{"id":18311,"date":"2023-04-13T22:48:41","date_gmt":"2023-04-13T15:48:41","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=18311"},"modified":"2023-04-18T15:32:01","modified_gmt":"2023-04-18T08:32:01","slug":"dieu-tri-hen","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/13\/dieu-tri-hen\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb 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 1851 Q\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 \u0111i\u1ec1u hen ph\u1ebf qu\u1ea3n \u1edf ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em \u2265 12 tu\u1ed5i c\u1ee7a B\u1ed9 Y t\u1ebf 2020.<\/p>\n

1.C\u00e1c nguy\u00ean t\u1eafc c\u1ee7a \u0111i\u1ec1u tr\u1ecb hen ph\u1ebf qu\u1ea3n<\/strong><\/h1>\n

1.1. M\u1ee5c ti\u00eau d\u00e0i h\u1ea1n c\u1ee7a \u0111i\u1ec1u tr\u1ecb hen ph\u1ebf qu\u1ea3n<\/strong><\/h3>\n

– Ki\u1ec3m so\u00e1t t\u1ed1t tri\u1ec7u ch\u1ee9ng hen v\u00e0 duy tr\u00ec kh\u1ea3 n\u0103ng ho\u1ea1t \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng<\/p>\n

– Gi\u1ea3m thi\u1ec3u nguy c\u01a1 trong t\u01b0\u01a1ng lai g\u1ed3m t\u1eed vong do hen, \u0111\u1ee3t c\u1ea5p, gi\u1edbi h\u1ea1n lu\u1ed3ng kh\u00ed dai d\u1eb3ng v\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c<\/p>\n

1.2. S\u1ef1 h\u1ee3p t\u00e1c gi\u1eefa b\u1ec7nh nh\u00e2n \u2013 nh\u00e2n vi\u00ean y t\u1ebf<\/strong><\/h3>\n

– \u0110i\u1ec1u tr\u1ecb hen hi\u1ec7u qu\u1ea3 \u0111\u00f2i h\u1ecfi s\u1ef1 h\u1ee3p t\u00e1c gi\u1eefa b\u1ec7nh nh\u00e2n v\u00e0 nh\u00e2n vi\u00ean y t\u1ebf. \u0110i\u1ec1u n\u00e0y gi\u00fap b\u1ec7nh nh\u00e2n c\u00f3 ki\u1ebfn th\u1ee9c v\u1ec1 b\u1ec7nh hen, c\u00f3 k\u1ef9 n\u0103ng s\u1eed d\u1ee5ng b\u00ecnh h\u00edt v\u00e0 t\u1ef1 tin trong x\u1eed tr\u00ed b\u1ec7nh hen. Nh\u00e2n vi\u00ean y t\u1ebf n\u00ean cho ph\u00e9p b\u1ec7nh nh\u00e2n tham gia trong c\u00e1c quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb hen, b\u00e0y t\u1ecf mong mu\u1ed1n v\u00e0 th\u1eafc m\u1eafc li\u00ean quan \u0111\u1ebfn b\u1ec7nh hen c\u1ee7a m\u00ecnh.<\/p>\n

– Kh\u1ea3 n\u0103ng giao ti\u1ebfp t\u1ed1t c\u1ee7a nh\u00e2n vi\u00ean y t\u1ebf: nh\u00e2n vi\u00ean y t\u1ebf n\u00ean \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n \u0111\u1ec3 c\u1ea3i thi\u1ec7n k\u1ef9 n\u0103ng giao ti\u1ebfp v\u1edbi b\u1ec7nh nh\u00e2n. Nh\u00e2n vi\u00ean y t\u1ebf c\u00f3 k\u1ef9 n\u0103ng giao ti\u1ebfp t\u1ed1t s\u1ebd t\u0103ng s\u1ef1 h\u00e0i l\u00f2ng c\u1ee7a b\u1ec7nh nh\u00e2n, t\u0103ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, gi\u1ea3m chi ph\u00ed y t\u1ebf, c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n m\u00e0 kh\u00f4ng t\u0103ng th\u1eddi gian t\u01b0 v\u1ea5n.<\/p>\n

– Ki\u1ebfn th\u1ee9c v\u1ec1 b\u1ec7nh hen c\u1ee7a b\u1ec7nh nh\u00e2n: ki\u1ebfn th\u1ee9c c\u1ee7a b\u1ec7nh nh\u00e2n v\u1ec1 b\u1ec7nh hen th\u1ea5p c\u00f3 th\u1ec3 khi\u1ebfn hen kh\u00f3 ki\u1ec3m so\u00e1t. T\u00f9y ho\u00e0n c\u1ea3nh v\u00e0 t\u00f9y t\u1eebng b\u1ec7nh nh\u00e2n m\u00e0 nh\u00e2n vi\u00ean y t\u1ebf n\u00ean c\u00f3 c\u00e1c bi\u1ec7n ph\u00e1p ph\u00f9 h\u1ee3p \u0111\u1ec3 cung c\u1ea5p ki\u1ebfn th\u1ee9c v\u1ec1 hen cho b\u1ec7nh nh\u00e2n nh\u1eb1m c\u1ea3i thi\u1ec7n tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, h\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n c\u00e1ch s\u1eed d\u1ee5ng \u0111\u00fang b\u00ecnh h\u00edt. Vi\u1ec7c gi\u00e1o d\u1ee5c v\u00e0 h\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n t\u1ea1i m\u1ed7i l\u1ea7n th\u0103m kh\u00e1m ho\u1eb7c t\u1ea1i c\u00e1c bu\u1ed5i sinh ho\u1ea1t c\u00e2u l\u1ea1c b\u1ed9 b\u1ec7nh nh\u00e2n hen.<\/p>\n

