 }}</ref>

Kuna uhusiano kati ya [[unene]] na hatari ya ugonjwa huku zikiwa zimeongezeka miaka iliyopita hivi karibuni.<ref>{{cite journal |author=Beuther DA |title=Recent insight into obesity and asthma |journal=Curr Opin Pulm Med|volume=16 |issue=1 |pages=64–70|year=2010 |month=January |pmid=19844182 |doi=10.1097/MCP.0b013e3283338fa7}}</ref><ref name=holguin>{{cite journal |author=Holguin F, Fitzpatrick A |title=Obesity, asthma, and oxidative stress|url=https://archive.org/details/sim_journal-of-applied-physiology_2010-03_108_3/page/754 |journal=J. Appl. Physiol. |volume=108 |issue=3 |pages=754–9 |year=2010|month=March |pmid=19926826|doi=10.1152/japplphysiol.00702.2009 }}</ref> Masuala kadhaa yanaweza kusababisha ikiwa ni pamoja na kupungua kwa utendakazi wa upumuo kwa sababu ya ongezeko la mafuta na hasa kwa kuwa tishu ya adiposi husababisha hali ya pro-inflamesheni.<ref name="Woods 2009">{{cite journal |author=Wood LG, Gibson PG |title=Masuala ya chakula husababisha innate immune activation katikia athma |journal=Pharmacol. Ther.|volume=123 |issue=1 |pages=37–53 |year=2009|month=July |pmid=19375453|doi=10.1016/j.pharmthera.2009.03.015 }}</ref>

Dawa za [[Beta blocker]] kama vile [[propranolol]] zinaweza kusababisha ugonjwa kwa walio na uwepesi wa kuipata.<ref>{{cite journal|author=O'Rourke ST |title=Antianginal actions of beta-adrenoceptor antagonists |journal=Am J Pharm Educ |volume=71|issue=5 |pages=95|year=2007 |month=October |pmid=17998992 |pmc=2064893 }}</ref> [[Cardioselective beta-blockers]], hata hivyo, huonekana kuwa salama kwa walio na ugonjwa mdogo au wa kiasi.<ref>{{cite journal|last=Salpeter|first=S|coauthors=Ormiston, T; Salpeter, E|title=Cardioselective beta-blocker use in patients with reversible airway disease.|journal=Cochrane database of systematic reviews (Online)|year=2001|issue=2|pages=CD002992|pmid=11406056}}</ref> Dawa zingine zinazoweza kusababisha matatizo ni [[ASA]], [[NSAID]], na [[vizuizi vya enzaimu anjiotensini-badilishi]].<ref>{{cite journal|last=Covar|first=RA|coauthors=Macomber, BA; Szefler, SJ|title=Medications as asthma trigers.|url=https://archive.org/details/sim_immunology-and-allergy-clinics-of-north-america_2005-02_25_1/page/169|journal=Immunology and allergy clinics of North America|date=2005 Feb|volume=25|issue=1|pages=169–90|pmid=15579370}}</ref>

===Ongezeko===
Baadhi ya watu huwa na pumu tulivu kwa majuma au miezi kisha kuwa kali kwa ghafla. Watu tofauti huathirika kwa njia tofauti na masuala mbalimbali.<ref name=Baxi2010>{{cite journal |author=Baxi SN, Phipatanakul W |title=The role of allergen exposure and avoidance in asthma |journal=Adolesc Med State Art Rev |volume=21 |issue=1|pages=57–71, viii–ix |year=2010 |month=April |pmid=20568555 |pmc=2975603 }}</ref> Watu wengi binafsi wanaweza kupata ongezeko kali kutokana na baadhi ya maajenti sababishi.<ref name=Baxi2010/>

Visababishi vya kinyumbani vya ugonjwa huu ni pamoja na [[vumbi]], [[magamba]] ya mnyama (hasa manyoya ya paka na mbwa), mende [[alejeni]] na [[kuvu]].<ref name=Baxi2010/> [[marashi]] ni kisababishi cha kawaida cha mashambulizi kali kwa kina mama na watoto. [[Ambukizo]] la [[virusi|virusi]] na bakteria la trakti ya juu ya kupumua unaweza kuongeza ugonjwa.<ref name=Baxi2010/> Mfadhaiko wa kisaikolojia [[(kibiolojia)|mfadhaiko]] unaweza kuzidisha dalili—inakisiwa kuwa mfadhaiko hubadilisha mfumo wa kingamwili na hivyo huongeza athari ya inflamesheni ya njia ya hewa kutokana na alejeni na vitu ambavyo huwasha.<ref name=Gold/><ref name="Chen2007">{{cite journal |author=Chen E, Miller GE |title=Stress and inflammation in exacerbations of asthma|journal=Brain Behav Immun. |volume=21 |issue=8 |pages=993–9|year=2007 |pmid=17493786|doi=10.1016/j.bbi.2007.03.009|pmc=2077080}}</ref>

==Pathofisiolojia==
[[File:Asthma.jpg|thumb|alt=Sehemu ya tishu ya njia ya hewa inayoonyesha ukuta ulio na doa la waridi na kamasi ya rangi nyeupe uliojaa upande wa ndani|Kizuizi cha mwanya wa [[bronkioli]] kutoka mucoid exudate, [[goblet cell]] [[metaplasia]], na epitheliumu [[utando msingi]] unaovimba kwa mtu aliye na pumu.]] Pumu husababishwa na uvimbe kwa njia za hewa ikifuatiwa na mikazo katika eneo hilo [[msuli mdogo]].<!-- <ref name=GINA2011p2/> --> Hii pamoja na visababishi vingine husababisha maumivu yanayotokana na njia ya hewa iliyonyembamba na dalili za hali ya juu za kukoroma.<!-- <ref name=GINA2011p2/> --> Uwembamba unaweza kurudi hali yake ya kawaida bila matibabu<!-- <ref name=GINA2011p2/> --> Mara kwa mara njia za hewa hujibadilisha.<ref name=GINA2011p2/> Mabadiliko ya njia za hewa ni pamoja na ongezeko kwa [[esinofili]] na kunenepa kwa [[lamina lililofanana na neti]].<!-- <ref name=M38/> --> Msuli wa njia za hewa inaweza kuwa kubwa kwa ukali na kuongezeka kwa idadi ya tezi ya miukosi.<!-- <ref name=M38/> --> Aina zingine za seli zilizohusika ni pamoja na: [[T lymphocytes]], [[macrophages]], na [[nutrofili]].<!-- <ref name=M38/> --> Pia kunaweza kuwa na vijenzi vya [[mfumo wa kinga]] pamoja na: [[cytokines]], [[chemokines]], [[histamine]], na [[leukotrienes]] miongoni mwa zingine.<ref name=M38/>

==Utambuzi==
Pumu umetambulika vizuri, ilhali hakuna ufafanuzi hata moja ulioidhinishwa.<ref name=M38/> Inafafanuliwa na [[Uvumbuzi wa Kidunia wa Pumu]] kama "ulemavu mkali wa inflamesheni katika njia za hewa ambapo seli mingi na elementi za seli huwa na jukumu. Inflamesheni kali inahusishwa na mwitikio uliozidi wa njia ya hewa zinazosababisha matukio ya kukoroma, kushindwa kupumua, mikazo kifuani na kukohoa hasa usiku au asubuhi na mapema. Matukio haya kwa kawaida yanahusiana na kutapakaa kwa hewa mwilini lakini mtiririko wa hewa uliozuiwa ambao unabadilika kwa pafu ambayo mara kwa mara inaweza kurudi kwa hali ya kawaida bila matibabu au na matibabu".<ref name=GINA2011p2 />

Kwa sasa hakuna uchunguzi maalum na utambuzi unaofanana hasa uliokatika muundo wa dalili na mwitikio kwa tiba muda unapoendelea.<ref name=lemanske/><ref name=M38/> Utambuzi unapaswa kushukiwa ikiwa kuna: ukoromaji unaotokea mara kwa mara, kukohoa au kupumua kwa ugumu na hizi dalili hutokea au kuzidi kwa sababu ya mazoezi, maambukizi ya virusi, alejeni au hewa chafu.<ref name=NAEPP42>{{harvnb|NHLBI Guideline|2007|p=42}}</ref> Kisha [[Spirometry]] hutumika kuthibitisha utambuzi.<ref name=NAEPP42/> Utambuzi kwa watoto waliochini ya miaka sita ni vigumu kwa sababu ni wadogo kufanyiwa spirometry.<ref name=GINA2011p20>{{harvnb|GINA|2011|p=20}}</ref>

