{"id":33271,"date":"2023-05-13T14:40:58","date_gmt":"2023-05-13T07:40:58","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=33271"},"modified":"2023-05-13T14:40:58","modified_gmt":"2023-05-13T07:40:58","slug":"thuoc-khang-muscarinic","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/13\/thuoc-khang-muscarinic\/","title":{"rendered":"Thu\u1ed1c kh\u00e1ng Muscarinic th\u01b0\u1eddng d\u00f9ng trong COPD"},"content":{"rendered":"

Thu\u1ed1c kh\u00e1ng Muscarinic c\u0169ng nh\u01b0 c\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1c nh\u01b0 beta agonists, \u0111\u1ec1u c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb COPD. Do \u0111\u00f3, vi\u1ec7c hi\u1ec3u \u0111\u01b0\u1ee3c m\u1ed9t s\u1ed1 thu\u1ed1c c\u01a1 b\u1ea3n trong nh\u00f3m Muscarinic s\u1ebd h\u1ed7 tr\u1ee3 trong vi\u1ec7c s\u1eed d\u1ee5ng \u0111i\u1ec1u tr\u1ecb c\u0169ng nh\u01b0 d\u1ef1 ph\u00f2ng.<\/strong><\/p>\n

1. \u00a0T\u1ed5ng quan thu\u1ed1c kh\u00e1ng Muscarinic<\/strong><\/h1>\n

C\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1ng muscarinic l\u00e0 m\u1ed9t ph\u1ea7n quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh ph\u1ed5i m\u00e3n t\u00ednh (COPD) v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 h\u00f4 h\u1ea5p. C\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch ch\u1eb7n ch\u1ea5t acetylcholine trong ph\u1ebf qu\u1ea3n, gi\u00fap l\u00e0m gi\u1ea3m s\u1ef1 co th\u1eaft c\u1ee7a ch\u00fang v\u00e0 gi\u1ea3m kh\u00f3 th\u1edf. C\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u1ed1i kh\u00e1ng muscarinic \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng c\u1ee7a COPD v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng ph\u1ed5i. C\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y bao g\u1ed3m Ipratropium, Tiotropium, Umeclidinium v\u00e0 Aclidinium bromide. B\u00ean c\u1ea1nh \u0111\u00f3, c\u00e1c lo\u1ea1i thu\u1ed1c beta-agonists v\u00e0 corticosteroids c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng c\u1ee7a COPD. Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi \u0111\u1ed1i kh\u00e1ng muscarinic \u0111\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

2. C\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1ng Muscarinic kh\u00e1c<\/strong><\/h2>\n

2.1. Ipratropium (Khi c\u00f3 link s\u1ebd g\u1eafn sau)<\/strong><\/h3>\n

2.2. Tiotropium<\/strong><\/h3>\n
\"\"
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Ngu\u1ed3n: Medscape<\/strong><\/figcaption><\/figure>\n

Tiotropium l\u00e0 ch\u1ea5t \u0111\u1ed1i kh\u00e1ng muscarinic t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i (LAMA) v\u1edbi t\u00ednh ch\u1ecdn l\u1ecdc M1 v\u00e0 M3. Tiotropium li\u00ean k\u1ebft v\u1edbi c\u1ea3 ba th\u1ee5 th\u1ec3 muscarinic, nh\u01b0ng n\u00f3 r\u1eddi kh\u1ecfi th\u1ee5 th\u1ec3 M2 kh\u00e1 nhanh m\u00e0 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 M1 v\u00e0 M3. Do \u0111\u00f3, tiotropium c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i th\u1ebf v\u1ec1 m\u1eb7t l\u00fd thuy\u1ebft so v\u1edbi ipratropium bromide v\u00ec s\u1ef1 \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 M2 s\u1ebd c\u00f3 t\u00e1c d\u1ee5ng co th\u1eaft ph\u1ebf qu\u1ea3n.<\/p>\n

