{"id":1476,"date":"2023-04-14T14:59:23","date_gmt":"2023-04-14T07:59:23","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=1476"},"modified":"2023-04-14T15:17:48","modified_gmt":"2023-04-14T08:17:48","slug":"hoi-chung-acos-hoi-chung-chong-lap-copd-va-hen","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/hoi-chung-acos-hoi-chung-chong-lap-copd-va-hen\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng ACOS – H\u1ed9i ch\u1ee9ng ch\u1ed3ng l\u1ea5p COPD v\u00e0 hen"},"content":{"rendered":"

H\u1ed9i ch\u1ee9ng ACOS (Asthma-COPD Overlap Syndrome), c\u00f3 t\u00ean g\u1ecdi kh\u00e1c l\u00e0 h\u1ed9i ch\u1ee9ng ch\u1ed3ng l\u1ea5p Hen ph\u1ebf qu\u1ea3n<\/a> v\u00e0 B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh<\/a>. B\u1ec7nh c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 suy gi\u1ea3m lu\u1ed3ng kh\u00ed m\u1ea1n t\u00ednh, v\u1edbi m\u1ed9t s\u1ed1 \u0111\u1eb7c tr\u01b0ng gi\u1ed1ng b\u1ec7nh hen suy\u1ec5n v\u00e0 m\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m gi\u1ed1ng b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD). Do \u0111\u00f3, ACOS \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m m\u00e0 n\u00f3 c\u00f3 chung v\u1edbi c\u1ea3 hen v\u00e0 COPD.<\/strong><\/p>\n

1.Nh\u1eefng kh\u00f3 kh\u0103n trong ph\u00e1t hi\u1ec7n h\u1ed9i ch\u1ee9ng ACOS<\/strong><\/h2>\n

1.1 Kh\u00f3 kh\u0103n trong nghi\u00ean c\u1ee9u<\/strong><\/h3>\n

Nh\u01b0 ch\u00fang ta \u0111\u1ec1u bi\u1ebft, hen ph\u1ebf qu\u1ea3n th\u01b0\u1eddng g\u1eb7p \u1edf \u0111\u1ed1i t\u01b0\u1ee3ng tr\u1ebb em v\u00e0 ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i. M\u1eb7t kh\u00e1c, COPD l\u1ea1i th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi cao tu\u1ed5i. V\u00ec v\u1eady, vi\u1ec7c nghi\u00ean c\u1ee9u c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 HC ACOS th\u1ef1c s\u1ef1 kh\u00f3 kh\u0103n.<\/p>\n

C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 HC ACOS \u0111a s\u1ed1 \u0111\u1ec1u d\u1ef1a v\u00e0o s\u1ef1 h\u1ed3i c\u1ee9u v\u00e0 quan s\u00e1t qu\u1ea7n th\u1ec3 COPD. Theo nghi\u00ean c\u1ee9u c\u1ee7a COPDGene, t\u1ef7 l\u1ec7 m\u1eafc ACOS trong s\u1ed1 b\u1ec7nh nh\u00e2n m\u1eafc hen v\u00e0 COPD l\u00e0 13%. T\u1ec9 l\u1ec7 n\u00e0y kh\u00f4ng h\u1ec1 nh\u1ecf, b\u1edfi h\u1eadu qu\u1ea3 c\u1ee7a ACOS c\u00f3 th\u1ec3 r\u1ea5t n\u1eb7ng n\u1ec1.<\/p>\n

1.2 Kh\u00f3 kh\u0103n trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n<\/strong><\/h3>\n

H\u1ed9i ch\u1ee9ng ACOS v\u1eeba mang \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a hen v\u00e0 v\u1eeba mang nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a COPD. Do \u0111\u00f3, \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 ch\u1ea9n \u0111o\u00e1n s\u1edbm HC ACOS l\u00e0 kh\u00e1 th\u00e1ch th\u1ee9c. C\u00e1c b\u00e1c s\u0129 ch\u01b0a c\u00f3 nhi\u1ec1u kinh nghi\u1ec7m c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng b\u1ecf qua v\u1ec1 b\u1ec7nh l\u00fd n\u00e0y.<\/p>\n