===Spirometry===
[[Spirometry]] inapendekezwa ili isaidie utambuzi na udhibiti.<ref name="AAAAIfive">{{Citation|author1=American Academy of Allergy, Asthma, and Immunology|author1-link=American Academy of Allergy, Asthma, and Immunology|date=|title=Five things physicians and patients should question|publisher=[[American Academy of Allergy, Asthma, and Immunology]]|work=Choosing wisely: an initiative of the [[ABIM Foundation]]|page=|url=http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_AAAAI.pdf|accessdate=August 14, 2012|archive-date=2012-11-03|archive-url=https://web.archive.org/web/20121103151124/http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_AAAAI.pdf|dead-url=yes}}</ref><ref name="NIHasthmaguide">{{cite book |author=Third Expert Panel on the Diagnosis and Management of Asthma |title=Guidelines for the diagnosis and management of asthma |year=2007 |publisher=National Heart, Lung, and Blood Institute (US) |url=http://www.ncbi.nlm.nih.gov/books/NBK7232/}}</ref> Hii ndio uchunguzi bora wa pumu.<!-- <ref name=M38/> --> Ikiwa [[FEV1]] kilichopimwa na mbinu hii kitakuwa bora na zaidi ya asilimia 12 kufuatiliwa na utoaji wa kipanua bronkasi kama vile [[sabutamoli]], husaidia kwa utambuzi.<!-- <ref name=M38/> --> Hata hivyo inaweza kuwa sawa kwa walio na historia ya ugonjwa isiyokali, isiyojitokeza.<!-- <ref name=M38/> --> [[Kiwango cha hewa mtu anaweza kuvuta kwa pumzi moja]] inaweza kusaidia kutofautisha pumu [[COPD]].<ref name=M38/> Ni muhimu kufuatilia spirometry kila mwaka moja au mbili ili kufuatilia jinsi ugonjwa unavyodhibitiwa.<ref name=NHLBI07p58>{{harvnb|NHLBI Guideline|2007|p=58}}</ref>

===Njia nyingine===
[[Kipimo]] cha [[tatizo la methacholine]] kinahusisha kuvuta hewa ya kuongeza viwango vya dutu vinavyosababisha njia ya hewa kuwa nyembamba katika eneo linalochangia kupata magonjwa.<!-- <ref name=M38/> --> Ikiwa hakuna dalili inamaanisha hana ugonjwa; ikiwa ana dalili, hata hivyo, si ya ugonjwa hasa.<ref name=M38/>

Ushahidi mwingine unaochangia ni: tofauti ya asilimia ≥20 kwa [[kiwango cha mwisho cha kupumua]] angalau siku tatu kwa wiki kwa wiki mbili, uboreshaji kwa asilimia ≥20 ya kiwango cha kupumua ukifuatiliwa na matibabu ya sabutamoli, kotikosteroidi ya kuvuta au prinisoni, au upungufu wa asilimia ≥20 ya kifaa cha kupima hewa kutoka kwa mapafu ikifuatiliwa na hatari ya kisababishi.<ref>{{cite journal|author=Pinnock H, Shah R |title=Asthma |journal=BMJ |volume=334 |issue=7598 |pages=847–50|year=2007 |pmid=17446617 |doi=10.1136/bmj.39140.634896.BE |pmc=1853223}}</ref> Kipimo cha kiwango cha juu cha kupumua hubadilika zaidi kuliko ya spirometry, hata hivyo, haijakubaliwa kwa utambuzi wa mara kwa mara.<!-- <ref name=NAEPP2007p59/> --> Inaweza kuwa ya manufaa ya kujitathmini kila siku kwa wale walio na ugonjwa uliokali kiasi hadi kwa iliyokali na kutathmini matokeo yanayofaa kwa matibabu mapya.<!-- <ref name=NAEPP2007p59/> --> Inaweza pia kuwa ya manufaa ya kuongoza kwa matibabu kwa walio na hali ya kuongezeka kwa ukali wa ugonjwa.<ref name=NAEPP2007p59>{{harvnb|NHLBI Guideline|2007|p=59}}</ref>

===Uainishaji===
{| class="wikitable" style = "float: right; margin-left:1em; text-align:center"
|+ Clinical classification (≥ 12 years old)<ref name=Yawn2008/>
|-
! scope="col" style="width:6em;" | Severity
! scope="col" style="width:4em;" | Symptom frequency
! scope="col" style="width:4em;" | Night time symptoms
! scope="col" style="width:4em;" | %FEV<sub>1</sub> of predicted
! scope="col" style="width:4em;" | FEV<sub>1</sub> Variability
! scope="col" style="width:4em;" | SABA use
|-
! scope="row" | Intermittent
| ≤2/week
| ≤2/month
| ≥80%
| <20%
| ≤2 days/week
|-
! scope="row" | Mild persistent
| >2/week
| 3–4/month
| ≥80%
| 20–30%
| >2 days/week
|-
! scope="row" | Moderate persistent
| Daily
| >1/week
| 60–80%
| >30%
| daily
|-
! scope="row" | Severe persistent
| Continuously
| Frequent (7×/week)
| <60%
| >30%
| ≥twice/day
|}

Ugonjwa huu huainishwa kulingana na dalili inavyojitokeza mara kwa mara, kutoka kwa pumzi inayotolewa nje ([[spirometry|FEV<sub>1</sub>]]), na [[kiwango cha mwisho cha kupumua]].<ref name=Yawn2008>{{cite journal |author=Yawn BP |title=Factors accounting for asthma variability: achieving optimal symptom control for individual patients |journal=Primary Care Respiratory Journal |volume=17 |issue=3 |pages=138–147 |month=September |year=2008 |url=http://www.thepcrj.org/journ/vol17/17_3_138_147.pdf |archiveurl=https://www.webcitation.org/5nySCf5x8?url=http://www.thepcrj.org/journ/vol17/17_3_138_147.pdf |archivedate=2010-03-04 |pmid=18264646 |doi=10.3132/pcrj.2008.00004 |access-date=2014-01-09 |dead-url=no }}</ref> Pumu inaweza kuainishwa kama atopi (iliyo ya nje) au isiyo ya atopi (iliyo ya ndani), kwa kuzingatia iwapo dalili zimechochewa na alejeni (atopi) au la (zisizo za atopi).<ref name="RobbinsCotran2010">{{cite book |editor1-last=Kumar|editor1-first=Vinay |editor2-last=Abbas |editor2-first=Abul K |editor3-last=Fausto|editor3-first=Nelson |editor4-last=Aster |editor4-first=Jon |title=Robbins and Cotran pathologic basis of disease |publisher=Saunders |edition=8th |year=2010|isbn=978-1-4160-3121-5 |page=688 |oclc=643462931 }}</ref> Pumu unapoainishwa kulingana na ukali, kwa sasa hakuna mbinu halisi ya kuainisha vikundi vidogo mbalimbali vya ugonjwa huu zaidi ya mfumo huu.<ref name=Moore2010>{{cite journal |author=Moore WC, Pascual RM |title=Update in asthma 2009 |journal=American Journal of Respiratory and Critical Care Medicine |volume=181 |issue=11 |pages=1181–7 |year=2010 |month=June|pmid=20516492 |doi=10.1164/rccm.201003-0321UP}}</ref> Kutafuta njia za kutambua vikundi vidogo vinavyoitikia vyema kwa aina tofauti za matibabu ni lengo muhimu la utafiti wa pumu.<ref name=Moore2010/>

Ingawa pumu ni hali kali [[pingamizi ya ugonjwa wa pafu|pingamizi]], haichukuliwi kama sehemu ya [[ugonjwa kali unaopinga mapafu]] kwa kuwa jina hili linahusu mchanganyiko wa magonjwa zisizoweza kurudi katika hali iliyosawa kama vile [[bronkektasisi]],[[bronkitisi kali]], na [[emphysema]].<ref name="Self, Timothy 2009">{{cite book|editor=Mary Anne Koda-Kimble, Brian K Alldredge, et al. |author1=Self, Timothy|author2=Chrisman, Cary |author3=Finch, Christopher |title=Applied therapeutics: the clinical use of drugs |edition=9th |location=Philadelphia |publisher=Lippincott Williams & Wilkins |year=2009 |chapter=22.
Asthma |oclc=230848069 }}</ref> Tofauti na magonjwa haya, kizuizi cha njia ya hewa huweza kurudi katika hali yake ya kawaida; hata hivyo, isipotibiwa, inflamesheni kali kutokana na pumu huweza kusababisha mapafu kuwa na kizuizi kisichorudi kwa hali yake ya kawaida kwa sababu ya njia ya hewa kupata muundo mwingine.<ref name=Delacourt2004>{{cite journal |last=Delacourt|first=C|title=Conséquencesbronchiques de l'asthme non traité|trans_title=Bronchial changes in untreated asthma |journal=Archives de Pédiatrie|volume=11 |issue=Suppl. 2 |pages=71s–73s|month=June |year=2004 |pmid=15301800}}</ref> Tofauti na [[emphysema]], ugonjwa huu huathiri bronkia, sio [[alveoli]].<ref name=Schiffman2009>{{cite web |url=http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/article.htm |title=Chronic obstructive pulmonary disease |first=George |last=Schiffman |date=18 December 2009 |publisher=MedicineNet |accessdate=2 September 2010 |archiveurl=https://web.archive.org/web/20100828011049/http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/article.htm |archivedate=2010-08-28 |deadurl=no }}</ref>