Ch\u1ebf ph\u1ea9m b\u1ed9t kh\u00f4 \u0111\u01b0\u1ee3c d\u00f9ng qua thi\u1ebft b\u1ecb h\u00edt vi\u00ean nang (HandiHaler), 18 mcg m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y. D\u1ea1ng s\u01b0\u01a1ng m\u1ec1m (Respimat) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng d\u01b0\u1edbi d\u1ea1ng hai l\u1ea7n h\u00edt 2.5 mcg (t\u1ed5ng c\u1ed9ng 5 mcg) m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y. T\u00f9y thu\u1ed9c v\u00e0o qu\u1ed1c gia, c\u00f3 th\u1ec3 c\u00f3 s\u1eb5n m\u1ed9t ho\u1eb7c c\u1ea3 hai lo\u1ea1i \u1ed1ng h\u00edt n\u00e0y.<\/p>\n

Tiotropium c\u00f3 t\u00e1c d\u1ee5ng l\u00e2u h\u01a1n ipratropium v\u00e0 cho ph\u00e9p m\u1ed9t l\u1ecbch d\u00f9ng thu\u1ed1c thu\u1eadn ti\u1ec7n h\u01a1n cho b\u1ec7nh nh\u00e2n COPD. M\u1ed9t nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ecdn ng\u1eabu nhi\u00ean 288 b\u1ec7nh nh\u00e2n m\u1eafc COPD n\u1eb7ng \u0111\u1ec3 nh\u1eadn tiotropium m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y ho\u1eb7c ipratropium b\u1ed1n l\u1ea7n m\u1ed7i ng\u00e0y. \u0110\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 gi\u00e3n ph\u1ebf qu\u1ea3n l\u1edbn h\u01a1n \u0111\u00e1ng k\u1ec3 v\u00e0 l\u01b0\u1ee3ng albuterol \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u00edt h\u01a1n \u0111\u00e1ng k\u1ec3 \u1edf nh\u00f3m d\u00f9ng tiotropium.<\/p>\n

\u0110i\u1ec1u tr\u1ecb li\u00ean t\u1ee5c v\u1edbi tiotropium d\u01b0\u1eddng nh\u01b0 \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t v\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn gi\u1ea3m kh\u00f3 th\u1edf, c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng, \u00edt \u0111\u1ee3t c\u1ea5p t\u00ednh h\u01a1n, gi\u1ea3m c\u0103ng ph\u1ed3ng ph\u1ed5i v\u00e0 c\u1ea3i thi\u1ec7n \u0111\u1ed9 b\u00e3o h\u00f2a oxy \u0111\u1ed9ng m\u1ea1ch qua \u0111\u00eam so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. M\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p 22 th\u1eed nghi\u1ec7m v\u1edbi 23.309 ng\u01b0\u1eddi tham gia cho th\u1ea5y li\u1ec7u ph\u00e1p tiotropium gi\u00fap c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng trung b\u00ecnh (ch\u00eanh l\u1ec7ch trung b\u00ecnh [MD] -2,89, KTC 95% -3,35 \u0111\u1ebfn -2,44) v\u00e0 gi\u1ea3m \u0111\u00e1ng k\u1ec3 s\u1ed1 l\u01b0\u1ee3ng ng\u01b0\u1eddi tham gia b\u1ecb \u0111\u1ee3t c\u1ea5p (OR 0.78, KTC 95% 0.70-0.87). Trong ph\u00e2n t\u00edch n\u00e0y, s\u1ed1 l\u01b0\u1ee3ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 c\u00f3 l\u1ee3i (NNTB) l\u00e0 16 \u0111\u1ec3 ng\u0103n ng\u1eeba m\u1ed9t \u0111\u1ee3t c\u1ea5p. Tiotropium c\u0169ng l\u00e0m gi\u1ea3m c\u00e1c \u0111\u1ee3t c\u1ea5p d\u1eabn \u0111\u1ebfn nh\u1eadp vi\u1ec7n nh\u01b0ng kh\u00f4ng t\u00ecm th\u1ea5y s\u1ef1 kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 v\u1ec1 nh\u1eadp vi\u1ec7n do b\u1ea5t k\u1ef3 nguy\u00ean nh\u00e2n n\u00e0o ho\u1eb7c t\u1ef7 l\u1ec7 t\u1eed vong.<\/p>\n