1.3. Chu tr\u00ecnh \u0111i\u1ec1u tr\u1ecb hen ph\u1ebf qu\u1ea3n<\/strong>\u00a0gi\u00fap gi\u1ea3m y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng: \u0110i\u1ec1u tr\u1ecb hen l\u00e0 chu tr\u00ecnh li\u00ean t\u1ee5c bao g\u1ed3m: \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n, \u0111i\u1ec1u ch\u1ec9nh tr\u1ecb li\u1ec7u v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng.<\/p>\n

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Chu tr\u00ecnh x\u1eed tr\u00ed hen d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 ki\u1ec3m so\u00e1t<\/figcaption><\/figure>\n

\u0110\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n:<\/strong> kh\u00f4ng ch\u1ec9 bao g\u1ed3m \u0111\u00e1nh gi\u00e1 tri\u1ec7u ch\u1ee9ng m\u00e0 c\u00f2n bao g\u1ed3m \u0111\u00e1nh gi\u00e1 y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0 b\u1ec7nh \u0111\u1ed3ng m\u1eafc c\u1ee7a m\u1ed7i b\u1ec7nh nh\u00e2n, c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n l\u00e0m gia t\u0103ng g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt, s\u1ee9c kh\u1ecfe, v\u00e0 d\u1ef1 b\u00e1o m\u1ee9c \u0111\u1ed9 k\u00e9m \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb. N\u00ean l\u01b0u t\u00e2m t\u1edbi m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb c\u1ee7a m\u1ed7i b\u1ec7nh nh\u00e2n.<\/p>\n

\u0110i\u1ec1u tr\u1ecb: nh\u1eb1m ng\u0103n ng\u1eeba \u0111\u1ee3t c\u1ea5p v\u00e0 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng. \u0110i\u1ec1u tr\u1ecb bao g\u1ed3m:<\/p>\n

– Thu\u1ed1c: GINA hi\u1ec7n khuy\u1ebfn c\u00e1o t\u1ea5t c\u1ea3 ng\u01b0\u1eddi l\u1edbn, tr\u1ebb l\u1edbn c\u00f3 hen ph\u1ebf qu\u1ea3n n\u00ean \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ki\u1ec3m so\u00e1t hen c\u00f3 ICS \u2013 gi\u00fap gi\u1ea3m c\u00e1c \u0111\u1ee3t c\u1ea5p n\u1eb7ng, th\u1eadm ch\u00ed v\u1edbi c\u1ea3 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng kh\u00f4ng th\u01b0\u1eddng xuy\u00ean. T\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n ph\u1ea3i c\u00f3 thu\u1ed1c c\u1eaft c\u01a1n mang theo b\u00ean m\u00ecnh trong m\u1ecdi l\u00fac, m\u1ecdi n\u01a1i.<\/p>\n

– Ph\u00f2ng tr\u00e1nh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc;<\/p>\n

– S\u1eed d\u1ee5ng c\u00e1c li\u1ec7u ph\u00e1p kh\u00f4ng d\u00f9ng thu\u1ed1c ph\u00f9 h\u1ee3p. L\u01b0u \u00fd: c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ec1u n\u00ean \u0111\u01b0\u1ee3c t\u1eadp hu\u1ea5n v\u1ec1 k\u1ef9 n\u0103ng c\u01a1 b\u1ea3n trong qu\u1ea3n l\u00fd hen bao g\u1ed3m:<\/p>\n

– Ki\u1ebfn th\u1ee9c v\u1ec1 hen;<\/p>\n

– K\u1ef9 thu\u1eadt d\u00f9ng thu\u1ed1c d\u1ea1ng phun – h\u00edt;<\/p>\n

– Tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb;<\/p>\n

– L\u1eadp k\u1ebf ho\u1ea1ch h\u00e0nh \u0111\u1ed9ng hen;<\/p>\n

– T\u1ef1 theo d\u00f5i tri\u1ec7u ch\u1ee9ng v\u00e0\/ ho\u1eb7c v\u1edbi l\u01b0u l\u01b0\u1ee3ng \u0111\u1ec9nh k\u1ebf;<\/p>\n

– Kh\u00e1m l\u1ea1i \u0111\u1ecbnh k\u1ef3.<\/p>\n

– \u0110\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng: n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1ea5t c\u1ee9 khi n\u00e0o c\u1ea7n xem x\u00e9t thay \u0111\u1ed5i \u0111i\u1ec1u tr\u1ecb. C\u00e1c \u0111\u00e1nh gi\u00e1 bao g\u1ed3m: \u0111\u00e1nh gi\u00e1 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng, \u0111\u1ee3t c\u1ea5p, t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c, ch\u1ee9c n\u0103ng ph\u1ed5i v\u00e0 s\u1ef1 h\u00e0i l\u00f2ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

2. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb v\u00e0 chi\u1ebfn l\u01b0\u1ee3c ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 gi\u1ea3m nguy c\u01a1<\/strong><\/h2>\n

2.1. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb hen<\/strong><\/h3>\n

Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb hen d\u00e0i h\u1ea1n \u0111\u01b0\u1ee3c chia th\u00e0nh 3 lo\u1ea1i ch\u00ednh:<\/p>\n

– Thu\u1ed1c ki\u1ec3m so\u00e1t hen: l\u00e0 c\u00e1c thu\u1ed1c d\u00f9ng duy tr\u00ec \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh hen gi\u00fap l\u00e0m gi\u1ea3m nguy c\u01a1 \u0111\u1ee3t c\u1ea5p v\u00e0 s\u1ee5t gi\u1ea3m ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p nh\u1edd t\u00e1c d\u1ee5ng gi\u1ea3m t\u00ecnh tr\u1ea1ng vi\u00eam \u0111\u01b0\u1eddng th\u1edf.<\/p>\n

– Thu\u1ed1c c\u1eaft c\u01a1n hen: l\u00e0 c\u00e1c thu\u1ed1c ch\u1ec9 d\u00f9ng \u0111\u1ec3 c\u1eaft c\u01a1n hen v\u00e0 gi\u1ea3m tri\u1ec7u ch\u1ee9ng, khi b\u1ec7nh nh\u00e2n c\u00f3 c\u01a1n kh\u00f3 th\u1edf ho\u1eb7c \u0111\u1ee3t c\u1ea5p hen. Gi\u1ea3m nhu c\u1ea7u ho\u1eb7c kh\u00f4ng c\u1ea7n d\u00f9ng thu\u1ed1c c\u1eaft c\u01a1n hen l\u00e0 m\u1ee5c ti\u00eau quan tr\u1ecdng c\u1ee7a \u0111i\u1ec1u tr\u1ecb hen.<\/p>\n

– Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p \u0111\u1ed1i v\u1edbi hen n\u1eb7ng: \u0111\u00e2y l\u00e0 c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c xem x\u00e9t khi b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng hen dai d\u1eb3ng v\u00e0\/ho\u1eb7c v\u1eabn c\u00f2n \u0111\u1ee3t c\u1ea5p d\u00f9 \u0111\u00e3 t\u1ed1i \u01b0u h\u00f3a \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec1u cao ICS\/LABA v\u00e0 \u0111\u00e3 ph\u00f2ng tr\u00e1nh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1.<\/p>\n

2.2. \u0110i\u1ec1u tr\u1ecb ban \u0111\u1ea7u b\u1eb1ng thu\u1ed1c ki\u1ec3m so\u00e1t hen <\/strong><\/h3>\n

\u0110\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng t\u1ed1t nh\u1ea5t, b\u1ec7nh nh\u00e2n n\u00ean b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c ki\u1ec3m so\u00e1t hen c\u00f3 ch\u1ee9a ICS c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t ngay sau khi hen \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n.<\/p>\n

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Li\u1ec1u ICS t\u01b0\u01a1ng \u0111\u01b0\u01a1ng h\u00e0ng ng\u00e0y \u1edf ng\u01b0\u1eddi l\u1edbn (\u00b5g)<\/figcaption><\/figure>\n

M\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c ki\u1ec3m so\u00e1t hen hi\u1ec7n c\u00f3 tr\u00ean th\u1ecb tr\u01b0\u1eddng Vi\u1ec7t Nam:<\/p>\n

– Formoterol\/budesonide 4,5\/160 mcg; 4,5\/80 mcg; d\u1ea1ng DPI<\/p>\n

– Formoterol\/budesonide 4,5\/160 mcg; 4,5\/80 mcg; 2,25\/80 d\u1ea1ng pMDI<\/p>\n

– Salmeterol\/fluticasone propionate 25\/50; 25\/125; 25\/250 mcg d\u1ea1ng pMDI<\/p>\n

– Salmeterol\/fluticasone propionate 50\/100; 50\/250; 50\/500 mcg d\u1ea1ng DPI<\/p>\n

– Fluticasone propionate 125 mcg d\u1ea1ng pMDI – Fluticasone propionate 0,5 mg\/2 ml d\u1ea1ng phun kh\u00ed dung – Budesonide 0,5 mg\/2 ml v\u00e0 0,5 mg\/ml d\u1ea1ng phun kh\u00ed dung<\/p>\n

2.3.<\/strong> \u0110i\u1ec1u ch\u1ec9nh \u0111i\u1ec1u tr\u1ecb hen theo b\u1eadc <\/strong><\/h3>\n