====Kuzidi kwa pumu====
{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"
|+ Severity of an acute exacerbation<ref name=BTS58/>
|-
! style="border-top: 3px solid darkgray;" | Near-fatal
| colspan="2" style="border-top: 3px solid darkgray;" | High [[Arterial blood gas|PaCO<sub>2</sub>]] and/or requiring mechanical ventilation
|-
! rowspan="9" style="border-top: 3px solid darkgray;" | Life threatening</br>(any one of)
|-
! Clinical signs
! Measurements
|-
| Altered [[level of consciousness]]
| [[Peak flow]]< 33%
|-
| Exhaustion
| [[Oxygen saturation]]< 92%
|-
| [[Arrhythmia]]
| [[Arterial blood gas|PaO<sub>2</sub>]]< 8 kPa
|-
| Low [[blood pressure]]
| "Normal" PaCO<sub>2</sub>
|-
| [[Cyanosis]]
|
|-
| Silent chest

|
|-
| Poor respiratory effort

|
|-
! rowspan="5" style="border-top: 3px solid darkgray;" | Acute severe</br>(any one of)
|-
| colspan="2" | Peak flow 33–50%
|-
| colspan="2" | Respiratory rate ≥ 25 breaths per minute
|-
| colspan="2" | Heart rate ≥ 110 beats per minute
|-
| colspan="2" | Unable to complete sentences in one breath
|-
! rowspan="3" style="border-top: 3px solid darkgray; border-bottom: 3 px solid darkgray;"| Moderate
| colspan="2" style="border-top: 3px solid darkgray;" | Worsening symptoms
|-
| colspan="2" | Peak flow 50–80% best or predicted
|-
| colspan="2" style="border-bottom: 3 px solid darkgray;" | No features of acute severe asthma
|}
Ugonjwa kali uliozidi huitwa ''shambulizi la pumu''. Dalili zinazotambulika ni [[upungufu wa hewa]], [[kukorota|ukorotaji]], na [[kujikaza kwa kifua]].<ref name=M38/> Wakati hizi ni dalili za kwanza za ugonjwa,<ref name=Barnes2008>{{cite book|last=Barnes |first=PJ |chapter=Asthma |title=Harrison's Principles of Internal Medicine|url=https://archive.org/details/harrisonsprincip00asfa |editor1-last=Fauci|editor1-first=Anthony S |editor2-last=Braunwald|editor2-first=E, |editor3-last=Kasper|editor3-first=DL |location=New York|publisher=McGraw-Hill |year=2008 |edition=17th|isbn=978-0-07-146633-2|pages=[https://archive.org/details/harrisonsprincip00asfa/page/1596 1596]–1607}}</ref> baadhi ya watu huonyesha kwa [[kukohoa]], na katika hali kali, mwendo wa kupumua unaweza kuwa umeharibika sana kiasi kwamba ukoromaji hausikiki.<ref name=BTS58/>

Dalili zinzazotokea wakati wa shambulizi la ugonjwa ni pamoja na matumizi zinazosaidia [[misuli]] za kupumua ([[sternocleidomastoid]] na [[misuli ya scalene]] za shingo), kunaweza kuwa na [[pulsus paradoxus|mpwito wa moyo wa kifumbo]] (mpwito uliodhaifu wakati wa kuvuta hewa na ulio na nguvu wakati wa kutoa hewa), na kuvimba kwa kifua.<ref name=Maitre1995>{{cite journal |author=Maitre B, Similowski T, Derenne JP |title=Physical examination of the adult patient with respiratory diseases: inspection and palpation |journal=Eur. Respir. J.|volume=8 |issue=9|pages=1584–93|year=1995 |month=September |pmid=8575588|url=http://erj.ersjournals.com/content/8/9/1584.long}}</ref> [[sinosisi|rangi ya bluu]] ya ngozi na kucha inaweza kutokea kutokana na ukosefu wa oksijeni.<ref name=Werner2001>{{cite journal|last=Werner |first=HA |title=Status asthmaticus in children: a review|journal=Chest |volume=119 |issue=6|pages=1596–1607 |year=2001|month=June|pmid=11399724|doi=10.1378/chest.119.6.1913 }}</ref>

Katika hali ya maumivu usio kali [[kiwango cha mwisho cha kupumua]] ni ≥200&nbsp;ya lita moja kwa dakika au asilimia ≥50 ya utabiri uliobora.<ref name=Shiber2006>{{cite journal |author=Shiber JR, Santana J|title=Dyspnea |url=https://archive.org/details/sim_medical-clinics-of-north-america_2006-05_90_3/page/453|journal=Med. Clin. North Am. |volume=90|issue=3 |pages=453–79 |year=2006|month=May|pmid=16473100 |doi=10.1016/j.mcna.2005.11.006 }}</ref> Wastani wake unafasiliwa kama kati ya 80 na 200&nbsp;ya lita moja kwa dakika au asilimia 20 na 50 ya utabiri uliobora bali iliokali inafasiliwa kama ≤&nbsp;80 ya lita kwa dakika au asilimia ≤25 ya utabiri uliobora.<ref name=Shiber2006/>

[[Pumu iliyo kali mno]], ulioitwa hali ya kuwa na pumu kali mbeleni, na inayoendelea kwa muda mrefu, ni ugonjwa kali uliozidi ambao hautibii na matibabu ya kawaida ya kipanua koromeo na kotikosteroidi.<ref name=Shah2012/> Nusu ya hali hizi zimesababishwa na maambukizi kutoka kwa mengine yaliyosababishwa na alejeni, hewa chafu, ukosefu wa dawa au kuzitumia kwa njia isiyofaa.<ref name=Shah2012>{{cite journal|last=Shah|first=R|coauthors=Saltoun, CA|title=Chapter 14: Athma uliokali mno (hali ya kuwa na athma kali, na inayoendelea kwa muda mrefu).|journal=Allergy and asthma proceedings : the official journal of regional and state allergy societies|date=2012 May–Jun|volume=33 Suppl 1|pages=S47-50|pmid=22794687}}</ref>

[[Pumu ya brittle]] ni aina ya ugonjwa unaotambuliwa na mashambulizi makali yanayorudi.<ref name=BTS58>{{harvnb|British Guideline|2009|p=54}}</ref> Aina ya kwanza ya ugonjwa wa brittle ni ugonjwa ulio tofauti na mtiririko wa upeo mpana, licha ya makali ya dawa. Aina ya pili ya ugonjwa wa brittle ni ugonjwa ulio na usuli uliothibitiwa kwa njia inayofaa na ukali wa ghafla.<ref name=BTS58/>

====Yanayosababisha na mazoezi ====
Zoezi linaweza kusababisha [[kuminya bronkasi]] kwa wote walio na wasio kuwa na ugonjwa.<ref name=EIB2012>{{cite journal|last=Khan|first=DA|title=Exercise-induced bronchoconstriction: burden and prevalence.|journal=Allergy and asthma proceedings : the official journal of regional and state allergy societies|date=2012 Jan–Feb|volume=33|issue=1|pages=1–6|pmid=22370526}}</ref> Hutokea kwa watu wengi walio na pumu na hadi asilimia 20 ya watu wasio kuwa na ugonjwa.<ref name=EIB2012/> Hutokea mara nyingi kwa wanariadha wa tabaka la juu, kwa viwango vinavyobadilika kutoka asilimia 3 kwa wanaoshiriki katika mashindano ya [[bobsled]] hadi asilimia 50 kwa [[wanariadha wa baiskeli]] na asilimia 60 kwa [[cross-country skiing]].<ref name=EIB2012/> Ingawa inaweza kutokea katika hali yoyote ya hewa ni ya kawaida zaidi wakati hewa ni kavu na baridi.<ref name=GINA_2011_page17>{{harvnb|GINA|2011|p=17}}</ref> Beta2-agonists ya kuvuta inaonekana kuwa haileti mabadiliko katika matokeo ya wanariadha wasiokuwa na pumu<ref>{{cite journal|last=Carlsen|first=KH|coauthors=Anderson, SD; Bjermer, L; Bonini, S; Brusasco, V; Canonica, W; Cummiskey, J; Delgado, L; Del Giacco, SR; Drobnic, F; Haahtela, T; Larsson, K; Palange, P; Popov, T; van Cauwenberge, P; European Respiratory, Society; European Academy of Allergy and Clinical, Immunology; GA(2)LEN,|title=Treatment of exercise-induced asthma, respiratory and allergic disorders in sports and the relationship to doping: Part II of the report from the Joint Task Force of European Respiratory Society (ERS) and European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA(2)LEN.|journal=Allergy|date=2008 May|volume=63|issue=5|pages=492–505|pmid=18394123}}</ref> hata hivyo dozi za kumeza zinaweza kuboresha uvumilivu na nguvu.<ref>{{cite journal|last=Kindermann|first=W|title=Do inhaled beta(2)-agonists have an ergogenic potential in non-asthmatic competitive athletes?|journal=Sports medicine (Auckland, N.Z.)|year=2007|volume=37|issue=2|pages=95–102|pmid=17241101}}</ref><ref>{{cite journal|last=Pluim|first=BM|coauthors=de Hon, O; Staal, JB; Limpens, J; Kuipers, H; Overbeek, SE; Zwinderman, AH; Scholten, RJ|title=β₂-Agonists and physical performance: a systematic review and meta-analysis of randomized controlled trials.|journal=Sports medicine (Auckland, N.Z.)|date=2011 Jan 1|volume=41|issue=1|pages=39–57|pmid=21142283}}</ref>