Vi\u1ec7c thi\u1ebfu \u0111\u00e1p \u1ee9ng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n ngay l\u1eadp t\u1ee9c v\u1edbi tiotropium kh\u00f4ng t\u01b0\u01a1ng quan v\u1edbi k\u1ebft qu\u1ea3 c\u1ee7a li\u1ec7u ph\u00e1p k\u00e9o d\u00e0i. \u0110i\u1ec1u n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh trong m\u1ed9t th\u1eed nghi\u1ec7m \u0111\u1ed1i ch\u1ee9ng ng\u1eabu nhi\u00ean l\u1edbn so s\u00e1nh m\u1ed9t n\u0103m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng tiotropium v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. Vi\u1ec7c c\u00f3 hay kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n v\u00e0o ng\u00e0y \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean kh\u00f4ng d\u1ef1 \u0111o\u00e1n \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 l\u00e2u d\u00e0i, v\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng tiotropium \u0111\u00e3 c\u1ea3i thi\u1ec7n ph\u1ebf dung k\u1ebf v\u00e0 \u00edt kh\u00f3 th\u1edf ch\u1ee7 quan h\u01a1n so v\u1edbi b\u1ec7nh nh\u00e2n \u0111\u1ed1i ch\u1ee9ng b\u1ea5t k\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi li\u1ec1u \u0111\u1ea7u ti\u00ean.<\/p>\n

Trong m\u1ed9t t\u1ed5ng quan h\u1ec7 th\u1ed1ng so s\u00e1nh tiotropium v\u1edbi ipratropium \u1edf b\u1ec7nh nh\u00e2n COPD (n = 1073), tiotropium c\u00f3 li\u00ean quan \u0111\u1ebfn c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng ph\u1ed5i, \u00edt nh\u1eadp vi\u1ec7n h\u01a1n, \u00edt \u0111\u1ee3t c\u1ea5p h\u01a1n c\u1ee7a COPD v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng. Quan s\u00e1t n\u00e0y h\u1ed7 tr\u1ee3 c\u00e1c khuy\u1ebfn ngh\u1ecb trong h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c c\u00e1c tri\u1ec7u ch\u1ee9ng khi s\u1eed d\u1ee5ng thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n t\u00e1c d\u1ee5ng ng\u1eafn ng\u1eaft qu\u00e3ng.<\/p>\n

Tiotropium, gi\u1ed1ng nh\u01b0 ipratropium, d\u01b0\u1eddng nh\u01b0 mang l\u1ea1i hi\u1ec7u qu\u1ea3 gi\u00e3n ph\u1ebf qu\u1ea3n v\u01b0\u1ee3t tr\u1ed9i v\u00e0 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng kh\u00f3 th\u1edf khi so s\u00e1nh v\u1edbi c\u00e1c thu\u1ed1c ch\u1ee7 v\u1eadn beta t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u1ed5n \u0111\u1ecbnh. \u0110i\u1ec1u n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh trong m\u1ed9t th\u1eed nghi\u1ec7m l\u1edbn g\u1ed3m ba nh\u00f3m so s\u00e1nh tiotropium v\u1edbi thu\u1ed1c ch\u1ee7 v\u1eadn beta t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i salmeterol v\u00e0 gi\u1ea3 d\u01b0\u1ee3c \u1edf h\u01a1n 1200 b\u1ec7nh nh\u00e2n m\u1eafc COPD. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng tiotropium l\u00e0m ch\u1eadm \u0111\u00e1ng k\u1ec3 th\u1eddi gian cho \u0111\u1ebfn \u0111\u1ee3t c\u1ea5p \u0111\u1ea7u ti\u00ean v\u00e0 \u00edt \u0111\u1ee3t c\u1ea5p h\u01a1n m\u1ed7i n\u0103m so v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng salmeterol ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c.<\/p>\n

