{"id":35560,"date":"2023-06-24T23:07:28","date_gmt":"2023-06-24T16:07:28","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=35560"},"modified":"2023-06-24T23:11:14","modified_gmt":"2023-06-24T16:11:14","slug":"xit-hen-tu-nhien-lua-chon-an-toan-cho-benh-nhan-hen-suyen","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/24\/xit-hen-tu-nhien-lua-chon-an-toan-cho-benh-nhan-hen-suyen\/","title":{"rendered":"X\u1ecbt hen t\u1ef1 nhi\u00ean: l\u1ef1a ch\u1ecdn an to\u00e0n cho b\u1ec7nh nh\u00e2n hen suy\u1ec5n"},"content":{"rendered":"

X\u1ecbt hen l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u00a0cung c\u1ea5p thu\u1ed1c d\u01b0\u1edbi d\u1ea1ng kh\u00ed dung \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u1eaft c\u01a1n v\u00e0 \u0111i\u1ec1u tr\u1ecb duy tr\u00ec d\u1ef1 ph\u00f2ng hen ph\u1ebf qu\u1ea3n. Hen ph\u1ebf qu\u1ea3n l\u00e0 b\u1ec7nh l\u00fd vi\u00eam m\u1ea1n t\u00ednh ph\u1ebf qu\u1ea3n g\u00e2y ra s\u1ef1 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf thay \u0111\u1ed5i r\u1ea5t nhanh ch\u00f3ng m\u1ed9t c\u00e1ch t\u1ef1 ph\u00e1t hay do \u0111i\u1ec1u tr\u1ecb. C\u00f3 s\u1ef1 tham gia c\u1ee7a nhi\u1ec1u t\u1ebf b\u00e0o v\u00e0 th\u00e0nh ph\u1ea7n t\u1ebf b\u00e0o g\u00e2y vi\u00eam, s\u1ef1\u00a0 k\u00edch th\u00edch l\u00e0m t\u0103ng ph\u1ea3n \u1ee9ng ph\u1ebf qu\u1ea3n, g\u00e2y n\u00ean t\u00ecnh tr\u1ea1ng co th\u1eaft ph\u00f9 n\u1ec1, t\u0103ng xu\u1ea5t ti\u1ebft ph\u1ebf qu\u1ea3n, l\u00e0m t\u1eafc ngh\u1ebdn ph\u1ebf qu\u1ea3n, h\u1ea1n ch\u1ebf lu\u1ed3ng kh\u00ed th\u1edf. \u0110i\u1ec1u tr\u1ecb hen bao g\u1ed3m \u0111i\u1ec1u tr\u1ecb c\u1eaft c\u01a1n hen v\u00e0 \u0111i\u1ec1u tr\u1ecb duy tr\u00ec.<\/strong><\/p>\n

\"xit-hen\"<\/p>\n

\u00a01. <\/span><\/b>\u0110i\u1ec1u tr\u1ecb duy tr\u00ec b\u1eb1ng thu\u1ed1c x\u1ecbt hen<\/b><\/h2>\n

\u00a0M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb duy tr\u00ec<\/span><\/p>\n

Ki\u1ec3m so\u00e1t t\u1ed1t b\u1ec7nh hen, gi\u00fap b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 sinh ho\u1ea1t g\u1ea7n nh\u01b0 tr\u1ebb b\u00ecnh th\u01b0\u1eddng<\/span><\/p>\n

Gi\u1ea3m t\u1ea7n su\u1ea5t v\u00e0o c\u01a1n hen c\u1ea5p<\/span><\/p>\n

Gi\u00e1o d\u1ee5c b\u1ec7nh nh\u00e2n v\u00e0 ng\u01b0\u1eddi nh\u00e0 bi\u1ebft x\u1eed tr\u00ed ngo\u1ea1i vi\u1ec7n k\u1ecbp th\u1eddi c\u01a1n hen, nh\u1eb1m gi\u1ea3m thi\u1ec3u b\u1ec7nh su\u1ea5t v\u00e0 t\u1eed su\u1ea5t do c\u01a1n hen<\/span><\/p>\n