\u0110\u1ed1i v\u1edbi m\u1ed7i b\u1ec7nh nh\u00e2n, m\u1ed9t khi \u0111\u00e3 kh\u1edfi \u0111\u1ed9ng \u0111i\u1ec1u tr\u1ecb hen, thu\u1ed1c ki\u1ec3m so\u00e1t hen s\u1ebd \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh b\u1eb1ng c\u00e1ch t\u0103ng ho\u1eb7c gi\u1ea3m b\u1eadc nh\u1eb1m ki\u1ec3m so\u00e1t t\u1ed1t tri\u1ec7u ch\u1ee9ng v\u00e0 gi\u1ea3m thi\u1ec3u nguy c\u01a1 trong t\u01b0\u01a1ng lai g\u1ed3m \u0111\u1ee3t c\u1ea5p, gi\u1edbi h\u1ea1n lu\u1ed3ng kh\u00ed dai d\u1eb3ng v\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c<\/p>\n

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T\u0103ng ho\u1eb7c gi\u1ea3m b\u1eadc thu\u1ed1c ki\u1ec3m so\u00e1t hen \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 gi\u1ea3m thi\u1ec3u nguy c\u01a1<\/figcaption><\/figure>\n

Ch\u1ecdn li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb hen<\/strong>: T\u1ea1i m\u1ed7i b\u1eadc \u0111i\u1ec1u tr\u1ecb hen, c\u00f3 v\u00e0i lo\u1ea1i thu\u1ed1c ki\u1ec3m so\u00e1t hen kh\u00e1c nhau, tuy hi\u1ec7u qu\u1ea3 kh\u00f4ng gi\u1ed1ng nhau, t\u00f9y b\u00e1c s\u0129 l\u1ef1a ch\u1ecdn.<\/p>\n

Thu\u1ed1c ki\u1ec3m so\u00e1t hen \u01b0u ti\u00ean l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n hen v\u00ec ch\u00fang \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh hi\u1ec7u qu\u1ea3 trong ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 gi\u1ea3m nguy c\u01a1 \u0111\u1ee3t c\u1ea5p qua c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng. Tuy nhi\u00ean, vi\u1ec7c l\u1ef1a ch\u1ecdn thu\u1ed1c ki\u1ec3m so\u00e1t hen n\u00e0o cho t\u1eebng b\u1ec7nh nh\u00e2n c\u00f2n ph\u1ea3i xem x\u00e9t c\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c nh\u01b0: thu\u1ed1c c\u00f3 s\u1eb5n, gi\u00e1 th\u00e0nh, kh\u1ea3 n\u0103ng s\u1eed d\u1ee5ng b\u00ecnh h\u00edt t\u01b0\u01a1ng \u1ee9ng, kh\u1ea3 n\u0103ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c \u0111\u00f3, kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c v\u00e0 th\u00f3i quen c\u1ee7a b\u1ec7nh nh\u00e2n<\/p>\n

2.4. \u0110\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng v\u00e0 \u0111i\u1ec1u ch\u1ec9nh \u0111i\u1ec1u tr\u1ecb<\/strong><\/h3>\n

B\u1ec7nh nh\u00e2n hen n\u00ean t\u00e1i kh\u00e1m \u0111\u1ecbnh k\u1ef3 \u0111\u1ec3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 ki\u1ec3m so\u00e1t hen, s\u1ef1 t\u1ed3n t\u1ea1i y\u1ebfu t\u1ed1 nguy c\u01a1, s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a \u0111\u1ee3t c\u1ea5p v\u00e0 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb hi\u1ec7n t\u1ea1i.<\/p>\n

Khi kh\u1edfi \u0111\u1ed9ng \u0111i\u1ec1u tr\u1ecb ki\u1ec3m so\u00e1t hen, ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n hen c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng trong v\u00f2ng v\u00e0i ng\u00e0y, nh\u01b0ng \u0111\u00e1p \u1ee9ng t\u1ed1i \u0111a c\u00f3 khi c\u1ea7n t\u1edbi 3-4 th\u00e1ng.<\/p>\n

Hen l\u00e0 m\u1ed9t b\u1ec7nh thay \u0111\u1ed5i theo th\u1eddi gian n\u00ean vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh \u0111i\u1ec1u tr\u1ecb l\u00e0 c\u1ea7n thi\u1ebft.<\/p>\n

2.4.1. T\u0103ng b\u1eadc \u0111i\u1ec1u tr\u1ecb <\/strong><\/p>\n

T\u0103ng b\u1eadc d\u00e0i h\u1ea1n (trong \u00edt nh\u1ea5t 2-3 th\u00e1ng): b\u1ec7nh nh\u00e2n v\u1eabn c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0\/ ho\u1eb7c \u0111\u1ee3t c\u1ea5p b\u1ea5t ch\u1ea5p vi\u1ec7c \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb thu\u1ed1c ki\u1ec3m so\u00e1t hen 2-3 th\u00e1ng, c\u1ea7n \u0111\u00e1nh gi\u00e1c c\u00e1c y\u1ebfu t\u1ed1 sau tr\u01b0\u1edbc khi t\u0103ng b\u1eadc d\u00e0i h\u1ea1n:<\/p>\n