V\u1ec1 l\u00e2u d\u00e0i, tiotropium c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng ph\u1ed5i v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng, \u0111\u1ed3ng th\u1eddi l\u00e0m gi\u1ea3m nguy c\u01a1 \u0111\u1ee3t c\u1ea5p, nh\u01b0ng kh\u00f4ng l\u00e0m gi\u1ea3m t\u1ed1c \u0111\u1ed9 gi\u1ea3m th\u1ec3 t\u00edch th\u1edf ra g\u1eafng s\u1ee9c trong m\u1ed9t gi\u00e2y (FEV1). \u0110i\u1ec1u n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh trong m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean k\u00e9o d\u00e0i b\u1ed1n n\u0103m, Hi\u1ec3u bi\u1ebft v\u1ec1 T\u00e1c \u0111\u1ed9ng L\u00e2u d\u00e0i Ti\u1ec1m \u1ea9n \u0111\u1ed1i v\u1edbi Ch\u1ee9c n\u0103ng v\u1edbi Tiotropium (Understanding Potential Long -Term Impacts on Function with Tiotropium – UPLIFT), so s\u00e1nh tiotropium d\u1ea1ng h\u00edt v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e9p d\u00f9ng c\u00e1c lo\u1ea1i thu\u1ed1c h\u00f4 h\u1ea5p kh\u00e1c n\u1ebfu c\u1ea7n.<\/p>\n

M\u1ed9t ph\u00e2n t\u00edch s\u00e2u h\u01a1n v\u1ec1 th\u1eed nghi\u1ec7m UPLIFT cho th\u1ea5y l\u1ee3i \u00edch c\u1ee7a tiotropium (so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c) \u0111\u1ed1i v\u1edbi FEV1 tr\u01b0\u1edbc v\u00e0 sau thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n, nguy c\u01a1 \u0111\u1ee3t c\u1ea5p v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng hi\u1ec7n di\u1ec7n b\u1ea5t k\u1ec3 t\u00ecnh tr\u1ea1ng h\u00fat thu\u1ed1c, m\u1eb7c d\u00f9 m\u1ee9c \u0111\u1ed9 c\u1ee7a l\u1ee3i \u00edch kh\u00e1c nhau gi\u1eefa nh\u1eefng ng\u01b0\u1eddi h\u00fat thu\u1ed1c hi\u1ec7n t\u1ea1i, nh\u1eefng ng\u01b0\u1eddi h\u00fat thu\u1ed1c kh\u00f4ng li\u00ean t\u1ee5c, v\u00e0 nh\u1eefng ng\u01b0\u1eddi h\u00fat thu\u1ed1c c\u0169 ti\u1ebfp t\u1ee5c.<\/p>\n

2.3. Umeclidinium<\/strong><\/h3>\n
\"\"
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Ngu\u1ed3n: Drugs<\/strong><\/figcaption><\/figure>\n

Umeclidinium l\u00e0 m\u1ed9t ch\u1ea5t \u0111\u1ed1i kh\u00e1ng muscarinic t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i (LAMA) ho\u1ea1t \u0111\u1ed9ng t\u1ed1t h\u01a1n tr\u00ean th\u1ee5 th\u1ec3 M3 muscarinic, t\u01b0\u01a1ng t\u1ef1 nh\u01b0 tiotropium. \u0110\u1ec9nh \u0111i\u1ec3m c\u1ee7a s\u1ef1 gi\u00e3n ph\u1ebf qu\u1ea3n l\u00e0 ba gi\u1edd sau m\u1ed9t li\u1ec1u v\u00e0 duy tr\u00ec trong 24 gi\u1edd. Th\u1eddi gian t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i, \u00edt nh\u1ea5t l\u00e0 m\u1ed9t ph\u1ea7n, l\u00e0 do th\u1eddi gian l\u01b0u tr\u00fa k\u00e9o d\u00e0i c\u1ee7a ph\u00e2n t\u1eed tr\u00ean th\u1ee5 th\u1ec3 M3.<\/p>\n

