{"id":18204,"date":"2023-04-11T18:00:46","date_gmt":"2023-04-11T11:00:46","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18204"},"modified":"2023-04-17T16:36:50","modified_gmt":"2023-04-17T09:36:50","slug":"hen-phe-quan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/11\/hen-phe-quan\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n hen ph\u1ebf qu\u1ea3n \u1edf ng\u01b0\u1eddi l\u1edbn"},"content":{"rendered":"

Ng\u00e0y 24\/04\/2020, B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf \u0111\u00e3 k\u00fd Quy\u1ebft \u0111\u1ecbnh s\u1ed1 1851Q\u0110-BYT ban h\u00e0nh H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb hen ph\u1ebf qu\u1ea3n ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em \u2265 12 tu\u1ed5i. \u0110\u00e2y l\u00e0 t\u00e0i li\u1ec7u chuy\u00ean m\u00f4n quan tr\u1ecdng, l\u00e0m c\u01a1 s\u1edf cho c\u00e1n b\u1ed9 y t\u1ebf th\u1ef1c h\u00e0nh chuy\u00ean m\u00f4n kh\u00e1m b\u1ec7nh, ch\u1eefa b\u1ec7nh theo chu\u1ea9n m\u1ef1c, gi\u00fap t\u0103ng c\u01b0\u1eddng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. D\u01b0\u1edbi \u0111\u00e2y l\u00e0 tr\u00edch d\u1eabn h\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n hen ph\u1ebf qu\u1ea3n \u1edf ng\u01b0\u1eddi l\u1edbn c\u1ee7a B\u1ed9 Y t\u1ebf 2020.<\/strong><\/p>\n

    \n
  1. \u0110\u1ecbnh ngh\u0129a hen ph\u1ebf qu\u1ea3n<\/strong><\/li>\n<\/ol>\n

    Hen ph\u1ebf qu\u1ea3n (HPQ) l\u00e0 m\u1ed9t b\u1ec7nh c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 vi\u00eam m\u1ea1n t\u00ednh ni\u00eam m\u1ea1c ph\u1ebf qu\u1ea3n l\u00e0m t\u0103ng ph\u1ea3n \u1ee9ng c\u1ee7a ph\u1ebf qu\u1ea3n th\u01b0\u1eddng xuy\u00ean v\u1edbi nhi\u1ec1u t\u00e1c nh\u00e2n k\u00edch th\u00edch, d\u1eabn \u0111\u1ebfn co th\u1eaft lan to\u1ea3 c\u01a1 tr\u01a1n ph\u1ebf qu\u1ea3n. S\u1ef1 co th\u1eaft ph\u1ebf qu\u1ea3n kh\u00f4ng c\u1ed1 \u0111\u1ecbnh, th\u01b0\u1eddng c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c t\u1ef1 nhi\u00ean ho\u1eb7c sau khi d\u00f9ng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n.<\/p>\n

    Tr\u00ean l\u00e2m s\u00e0ng, HPQ bi\u1ec3u hi\u1ec7n v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 th\u1edf kh\u00f2 kh\u00e8, kh\u00f3 th\u1edf, n\u1eb7ng ng\u1ef1c v\u00e0 ho. B\u1ec7nh bi\u1ebfn \u0111\u1ed5i theo m\u00f9a, n\u1eb7ng khi ti\u1ebfp x\u00fac y\u1ebfu t\u1ed1 nguy c\u01a1 ho\u1eb7c thay \u0111\u1ed5i th\u1eddi ti\u1ebft. C\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y c\u00f3 li\u00ean quan v\u1edbi s\u1ef1 bi\u1ebfn \u0111\u1ed5i c\u1ee7a lu\u1ed3ng kh\u00f4ng kh\u00ed th\u1edf ra do t\u00ecnh tr\u1ea1ng t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf (ph\u00f9 n\u1ec1 ni\u00eam m\u1ea1c, co th\u1eaft c\u01a1 tr\u01a1n, t\u0103ng ti\u1ebft \u0111\u1eddm).<\/p>\n

      \n
    1. Ch\u1ea9n \u0111o\u00e1n<\/strong><\/li>\n<\/ol>\n

      2.1.Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/strong><\/p>\n

      – Kh\u00f3 th\u1edf, kh\u00f2 kh\u00e8, th\u1edf r\u00edt, \u0111\u1eb7c bi\u1ec7t th\u00ec th\u1edf ra;<\/p>\n

      – Th\u1eddi \u0111i\u1ec3m xu\u1ea5t hi\u1ec7n c\u01a1n kh\u00f3 th\u1edf: v\u1ec1 \u0111\u00eam, theo m\u00f9a, sau m\u1ed9t s\u1ed1 k\u00edch th\u00edch (c\u1ea3m c\u00fam, g\u1eafng s\u1ee9c, thay \u0111\u1ed5i th\u1eddi ti\u1ebft, kh\u00f3i b\u1ee5i);<\/p>\n

      – Ti\u1ec1n s\u1eed c\u00f3 c\u01a1n kh\u00f3 th\u1edf ki\u1ec3u hen: ho kh\u1ea1c \u0111\u1eddm, kh\u00f3 th\u1edf, c\u00f2 c\u1eed, n\u1eb7ng ng\u1ef1c, nghe ph\u1ed5i c\u00f3 ran r\u00edt, ran ng\u00e1y;<\/p>\n

      – Ti\u1ec1n s\u1eed b\u1ea3n th\u00e2n: vi\u00eam m\u0169i d\u1ecb \u1ee9ng, vi\u00eam k\u1ebft m\u1ea1c d\u1ecb \u1ee9ng, d\u1ecb \u1ee9ng thu\u1ed1c, th\u1ee9c \u0103n;<\/p>\n

      – Ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi m\u1eafc hen ph\u1ebf qu\u1ea3n v\u00e0\/ ho\u1eb7c c\u00e1c b\u1ec7nh d\u1ecb \u1ee9ng;<\/p>\n

      – C\u1ea7n l\u01b0u \u00fd lo\u1ea1i tr\u1eeb c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c c\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ed1ng hen ph\u1ebf qu\u1ea3n nh\u01b0 b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh (COPD), gi\u00e3n ph\u1ebf qu\u1ea3n, vi\u00eam ph\u1ebf qu\u1ea3n co th\u1eaft ….;<\/p>\n

      – Kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n n\u1ebfu th\u1ea5y c\u01a1n hen ph\u1ebf qu\u1ea3n v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u \u0111\u1eb7c tr\u01b0ng:<\/p>\n

      + Ti\u1ec1n tri\u1ec7u: h\u1eaft h\u01a1i, s\u1ed5 m\u0169i, ng\u1ee9a m\u1eaft, ho khan, bu\u1ed3n ng\u1ee7…<\/p>\n

      + C\u01a1n kh\u00f3 th\u1edf: l\u00fac b\u1eaft \u0111\u1ea7u kh\u00f3 th\u1edf ch\u1eadm, \u1edf th\u00ec th\u1edf ra, c\u00f3 ti\u1ebfng c\u00f2 c\u1ee9 ng\u01b0\u1eddi kh\u00e1c c\u0169ng nghe \u0111\u01b0\u1ee3c, kh\u00f3 th\u1edf t\u0103ng d\u1ea7n, sau c\u00f3 th\u1ec3 kh\u00f3 th\u1edf nhi\u1ec1u, v\u00e3 m\u1ed3 h\u00f4i, n\u00f3i t\u1eebng t\u1eeb ho\u1eb7c ng\u1eaft qu\u00e3ng. C\u01a1n kh\u00f3 th\u1edf k\u00e9o d\u00e0i 5- 15 ph\u00fat, c\u00f3 khi h\u00e0ng gi\u1edd, h\u00e0ng ng\u00e0y. C\u01a1n kh\u00f3 th\u1edf gi\u1ea3m d\u1ea7n v\u00e0 k\u1ebft th\u00fac v\u1edbi ho v\u00e0 kh\u1ea1c \u0111\u1eddm. \u0110\u1eddm th\u01b0\u1eddng trong, qu\u00e1nh, d\u00ednh. Kh\u00e1m trong c\u01a1n hen th\u1ea5y c\u00f3 ran r\u00edt, ran ng\u00e1y lan to\u1ea3 2 ph\u1ed5i.<\/p>\n

      2.2. C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/p>\n

      \u0110o ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed ph\u1ed5i<\/strong><\/p>\n

      – Khi \u0111o v\u1edbi h\u00f4 h\u1ea5p k\u00fd:<\/p>\n

      + \u0110o ngo\u00e0i c\u01a1n: k\u1ebft qu\u1ea3 ch\u1ee9c n\u0103ng th\u00f4ng kh\u00ed (CNTK) ph\u1ed5i b\u00ecnh th\u01b0\u1eddng;<\/p>\n

      + Tr\u01b0\u1eddng h\u1ee3p \u0111o trong c\u01a1n: r\u1ed1i lo\u1ea1n th\u00f4ng kh\u00ed (RLTK) t\u1eafc ngh\u1ebdn ph\u1ee5c h\u1ed3i ho\u00e0n to\u00e0n v\u1edbi thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n: ch\u1ec9 s\u1ed1 FEV1\/FVC \u2265 75% sau h\u00edt 400\u03bcg salbutamol;<\/p>\n

      – S\u1ef1 bi\u1ebfn \u0111\u1ed5i th\u00f4ng kh\u00ed \u0111o b\u1eb1ng l\u01b0u l\u01b0\u1ee3ng \u0111\u1ec9nh k\u1ebf: l\u01b0u l\u01b0\u1ee3ng \u0111\u1ec9nh (LL\u0110) t\u0103ng >15% sau 30 ph\u00fat h\u00edt 400\u03bcg salbutamol. LL\u0110 bi\u1ebfn thi\u00ean h\u01a1n 20% gi\u1eefa l\u1ea7n \u0111o bu\u1ed5i s\u00e1ng v\u00e0 chi\u1ec1u c\u00e1ch nhau 12 gi\u1edd \u1edf ng\u01b0\u1eddi b\u1ec7nh d\u00f9ng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n (ho\u1eb7c h\u01a1n 10% khi kh\u00f4ng d\u00f9ng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n), ho\u1eb7c LL\u0110 gi\u1ea3m h\u01a1n 15% sau 6 ph\u00fat \u0111i b\u1ed9 ho\u1eb7c g\u1eafng s\u1ee9c.<\/p>\n

      2.3. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/strong><\/p>\n

      Hen ph\u1ebf qu\u1ea3n l\u00e0 b\u1ec7nh bi\u1ebfn \u0111\u1ed5i (kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t), \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p m\u1ea1n t\u00ednh.<\/p>\n

      2.3.1<\/strong>. Hai \u0111\u1eb7c \u0111i\u1ec3m c\u01a1 b\u1ea3n c\u1ee7a HPQ<\/strong><\/p>\n

      – (1) B\u1ec7nh s\u1eed c\u1ee7a c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p nh\u01b0 th\u1edf kh\u00f2 kh\u00e8, kh\u00f3 th\u1edf, t\u1ee9c ng\u1ef1c v\u00e0 ho. C\u00e1c bi\u1ec3u hi\u1ec7n b\u1ec7nh bi\u1ebfn \u0111\u1ed5i theo th\u1eddi gian, m\u1ee9c \u0111\u1ed9 n\u1eb7ng, V\u00c0<\/p>\n

      – (2) Gi\u1edbi h\u1ea1n lu\u1ed3ng kh\u00ed th\u1edf ra bi\u1ebfn \u0111\u1ed5i, \u0111\u01b0\u1ee3c kh\u1eb3ng \u0111\u1ecbnh \u00edt nh\u1ea5t m\u1ed9t l\u1ea7n.<\/p>\n

      \"\"
      L\u01b0u \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n hen ph\u1ebf qu\u1ea3n tr\u00ean l\u00e2m s\u00e0ng theo GINA (2019)<\/figcaption><\/figure>\n