– K\u1ef9 thu\u1eadt d\u00f9ng thu\u1ed1c phun \u2013 h\u00edt;<\/p>\n

– Tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb;<\/p>\n

– C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1;<\/p>\n

– Tri\u1ec7u ch\u1ee9ng do b\u1ec7nh \u0111\u1ed3ng m\u1eafc … v\u00ed d\u1ee5 vi\u00eam m\u0169i d\u1ecb \u1ee9ng, GERD. T\u0103ng b\u1eadc ng\u1eafn h\u1ea1n (trong 1-2 tu\u1ea7n): do b\u00e1c s\u0129, ho\u1eb7c b\u1ec7nh nh\u00e2n th\u1ef1c hi\u1ec7n theo k\u1ebf ho\u1ea1ch h\u00e0nh \u0111\u1ed9ng hen, th\u01b0\u1eddng trong nh\u1eefng \u0111\u1ee3t nhi\u1ec5m vi r\u00fat ho\u1eb7c ph\u01a1i nhi\u1ec5m d\u1ecb nguy\u00ean theo m\u00f9a. C\u00f3 th\u1ec3 t\u0103ng li\u1ec1u ICS duy tr\u00ec l\u00ean g\u1ea5p 4 l\u1ea7n trong 1-2 tu\u1ea7n. \u0110i\u1ec1u ch\u1ec9nh t\u1eebng ng\u00e0y: do b\u1ec7nh nh\u00e2n t\u1ef1 th\u1ef1c hi\u1ec7n khi \u0111\u01b0\u1ee3c k\u00ea li\u1ec1u th\u1ea5p ICS\/formoterol d\u00f9ng khi c\u1ea7n cho hen nh\u1eb9, ho\u1eb7c li\u1ec1u th\u1ea5p ICS\/formoterol d\u00f9ng duy tr\u00ec v\u00e0 c\u1eaft c\u01a1n.<\/p>\n

2.4.2. Gi\u1ea3m b\u1eadc \u0111i\u1ec1u tr\u1ecb khi hen \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n <\/strong><\/p>\n

– Gi\u1ea3m b\u1eadc khi hen ph\u1ebf qu\u1ea3n \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t, \u0111\u1ea1t \u0111\u01b0\u1ee3c trong 3 th\u00e1ng. Vi\u1ec7c gi\u1ea3m b\u1eadc nh\u1eb1m t\u00ecm li\u1ec1u ICS th\u1ea5p nh\u1ea5t (li\u1ec1u hi\u1ec7u qu\u1ea3 t\u1ed1i thi\u1ec3u) m\u00e0 v\u1eabn \u0111\u1ea3m b\u1ea3o ki\u1ec3m so\u00e1t c\u1ea3 tri\u1ec7u ch\u1ee9ng v\u00e0 \u0111\u1ee3t c\u1ea5p, \u0111\u1ed3ng th\u1eddi gi\u1ea3m t\u00e1c d\u1ee5ng ph\u1ee5. M\u1ed9t s\u1ed1 l\u01b0u \u00fd:<\/p>\n

– Ch\u1ecdn th\u1eddi \u0111i\u1ec3m th\u00edch h\u1ee3p \u0111\u1ec3 gi\u1ea3m b\u1eadc (kh\u00f4ng nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p, kh\u00f4ng \u0111i du l\u1ecbch, kh\u00f4ng c\u00f3 thai) khi th\u1eddi ti\u1ebft kh\u00f4ng thu\u1eadn l\u1ee3i.<\/p>\n

– Ghi nh\u1eadn \u0111\u1ea7y \u0111\u1ee7 t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n (tri\u1ec7u ch\u1ee9ng, ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p), c\u00f3 k\u1ebf ho\u1ea1ch h\u00e0nh \u0111\u1ed9ng hen, theo d\u00f5i ch\u1eb7t ch\u1ebd v\u00e0 h\u1eb9n kh\u00e1m l\u1ea1i;<\/p>\n

– Gi\u1ea3m li\u1ec1u ICS 25-50% m\u1ed7i 2-3 th\u00e1ng;<\/p>\n

– N\u1ebfu hen \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u1edbi li\u1ec1u th\u1ea5p ICS ho\u1eb7c LTRA, gi\u1ea3m li\u1ec1u v\u1ec1 li\u1ec1u hi\u1ec7u qu\u1ea3 t\u1ed1i thi\u1ec3u ICS ho\u1eb7c d\u00f9ng li\u1ec1u th\u1ea5p ICS \/formoterol khi c\u1ea7n;<\/p>\n

– Kh\u00f4ng d\u1eebng ho\u00e0n to\u00e0n ICS \u1edf ng\u01b0\u1eddi l\u1edbn ho\u1eb7c tr\u1ebb l\u1edbn khi \u0111\u00e3 ch\u1ea9n \u0111o\u00e1n hen tr\u1eeb khi c\u1ea7n d\u1eebng t\u1ea1m th\u1eddi \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 l\u1ea1i ch\u1ea9n \u0111o\u00e1n;<\/p>\n

– N\u1ebfu gi\u1ea3m b\u1eadc qu\u00e1 nhi\u1ec1u ho\u1eb7c qu\u00e1 nhanh ho\u1eb7c n\u1ebfu ng\u01b0ng ho\u00e0n to\u00e0n ICS th\u00ec nguy c\u01a1 \u0111\u1ee3t c\u1ea5p s\u1ebd t\u0103ng l\u00ean.<\/p>\n

– C\u1ea7n ch\u1eafc ch\u1eafn \u0111\u00e3 h\u1eb9n kh\u00e1m \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 l\u1ea1i<\/p>\n