====Kazini====
Pumu unaotokea (au kuzidishwa na) mazingira ya kazini, hurejelewa kama [[magonjwa ya kazini]].<ref name=Baur2012/> Hata hivyo hali nyingi haziripotiwi au kutambuliwa.<ref>{{cite book|last=Kunnamo|first=ed.-in-chief: Ilkka|title=Evidence-based medicine guidelines|year=2005|publisher=Wiley|location=Chichester|isbn=978-0-470-01184-3|page=214|url=http://books.google.ca/books?id=frYEiHYtOv0C&pg=PA214}}</ref><ref>{{cite book|last=Kraft|first=editors, Mario Castro, Monica|title=Clinical asthma|year=2008|publisher=Mosby / Elsevier|location=Philadelphia|isbn=978-0-323-07081-2|pages=Chapter 42|url=http://books.google.ca/books?id=y9WYwLVn7pgC&pg=PT1185}}</ref> Inakadiriwa kuwa asilimia 5-25 ya ugonjwa huu kwa watu wazima huhusiana na mahali pa kazi.<!-- <ref name=Baur2012/> --> Maajenti karibu mia moja wamehusishwa na ya kawaida ikiwa: [[isocyanates]], nafaka na uchafu wa mbao, [[colophony]], [[soldering flux]], [[ulimbo wa mpira]], wanyama, na [[aldehydes]].<!-- <ref name=Baur2012/> --> Uajiri uliohusishwa na hatari kubwa ya matatizo inajumuisha: wale ambao [[wanajipaka rangi]], waokaji na watengenezao chakula, wauguzi, wafanyikazi wa kemikali, wanaofanyakazi na wanyama, [[wati weko]], watengenezaji nywele na wafanyikazi wa mabao.<ref name=Baur2012>{{cite journal|last=Baur|first=X|coauthors=Aasen, TB; Burge, PS; Heederik, D; Henneberger, PK; Maestrelli, P; Schlünssen, V; Vandenplas, O; Wilken, D; ERS Task Force on the Management of Work-related, Asthma|title=The management of work-related asthma guidelines: a broader perspective.|journal=European respiratory review : an official journal of the European Respiratory Society|date=2012 Jun 1|volume=21|issue=124|pages=125–39|pmid=22654084}}</ref>

===Utambuzi tofauti===
Hali zingine zinaweza kusababisha dalili zinazofanana na za pumu.<!-- <ref name=NAEPP46/> --> Kwa watoto, magonjwa mengine ya njia ya hewa kama vile [[mzio wa pua]] na [[sinositisi]] zinapaswa kuangiliwa pia kama visababishi vinavyofunga njia ya hewa ikijumuisha: [[Kifaa_kigeni#Kwa njia za hewa|kitu kigeni mwilini]], [[tracheal stenosis]] au [[laryngotracheomalacia]], [[vizingo vya utomvu]], hurefushwa [[Tezi]] au uzito wa shingo.<!-- <ref name=NAEPP46> --> Kwa watu wazima, [[COPD]], [[kutofanya kazi kwa moyo]], uzito wa hewa kupita, vile vile dawa za kukomesha athiri ya ACE zinapaswa kuangaliwa.<!-- <ref name=NAEPP46> --> Kwa watu wote [[kutofanya kazi kwa mshipi wa sauti]] inaweza kutokea pia.<ref name=NAEPP46>{{harvnb|NHLBI Guideline|2007|p=46}}</ref>

[[Pumu zibifu wa kudumu]] inaweza kuwa na ugonjwa huu na inaweza kutokea kama tatizo la kudumu. Katika umri wa miaka 65 watu wengi walio na ugonjwa wa njia ya hewa iliyofunganga watakuwa na pumu na COPD. Kati hali hii, COPD inaweza kutofautishwa kwa nutrofili nyingi katika njia ya hewa, inayoongezwa na ukubwa wa ukuta, na kuongezeka kwa msuli mdogo bronkia. Hata hivyo, kiwango hiki cha kuchunguza haiwezi kutekelezwa kwa sababu COPD na pumu huwa na kanuni sawa za usimamizi: kotikosteroidi, kuwepo kwa beta agonists, na hatua za kuacha kuvuta sigara.<ref name=Gibson>{{cite journal |author=Gibson PG, McDonald VM, Marks GB |title=Asthma in older adults |journal=Lancet |volume=376|issue=9743 |pages=803–13 |year=2010 |month=September |pmid=20816547|doi=10.1016/S0140-6736(10)61087-2 }}</ref> Hukaribiana na pumu kwa dalili, huhusiana na uvutaji wa sigara, umri mkubwa, kutobadilika kwa dalili baada ya kuweka kipanua bronkasi, na upungufu wa kuwepo kwa atopi katika familia.<ref name=Hargreave>{{cite journal | author1=Hargreave FE |author2=Parameswaran K|title=Asthma, COPD and bronchitis are just components of airway disease |journal=European Respiratory Journal |volume=28 |issue=2 |pages=264–267 |month=August |year=2006|url=http://erj.ersjournals.com/content/28/2/264.full |pmid=16880365|doi=10.1183/09031936.06.00056106 }}</ref><ref name="Applied Therapeutics 2009">{{cite book|author=Diaz, P. Knoell |title=Applied therapeutics: the clinical use of drugs|edition=9th |location=Philadelphia |publisher=Lippincott Williams & Wilkins |year=2009|chapter=23. ugonjwa sugu wa mapafu zibifu }}</ref>

==Uzuiaji==
Ushahidi wa kufanya kazi kwa mikakati ya kuzuia kutokea kwa ugonjwa ni finyu.<ref name="NHLBI07p184"/> Baadhi huonyesha matumaini ikijumuisha: kuepekuna na sehemu zilizo na moshi [[katika uterasi]] na baada ya kuzaa, [[unyonyeshaji]], na ongezeko la utunzaji au familia kubwa lakini hakuna hata moja inayopendekezwa kwa dalili hii.<ref name="NHLBI07p184">{{harvnb|NHLBI Guideline|2007|pp=184–5}}</ref> Kufichuliwa kwa mnyama mapema inaweza kusaidia.<ref>{{cite journal|last=Lodge|first=CJ|coauthors=Allen, KJ; Lowe, AJ; Hill, DJ; Hosking, CS; Abramson, MJ; Dharmage, SC|title=Perinatal cat and dog exposure and the risk of asthma and allergy in the urban environment: a systematic review of longitudinal studies.|journal=Clinical & developmental immunology|year=2012|volume=2012|pages=176484|pmid=22235226}}</ref> Matokeo ya ufichuzi kwa wanyma wakati mwingine inashida<ref>{{cite journal|last=Chen|first=CM|coauthors=Tischer, C; Schnappinger, M; Heinrich, J|title=The role of cats and dogs in asthma and allergy—a systematic review.|journal=International journal of hygiene and environmental health|date=2010 Jan|volume=213|issue=1|pages=1–31|pmid=20053584}}</ref> na inapendekezwa tu wanyma watolewe nyumbani ikiwa binadamu ana dalili za aleji ya mnyama huyo.<ref name=Au2005/> Upangaji mlo wakati wa ujauzito au unyonyeshaji haibainishi kama njia nzuri na hivyo haipendekezwi.<ref name=Au2005>{{cite journal|last=Prescott|first=SL|coauthors=Tang, ML; Australasian Society of Clinical Immunology and, Allergy|title=The Australasian Society of Clinical Immunology and Allergy position statement: Muhtasari wa uzuiaji wa aleji kwa watoto.|url=https://archive.org/details/sim_medical-journal-of-australia_2005-05-02_182_9/page/464|journal=The Medical journal of Australia|date=2005 May 2|volume=182|issue=9|pages=464–7|pmid=15865590}}</ref> Utoaji au upunguzaji wa vitu vilivyo hatari kwa watu kazini inaweza kuwa salama.<ref name=Baur2012/>

==Udhibiti==
Ilhali hakuna matibabu ya pumu, dalili zinaweza kuboreshwa.<ref>{{cite book|last=Ripoll|first=Brian C. Leutholtz, Ignacio|title=Exercise and disease management|publisher=CRC Press|location=Boca Raton|isbn=978-1-4398-2759-8|page=100|url=http://books.google.ch/books?id=eAn9-bm_pi8C&pg=PA100|edition=2nd ed.}}</ref> Mpango maalum, ulioboreshwa kwa kufuatilia na kudhibiti dalili inapaswa kutengenezwa. Mpango huu unapaswa kujumuisha upunguzaji wa alejeni, kwa uchunguzi wa kutathmini ukali, na matumizi ya dawa. Mpango wa matibabu unapaswa kuandikwa chini na kuwashauri kuhusu marekebisho ya matibabu kulingana na mabadiliko ya dalili.<ref name=GINA_2011_page56>{{harvnb|GINA|2011|p=56}}</ref>

Njia mwafaka ya kutibu ni kutambua visababishi, kama vile [[Madhara ya uvutaji wa sigara kwa afya|uvutaji wa sigara]], wanyama, au [[aspirin]], na kuepukana nao. Ikiwa haiwezekani, matumizi ya dawa utahitajika. Dawa ya matibabu yanachaguliwa kwa kuzingatia, vitu vingi, ukali wa ugonjwa na marudio ya dalili. Matibabu maalum ya pumu huanishwa kwa jumla katika kategoria zinazojitokeza na zinazochukua muda.<ref name=NHLBI07p213>{{harvnb|NHLBI Guideline|2007|p=213}}</ref><ref name=BGMA08>{{cite web|url=http://www.sign.ac.uk/pdf/sign101.pdf|title=British Guideline on the Management of Asthma|format=PDF|publisher=Scottish Intercollegiate Guidelines Network|year=2008|accessdate=2008-08-04|archiveurl=https://web.archive.org/web/20080819203455/http://www.sign.ac.uk/pdf/sign101.pdf|archivedate=2008-08-19|deadurl=no}}</ref>