      L\u01b0u \u00fd: Ch\u1ea9n \u0111o\u00e1n hen ph\u1ebf qu\u1ea3n n\u00ean d\u1ef1a tr\u00ean nh\u1eefng th\u00f4ng tin ghi nh\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb ki\u1ec3m so\u00e1t hen. Vi\u1ec7c kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n hen tr\u1edf n\u00ean kh\u00f3 h\u01a1n nhi\u1ec1u sau khi b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb ki\u1ec3m so\u00e1t.<\/p>\n

      2.3.2. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n hen ph\u1ebf qu\u1ea3n<\/strong><\/p>\n

      2.3.2.1. Ti\u1ec1n s\u1eed c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p thay \u0111\u1ed5i<\/strong><\/p>\n

      C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh l\u00e0 th\u1edf kh\u00f2 kh\u00e8, kh\u00f3 th\u1edf, n\u1eb7ng ng\u1ef1c v\u00e0 ho.<\/p>\n

      – Ng\u01b0\u1eddi b\u1ecb hen th\u01b0\u1eddng c\u00f3 nhi\u1ec1u h\u01a1n m\u1ed9t trong c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00eau tr\u00ean;<\/p>\n

      – C\u00e1c tri\u1ec7u ch\u1ee9ng bi\u1ebfn \u0111\u1ed5i theo th\u1eddi gian v\u00e0 c\u01b0\u1eddng \u0111\u1ed9;<\/p>\n

      – C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng x\u1ea3y ra ho\u1eb7c n\u1eb7ng h\u01a1n v\u00e0o ban \u0111\u00eam hay l\u00fac th\u1ee9c gi\u1ea5c;<\/p>\n

      – C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng kh\u1edfi ph\u00e1t khi g\u1eafng s\u1ee9c, c\u01b0\u1eddi l\u1edbn, ti\u1ebfp x\u00fac c\u00e1c d\u1ecb nguy\u00ean hay kh\u00f4ng kh\u00ed l\u1ea1nh;<\/p>\n

      – C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng x\u1ea3y ra ho\u1eb7c tr\u1edf n\u00ean x\u1ea5u \u0111i khi nhi\u1ec5m vi r\u00fat.<\/p>\n

      2.3.2.2. B\u1eb1ng ch\u1ee9ng gi\u1edbi h\u1ea1n lu\u1ed3ng kh\u00ed th\u1edf ra bi\u1ebfn \u0111\u1ed5i<\/strong><\/p>\n

      – It nh\u1ea5t m\u1ed9t l\u1ea7n trong qu\u00e1 tr\u00ecnh ch\u1ea9n \u0111o\u00e1n c\u00f3 FEV1 th\u1ea5p, ghi nh\u1eadn t\u1ec9 l\u1ec7 FEV1\/FVC th\u1ea5p h\u01a1n gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng th\u1ea5p. T\u1ec9 l\u1ec7 FEV1\/FVC b\u00ecnh th\u01b0\u1eddng l\u1edbn h\u01a1n 0,75-0,80 \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1edbn v\u00e0 h\u01a1n 0,85 \u0111\u1ed1i v\u1edbi tr\u1ebb em.<\/p>\n

      – Ghi nh\u1eadn bi\u1ebfn \u0111\u1ed5i ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p cao h\u01a1n \u1edf ng\u01b0\u1eddi kh\u1ecfe m\u1ea1nh. V\u00ed d\u1ee5:<\/p>\n

      + FEV1 t\u0103ng h\u01a1n 12% v\u00e0 200mL so v\u1edbi gi\u00e1 tr\u1ecb ban \u0111\u1ea7u (\u1edf tr\u1ebb em, >12% gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n) sau khi h\u00edt thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n. \u0110\u01b0\u1ee3c g\u1ecdi l\u00e0 \u201cgi\u00e3n ph\u1ebf qu\u1ea3n h\u1ed3i ph\u1ee5c\u201d.<\/p>\n

      + Trung b\u00ecnh h\u1eb1ng ng\u00e0y LL\u0110 thay \u0111\u1ed5i >10% (\u1edf tr\u1ebb em, >13%)<\/p>\n

      + FEV1 t\u0103ng h\u01a1n 12% v\u00e0 200mL so v\u1edbi gi\u00e1 tr\u1ecb ban \u0111\u1ea7u (\u1edf tr\u1ebb em, >12% gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n) sau 4 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1ngvi\u00eam (ngo\u00e0i c\u00e1c \u0111\u1ee3t nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p)<\/p>\n

      – S\u1ef1 thay \u0111\u1ed5i v\u01b0\u1ee3t m\u1ee9c c\u00e0ng l\u1edbn trong nhi\u1ec1u l\u1ea7n \u0111\u00e1nh gi\u00e1 th\u00ec vi\u1ec7c ch\u1ea9n \u0111o\u00e1n HPQ c\u00e0ng ch\u1eafc ch\u1eafn h\u01a1n.<\/p>\n

      – Vi\u1ec7c th\u0103m d\u00f2 n\u00ean \u0111\u01b0\u1ee3c l\u1eb7p l\u1ea1i trong khi c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng, v\u00e0o s\u00e1ng s\u1edbm hay sau khi s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n.<\/p>\n

      – H\u1ed3i ph\u1ee5c ph\u1ebf qu\u1ea3n c\u00f3 th\u1ec3 kh\u00f4ng th\u1ea5y trong \u0111\u1ee3t c\u1ea5p n\u1eb7ng hay nhi\u1ec5m vi r\u00fat. N\u1ebfu h\u1ed3i ph\u1ee5c ph\u1ebf qu\u1ea3n kh\u00f4ng th\u1ea5y trong th\u0103m d\u00f2 ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p l\u1ea7n \u0111\u1ea7u, th\u00ec b\u01b0\u1edbc ti\u1ebfp theo ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ednh c\u1ea5p b\u00e1ch c\u1ee7a l\u00e2m s\u00e0ng v\u00e0 s\u1ef1 s\u1eb5n c\u00f3 c\u1ee7a c\u00e1c th\u0103m d\u00f2 kh\u00e1c.<\/p>\n

      – L\u00e0m th\u00eam c\u00e1c th\u0103m d\u00f2 kh\u00e1c \u0111\u1ec3 h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n, bao g\u1ed3m c\u1ea3 th\u1eed nghi\u1ec7m g\u00e2y co th\u1eaft ph\u1ebf qu\u1ea3n.<\/p>\n