2. C\u01a1 ch\u1ebf g\u00e2y b\u1ec7nh<\/strong><\/h2>\n

2.1 C\u00e1c con \u0111\u01b0\u1eddng c\u00f3 th\u1ec3 g\u00e2y n\u00ean h\u1ed9i ch\u1ee9ng ACOS<\/strong><\/h3>\n

– Con \u0111\u01b0\u1eddng th\u1ee9 nh\u1ea5t: Kh\u1edfi ngu\u1ed3n t\u1eeb b\u1ec7nh nh\u00e2n hen suy\u1ec5n kh\u1edfi ph\u00e1t s\u1edbm. Th\u00f3i quen h\u00fat thu\u1ed1c trong cu\u1ed9c s\u1ed1ng h\u00e0ng ng\u00e0y d\u1eabn \u0111\u1ebfn s\u1ef1 ph\u00e1t tri\u1ec3n h\u1ea1n ch\u1ebf lu\u1ed3ng th\u00f4ng kh\u00ed c\u1ed1 \u0111\u1ecbnh v\u00e0 COPD.<\/p>\n

– Con \u0111\u01b0\u1eddng th\u1ee9 hai: Kh\u1edfi ngu\u1ed3n t\u1eeb b\u1ec7nh nh\u00e2n m\u1eafc COPD c\u00f3 ti\u1ec1n s\u1eed h\u00fat thu\u1ed1c l\u00e1 l\u00e2u n\u0103m v\u00e0 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m mu\u1ed9n c\u1ee7a b\u1ec7nh hen suy\u1ec5n.<\/p>\n

\"Con
Con \u0111\u01b0\u1eddng d\u1eabn \u0111\u1ebfn h\u1ed9i ch\u1ee9ng ACOS<\/figcaption><\/figure>\n

2.2 C\u01a1 ch\u1ebf b\u1ec7nh sinh<\/strong><\/h3>\n

ACOS l\u00e0 tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ebft b\u1eaft ngu\u1ed3n t\u1eeb s\u1ef1 t\u01b0\u01a1ng t\u00e1c gi\u1eefa c\u00e1c r\u1ed1i lo\u1ea1n v\u1ec1 di truy\u1ec1n, m\u00f4 b\u1ec7nh h\u1ecdc v\u00e0 ch\u1ee9c n\u0103ng trong hen ho\u1eb7c COPD.<\/p>\n

V\u1ec1 r\u1ed1i lo\u1ea1n di truy\u1ec1n, Christenson v\u00e0 c\u00f4ng s\u1ef1 t\u00ecm ra nh\u1eefng d\u1ea5u \u1ea5n c\u00e1c gen li\u00ean quan \u0111\u1ebfn hen t\u0103ng l\u00ean r\u00f5 r\u1ec7t \u1edf b\u1ec7nh nh\u00e2n COPD ch\u01b0a m\u1eafc hen nh\u01b0ng c\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ed1ng hen.<\/p>\n

V\u1ec1 m\u00f4 b\u1ec7nh h\u1ecdc, l\u1edbp m\u00e0ng n\u1ec1n v\u00e0 kh\u1ed1i l\u01b0\u01a1ng c\u01a1 tr\u01a1n ph\u1ebf qu\u1ea3n t\u0103ng l\u00ean, l\u1edbn h\u01a1n \u1edf b\u1ec7nh nh\u00e2n COPD d\u1eabn \u0111\u1ebfn s\u1ef1u \u1ee9 kh\u00ed nhi\u1ec1u h\u01a1n \u1edf b\u1ec7nh nh\u00e2n ACOS. Ngo\u00e0i ra, c\u00f2n c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a b\u1ea1ch c\u1ea7u \u00e1i toan ho\u1eb7c b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh. Theo c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c nhau ch\u1ec9 ra r\u1eb1ng, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a b\u1ea1ch c\u1ea7u ai toan \u0111\u00e1ng k\u1ec3 trong m\u1eabu \u0111\u1eddm d\u1ef1 \u0111o\u00e1n \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi ICS. M\u1eb7t kh\u00e1c, s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh nhi\u1ec1u h\u01a1n trong \u0111\u1eddm g\u1ea7n \u0111\u00e2y c\u00f3 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng x\u1ea5u h\u01a1n \u1edf b\u1ec7nh nh\u00e2n.<\/p>\n