[[Vipanua bronkasi]] vinapendekezwa kwa dalili za muda mfupi.<!-- <ref name=NAEPP/> --> Matibabu mengine hayahitajiki, kwa wanaokuwa na maumivu kila mara.<!-- <ref name=NAEPP/> --> Ikiwa ugonjwa itaendelea kudumu (kuwa mgonjwa zaidi ya mara mbili kwa wiki moja), dozi ndogo ya kuvuta ya kotikosteroidi au nyingine, ya kunywa [[leukotriene antagonist]] au [[mast cell stabilizer]] inapendekezwa.<!-- <ref name=NAEPP/> --> Kwa walio na maumivu kila siku, dozi kubwa ya kotikosteroidi ya kuvuta inatumiwa. Wakati wa maumivu, kotikosteroidi ya kumeza zinaongezwa kwa matibau haya.<ref name="NHLBI07p214">{{harvnb|NHLBI kielekezie|200707|p=214}}</ref>

===Ubadilishaji wa mtindo wa maisha===
Uepaji wa visababishi ni sehemu kuu ya kuboresha udhibiti na kuzuia kupatwa na ugonjwa. Visababishi vya kawaida sana ni pamoja na [[alejeni]], moshi (tobako na vingine), uchafuzi wa hewa, [[Kizuizi beta#Maajenti wasio chaguzi|vizuizi beta visivyo chaguzi]], na chakula kilicho na salfeti.<ref name=NAEPP2007p69>{{harvnb|NHLBI Guideline|2007|p=69}}</ref><ref name=thomson>{{cite journal |author=Thomson NC, Spears M |title=Athari ya kuvuta sigara kwa matokeo ya matibabu kwa wagonjwa walio na pumu |journal=Curr Opin Allergy Clin Immunol|volume=5 |issue=1 |pages=57–63 |year=2005 |pmid=15643345|doi=10.1097/00130832-200502000-00011}}</ref> Uvutaji sigara na [[uvutaji moshi kutoka kwa anayevuta sigara]](moshi wa mtu mwingine) unaweza kupunguza utendakazi wa dawa kama vile kotikosteroidi.<ref name=Stap2011>{{cite journal| author=Stapleton M, Howard-Thompson A, George C, Hoover RM, Self TH| title=Smoking and asthma. | journal=J Am Board Fam Med | year= 2011 | volume= 24| issue= 3 | pages= 313–22 | pmid=21551404 | doi=10.3122/jabfm.2011.03.100180}}</ref> Juhudi za kudhibiti wadudu wa vumbi, pamoja na kuchunja hewa, kemikali za kuua wadudu, kutumia kivuta vumbi, vitu vya kufunika godoro na njia zingine hazikuwa na mabadiliko kwa dalili za ugonjwa.<ref name=Gotzsche2008>{{cite journal |author=[[Peter C. Gøtzsche|PC Gøtzsche]], HK Johansen|title=House dust mite control measures for asthma|journal=Cochrane Database Syst Rev|issue=2 |pages=CD001187 |year=2008 |doi=10.1002/14651858.CD001187.pub3 |pmid=18425868|editor1-last=Gøtzsche |editor1-first=Peter C}}</ref>

===Dawa===
[[Dawa]] zinazotumika kutibu pumu zimegawanywa mara mbili: zinazotuliza maumivu haraka kwa kutibu dalili kali; na za kudhibiti maumivu kwa muda mrefu ambazo huzuia ongezeko la ugonjwa.<ref name="NHLBI07p213">{{harvnb|NHLBI Guideline|2007|p=560}}</ref>

;Zinazofanya kazi haraka
[[File:Salbutamol2.JPG|thumb|alt=Kopo la mviringo juu ya kishikizi cha buluu cha plastiki|[[Sabutamoli]] kivutia dawa cha dozi kinachotumika kwa matibabu.]]
* beta2-adrenajiki agonisti[[inayofanya kazi kwa muda mfupi|beta<sub>2</sub>-adrenosepta agonistsi]] (SABA), kama vile [[sabutamoli]] (''albuterol'' [[Jina linalotumika Marekani|USAN]]) ni matibabu ya kwanza ya dalili za ugonjwa.<ref name="NHLBI07p214" />
*Dawa za [[Anticholinergic]] kama vile [[ipratropiamu|bromidi ya ipratropiamu]], hupeana faida zinapotumika pamoja na SABA kwa walio na dalili.<ref name="NHLBI07p214" /> Vipanuzi vya bronkasi visivyo na anticholinergic inaweza pia hutumika iwapo mtu hawezi kustahimili SABA.<ref name="Self, Timothy 2009"/>
* Kipokezi cha adrenaji cha zamani, kisichochaguliwa sana [[adrenajiki agonistsi]], kama vile [[epinephrine]] ya kuvuta huwa na matokeo sawa na yale ya SABA.<ref name=Rodrigo>{{cite journal|author=Rodrigo GJ, Nannini LJ |title=Comparison between nebulized adrenaline and beta2 agonists for the treatment of acute asthma. Uchunguzi wa meta wa majaribio tofauti meta-analysis of randomized trials|url=https://archive.org/details/sim_american-journal-of-emergency-medicine_2006-03_24_2/page/217 |journal=Am J Emerg Med |volume=24 |issue=2 |pages=217–22 |year=2006 |pmid=16490653|doi=10.1016/j.ajem.2005.10.008}}</ref> Hazipendekezwi kwa sababu ya tatizo la kuchangamsha moyo.<ref name="NHLBI07p351">{{harvnb|NHLBI Guideline|2007|p=351}}</ref>

;Udhibiti wa muda mrefu
[[File:Fluticasone.JPG|thumb|alt=Kopo la mviringo juu ya kishikizi cha plastiki cha rangi ya chungwa|[[Fluticasone propionate]] kivutia dawa kwa kawaida kinachotumika kwa udhibiti wa muda mrefu.]]
*Kotikosteroidi huchukuliwa kama matibabu yanayofaa kwa udhibiti wa muda mrefu.<ref name=NHLBI07p213/> Aina zinazovutwa hutumika isipokuwa kwa ugonjwa kali unaoendelea, ambapo kotikosteroidi za kumeza zitahitajika.<ref name=NHLBI07p213/> Hupendekezwa kuwa aina za kuvutwa zitumike mara moja au mbili kwa siku, kulingana na ukali wa dalili.<ref name="NHLBI07p218">{{harvnb|NHLBI Guideline|2007|p=218}}</ref>
*[[Adrenosepta agonisti beta zinazofanya kazi kwa muda mrefu]] (LABA) kama vile [[salmeterol]] na [[formoterol]] zinaweza kuboresha udhibiti wa ugonjwa, angalau kwa watu wazima, zinapopeanwa pamoja na kotikosteroidi za kuvuta.<ref name=Ducharme2010>{{cite journal|last=Ducharme|first=FM|coauthors=Ni Chroinin, M; Greenstone, I; Lasserson, TJ|title=Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children.|journal=Cochrane database of systematic reviews (Online)|date=2010 May 12|issue=5|pages=CD005535|pmid=20464739}}</ref> Kwa watoto faida hii si hakika.<ref name=Ducharme2010/><ref>{{cite journal|last=Ducharme|first=FM|coauthors=Ni Chroinin, M; Greenstone, I; Lasserson, TJ|title=Addition of long-acting beta2-agonists to inhaled steroids versus higher dose inhaled corticosteroids in adults and children with persistent asthma.|journal=Cochrane database of systematic reviews (Online)|date=2010 Apr 14|issue=4|pages=CD005533|pmid=20393943}}</ref> Zinapotumika bila steroidi huongeza hatari ya [[athari]]<ref name=Fanta2009>{{cite journal |author=Fanta CH|title=Asthma |journal=New England Journal of Medicine |volume=360|issue=10|pages=1002–14 |year=2009|month=March |pmid=19264689 |doi=10.1056/NEJMra0804579 }}</ref> na hata zikitumiwa na kotikosteroidi zinaweza kuongeza hatari kidogo.<ref name=Cates2012>{{cite journal|last=Cates|first=CJ|coauthors=Cates, MJ|title=Regular treatment with formoterol for chronic asthma: serious adverse events.|journal=Cochrane database of systematic reviews (Online)|date=2012 Apr 18|volume=4|pages=CD006923|pmid=22513944}}</ref><ref>{{cite journal|last=Cates|first=CJ|coauthors=Cates, MJ|title=Regular treatment with salmeterol for chronic asthma: serious adverse events.|journal=Cochrane database of systematic reviews (Online)|date=2008 Jul 16|issue=3|pages=CD006363|pmid=18646149}}</ref>
*[[Leukotriene antagonist]] (kama vile [[montelukast]] na [[zafirlukast]]) zinaweza kutumika kando na kotikosteroidi za kuvuta, pia pamoja na LABA.<ref name=NHLBI07p213/> Dhibitisho hairuhusu matumizi katika ongezeko la ugonjwa.<ref name=GINA_2011_page74>{{harvnb|GINA|2011|p=74}}</ref><ref>{{cite journal|last=Watts|first=K|coauthors=Chavasse, RJ|title=Leukotriene receptor antagonists in addition to usual care for acute asthma in adults and children.|journal=Cochrane database of systematic reviews (Online)|date=2012 May 16|volume=5|pages=CD006100|pmid=22592708}}</ref> Kwa watoto chini ya umri wa miaka mitano, therapi ya kuongeza baada ya kuvuta kotikosteroidi inapendekezwa.<ref name=bts2009p43>{{harvnb|British Guideline|2009|p=43}}</ref>
*[[Mast cell stabilizer]] (kama vile [[sodiamu kromolini]]) haitumiki badala ya kotokosteroidi.<ref name=NHLBI07p213/>