      2.3.3. C\u00e1c b\u01b0\u1edbc ti\u1ebfn h\u00e0nh \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n HPQ<\/strong><\/p>\n

      – Khai th\u00e1c b\u1ec7nh s\u1eed v\u00e0 ti\u1ec1n s\u1eed gia \u0111\u00ecnh: th\u1eddi \u0111i\u1ec3m v\u00e0 c\u00e1ch kh\u1edfi ph\u00e1t c\u1ee7a c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p, ti\u1ec1n s\u1eed m\u1eafc c\u00e1c b\u1ec7nh d\u1ecb \u1ee9ng nh\u01b0 VMDU, ch\u00e0m c\u01a1 \u0111\u1ecba c\u1ee7a ng\u01b0\u1eddib\u1ec7nh ho\u1eb7c gia \u0111\u00ecnh<\/p>\n

      – Kh\u00e1m th\u1ef1c th\u1ec3: ph\u00e1t hi\u1ec7n ti\u1ebfng ran r\u00edt, ran ng\u00e1y th\u00ec th\u1edf ra khi nghe ph\u1ed5i ho\u1eb7c c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh l\u00fd m\u1eafc k\u00e8m nh\u01b0 vi\u00eam m\u0169i d\u1ecb \u1ee9ng ho\u1eb7c polyp m\u0169i.<\/p>\n

      – \u0110o h\u00f4 h\u1ea5p k\u00fd \u0111\u1ec3 ghi nh\u1eadn gi\u1edbi h\u1ea1n lu\u1ed3ng kh\u00ed th\u1edf ra dao \u0111\u1ed9ng<\/p>\n

      – C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c:<\/p>\n

      + Test k\u00edch th\u00edch ph\u1ebf qu\u1ea3n: d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 t\u0103ng t\u00ednh ph\u1ea3n \u1ee9ng c\u1ee7a \u0111\u01b0\u1eddng th\u1edf. C\u00e1c t\u00e1c nh\u00e2n k\u00edch th\u00edch bao g\u1ed3m methacholine h\u00edt, histamine, v\u1eadn \u0111\u1ed9ng, t\u0103ng th\u00f4ng kh\u00ed t\u1ef1 \u00fd v\u1edbi CO2 m\u00e1u b\u00ecnh th\u01b0\u1eddng ho\u1eb7c mannitol h\u00edt.<\/p>\n

      + Th\u1eed nghi\u1ec7m d\u1ecb \u1ee9ng: test l\u1ea9y da ho\u1eb7c \u0111\u1ecbnh l\u01b0\u1ee3ng n\u1ed3ng \u0111\u1ed9 immunoglobulin E (lgE) \u0111\u1eb7c hi\u1ec7u trong huy\u1ebft thanh v\u1edbi c\u00e1c d\u1ecb nguy\u00ean h\u00f4 h\u1ea5p th\u00f4ng th\u01b0\u1eddng \u0111\u1ec3 ph\u00e1t hi\u1ec7n t\u00ecnh tr\u1ea1ng qu\u00e1 m\u1eabn v\u1edbi c\u00e1c d\u1ecb nguy\u00ean n\u00e0y.<\/p>\n

      + \u0110o n\u1ed3ng \u0111\u1ed9 Oxit Nitric trong kh\u00ed th\u1edf ra (FENO).<\/p>\n

      2.4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/strong><\/p>\n

      – B\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh:<\/strong> ti\u1ec1n s\u1eed th\u01b0\u1eddng h\u00fat thu\u1ed1c l\u00e1, thu\u1ed1c l\u00e0o, ho kh\u1ea1c \u0111\u1eddm k\u00e9o d\u00e0i, kh\u00f3 th\u1edf li\u00ean t\u1ee5c, th\u0103m d\u00f2 CNTK ph\u1ed5i c\u00f3 RLTK t\u1eafc ngh\u1ebdn kh\u00f4ng h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n v\u1edbi c\u00e1c thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n.<\/p>\n

      – Suy tim<\/strong>: suy tim tr\u00e1i do t\u0103ng huy\u1ebft \u00e1p, h\u1eb9p van hai l\u00e1. H\u1ecfi ti\u1ec1n s\u1eed, kh\u00e1m l\u00e2m s\u00e0ng, ch\u1ee5p quang tim ph\u1ed5i, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 s\u1ebd gi\u00fap x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n.<\/p>\n

      – B\u1ea5t th\u01b0\u1eddng ho\u1eb7c t\u1eafc \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p<\/strong> do nhuy\u1ec5n s\u1ee5n ph\u1ebf qu\u1ea3n, u thanh – kh\u00ed – ph\u1ebf qu\u1ea3n, h\u1eb9p kh\u00ed ph\u1ebf qu\u1ea3n do ch\u00e8n \u00e9p, x\u01a1, d\u1ecb d\u1ea1ng quai \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, d\u1ecb v\u1eadt: kh\u00f3 th\u1edf, ti\u1ebfng r\u00edt c\u1ed1 \u0111\u1ecbnh kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n, h\u00ecnh \u1ea3nh \u0111\u1eb7c tr\u01b0ng tr\u00ean h\u00f4 h\u1ea5p k\u00fd.<\/p>\n

      – Tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n<\/strong> v\u1edbi ho, kh\u00f3 th\u1edf hay xu\u1ea5t hi\u1ec7n khi n\u1eb1m, c\u00fai ng\u01b0\u1eddi v\u1ec1 ph\u00eda tr\u01b0\u1edbc. Soi d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n gi\u00fap x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n.<\/p>\n

      – R\u00f2 th\u1ef1c qu\u1ea3n – kh\u00ed qu\u1ea3n<\/strong>: ho, kh\u00f3 th\u1edf hay xu\u1ea5t hi\u1ec7n, t\u0103ng l\u00ean khi \u0103n u\u1ed1ng. Soi, ch\u1ee5p th\u1ef1c qu\u1ea3n, d\u1ea1 d\u00e0y c\u00f3 c\u1ea3n quang gi\u00fap x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n.<\/p>\n