Trong m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean k\u00e9o d\u00e0i 28 ng\u00e0y, ba li\u1ec1u umeclidinium m\u1ed7i ng\u00e0y m\u1ed9t l\u1ea7n (125 mcg, 250 mcg, 500 mcg) \u0111\u01b0\u1ee3c so s\u00e1nh v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. C\u1ea3 ba li\u1ec1u umeclidinium \u0111\u1ec1u t\u0103ng \u0111\u00e1ng k\u1ec3 th\u1ec3 t\u00edch th\u1edf ra g\u1eafng s\u1ee9c trong m\u1ed9t gi\u00e2y (FEV1) (150 \u0111\u1ebfn 160 mL) v\u00e0o 24 gi\u1edd sau li\u1ec1u cu\u1ed1i c\u00f9ng v\u00e0o c\u00e1c ng\u00e0y 2, 14, 28 v\u00e0 29, \u0111\u1ed3ng th\u1eddi gi\u1ea3m s\u1eed d\u1ee5ng salbutamol (albuterol) c\u1ea5p c\u1ee9u trong nghi\u00ean c\u1ee9u. Nh\u00ecn chung, c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 \u1edf nh\u00f3m 125 mcg v\u00e0 250 mcg kh\u00f4ng kh\u00e1c bi\u1ec7t so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c, nh\u01b0ng t\u0103ng l\u00ean \u1edf nh\u00f3m 500 mcg. Ho v\u00e0 \u0111au \u0111\u1ea7u t\u0103ng t\u1ea7n su\u1ea5t \u1edf li\u1ec1u cao h\u01a1n.<\/p>\n

Umeclidinium c\u00f3 s\u1eb5n \u1edf d\u1ea1ng thu\u1ed1c h\u00edt k\u1ebft h\u1ee3p, umeclidinium-vilanterol (62,5 mcg\/25 mcg), \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn s\u1eed d\u1ee5ng trong b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u00e3n t\u00ednh. Li\u1ec1u l\u01b0\u1ee3ng umeclidinium trong \u1ed1ng h\u00edt n\u00e0y th\u1ea5p h\u01a1n li\u1ec1u l\u01b0\u1ee3ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong nghi\u00ean c\u1ee9u v\u1ec1 ph\u1ea1m vi li\u1ec1u l\u01b0\u1ee3ng \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u1edf tr\u00ean.<\/p>\n

2.4. Aclidinium bromide<\/strong><\/h3>\n
\"\"
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Ngu\u1ed3n: MIMS<\/strong><\/figcaption><\/figure>\n

Aclidinium bromide l\u00e0 m\u1ed9t ch\u1ea5t \u0111\u1ed1i kh\u00e1ng muscarinic t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i (LAMA) \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc th\u1ee5 th\u1ec3 muscarinic M3. Aclidinium t\u00e1c d\u1ee5ng l\u00e2u h\u01a1n ipratropium, nh\u01b0ng t\u00e1c d\u1ee5ng ng\u1eafn h\u01a1n tiotropium. N\u00f3 \u0111\u01b0\u1ee3c d\u00f9ng qua \u1ed1ng h\u00edt b\u1ed9t kh\u00f4 (Tudorza Pressair) v\u1edbi li\u1ec1u 400 mcg hai l\u1ea7n m\u1ed7i ng\u00e0y. Ban \u0111\u1ea7u n\u00f3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n d\u01b0\u1edbi d\u1ea1ng thu\u1ed1c d\u00f9ng m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y, nh\u01b0ng nghi\u00ean c\u1ee9u s\u00e2u h\u01a1n cho th\u1ea5y hi\u1ec7u qu\u1ea3 t\u1ed1t h\u01a1n v\u1edbi l\u1ecbch tr\u00ecnh d\u00f9ng thu\u1ed1c hai l\u1ea7n m\u1ed7i ng\u00e0y.<\/p>\n