\"\"
C\u00e1c l\u1ef1a ch\u1ecdn gi\u1ea3m b\u1eadc khi hen \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n<\/figcaption><\/figure>\n

2.5. Qu\u1ea3n l\u00fd c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 thay \u0111\u1ed5i \u0111\u01b0\u1ee3c kh\u00e1c<\/strong><\/h3>\n

B\u00ean c\u1ea1nh t\u1ed1i \u01b0u h\u00f3a thu\u1ed1c \u0111i\u1ec1u tr\u1ecb hen, nh\u1eadn bi\u1ebft v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 thay \u0111\u1ed5i \u0111\u01b0\u1ee3c c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n gi\u1ea3m thi\u1ec3u nguy c\u01a1 \u0111\u1ee3t c\u1ea5p hen.<\/p>\n

B\u1ec7nh nh\u00e2n c\u00f3 b\u1ea5t k\u1ef3 y\u1ebfu t\u1ed1 nguy c\u01a1 cho \u0111\u1ee3t c\u1ea5p hen:<\/strong><\/p>\n

– Nh\u1eadn d\u1ea1ng y\u1ebfu t\u1ed1 nguy c\u01a1 c\u00f3 th\u1ec3 thay \u0111\u1ed5i \u0111\u01b0\u1ee3c v\u00e0 \u0111i\u1ec1u ch\u1ec9nh y\u1ebfu t\u1ed1 \u0111\u00f3 n\u1ebfu \u0111\u01b0\u1ee3c.<\/p>\n

– B\u1ea3o \u0111\u1ea3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c ki\u1ec3m so\u00e1t hen c\u00f3 ch\u1ee9a ICS; cung c\u1ea5p k\u1ebf ho\u1ea1ch h\u00e0nh \u0111\u1ed9ng hen ph\u00f9 h\u1ee3p cho t\u1eebng b\u1ec7nh nh\u00e2n; ki\u1ec3m tra k\u1ef9 thu\u1eadt h\u00edt v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 tu\u00e2n th\u1ee7; h\u1eb9n t\u00e1i kh\u00e1m th\u01b0\u1eddng xuy\u00ean h\u01a1n.<\/p>\n

B\u1ec7nh nh\u00e2n c\u00f3 \u00edt nh\u1ea5t 1 \u0111\u1ee3t c\u1ea5p hen trong n\u0103m qua<\/strong>:<\/p>\n

D\u00f9ng li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb hen ph\u00f9 h\u1ee3p \u0111\u1ec3 gi\u1ea3m thi\u1ec3u \u0111\u1ee3t c\u1ea5p nh\u01b0 li\u1ec7u ph\u00e1p li\u1ec1u th\u1ea5p ICS\/formoterol v\u1eeba duy tr\u00ec v\u1eeba c\u1eaft c\u01a1n trong m\u1ed9t b\u00ecnh h\u00edt; ho\u1eb7c t\u0103ng b\u1eadc \u0111i\u1ec1u tr\u1ecb n\u1ebfu kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 c\u00f3 th\u1ec3 thay \u0111\u1ed5i \u0111\u01b0\u1ee3c.<\/p>\n

B\u1ec7nh nh\u00e2n c\u00f3 FEV1 th\u1ea5p:<\/strong><\/p>\n

Th\u1eed li\u1ec1u cao ICS trong 3 th\u00e1ng. L\u01b0u \u00fd lo\u1ea1i tr\u1eeb b\u1ec7nh ph\u1ed5i kh\u00e1c nh\u01b0 COPD, gi\u00e3n ph\u1ebf qu\u1ea3n.<\/p>\n

Cai thu\u1ed1c l\u00e1<\/strong>: khuy\u1ebfn kh\u00edch ng\u01b0\u1eddi h\u00fat thu\u1ed1c ng\u01b0ng h\u00fat thu\u1ed1c t\u1ea1i m\u1ed7i l\u1ea7n th\u0103m kh\u00e1m, t\u01b0 v\u1ea5n ho\u1eb7c gi\u1edbi thi\u1ec7u b\u1ec7nh nh\u00e2n \u0111\u1ebfn n\u01a1i cung c\u1ea5p d\u1ecbch v\u1ee5 cai thu\u1ed1c l\u00e1.<\/p>\n

Khuy\u1ebfn kh\u00edch b\u1ec7nh nh\u00e2n hen tr\u00e1nh ph\u01a1i nhi\u1ec5m th\u1ee5 \u0111\u1ed9ng v\u1edbi kh\u00f3i thu\u1ed1c l\u00e1.<\/p>\n

T\u1eadp luy\u1ec7n th\u1ec3 l\u1ef1c<\/strong>: khuy\u1ebfn kh\u00edch b\u1ec7nh nh\u00e2n hen tham gia t\u1eadp luy\u1ec7n th\u1ec3 l\u1ef1c v\u00ec n\u00f3 c\u1ea3i thi\u1ec7n s\u1ee9c kho\u1ebb chung.<\/p>\n

H\u01b0\u1edbng d\u1eabn c\u00e1ch x\u1eed tr\u00ed co th\u1eaft ph\u1ebf qu\u1ea3n do g\u1eafng s\u1ee9c.<\/p>\n