;Njia za kupeana
Dawa hupeanwa kama [[kifaa cha kuvutia dawa]] (KKD) pamoja na [[kifaa cha kupeana dawa ya pumu]] au kama [[kivutia dawa cha poda]]. Kifaa kinachopeana dawa ni [[silinda]] ya [[plastiki]] ambayo huchanganya dawa na hewa, na kurahisisha kupata [[dozi]] kamili ya dawa. [[Nebulaiza]] inaweza kutumiwa. Nebulaiza na kifaa cha kutoa nafasi hufaa kwa walio na dalili, hata hivyo hakuna thibitisho kuamua iwapo kuna au hakuna tofauti kwa dalili kali.<ref name="NHLBI07p250">{{harvnb|NHLBI Guideline|2007|p=250}}</ref>

;Athari
Matumizi ya muda mrefu ya kotikosteroidi ya kuvuta huwa na hatari ndogo ya athari.<ref name=Safe09>{{cite journal|last=Rachelefsky|first=G|title=Inhaled corticosteroids and asthma control in children: assessing impairment and risk.|journal=Pediatrics|date=2009 Jan|volume=123|issue=1|pages=353–66|pmid=19117903|doi=10.1542/peds.2007-3273}}</ref> Hatari ni pamoja na kutokea kwa [[cataract]] na kurudi nyuma kidogo kwa akili.<ref name=Safe09/><ref>{{cite journal |author=Dahl R |title=Systemic side effects of inhaled corticosteroids in patients with asthma |journal=Respir Med |volume=100 |issue=8|pages=1307–17 |year=2006 |month=August|pmid=16412623|doi=10.1016/j.rmed.2005.11.020}}</ref>

===Dawa nyingine===
Pumu isipobadilika na dawa za kawaida, kuna aina zingine za chaguo zinazopatikana kwa udhibiti wa dharura na uzuizi wa milipuko. Kwa udhibiti wa dharura aina zingine za chaguo ni: 
*[[Oksijeni]] ili kutuliza [[haipoksia (dawa)|haipoksia]] ikiwa [[kiwango cha juu cha oksijeni|viwango vya juu]] iko chini ya asilimia 92.<ref name=rodrigo>{{cite journal |author=Rodrigo GJ, Rodrigo C, Hall JB |title=Acute asthma in adults: a review |url=https://archive.org/details/sim_chest_2004-03_125_3/page/1081 |journal=Chest |volume=125|issue=3 |pages=1081–102 |year=2004 |pmid=15006973| doi = 10.1378/chest.125.3.1081}}</ref>
*[[Salfeti ya magnesia]] matibabu ya mishipa ya ndani yameonyeshwa kusababisha athari ya kupanua bronkasi inapotumika pamoja na matibabu mengine katika mashambulizi makali ya ugonjwa.<ref name="NHLBI07p373">{{harvnb|NHLBI Guideline|2007|p=373}}</ref><ref>{{cite journal|journal=Chest |volume=122 |issue=2 |pages=396–8 |date = August 2002|doi=10.1378/chest.122.2.396 |title=Magnesium Treatment for Asthma : Where Do We Stand? |url=https://archive.org/details/sim_chest_2002-08_122_2/page/396 |last1=Noppen |first1=M. |pmid=12171805 }}</ref>
*[[Helioksi]], mchanganyiko wa heli na oksijeni, unaweza kutumiwa kwa visa vikali visivyoonyesha mabadiliko kwa kutumia dawa.<ref name="NHLBI07p373"/>
* Sabutamoli ya mishipa ya ndani haitetewi na dhibitisho linalopatikana na hivyo hutumika tu kwa visa vikali zaidi.<ref name=rodrigo/>
*[[Methylxanthines]] (kama vile [[theophylline]]) wakati mmoja ilitumika kwa wingi, lakini haiongezi athari za beta-agonistsi.<ref name=rodrigo/> Matumizi yake kwa maumivu makali huwa na pingamizi.<ref name=GINA_2011_page37>{{harvnb|GINA|2011|p=37}}</ref>
* Kitiaganzi kinachojitenga [[ketamini]] inaweza kutumiwa kinadharia iwapo [[intubesheni]] na [[uingizaji wa hewa]] utahitajika kwa watu wanaokaribia kuwa na tatizo la upumuo; hata hivyo, hakuna dibitisho kutoka kwa majaribio ya kliniki ili kudhibitisha hili.<ref name="NHLBI07p399">{{harvnb|NHLBI Guideline|2007|p=399}}</ref>
Kwa walio na ugonjwa kali unaoendelea usiodhibitiwa na kotikosteroidi za kuvuta na LABAS [[themoplasti ya bronkasi]] inaweza kutumiwa.<ref name=Bronch10>{{cite journal|last=Castro|first=M|coauthors=Musani, AI, Mayse, ML, Shargill, NS|title=Bronchial thermoplasty: a novel technique in the treatment of severe asthma.|journal=Therapeutic advances in respiratory disease|date=2010 Apr|volume=4|issue=2|pages=101–16|pmid=20435668|doi=10.1177/1753465810367505}}</ref> Huhusisha hupeanaji wa nishati joto kwa njia za hewa wakati wa mifululizo ya [[bronkoskopi|bronkoskopi]].<ref name=Bronch10/> Ingawa inaweza kuongeza idadi ya maumivu katika miezi michache ya kwanza huonekana kupunguza idadi ambayo hufuata.<!-- <ref name=GINA_2011_page70> -->Athari za kupita mwaka mmoja hazijulikani.<ref name=GINA_2011_page70>{{harvnb|GINA|2011|p=70}}</ref>

===Dawa mbadala===
Watu wengi, kama wale walio na matatizo ya muda mrefu, hutumia [[dawa mbadala|matibabu mbadala]]; uchunguzi unaonyesha kuwa takribani asilimia 50 hutumia baadhi ya therapi isiyo ya kawaida.<ref name=blanc>{{cite journal |author=Blanc PD, Trupin L, Earnest G, Katz PP, Yelin EH, Eisner MD |title=Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis : data from a population-based survey |url=https://archive.org/details/sim_chest_2001-11_120_5/page/1461 |journal=Chest|volume=120 |issue=5 |pages=1461–7 |year=2001 |pmid=11713120| doi = 10.1378/chest.120.5.1461}}</ref><ref name=shenfield>{{cite journal |author=Shenfield G, Lim E, Allen H |title=Survey of the use of complementary medicines and therapies in children with asthma |url=https://archive.org/details/sim_journal-of-paediatrics-and-child-health_2002-06_38_3/page/252 |journal=J Paediatr Child Health |volume=38 |issue=3 |pages=252–7|year=2002 |pmid=12047692| doi = 10.1046/j.1440-1754.2002.00770.x}}</ref> Kuna data chache ya kudhibitisha utendakazi wa therapi hizi. Ushahidi hautoshi kudhibitisha matumizi ya vitamini C.<ref>{{cite journal | last=Kaur | first=B | title=Vitamin C supplementation for asthma | journal=Cochrane Database Syst Rev | issue=1 | pages=CD000993| year=2009 | pmid=19160185 | doi=10.1002/14651858.CD000993.pub3 | coauthors=Rowe BH, Arnold E | editor1-last=Arnold | editor1-first=Elizabeth | unused_data=coauthorsRowe BH, Arnold E }}</ref> [[Acupuncture]] haipendekezwi kwa matibabu maana hakuna ushahidi wa kudhibitisha matumizi yake.<ref name="NHLBI07p240"/><ref name=mccartney>{{cite journal |author=McCarney RW, Brinkhaus B, Lasserson TJ, Linde K|title=Acupuncture for chronic asthma |journal=Cochrane Database Syst Rev |issue=1|pages=CD000008 |year=2004 |pmid=14973944 |doi=10.1002/14651858.CD000008.pub2|editor1-last=McCarney |editor1-first=Robert W}}</ref> [[Kutia aioni kwa hewa]] haionyeshi ushahidi wa mabadiliko ya dalili au kusaidia utendakazi wa mapafu; hii ikitumika sawa kwa jenereta hasi na zisizo hasi.<ref>{{cite journal|last=Blackhall|first=K|coauthors=Appleton, S; Cates, CJ|title=Ionisers for chronic asthma.|journal=Cochrane database of systematic reviews (Online)|date=2012 Sep 12|volume=9|pages=CD002986|pmid=22972060}}</ref>