H\u1ed7 tr\u1ee3 cho vi\u1ec7c s\u1eed d\u1ee5ng aclidinium trong b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u00e3n t\u00ednh \u1ed5n \u0111\u1ecbnh (COPD) \u0111\u1ebfn t\u1eeb m\u1ed9t s\u1ed1 th\u1eed nghi\u1ec7m:<\/p>\n

    \n
  • Trong m\u1ed9t th\u1eed nghi\u1ec7m k\u00e9o d\u00e0i 24 tu\u1ea7n, nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u1ea1n t\u00ednh v\u00e0 h\u1ea1n ch\u1ebf lu\u1ed3ng kh\u00ed t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng (th\u1ec3 t\u00edch th\u1edf ra g\u1eafng s\u1ee9c trong m\u1ed9t gi\u00e2y [FEV1] <80% d\u1ef1 \u0111o\u00e1n) \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ng\u1eabu nhi\u00ean d\u00f9ng aclidinium hai l\u1ea7n m\u1ed7i ng\u00e0y (200 mcg ho\u1eb7c 400 mcg) ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c. Nh\u1eefng c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 v\u1ec1 FEV1 \u0111\u00e1y v\u00e0 \u0111\u1ec9nh \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn v\u1edbi c\u1ea3 hai li\u1ec1u aclidinium v\u00e0 nh\u1eefng c\u1ea3i thi\u1ec7n FEV1 \u0111\u1ec9nh trong tu\u1ea7n 24 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ng\u00e0y \u0111\u1ea7u ti\u00ean. T\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1eb1ng b\u1ea3ng c\u00e2u h\u1ecfi v\u00e0 t\u00ecnh tr\u1ea1ng kh\u00f3 th\u1edf c\u0169ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c.<\/li>\n
  • Trong m\u1ed9t th\u1eed nghi\u1ec7m nh\u1ecf, aclidinium 400 mcg hai l\u1ea7n m\u1ed7i ng\u00e0y \u0111\u01b0\u1ee3c so s\u00e1nh v\u1edbi tiotropium 18 mcg m\u1ed9t l\u1ea7n m\u1ed7i ng\u00e0y. V\u1edbi c\u1ea3 hai lo\u1ea1i thu\u1ed1c, s\u1ef1 c\u1ea3i thi\u1ec7n v\u1ec1 FEV1 l\u1edbn h\u01a1n so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c nh\u01b0ng kh\u00f4ng kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 v\u1edbi nhau.<\/li>\n
  • Trong m\u1ed9t th\u1eed nghi\u1ec7m ch\u01b0a \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1, aclidinium 400 mcg hai l\u1ea7n m\u1ed7i ng\u00e0y \u0111\u01b0\u1ee3c so s\u00e1nh v\u1edbi thu\u1ed1c ch\u1ee7 v\u1eadn beta t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i formoterol 12 mcg hai l\u1ea7n m\u1ed7i ng\u00e0y \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh ph\u1ed5i t\u1eafc ngh\u1ebdn m\u00e3n t\u00ednh v\u00e0 h\u1ea1n ch\u1ebf lu\u1ed3ng kh\u00ed trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng (FEV1 <80%). C\u00e1c gi\u00e1 tr\u1ecb FEV1 \u0111\u00e1y v\u00e0 \u0111\u1ec9nh kh\u00f4ng kh\u00e1c bi\u1ec7t \u0111\u00e1ng k\u1ec3 gi\u1eefa c\u00e1c nh\u00f3m n\u00e0y.<\/li>\n
  • C\u00e1c nghi\u00ean c\u1ee9u l\u1edbn h\u01a1n v\u1edbi th\u1eddi gian \u0111i\u1ec1u tr\u1ecb d\u00e0i h\u01a1n l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u01b0a ra nh\u1eefng so s\u00e1nh c\u00f3 \u00fd ngh\u0129a gi\u1eefa aclidinium, tiotropium v\u00e0 c\u00e1c ch\u1ea5t ch\u1ee7 v\u1eadn beta t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i.<\/li>\n
  • Aclidinium kh\u00f4ng th\u00edch h\u1ee3p \u0111\u1ec3 gi\u1ea3m kh\u00f3 th\u1edf c\u1ea5p t\u00ednh do co th\u1eaft ph\u1ebf qu\u1ea3n v\u00e0 ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u1edf nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng d\u01b0\u1edbi 18 tu\u1ed5i.<\/li>\n<\/ul>\n