      – Gi\u00e3n ph\u1ebf qu\u1ea3n<\/strong>: th\u01b0\u1eddng c\u00f3 ho kh\u1ea1c \u0111\u1eddm t\u1eeb nhi\u1ec1u n\u0103m v\u1edbi nh\u1eefng \u0111\u1ee3t \u0111\u1eddm nh\u00e0y m\u1ee7. Ch\u1ee5p X-quang tim ph\u1ed5i chu\u1ea9n ho\u1eb7c ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh s\u1ebd x\u00e1c \u0111\u1ecbnh b\u1ec7nh.<\/p>\n

      2.5. Ch\u1ea9n \u0111o\u00e1n hen ph\u1ebf qu\u1ea3n khi b\u1ec7nh nh\u00e2n \u0111\u00e3 d\u00f9ng thu\u1ed1c ki\u1ec3m so\u00e1t hen<\/strong><\/p>\n

      V\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n HPQ, \u0111ang d\u00f9ng thu\u1ed1c ki\u1ec3m so\u00e1t, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh HPQ c\u00f3 th\u1ec3 g\u1eb7p kh\u00f3 kh\u0103n. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, vi\u1ec7c kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n th\u01b0\u1eddng d\u1ef1a v\u00e0o:<\/p>\n

      – Th\u0103m kh\u00e1m l\u00e2m s\u00e0ng, h\u1ecfi b\u1ec7nh s\u1eed, ti\u1ec1n s\u1eed b\u1ec7nh t\u1ef7 m\u1ef7, nh\u1eb1m t\u00ecm ki\u1ebfm c\u00e1c d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd ch\u1ea9n \u0111o\u00e1n hen<\/p>\n

      – H\u1ecfi ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng, ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi b\u1ecb HPQ?<\/p>\n

      – T\u00ecm ki\u1ebfm c\u00e1c b\u1eb1ng ch\u1ee9ng v\u1ec1 vi\u1ec7c \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n ho\u1eb7c corticoid;<\/p>\n

      – \u0110\u00e1nh gi\u00e1 c\u00e1c \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb hi\u1ec7n t\u1ea1i c\u00e1c thu\u1ed1c ki\u1ec3m so\u00e1t hen. N\u1ebfu \u0111\u00e1p \u1ee9ng\u0111i\u1ec1u tr\u1ecb t\u1ed1t th\u00ec xem \u0111\u00f3 l\u00e0 d\u1ea5u hi\u1ec7u quan tr\u1ecdng gi\u00fap kh\u1eb3ng \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n;<\/p>\n

      – N\u1ebfu b\u1ec7nh nh\u00e2n v\u1eabn \u0111ang c\u00f3 tri\u1ec7u ch\u1ee9ng, kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb hi\u1ec7n t\u1ea1i:\u00a0 xem x\u00e9t d\u1eebng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb duy tr\u00ec > 12h (ICS ho\u1eb7c ICS+LABA), d\u1eebng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n t\u00e1c d\u1ee5ng nhanh (SABA) > 6 gi\u1edd v\u00e0 ti\u1ebfn h\u00e0nh \u0111o CNTK ph\u1ed5i, l\u00e0m test h\u1ed3i ph\u1ee5c ph\u1ebf qu\u1ea3n;<\/p>\n

      – Xem x\u00e9t l\u00e0m test k\u00edch th\u00edch ph\u1ebf qu\u1ea3n cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 ti\u1ebfn h\u00e0nh c\u00e1c bi\u1ec7n ph\u00e1p n\u00eau tr\u00ean nh\u01b0ng v\u1eabn ch\u01b0a \u0111\u1ee7 c\u01a1 s\u1edf \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n HPQ.<\/p>\n

      2.6. Ch\u1ea9n \u0111o\u00e1n hen ph\u1ebf qu\u1ea3n \u1edf m\u1ed9t\u00a0 s\u1ed1 th\u1ec3 l\u00e2m s\u00e0ng<\/strong><\/p>\n

      2.6.1. Hen ph\u1ebf qu\u1ea3n v\u1edbi ho l\u00e0 tri\u1ec7u ch\u1ee9ng duy nh\u1ea5t<\/strong><\/p>\n

      Th\u1ec3 n\u00e0y \u0111\u1eb7c tr\u01b0ng b\u1edfi tri\u1ec7u ch\u1ee9ng ho, xu\u1ea5t hi\u1ec7n th\u00e0nh c\u01a1n, th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n khi thay \u0111\u1ed5i th\u1eddi ti\u1ebft, n\u1eeda \u0111\u00eam v\u1ec1 s\u00e1ng;<\/p>\n

      Th\u1ec3 b\u1ec7nh n\u00e0y \u0111\u00f4i khi kh\u00f3 ch\u1ea9n \u0111o\u00e1n, do b\u1ec7nh nh\u00e2n th\u01b0\u1eddng \u0111\u1ebfn kh\u00e1m b\u1ec7nh khi kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, k\u1ebft qu\u1ea3 \u0111o CNTK ph\u1ed5i b\u00ecnh th\u01b0\u1eddng. \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, c\u00f3 th\u1ec3 c\u1ea7n l\u00e0m test k\u00edch th\u00edch ph\u1ebf qu\u1ea3n, theo d\u00f5i dao \u0111\u1ed9ng l\u01b0u l\u01b0\u1ee3ng \u0111\u1ec9nh (LL\u0110) trong ng\u00e0y ho\u1eb7c c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb th\u1eed v\u1edbi thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n, ho\u1eb7c corticoid h\u00edt. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c kh\u1eb3ng \u0111\u1ecbnh HPQ khi c\u00f3 test k\u00edch th\u00edch ph\u1ebf qu\u1ea3n d\u01b0\u01a1ng t\u00ednh.<\/p>\n

      Khi ch\u1ea9n \u0111o\u00e1n HPQ th\u1ec3 ho l\u00e0 tri\u1ec7u ch\u1ee9ng duy nh\u1ea5t: c\u1ea7n l\u01b0u \u00fd lo\u1ea1i tr\u1eeb m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd g\u00e2y c\u00e1c tri\u1ec7u ch\u1ee9ng ho k\u00e9o d\u00e0i nh\u01b0: h\u1ed9i ch\u1ee9ng ch\u1ea3y d\u1ecbch t\u1eeb m\u0169i sau, vi\u00eam xoang m\u1ea1n, tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n (GERD), r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng d\u00e2y thanh, vi\u00eam ph\u1ebf qu\u1ea3n t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan.<\/p>\n