"Therapi za mikono", ikiwa ni pamoja na [[osteopathi|osteopathi]], [[kiropraktiki]], [[therapi ya kimwili|fiziotherapi]] na [[therapi ya pumzi|therapi ya pumzi]] washawishi, wasio na ushahidi wa kudhibitisha matumizi kwa kutibu pumu.<ref name=hondras>{{cite journal |author=Hondras MA, Linde K, Jones AP |title=Manual therapy for asthma |journal=Cochrane Database Syst Rev |issue=2 |pages=CD001002 |year=2005|pmid=15846609 |doi=10.1002/14651858.CD001002.pub2 |editor1-last=Hondras|editor1-first=Maria A}}</ref> [[Mbinu ya Butyko ya kupumua]] ya kudhibiti upitishaji wa hewa nyingi inaweza kusababisha upungufu wa matumizi ya dawa hata hivyo haina athari yoyote kwa pafu.<ref name=BGMA08/> Hivyo kamati ya wastadi ilihisi kuwa ushahidi haukutosha kudhibitisha matumizi yake.<ref name="NHLBI07p240">{{harvnb|NHLBI Guideline|2007|p=240}}</ref>

== Prognosisi==
[[File:Asthma world map - DALY - WHO2004.svg|thumb|alt=Ramani ya ulimwengu Ulaya ukiwa umepakwa rangi ya manjano, sehemu nyingi za Amerika ukiwa na rangi ya chungwa na Kusini mwa Afrika ukiwa na rangi nyekundu nzito|[[Ulemavu-uliobadilisha miaka ya maisha]] kwa pumu kwa watu 100,000&nbsp;mwaka wa 2004.<ref>{{cite web|url=http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html|title=WHO Disease and injury country estimates |year=2009 |work=World Health Organization |accessdate=Nov. 11, 2009}}</ref><ref>|archiveurl=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html%7Carchivedate%3D 11 November 2009 <!--DASHBot-->| deadurl= no}}</ref>
{{Multicol}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff65|<100}}
{{legend|#fff200|100–150}}
{{legend|#ffdc00|150–200}}
{{legend|#ffc600|200–250}}
{{legend|#ffb000|250–300}}
{{legend|#ff9a00|300–350}}
{{Multicol-break}}
{{legend|#ff8400|350–400}}
{{legend|#ff6e00|400–450}}
{{legend|#ff5800|450–500}}
{{legend|#ff4200|500–550}}
{{legend|#ff2c00|550–600}}
{{legend|#cb0000|>600}}
{{Multicol-end}} ]]
Prognosi ya pumu ni nzuri, hasa kwa watoto walio na ugonjwa usio mkali.<ref>{{cite book |editor1-first=Allan B. |editor1-last=Wolfson |editor2-first=Ann|editor2-last=Harwood-Nuss |title=Harwood-Nuss' Clinical Practice of Emergency Medicine|chapterurl=http://books.google.com/books?id=Idb0Z658lFQC&pg=PT465 |date=September 2009|publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-8943-1 |pages=432–|first1=Michelle J. |last1=Sergel |first2=Rita K. |last2=Cydulka |chapter=Ch. 75: Asthma|edition=5th}}</ref> Vifo vimepungua katika miongo michache iliyopita kwa sababu ya utambuzi na uboreshaji wa utunzaji.<ref name=NHLBI07p1>{{harvnb|NHLBI Guideline|2007|p=1}}</ref> 

Ulimwenguni umesababisha [[ulemavu]] wa watu milioni 19.4&nbsp; kufikia mwaka wa 2004 (milioni 16&nbsp;wakiwa katika hali ya chini na ya kawaida katika nchi zinazoendelea).<ref>{{cite book|last=Organization|first=World Health|title=The global burden of disease : 2004 update.|url=https://archive.org/details/globalburdenofdi0000unse_i1e5|year=2008|publisher=World Health Organization|location=Geneva, Switzerland|isbn=978-92-4-156371-0|page=[https://archive.org/details/globalburdenofdi0000unse_i1e5/page/35 35]|edition=[Online-Ausg.]}}</ref> Kwa pumu uliotambuliwa wakati wa utotoni, [[nusu]] ya hali hizi hazitafanyiwa utambuzi baada ya mwongo mmoja.<ref name=El2010/> Upitishaji wa hewa hutengenezwa upya, lakini haijulikani ikiwa italeta faida au madhara.<ref name=Maddox>{{cite journal |author=Maddox L, Schwartz DA |title=The pathophysiology of asthma |journal=Annu. Rev. Med. |volume=53|pages=477–98 |year=2002 |pmid=11818486 |doi=10.1146/annurev.med.53.082901.103921}}</ref> Matibabu ya mapema kwa kutumia kotikosteroidi inaonekana kuzuia au kusaidia kupunguza matumizi kwa pafu.<ref name=beckett>{{cite journal |author=Beckett PA, Howarth PH|title=Pharmacotherapy and airway remodelling in asthma? |url=https://archive.org/details/sim_thorax_2003-02_58_2/page/163|journal=Thorax |volume=58|issue=2 |pages=163–74 |year=2003 |pmid=12554904| doi = 10.1136/thorax.58.2.163|pmc=1746582}}</ref>

==Epidemiolojia==
[[Image:Prevalence of Clinical Asthma world map - GINA2004.svg|thumb|left|alt=Ramani ya dunia ikiwa na Ulaya, Marekani Kaskazini, Australia na sehemu nyingi za Marekani Kusini yakichorwa nyekundu, sehemu nyingi za Asia yakiwa manjano, na sehemu nyingi za Afrika yakiwa kijivu|Viwango vya pumu katika nchi tofauti ulimwenguni kufikia mwaka wa 2004.
{{Multicol}}
{{legend|#e0e0e0|no data}}
{{legend|#ffff65|<1%}}
{{legend|#fff200|1-2%}}
{{legend|#ffdc00|2-3%}}
{{legend|#ffc600|3-4%}}
{{legend|#ffb000|4-5%}}
{{legend|#ff9a00|5-6%}}
{{Multicol-break}}
{{legend|#ff8400|6-7%}}
{{legend|#ff6e00|7-8%}}
{{legend|#ff5800|8-10%}}
{{legend|#ff4200|10-12.5%}}
{{legend|#ff2c00|12.5–15%}}
{{legend|#cb0000|>15%}}
{{Multicol-end}}]]
Kufikia mwaka wa 2011, watu milioni 235–300 ulimwenguni walikuwa wameathiriwa na ugonjwa huu,<ref name=WHO2011>{{cite web|title=World Health Organization Fact Sheet Fact sheet No 307: Asthma|year=2011|url=http://www.who.int/mediacentre/factsheets/fs307/en/|accessdate=Jan 17th,2013|archivedate=2011-06-29|archiveurl=https://web.archive.org/web/20110629035454/http://www.who.int/mediacentre/factsheets/fs307/en/}}</ref><ref name=GINA_2011_page3/> na karibu watu 250,000 hufa kila mwaka.<ref name=GINA2011p2/> Viwango vyao hutofautiana kati ya nchi zilizo na maambukizi kati ya asilimia 1 hadi 18.<ref name=GINA2011p2/> Zinapatikana sana katika [[katika nchi zilizoendelea|zilizoendelea]] kuliko [[nchi zinazokuwa]].<ref name=GINA2011p2/> Kuna viwango vya chini barani Asia, Ulaya Mashariki na Afrika.<ref name=M38/> Katika nchi zilizoendelea ni kawaida kwa wale walio na shida ya kifedha unapolinganisha na nchi zinazokuwa inapatikana sana kwa walio na fedha.<ref name=GINA2011p2/> Sababu ya tofauti hizi haijulikani.<ref name=GINA2011p2/> Nchi zilizo na pato la chini wanajumulisha asilimia 80 ya vifo.<ref>{{cite web|author=World Health Organization|authorlink=World Health Organization|title=WHO: Asthma|url=http://www.who.int/mediacentre/factsheets/fs307/en/|accessdate=2007-12-29|archiveurl=https://web.archive.org/web/20071215181927/http://www.who.int/mediacentre/factsheets/fs307/en/|archivedate=2007-12-15|deadurl=no}}</ref>

Ilhali ugonjwa huu unapatikana kwa [[wavulana]] mara mbili zaidi ya [[wasichana]],<ref name=GINA2011p2/> ukali wa ugonjwa hutokea kwa viwango sawa.<ref name=Bush2009>{{cite journal|author=Bush A, Menzies-Gow A|title=Phenotypic differences between pediatric and adult asthma |journal=Proc Am Thorac Soc |volume=6|issue=8 |pages=712–9 |year=2009 |month=December |pmid=20008882|doi=10.1513/pats.200906-046DP }}</ref> Katika utofautishaji, wanawake wana viwango vikubwa vya pumu kuliko wanaume<ref name=GINA2011p2/> na hupatikana sana kwa wachanga kuliko wakubwa.<ref name=M38/>