3. C\u00e1c d\u1ea5u hi\u1ec7u ch\u1ea9n \u0111o\u00e1n b\u1ec7nh<\/strong><\/h2>\n

3.1 Y\u1ebfu t\u1ed1 nguy c\u01a1<\/strong><\/h3>\n
    \n
  • Tu\u1ed5i > 35<\/li>\n
  • H\u00fat thu\u1ed1c l\u00e1 (\u0111\u00e3 h\u00fat thu\u1ed1c l\u00e1) >= 10 bao – n\u0103m<\/li>\n
  • Ti\u1ebfp x\u00fac kh\u00f3i b\u1ee5i, kh\u00ed \u0111\u1ed9c h\u1ea1i<\/li>\n
  • Ti\u1ec1n s\u1eed c\u00f3 th\u1ec3 m\u1eafc hen<\/li>\n<\/ul>\n

    3.2 C\u00e1c tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd<\/strong><\/h3>\n
      \n
    • Ho nhi\u1ec1u, t\u1eebng c\u01a1n<\/li>\n
    • \u0110\u1eddm nh\u1ea7y, trong. C\u00f3 th\u1ec3 tr\u1eafng \u0111\u1ee5c ho\u1eb7c xanh, v\u00e0ng<\/li>\n
    • Kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c dai d\u1eb3ng, c\u00f3 th\u1ec3 thay \u0111\u1ed5i ho\u1eb7c n\u1eb7ng h\u01a1n<\/li>\n<\/ul>\n

      3.3 C\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h3>\n

      \u0110o ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p:<\/strong><\/p>\n

        \n
      • FEV1\/FVC sau test h\u1ed3i ph\u1ee5c ph\u1ebf qu\u1ea3n < 70% \u0111\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n c\u0103n hen<\/li>\n
      • FEV1 c\u1ea3i thi\u1ec7n >= 15% v\u00e0 >= 400 ml sau test h\u1ed3i ph\u1ee5c ph\u1ebf qu\u1ea3n v\u00e0\/ho\u1eb7c b\u1ea1ch c\u1ea7u \u00e1i toan m\u00e1u >= 300 BC\/uL<\/li>\n<\/ul>\n

        XQ ng\u1ef1c th\u1eb3ng:<\/strong><\/p>\n

          \n
        • T\u0103ng \u0111\u1eadm c\u00e1c nh\u00e1nh ph\u1ebf qu\u1ea3n, h\u00ecnh \u1ea3nh ph\u1ed5i b\u1ea9n.<\/li>\n
        • Gi\u00e3n ph\u1ebf nang<\/li>\n
        • M\u1ea1ch m\u00e1u ngo\u1ea1i vi th\u01b0a th\u1edbt, b\u00f3ng kh\u00ed<\/li>\n<\/ul>\n

          C\u1eaft l\u1edbp vi t\u00ednh l\u1ed3ng ng\u1ef1c<\/strong>: H\u00ecnh \u1ea3nh kh\u00ed ph\u1ebf th\u0169ng<\/p>\n

          X\u00e9t nghi\u1ec7m \u0111\u1eddm<\/strong>: t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan v\u00e0\/ho\u1eb7c t\u0103ng b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh<\/p>\n

          4. \u0110i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng ACOS<\/strong><\/h2>\n

          4.1 \u0110i\u1ec1u tr\u1ecb thu\u1ed1c<\/strong><\/h3>\n
            \n
          • ICS (li\u1ec1u l\u01b0\u1ee3ng ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 c\u00e1c tri\u1ec7u ch\u1ee9ng)<\/li>\n
          • LABA v\u00e0\/ho\u1eb7c LAMA<\/li>\n<\/ul>\n