      2.6.2. B\u1ec7nh hen ngh\u1ec1 nghi\u1ec7p<\/strong><\/p>\n

      T\u1ea5t c\u1ea3 nh\u1eefng b\u1ec7nh nh\u00e2n HPQ kh\u1edfi ph\u00e1t \u1edf tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh \u0111\u1ec1u c\u1ea7n \u0111\u01b0\u1ee3c h\u1ecfi v\u1ec1:<\/p>\n

      – T\u00ecnh tr\u1ea1ng ph\u01a1i nhi\u1ec5m ngh\u1ec1 nghi\u1ec7p;<\/p>\n

      – B\u1ec7nh hen c\u00f3 tr\u1edf n\u00ean t\u1ed1t h\u01a1n khi tr\u00e1nh xa c\u00f4ng vi\u1ec7c kh\u00f4ng;<\/p>\n

      – Trong x\u1eed tr\u00ed: c\u1ea7n c\u00f3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh s\u1edbm v\u00e0 lo\u1ea1i tr\u1eeb ph\u01a1i nhi\u1ec5m ngh\u1ec1 nghi\u1ec7p c\u00e0ng nhanh c\u00e0ng t\u1ed1t.<\/p>\n

      2.6.3. Ph\u1ee5 n\u1eef mang thai<\/strong><\/p>\n

      Trong th\u1eddi k\u1ef3 thai ngh\u00e9n, t\u00ecnh tr\u1ea1ng ki\u1ec3m so\u00e1t hen c\u00f3 th\u1ec3 thay \u0111\u1ed5i, do \u0111\u00f3 c\u1ea7n h\u1ecfi v\u1ec1 b\u1ec7nh hen cho t\u1ea5t c\u1ea3 ph\u1ee5 n\u1eef mang thai v\u00e0 d\u1ef1 \u0111\u1ecbnh mang thai, v\u00e0 khuy\u1ebfn c\u00e1o h\u1ecd v\u1ec1 t\u1ea7m quan tr\u1ecdng c\u1ee7a \u0111i\u1ec1u tr\u1ecb hen v\u00ec s\u1ee9c kh\u1ecfe c\u1ea3 m\u1eb9 v\u00e0 b\u00e9.<\/p>\n

      2.6.4. Hen \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i<\/strong><\/p>\n

      HPQ c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0111\u1ea7y \u0111\u1ee7 \u1edf ng\u01b0\u1eddi gi\u00e0, do nh\u1eadn th\u1ee9c k\u00e9m, do \u0111\u1ecbnhki\u1ebfn r\u1eb1ng kh\u00f3 th\u1edf l\u00e0 b\u00ecnh th\u01b0\u1eddng \u1edf ng\u01b0\u1eddi gi\u00e0, do thi\u1ebfu t\u1eadp th\u1ec3 d\u1ee5c, hay gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng. B\u1ec7nh hen c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n qu\u00e1 m\u1ee9c do nh\u1ea7m l\u1eabn v\u1edbi kh\u00f3 th\u1edf do suy tim tr\u00e1i hay b\u1ec7nh tim do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9.<\/p>\n

      2.6.5. Hen \u1edf ng\u01b0\u1eddi h\u00fat thu\u1ed1c v\u00e0 nh\u1eefng ng\u01b0\u1eddi \u0111\u00e3 t\u1eebng h\u00fat thu\u1ed1c<\/strong><\/p>\n

      C\u00f3 th\u1ec3 g\u1eb7p c\u1ea3 HPQ, COPD, ho\u1eb7c ch\u1ed3ng l\u1ea5p hen-COPD (ACO), \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng ng\u01b0\u1eddi h\u00fat thu\u1ed1c l\u00e1 v\u00e0 ng\u01b0\u1eddi gi\u00e0. B\u1ec7nh s\u1eed, ki\u1ec3u h\u00ecnh c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00e1c ghi nh\u1eadn trong ti\u1ec1n s\u1eed b\u1ec7nh c\u00f3 th\u1ec3 gi\u00fap ph\u00e2n bi\u1ec7t HPQ v\u1edbi gi\u1edbi h\u1ea1n lu\u1ed3ng kh\u00ed c\u1ed1 \u0111\u1ecbnh trong COPD. Tr\u01b0\u1eddng h\u1ee3p ch\u1ea9n \u0111o\u00e1n kh\u00f4ng ch\u1eafc ch\u1eafn: c\u1ea7n chuy\u1ec3n s\u1edbm b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m c\u00e1c chuy\u00ean gia, ho\u1eb7c c\u00e1c c\u01a1 s\u1edf kh\u00e1m, \u0111i\u1ec1u tr\u1ecb chuy\u00ean khoa.<\/p>\n

      2.7. \u0110\u00e1nh gi\u00e1 hen ph\u1ebf qu\u1ea3n<\/strong><\/p>\n

      T\u1eadn d\u1ee5ng m\u1ecdi c\u01a1 h\u1ed9i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u1ea7y \u0111\u1ee7 khi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n HPQ, \u0111\u1eb7c bi\u1ec7t khi h\u1ecd c\u00f3 tri\u1ec7u ch\u1ee9ng hay sau m\u1ed9t \u0111\u1ee3t c\u1ea5p g\u1ea7n \u0111\u00e2y, c\u0169ng nh\u01b0 khi h\u1ecd y\u00eau c\u1ea7u k\u00ea \u0111\u01a1n thu\u1ed1c. Ngo\u00e0i ra, ph\u1ea3i l\u1eadp k\u1ebf ho\u1ea1ch ki\u1ec3m tra \u0111\u1ecbnh k\u1ef3 t\u1ed1i thi\u1ec3u m\u1ed7i n\u0103m m\u1ed9t l\u1ea7n.<\/p>\n