Viwango vya ugonjwa huu ulimwenguni viliongezeka kwa kasi kati ya [[miaka ya 1960]] na [[2008]]<ref>{{cite journal |author=Grant EN, Wagner R, Weiss KB |title=Observations on emerging patterns of asthma in our society |journal=[[J Allergy Clin Immunol]] |year=1999 |month=August|volume=104 |pages=S1–S9 |pmid=10452783 |doi=10.1016/S0091-6749(99)70268-X |issue=2 Pt 2}}</ref><ref>{{cite journal |author=Anandan C, Nurmatov U, van Schayck OC, Sheikh A|title=Is the prevalence of asthma declining? Systematic review of epidemiological studies|journal=Allergy |volume=65 |issue=2 |pages=152–67 |year=2010 |month=February|pmid=19912154 |doi=10.1111/j.1398-9995.2009.02244.x }}</ref> ikipitishwa kama shida kubwa katika [[afya ya umma]] kwanzia miaka ya 1970.<ref name=M38>{{cite book|first=John F. Murray|title=Murray and Nadel's textbook of respiratory medicine.|url=https://archive.org/details/murraynadelstext0002unse|year=2010|publisher=Saunders/Elsevier|location=Philadelphia, PA|isbn=1-4160-4710-7|pages=Chapter 38|edition=5th ed.}}</ref> Viwango vya ugonjwa havijabadilika tangu katikati ya miaka ya 1990 kukiwa na ongezeko katika [[nchi zinazoendelea]].<ref>{{cite journal|last=Bousquet|first=J|coauthors=Bousquet, PJ; Godard, P; Daures, JP|title=The public health implications of asthma.|journal=Bulletin of the World Health Organization|date=2005 Jul|volume=83|issue=7|pages=548–54|pmid=16175830}}</ref> Pumu huathiri takriban asilimia 7 ya watu nchini Marekani<ref name=Fanta2009/> na asilimia 5 nchini Uingereza.<ref name=Anderson2007>{{cite journal | last=Anderson | first=HR | coauthors=Gupta R, Strachan DP, Limb ES | title=50 years of asthma: UK trends from 1955 to 2004 | url=https://archive.org/details/sim_thorax_2007-01_62_1/page/85 |journal=Thorax | volume=62 | issue=1 | pages=85–90 |month=January |year=2007 |pmid=17189533 | doi=10.1136/thx.2006.066407 | pmc=2111282 }}</ref> Kanada, Australia and Nyuzelandi vina viwango vya kati ya asilimia 14-15.<ref>{{cite book|last=Masoli|first=Matthew|title=Global Burden of Asthma|year=2004|page=9|url=http://www.ginasthma.org/pdf/GINABurdenReport.pdf|access-date=2014-01-09|archive-date=2013-05-02|archive-url=https://web.archive.org/web/20130502065938/http://www.ginasthma.org/pdf/GINABurdenReport.pdf|dead-url=yes|=https://web.archive.org/web/20130502065938/http://www.ginasthma.org/pdf/GINABurdenReport.pdf}}</ref>

== Historia==
Pumu uligunduliwa kitambo nchini [[Misri]] na ulitibiwa kwa kunywa [[ubani]] mchanganyiko unaoitwa [[kyphi]].<ref name="Manniche1999">{{cite book | author = Manniche L |title = Sacred luxuries: fragrance, aromatherapy, and cosmetics in ancient Egypt | pages =[http://books.google.com/books?id=ZCgVdm7UKhIC&pg=PA49 49] | year = 1999 | publisher =[[Cornell University Press]] | isbn=978-0-8014-3720-5 }}</ref> Ulitajwa rasmi kama tatizo la upumuaji na [[Hippocrates]] mwaka [[450 KK]] hivi, kutoka kwa neno la [[Kigriki]] kumaanisha "kuhema" ikiunda asili ya neno la kisasa.<ref name=M38/> Mnamo [[200 KK]] uliaminika kuhusiana kidogo na [[hisia]].<ref name=Andrew2010/>

Mwaka wa [[1873]], mmoja kati ya [[karatasi]] za kwanza za dawa za kisasa kuhusu taarifa zilijaribu kuelezea ugonjwa wa [[pathofisiolojia]] ilhali nyingine mwaka wa [[1872]] ilihitimisha kuwa ugonjwa huu unaweza kutibiwa kwa kupanguza kifua na [[A.B.C. Liniment|chloroform liniment]].<ref name="pmid20747287">{{cite journal | author = Thorowgood JC | title = On bronchial asthma| journal =[[British Medical Journal]] | volume = 2 | issue = 673 | pages = 600 | year = 1873 | month = November | pmid = 20747287| pmc = 2294647 |doi = 10.1136/bmj.2.673.600}}</ref><ref name="pmid20746575">{{cite journal | author = Gaskoin G | title = On the treatment of asthma | journal = [[British Medical Journal]] | volume = 1 | issue = 587 |pages = 339 | year = 1872 |month = March | pmid = 20746575 | pmc = 2297349 | doi = 10.1136/bmj.1.587.339 }}</ref> [[Dawa ya kutibu|Matibabu ya afya]] mwaka wa 1880, ilijumuisha matumizi ya [[Kudungiwa sindano ya vena |sindano ya vena]] inayoitwa [[pilocarpin]].<ref name="pmid20749537">{{cite journal | author = Berkart JB | title = The treatment of asthma| journal = [[British Medical Journal]] | volume = 1 | issue = 1016 | pages = 917–8 | year = 1880 | month = June| pmid = 20749537 | pmc = 2240555 | doi = 10.1136/bmj.1.1016.917}}<br/>{{cite journal | author = Berkart JB | title = The treatment of asthma | journal =[[British Medical Journal]] | volume = 1 | issue = 1017 | pages = 960–2 | year = 1880 |month = June | pmid = 20749546 | pmc = 2240530 | doi = 10.1136/bmj.1.1017.960 }}</ref> Mnamo mwaka wa 1886, F.H. Bosworth alieleza uhusiano kati ya pumu na [[mafua ya mzio]].<ref name="pmid21407325">{{cite journal | author = Bosworth FH| title = Hay fever, asthma, and allied affections | journal = Transactions of the Annual Meeting of the American Climatological Association | volume = 2 | pages = 151–70 | year = 1886 | pmid = 21407325 |pmc = 2526599}}</ref> [[epinefrini]] ulirejelewa mara ya kwanza mwaka wa 1905 katika matibabu ya pumu.<ref name="pmid18733372">{{cite journal |author = Doig RL | title = Epinephrin; especially in asthma | journal = California State Journal of Medicine | volume = 3 | issue = 2 | pages = 54–5 | year = 1905 | month = February | pmid = 18733372 | pmc = 1650334}}</ref> Kotikosteroidi za kunywa zilianza kutumiwa miaka ya 1950 ilhali kotikosteroidi za kuvuta na beta agonist za kuchagua zilianza kutumika miaka ya 1960.<ref>{{cite journal|last=von Mutius|first=E|coauthors=Drazen, JM|title=A patient with asthma seeks medical advice in 1828, 1928, and 2012.|url=https://archive.org/details/sim_new-england-journal-of-medicine_2012-03-01_366_9/page/827|journal=New England Journal of Medicine|date=2012 Mar 1|volume=366|issue=9|pages=827–34|pmid=22375974}}</ref><ref>{{cite journal|author=Crompton G |title=A brief history of inhaled asthma therapy over the last fifty years |journal=Primary care respiratory journal : journal of the General Practice Airways Group|date=2006 Dec|volume=15|issue=6|pages=326–31|pmid=17092772}}</ref>

Kati ya [[miaka ya 1930]]–[[Miaka ya 1950|1950]], ugonjwa huu ulijulikana kama "takatifu saba" [[maradhi ya saikosomatiki]]. Kisababishi chake kilichukuliwa kama [[saikolojia]], na matibabu kuangaliwa kwa uchunguzi nafsia na matibabu mengine ya [[kuzungumza]].<ref name="pmid16185365"/> Walivyofafanua wachanganuzi ukoromaji wa pumu jinsi [[mtoto]] alivyolilia [[mama]] yake, walibaini kuwa matibabu ya masumbuko ni muhimu kwa walio na pumu.<ref name="pmid16185365">{{cite journal |author=Opolski M, Wilson I |title=Asthma and depression: a pragmatic review of the literature and recommendations for future research |journal=Clin Pract Epidemol Ment Health |volume=1 |page=18 |year=2005|month=September |pmid=16185365 |pmc=1253523 |doi=10.1186/1745-0179-1-18 }}</ref>

==Tanbihi==
{{Reflist|colwidth=30em}}

==Viungo vya nje==
{{Refbegin}}
*{{dmoz|Health/Conditions_and_Diseases/Respiratory_Disorders/Asthma/}}
*{{cite web |author=National Asthma Education and Prevention Program (NAEPP) |url=http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf | title=Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma | format=PDF | work=[[National Heart Lung and Blood Institute]] | year=2007 |ref={{harvid|NHLBI Guideline|2007}}}}
*{{cite web| url=http://www.sign.ac.uk/pdf/sign101.pdf| format=PDF| title=British Guideline on the Management of Asthma| work=[[British Thoracic Society]]| year=2008 - revised 2012| ref={{harvid|British Guideline|2009}}| accessdate=2014-01-09| archivedate=2008-08-19| archiveurl=https://web.archive.org/web/20080819203455/http://www.sign.ac.uk/pdf/sign101.pdf}}
*{{cite web |url=http://www.ginasthma.org/uploads/users/files/GINA_Report2011_May4.pdf |format=PDF |title=Global Strategy for Asthma Management and Prevention |publisher=Global Initiative for Asthma |year=2011 |ref={{harvid|GINA|2011}} |accessdate=2014-01-09 |=https://web.archive.org/web/20121120205023/http://www.ginasthma.org/uploads/users/files/GINA_Report2011_May4.pdf |archivedate=2012-11-20 |archiveurl=https://web.archive.org/web/20121120205023/http://www.ginasthma.org/uploads/users/files/GINA_Report2011_May4.pdf }}

[[Jamii:Magonjwa]]
[[Jamii:Mapafu]]