Tr\u00e1nh c\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 l\u00e0m b\u1ec7nh hen n\u1eb7ng l\u00ean: lu\u00f4n h\u1ecfi v\u1ec1 b\u1ec7nh hen tr\u01b0\u1edbc khi k\u00ea thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid ho\u1eb7c thu\u1ed1c ch\u1eb9n beta. Tr\u00e1nh s\u1eed d\u1ee5ng n\u1ebfu c\u00e1c thu\u1ed1c n\u00e0y l\u00e0m cho hen n\u1eb7ng l\u00ean. Khi b\u1ec7nh nh\u00e2n hen c\u00f3 h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p th\u00ec c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta ch\u1ecdn l\u1ecdc cho tim m\u1ea1ch n\u1ebfu l\u1ee3i nhi\u1ec1u h\u01a1n h\u1ea1i.<\/p>\n

Ch\u1ebf \u0111\u1ed9 \u0103n ph\u00f9 h\u1ee3p: khuy\u1ebfn kh\u00edch b\u1ec7nh nh\u00e2n hen \u0103n th\u1ee9c \u0103n ch\u1ee9a nhi\u1ec1u rau v\u00e0 tr\u00e1i c\u00e2y t\u01b0\u01a1i v\u00ec n\u00f3 t\u1ed1t cho s\u1ee9c kho\u1ebb chung. Kh\u00f4ng d\u00f9ng c\u00e1c th\u1ee9c \u0103n c\u00f3 nguy c\u01a1 g\u00e2y d\u1ecb \u1ee9ng.<\/p>\n

Tuy\u1ec7t \u0111\u1ed1i tr\u00e1nh \u0103n nh\u1eefng th\u1ee9c \u0103n \u0111\u00e3 bi\u1ebft g\u00e2y d\u1ecb \u1ee9ng cho b\u1ec7nh nh\u00e2n.<\/p>\n

Tr\u00e1nh \u00f4 nhi\u1ec5m kh\u00f4ng kh\u00ed trong nh\u00e0: khuy\u1ebfn kh\u00edch b\u1ec7nh nh\u00e2n hen kh\u00f4ng s\u1eed d\u1ee5ng bi\u1ec7n ph\u00e1p \u0111un n\u1ea5u g\u00e2y \u00f4 nhi\u1ec5m kh\u00f4ng kh\u00ed trong nh\u00e0 ho\u1eb7c ph\u1ea3i th\u00f4ng kh\u00ed t\u1ed1t ra ngo\u00e0i n\u1ebfu ph\u1ea3i s\u1eed d\u1ee5ng.<\/p>\n

Tr\u00e1nh \u00f4 nhi\u1ec5m kh\u00f4ng kh\u00ed ngo\u00e0i nh\u00e0: tr\u00e1nh ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c c\u01b0\u1eddng \u0111\u1ed9 cao ngo\u00e0i tr\u1eddi khi kh\u00f4ng kh\u00ed b\u1ecb \u00f4 nhi\u1ec5m n\u1eb7ng, th\u1eddi ti\u1ebft qu\u00e1 l\u1ea1nh ho\u1eb7c \u0111\u1ed9 \u1ea9m th\u1ea5p; tr\u00e1nh m\u00f4i tr\u01b0\u1eddng \u0111\u00f4ng ng\u01b0\u1eddi trong nh\u1eefng \u0111\u1ee3t vi-r\u00fat h\u00f4 h\u1ea5p \u0111ang l\u00e2y lan.<\/p>\n

\u0110\u1ed1i ph\u00f3 v\u1edbi c\u1ea3m x\u00fac: t\u0103ng th\u00f4ng kh\u00ed khi c\u01b0\u1eddi to, kh\u00f3c, gi\u1eadn d\u1eef ho\u1eb7c s\u1ee3 h\u00e3i c\u00f3 th\u1ec3 kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng hen n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng d\u00f9ng thu\u1ed1c ki\u1ec3m so\u00e1t hen. Trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00f3, khuy\u1ebfn kh\u00edch b\u1ec7nh nh\u00e2n c\u00f3 chi\u1ebfn l\u01b0\u1ee3c \u0111\u1ed1i ph\u00f3 v\u1edbi c\u1ea3m x\u00fac nh\u01b0 t\u1eadp th\u01b0 gi\u00e3n ho\u1eb7c h\u00edt th\u1edf ph\u00f9 h\u1ee3p.<\/p>\n

Tr\u00e1nh y\u1ebfu t\u1ed1 k\u00edch ph\u00e1t c\u01a1n hen kh\u00e1c: cung c\u1ea5p cho b\u1ec7nh nh\u00e2n t\u1edd r\u01a1i li\u1ec7t k\u00ea c\u00e1c y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 k\u00edch ph\u00e1t c\u01a1n hen \u0111\u1ec3 b\u1ec7nh nh\u00e2n nh\u1eadn bi\u1ebft v\u00e0 tr\u00e1nh ti\u1ebfp x\u00fac n\u1ebfu \u0111\u01b0\u1ee3c.<\/p>\n