            4.2 \u0110i\u1ec1u tr\u1ecb kh\u00f4ng d\u00f9ng thu\u1ed1c<\/strong><\/h3>\n
              \n
            • Ng\u1eebng h\u00fat thu\u1ed1c l\u00e1<\/li>\n
            • Ti\u00eam vacxin ph\u00f2ng ng\u1eeba: c\u00f9m, ph\u1ebf c\u1ea7u<\/li>\n
            • Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p<\/li>\n
            • T\u1eadp th\u1ec3 d\u1ee5c th\u01b0\u1eddng xuy\u00ean<\/li>\n
            • V\u1ec7 sinh r\u0103ng mi\u1ec7ng s\u1ea1ch s\u1ebd ph\u00f2ng c\u00e1c \u1ed5 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/li>\n<\/ul>\n

              K\u1ebft lu\u1eadn, h\u1ed9i ch\u1ee9ng ACOS l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ph\u1ed5i ph\u1ee9c t\u1ea1p, c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m h\u1ed7n h\u1ee3p gi\u1eefa hen suy\u1ec5n v\u00e0 ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD). B\u1ec7nh th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi h\u00fat thu\u1ed1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 h\u00fat thu\u1ed1c l\u00e1 k\u00e9o d\u00e0i. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i b\u1ec7nh ACOS l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c cho c\u00e1c chuy\u00ean gia y t\u1ebf. Tuy nhi\u00ean, vi\u1ec7c ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm b\u1ec7nh ACOS l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 gi\u1ea3m thi\u1ec3u c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh, c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh ACOS bao g\u1ed3m c\u00e1c ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 s\u1eed d\u1ee5ng thu\u1ed1c, \u0111\u1ed3ng th\u1eddi b\u1ec7nh nh\u00e2n c\u1ea7n thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng, ng\u1eebng h\u00fat thu\u1ed1c v\u00e0 t\u1eadp th\u1ec3 d\u1ee5c th\u01b0\u1eddng xuy\u00ean… Hy v\u1ecdng b\u00e0i vi\u1ebft n\u00e0y gi\u00fap b\u1ea1n \u0111\u1ecdc hi\u1ec3u m\u1ed9t c\u00e1ch c\u01a1 b\u1ea3n nh\u1ea5t v\u1ec1 h\u1ed9i ch\u1ee9ng ch\u1ed3ng l\u1ea5p b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh v\u00e0 hen (HC ACOS).<\/p>\n

              <\/div>\n","protected":false},"excerpt":{"rendered":"

              H\u1ed9i ch\u1ee9ng ACOS (Asthma-COPD Overlap Syndrome), c\u00f3 t\u00ean g\u1ecdi kh\u00e1c l\u00e0 h\u1ed9i ch\u1ee9ng ch\u1ed3ng l\u1ea5p Hen ph\u1ebf qu\u1ea3n v\u00e0 B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh. B\u1ec7nh c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 suy gi\u1ea3m lu\u1ed3ng kh\u00ed m\u1ea1n t\u00ednh, v\u1edbi m\u1ed9t s\u1ed1 \u0111\u1eb7c tr\u01b0ng gi\u1ed1ng b\u1ec7nh hen suy\u1ec5n v\u00e0 m\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m gi\u1ed1ng b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn […]<\/p>\n","protected":false},"author":26,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[3],"yoast_head":"\nH\u1ed9i ch\u1ee9ng ACOS - H\u1ed9i ch\u1ee9ng ch\u1ed3ng l\u1ea5p COPD v\u00e0 hen - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ed9i ch\u1ee9ng ACOS l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd ph\u1ed5i ph\u1ee9c t\u1ea1p, c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m h\u1ed7n h\u1ee3p gi\u1eefa hen suy\u1ec5n v\u00e0 ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD).\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"H\u1ed9i ch\u1ee9ng ACOS - 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