      2.7.1. \u0110\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng c\u1ee7a hen ph\u1ebf qu\u1ea3n<\/strong><\/p>\n

      2.7.2. Ki\u1ec3m so\u00e1t hen – \u0111\u00e1nh gi\u00e1 c\u1ea3 vi\u1ec7c ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1<\/strong><\/p>\n

      – \u0110\u00e1nh gi\u00e1 vi\u1ec7c ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng trong v\u00f2ng 4 tu\u1ea7n qua<\/p>\n

      – X\u00e1c \u0111\u1ecbnh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c d\u1eabn \u0111\u1ebfn k\u1ebft c\u1ee5c x\u1ea5u;<\/p>\n

      – \u0110o ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, 3-6 th\u00e1ng sau v\u00e0 \u0111\u1ecbnh k\u1ef3, v\u00ed d\u1ee5 h\u1eb1ng n\u0103m<\/p>\n

      2.7.3. C\u00f3 b\u1ec7nh \u0111\u1ed3ng m\u1eafc kh\u00f4ng<\/strong><\/p>\n

      – Bao g\u1ed3m: vi\u00eam m\u0169i, vi\u00eam m\u0169i xoang, tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n (GERD), b\u00e9o ph\u00ec, h\u1ed9i ch\u1ee9ng ng\u01b0ng th\u1edf khi ng\u1ee7, tr\u1ea7m c\u1ea3m, lo \u00e2u.<\/p>\n

      – B\u1ec7nh \u0111\u1ed3ng m\u1eafc n\u00ean c\u1ea7n \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n v\u00ec ch\u00fang c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n l\u00e0m t\u0103ng c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p, xu\u1ea5t hi\u1ec7n \u0111\u1ee3t c\u1ea5p v\u00e0 l\u00e0m gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.<\/p>\n

      – \u0110i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u1ed3ng m\u1eafc c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n c\u1ea3i thi\u1ec7n ki\u1ec3m so\u00e1t hen.<\/p>\n

      2.7.4. V\u1ea5n \u0111\u1ec1 \u0111i\u1ec1u tr\u1ecb<\/strong><\/p>\n

      – Ghi l\u1ea1i \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 h\u1ecfi v\u1ec1 t\u00e1c d\u1ee5ng ph\u1ee5<\/p>\n

      – Quan s\u00e1t b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng b\u00ecnh x\u1ecbt v\u00e0 ki\u1ec3m tra k\u1ef9 thu\u1eadt c\u1ee7a h\u1ecd<\/p>\n

      – Th\u1ea3o lu\u1eadn c\u1edfi m\u1edf v\u00e0 \u0111\u1ed3ng c\u1ea3m v\u1ec1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb<\/p>\n

      – Ki\u1ec3m tra b\u1ec7nh nh\u00e2n c\u00f3 b\u1ea3ng k\u1ebf ho\u1ea1ch h\u00e0nh \u0111\u1ed9ng cho hen<\/p>\n

      – H\u1ecfi ng\u01b0\u1eddi b\u1ec7nh v\u1ec1 th\u00e1i \u0111\u1ed9 v\u00e0 m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi b\u1ec7nh hen c\u1ee7a h\u1ecd<\/p>\n

      2.7.5. \u0110\u00e1nh gi\u00e1 \u0111\u1ed9 n\u1eb7ng c\u1ee7a hen ph\u1ebf qu\u1ea3n<\/strong><\/p>\n

      – M\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a hen \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 h\u1ed3i c\u1ee9u t\u1eeb m\u1ee9c \u0111i\u1ec1u tr\u1ecb c\u1ea7n thi\u1ebft \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 \u0111\u1ee3t c\u1ea5p. \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 hen c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n khi ng\u01b0\u1eddi b\u1ec7nh \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng xuy\u00ean v\u1edbi thu\u1ed1c ki\u1ec3m so\u00e1t trong v\u00e0i th\u00e1ng:<\/p>\n

      + Hen nh\u1eb9 l\u00e0 hen \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1eadc 1 ho\u1eb7c b\u1eadc 2, ngh\u0129a l\u00e0 ch\u1ec9 d\u00f9ng thu\u1ed1c ki\u1ec3m so\u00e1t khi c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c \u0111i\u1ec1u tr\u1ecb v\u1edbi c\u00e1c thu\u1ed1c ki\u1ec3m so\u00e1t nh\u01b0 ICS li\u1ec1u th\u1ea5p, kh\u00e1ng th\u1ee5 th\u1ec3 leukotriene (LTRA) ho\u1eb7c chromone.<\/p>\n

      + Hen trung b\u00ecnh l\u00e0 hen \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1eadc 3, v\u00ed d\u1ee5 nh\u01b0 v\u1edbi ICS\/LABA li\u1ec1u th\u1ea5p.<\/p>\n

      + Hen n\u1eb7ng l\u00e0 hen \u0111\u00f2i h\u1ecfi \u0111i\u1ec1u tr\u1ecb \u1edf b\u1eadc 4 ho\u1eb7c 5 \u0111\u1ec3 duy tr\u00ec s\u1ef1 ki\u1ec3m so\u00e1t ho\u1eb7c hen kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c d\u00f9 \u0111i\u1ec1u tr\u1ecb \u1edf m\u1ee9c n\u00e0y.<\/p>\n

      2.7.6.\u00a0 \u0110\u00e1nh gi\u00e1 ki\u1ec3m so\u00e1t hen<\/strong><\/p>\n

      Ki\u1ec3m so\u00e1t hen gi\u00fap h\u1ea1n ch\u1ebf, gi\u1ea3m \u1ea3nh h\u01b0\u1edfng c\u1ee7a hen c\u00f3 th\u1ec3 quan s\u00e1t th\u1ea5y \u0111\u01b0\u1ee3c tr\u00ean b\u1ec7nh nh\u00e2n do \u0111i\u1ec1u tr\u1ecb. Ki\u1ec3m so\u00e1t hen g\u1ed3m c\u00f3 hai v\u1ea5n \u0111\u1ec1: ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 gi\u1ea3m y\u1ebfu t\u1ed1 nguy c\u01a1 l\u00e0m b\u1ec7nh x\u1ea5u h\u01a1n trong t\u01b0\u01a1ng lai.<\/p>\n