Ti\u00eam ph\u00f2ng c m: m\u1ed7i n\u0103m m\u1ed9t l\u1ea7n nh\u1eb1m gi\u1ea3m \u0111\u1ee3t c\u1ea5p hen.<\/p>\n

2.6. C\u00e1c \u0111i\u1ec1u tr\u1ecb kh\u00e1c<\/strong><\/h3>\n

2.6.1. Li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch \u0111\u1eb7c hi\u1ec7u <\/strong><\/p>\n

Li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn khi d\u1ecb \u1ee9ng \u0111\u00f3ng m\u1ed9t vai tr\u00f2 n\u1ed5i tr\u1ed9i trong hen, bao g\u1ed3m hen k\u1ebft h\u1ee3p v\u1edbi vi\u00eam m\u0169i xoang d\u1ecb \u1ee9ng. Hi\u1ec7n c\u00f3 2 ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0 li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch \u0111\u1eb7c hi\u1ec7u d\u01b0\u1edbi da (SCIT) v\u00e0 li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch \u0111\u1eb7c hi\u1ec7u d\u01b0\u1edbi l\u01b0\u1ee1i (SLIT).<\/p>\n

Theo h\u01b0\u1edbng d\u1eabn c\u1ee7a GINA, C\u00e2n nh\u1eafc ph\u1ed1i h\u1ee3p th\u00eam SLIT \u1edf ng\u01b0\u1eddi b\u1ec7nh hen tr\u01b0\u1edfng th\u00e0nh c\u00f3 m\u1eafc k\u00e8m VMDU v\u00e0 m\u1eabn c\u1ea3m v\u1edbi m\u1ea1t b\u1ecd nh\u00e0 v\u1edbi tri\u1ec7u ch\u1ee9ng hen dai d\u1eb3ng b\u1ea5t ch\u1ea5p \u0111i\u1ec1u tr\u1ecb ki\u1ec3m so\u00e1t v\u1edbi ICS li\u1ec1u th\u1ea5p-trung b\u00ecnh v\u00e0 FEV1>70% d\u1ef1 \u0111o\u00e1n.<\/p>\n

2.6.2. Vitamin D <\/strong><\/p>\n

B\u1ed5 sung Vitamin D \u1edf ng\u01b0\u1eddi b\u1ec7nh hen v\u1edbi n\u1ed3ng \u0111\u1ed9 25(OH)D c\u01a1 b\u1ea3n < 25 nmol\/L gi\u00fap gi\u1ea3m t\u1ef7 l\u1ec7 \u0111\u1ee3t hen c\u1ea5p \u0111\u00f2i h\u1ecfi \u0111i\u1ec1u tr\u1ecb v\u1edbi OCS.<\/p>\n

2.7. Ch\u1ec9 \u0111\u1ecbnh chuy\u1ec3n tuy\u1ebfn tr\u00ean \u0111\u1ec3 kh\u00e1m chuy\u00ean khoa<\/strong><\/h3>\n

Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n hen c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c qu\u1ea3n l\u00fd v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u1ea1i y t\u1ebf c\u01a1 s\u1edf. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p sau c\u00f3 th\u1ec3 xem x\u00e9t chuy\u1ec3n tuy\u1ebfn tr\u00ean \u0111\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0\/ho\u1eb7c \u0111i\u1ec1u tr\u1ecb:<\/p>\n

– Kh\u00f3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh hen<\/p>\n

– Nghi ng\u1edd hen ngh\u1ec1 nghi\u1ec7p<\/p>\n

– Th\u01b0\u1eddng xuy\u00ean c\u00f3 \u0111\u1ee3t c\u1ea5p ho\u1eb7c hen v\u1eabn kh\u00f4ng ki\u1ec3m so\u00e1t d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb b\u1eadc 4<\/p>\n

– C\u00f3 b\u1ea5t k\u1ef3 y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y t\u1eed vong do hen nh\u01b0 ti\u1ec1n s\u1eed \u0111\u1ee3t c\u1ea5p ph\u1ea3i th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc, ph\u1ea3n v\u1ec7, d\u1ecb \u1ee9ng th\u1ee9c \u0103n \u0111\u00e3 x\u00e1c \u0111\u1ecbnh<\/p>\n

– B\u1eb1ng ch\u1ee9ng ho\u1eb7c nguy c\u01a1 b\u1ecb t\u00e1c d\u1ee5ng ph\u1ee5 \u0111\u00e1ng k\u1ec3 c\u1ee7a \u0111i\u1ec1u tr\u1ecb nh\u01b0 ph\u1ea3i d\u00f9ng corticoid u\u1ed1ng th\u01b0\u1eddng xuy\u00ean ho\u1eb7c l\u00e2u d\u00e0i<\/p>\n

– Tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd bi\u1ebfn ch\u1ee9ng ho\u1eb7c ki\u1ec3u h\u00ecnh hen \u0111\u1eb7c bi\u1ec7t nh\u01b0 b\u1ec7nh h\u00f4 h\u1ea5p b\u00f9ng ph\u00e1t do aspirin, nhi\u1ec5m n\u1ea5m aspergillus ph\u1ebf qu\u1ea3n ph\u1ed5i d\u1ecb \u1ee9ng.<\/p>\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 B\u1ed9 Y t\u1ebf 2020<\/p>\n

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

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