Kh\u1ed1ng ch\u1ebf t\u1ed1t qu\u00e1 tr\u00ecnh vi\u00eam m\u1ea1n t\u00ednh \u0111\u01b0\u1eddng th\u1edf, nh\u1eb1m l\u00e0m ch\u1eadm\/ng\u0103n c\u1ea3n ti\u1ebfn tri\u1ec3n t\u00e1i c\u1ea5u tr\u00fac \u0111\u01b0\u1eddng th\u1edf<\/span><\/p>\n

Gi\u1ea3m thi\u1ec3u t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c hen.<\/span><\/p>\n

Ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng d\u00f9ng thu\u1ed1c ng\u1eeba c\u01a1n hen<\/span><\/p>\n

Tr\u00e1nh y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t hen<\/span><\/p>\n

V\u1ec7 sinh m\u00f4i tr\u01b0\u1eddng sinh ho\u1ea1t<\/span><\/p>\n

Ch\u1ee7ng ng\u1eeba \u0111\u1ea7y \u0111\u1ee7, \u0111\u1eb7c bi\u1ec7t l\u00e0 ch\u1ee7ng ng\u1eeba c\u00fam v\u00e0 ph\u00ea c\u00e2u<\/span><\/p>\n

Tr\u00e1nh b\u00e9o ph\u00ec<\/span><\/p>\n

S\u1eed d\u1ee5ng SABA khi c\u1ea7n<\/span><\/p>\n

Gi\u00e1o d\u1ee5c c\u00e1ch s\u1eed d\u1ee5ng b\u1ea3n k\u1ebf ho\u1ea1ch x\u1eed tr\u00ed hen cho t\u1eebng b\u1ec7nh nhi v\u00e0 th\u00e2n nh\u00e2n.<\/span><\/p>\n

Ph\u01b0\u01a1ng ph\u00e1p d\u00f9ng thu\u1ed1c ng\u1eeba c\u01a1n hen<\/span><\/p>\n

Ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c ng\u1eeba c\u01a1n hen \u1edf tr\u1ebb em < 5 tu\u1ed5i<\/span><\/p>\n

+ Hen kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p kh\u00f4ng d\u00f9ng thu\u1ed1c ng\u1eeba c\u01a1n.<\/span><\/p>\n

+ Nh\u1eadp vi\u1ec7n v\u00ec c\u01a1n hen n\u1eb7ng ho\u1eb7c nguy k\u1ecbch<\/span><\/p>\n

+ Trong m\u1ed9t m\u00f9a c\u00f3 1-2 \u0111\u1ee3t kh\u00f2 kh\u00e8 n\u1eb7ng sau nhi\u1ec5m si\u00eau vi h\u00f4 h\u1ea5p<\/span><\/p>\n

+ Kh\u00f2 kh\u00e8 g\u1ee3i \u00fd hen th\u01b0\u1eddng xuy\u00ean > 3 \u0111\u1ee3t\/m\u00f9a.<\/span><\/p>\n

+ Kh\u00f2 kh\u00e8 c\u1ea7n d\u00f9ng x\u1ecbt hen b\u1eb1ng SABA m\u1ed7i 6 – 8 tu\u1ea7n: c\u00f3 th\u1ec3 th\u1eed \u0111i\u1ec1u tr\u1ecb thu\u1ed1c ng\u1eeba c\u01a1n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

– Ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c\u00a0 x\u1ecbt ng\u1eeba c\u01a1n hen \u1edf tr\u1ebb em > 5 tu\u1ed5i<\/span><\/p>\n