    C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ph\u1ed5 bi\u1ebfn nh\u1ea5t (v\u1edbi t\u1ea7n su\u1ea5t cao h\u01a1n gi\u1ea3 d\u01b0\u1ee3c) trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng l\u00e0 nh\u1ee9c \u0111\u1ea7u (6.6% so v\u1edbi 5%), vi\u00eam m\u0169i h\u1ecdng (5.5% so v\u1edbi 3.9%) v\u00e0 ho (3% so v\u1edbi 2.2%). T\u00e1c d\u1ee5ng ph\u1ee5 kh\u00e1ng cholinergic, ch\u1eb3ng h\u1ea1n nh\u01b0 b\u00ed ti\u1ec3u, kh\u00f4 mi\u1ec7ng v\u00e0 t\u00e1o b\u00f3n, kh\u00f4ng kh\u00e1c bi\u1ec7t so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng bao g\u1ed3m 2717 b\u1ec7nh nh\u00e2n d\u00f9ng ch\u1ebf \u0111\u1ed9 d\u00f9ng thu\u1ed1c hai l\u1ea7n m\u1ed7i ng\u00e0y.<\/p>\n

    Ngu\u1ed3n tham kh\u1ea3o<\/strong>:<\/p>\n

      \n
    • Raed A Dweik, MD, FACP, FCCP, FRCP(C), FCCM, FAHA, \u201cRole of muscarinic antagonist therapy in COPD\u201d,\u00a0 UPTODATE 2023.<\/li>\n<\/ul>\n

      <\/h1>\n
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      Thu\u1ed1c kh\u00e1ng Muscarinic c\u0169ng nh\u01b0 c\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1c nh\u01b0 beta agonists, \u0111\u1ec1u c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb COPD. Do \u0111\u00f3, vi\u1ec7c hi\u1ec3u \u0111\u01b0\u1ee3c m\u1ed9t s\u1ed1 thu\u1ed1c c\u01a1 b\u1ea3n trong nh\u00f3m Muscarinic s\u1ebd h\u1ed7 tr\u1ee3 trong vi\u1ec7c s\u1eed d\u1ee5ng \u0111i\u1ec1u tr\u1ecb c\u0169ng nh\u01b0 d\u1ef1 ph\u00f2ng. 1. \u00a0T\u1ed5ng quan thu\u1ed1c kh\u00e1ng Muscarinic C\u00e1c […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[],"yoast_head":"\nThu\u1ed1c kh\u00e1ng Muscarinic th\u01b0\u1eddng d\u00f9ng trong COPD - Vinmec<\/title>\n<meta name=\"description\" content=\"Thu\u1ed1c kh\u00e1ng Muscarinic c\u0169ng nh\u01b0 c\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1c nh\u01b0 beta agonists, \u0111\u1ec1u c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb COPD. 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