      \"\"<\/p>\n

      2.7.6.1. Vai tr\u00f2 c\u1ee7a ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p trong theo d\u00f5i hen ph\u1ebf qu\u1ea3n<\/strong><\/p>\n

      Khi \u0111\u00e3 c\u00f3 ch\u1ea9n \u0111o\u00e1n hen, ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p r\u1ea5t h\u1eefu \u00edch v\u1edbi vai tr\u00f2 l\u00e0 m\u1ed9t ch\u1ec9 s\u1ed1 quan tr\u1ecdng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c nguy c\u01a1 t\u01b0\u01a1ng lai. FEV1 th\u1ea5p l\u00e0 d\u1ea5u hi\u1ec7u d\u1ef1 b\u00e1o \u0111\u1ed9c l\u1eadp nguy c\u01a1 \u0111\u1ee3t c\u1ea5p, nh\u1ea5t l\u00e0 khi FEV1 < 60% d\u1ef1 \u0111o\u00e1n.<\/p>\n

      Ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p c\u1ea7n \u0111\u01b0\u1ee3c \u0111o khi kh\u00e1m, ch\u1ea9n \u0111o\u00e1n b\u1ec7nh; sau 3-6 th\u00e1ng \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u1ecbnh k\u1ef3 sau \u0111\u00f3. H\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n khi \u0111\u00e3 \u1ed5n \u0111\u1ecbnh v\u1eabn c\u1ea7n \u0111\u01b0\u1ee3c \u0111o ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p \u0111\u1ecbnh k\u1ef3. Vi\u1ec7c \u0111o ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh th\u01b0\u1eddng xuy\u00ean h\u01a1n v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao xu\u1ea5t hi\u1ec7n \u0111\u1ee3t c\u1ea5p, ho\u1eb7c gi\u1ea3m ch\u1ee9c n\u0103ng ph\u1ed5i.<\/p>\n

      Khi \u0111\u00e3 c\u00f3 ch\u1ea9n \u0111o\u00e1n hen, theo d\u00f5i LL\u0110 ng\u1eafn h\u1ea1n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, x\u00e1c \u0111\u1ecbnh hen tr\u1edf n\u1eb7ng. Sau \u0111i\u1ec1u tr\u1ecb ICS, LL\u0110 s\u1ebd \u0111\u1ea1t m\u1ee9c trung b\u00ecnh 2 tu\u1ea7n, v\u00e0 ti\u1ebfp t\u1ee5c t\u0103ng trong kho\u1ea3ng 3 th\u00e1ng. Theo d\u00f5i LL\u0110 d\u00e0i h\u1ea1n th\u01b0\u1eddng \u00e1p d\u1ee5ng trong hen n\u1eb7ng, tr\u00ean l\u00e2m s\u00e0ng, ch\u1ec9 s\u1ed1 LL\u0110 gi\u00fap h\u1ed7 tr\u1ee3 trong t\u01b0 v\u1ea5n ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

      2.7.6.2. \u00a0C\u00e1c \u0111\u00e1nh gi\u00e1 c\u1ea7n thi\u1ebft cho b\u1ec7nh nh\u00e2n hen kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t<\/strong><\/p>\n

      H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n \u0111\u1ea1t ki\u1ec3m so\u00e1t hen t\u1ed1t nh\u1edd \u0111i\u1ec1u tr\u1ecb \u0111\u00fang, tr\u00e1nh y\u1ebfu t\u1ed1 nguy c\u01a1, v\u00e0 kh\u00e1m \u0111\u1ecbnh k\u1ef3. Tuy nhi\u00ean, v\u1eabn c\u00f3 nhi\u1ec1u b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t hen ph\u1ebf qu\u1ea3n. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u00f3: c\u1ea7n ti\u1ebfn h\u00e0nh c\u00e1c th\u0103m d\u00f2 theo l\u01b0\u1ee3c \u0111\u1ed3 sau<\/p>\n

      \"\"
      S\u01a1 \u0111\u1ed3 c\u00e1c \u0111\u00e1nh gi\u00e1 c\u1ea7n thi\u1ebft cho hen kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t<\/figcaption><\/figure>\n

      Ngu\u1ed3n<\/strong>: H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb hen ph\u1ebf qu\u1ea3n ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em \u2265 12 tu\u1ed5i c\u1ee7a\u00a0B\u1ed9 Y T\u1ebf2020.<\/p>\n","protected":false},"excerpt":{"rendered":"

      Ng\u00e0y 24\/04\/2020, B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u1ebf \u0111\u00e3 k\u00fd Quy\u1ebft \u0111\u1ecbnh s\u1ed1 1851Q\u0110-BYT ban h\u00e0nh H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb hen ph\u1ebf qu\u1ea3n ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em \u2265 12 tu\u1ed5i. \u0110\u00e2y l\u00e0 t\u00e0i li\u1ec7u chuy\u00ean m\u00f4n quan tr\u1ecdng, l\u00e0m c\u01a1 s\u1edf cho c\u00e1n b\u1ed9 y t\u1ebf th\u1ef1c h\u00e0nh chuy\u00ean m\u00f4n kh\u00e1m b\u1ec7nh, […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[3],"yoast_head":"\nH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n hen ph\u1ebf qu\u1ea3n \u1edf ng\u01b0\u1eddi l\u1edbn - Vinmec<\/title>\n<meta name=\"description\" content=\"Hen ph\u1ebf qu\u1ea3n (HPQ) l\u00e0 m\u1ed9t b\u1ec7nh c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 vi\u00eam m\u1ea1n t\u00ednh ni\u00eam m\u1ea1c ph\u1ebf qu\u1ea3n l\u00e0m t\u0103ng ph\u1ea3n \u1ee9ng c\u1ee7a ph\u1ebf qu\u1ea3n th\u01b0\u1eddng xuy\u00ean v\u1edbi nhi\u1ec1u t\u00e1c nh\u00e2n\" \/>\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\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n hen ph\u1ebf qu\u1ea3n \u1edf ng\u01b0\u1eddi l\u1edbn - 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