+ Kh\u1edfi \u0111\u1ea7u v\u1edbi ICS li\u1ec1u th\u1ea5p:<\/span><\/p>\n

\u25a0<\/span>\u00a0 \u00a0 <\/span>C\u00f3 tri\u1ec7u ch\u1ee9ng hen > 2 l\u1ea7n\/th\u00e1ng<\/span><\/p>\n

\u25a0<\/span>\u00a0 \u00a0 <\/span>Th\u1ee9c gi\u1ea5c v\u00ec hen > 1 l\u1ea7n\/th\u00e1ng<\/span><\/p>\n

\u25a0<\/span>\u00a0 \u00a0 <\/span>C\u00f3 tri\u1ec7u ch\u1ee9ng hen v\u00e0 c\u00f3 b\u1ea5t k\u1ef3 y\u1ebfu t\u1ed1 nguy c\u01a1 v\u00e0o c\u01a1n hen: FEV1 < 60% gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n, c\u00f3 ti\u1ebfp x\u00fac kh\u00f3i thu\u1ed1c l\u00e1, c\u00f3 b\u1ec7nh k\u00e8m theo (b\u00e9o ph\u00ec, vi\u00eam m\u0169i xoang m\u1ea1n, d\u1ecb \u1ee9ng th\u1ee9c \u0103n), t\u1eebng \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00ec hen, c\u00f3 > 1 c\u01a1n hen trung b\u00ecnh – n\u1eb7ng trong n\u0103m qua, s\u1eed d\u1ee5ng > 1 chai salbutamol MDI\/th\u00e1ng, c\u00f3 v\u1ea5n \u0111\u1ec1 t\u00e2m th\u1ea7n, t\u00e2m l\u00fd x\u00e3 h\u1ed9i.<\/span><\/p>\n

+ Kh\u1edfi \u0111\u1ea7u v\u1edbi ICS li\u1ec1u cao (cho tr\u1ebb < 12 tu\u1ed5i) ho\u1eb7c ICS li\u1ec1u trung b\u00ecnh + LABA (cho tr\u1ebb > 12 tu\u1ed5i):<\/span><\/p>\n

\u25a0<\/span>\u00a0 \u00a0 <\/span>Nh\u1eadp vi\u1ec7n v\u00ec c\u01a1n hen trung b\u00ecnh – n\u1eb7ng<\/span><\/p>\n

\u25a0<\/span>\u00a0 \u00a0 <\/span>C\u00f3 tri\u1ec7u ch\u1ee9ng hen h\u1ea7u h\u1ebft c\u00e1c ng\u00e0y<\/span><\/p>\n

\u25a0<\/span>\u00a0 \u00a0 <\/span>Th\u1ee9c gi\u1ea5c v\u00ec hen > 1 l\u1ea7n\/tu\u1ea7n.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

<\/b> \u00a02. <\/span>Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb c\u01a1n hen<\/b><\/h2>\n

2.1 Thu\u1ed1c x\u1ecbt c\u1eaft c\u01a1n hen<\/b><\/p>\n

–<\/span> \u00a0 <\/span>SABA (Short acting beta agonist): p<\/span>2<\/span>-adrenergic receptor (B<\/span>2<\/span>AR) hi\u1ec7n di\u1ec7n nhi\u1ec1u tr\u00ean t\u1ebf b\u00e0o c\u01a1 tr\u01a1n \u0111\u01b0\u1eddng th\u1edf. Salbutamol l\u00e0 m\u1ed9t ch\u1ea5t \u0111\u1ed3ng v\u1eadn p2 g\u1eafn l\u00ean B2AR k\u00edch th\u00edch s\u1ef1 s\u1ea3n xu\u1ea5t AMP v\u00f2ng (cAMP – cyclic adenosine monophosphate) n\u1ed9i b\u00e0o, g\u00e2y t\u00e1c d\u1ee5ng gi\u00e3n c\u01a1 tr\u01a1n. Hi\u1ec7u qu\u1ea3 c\u1ee7a salbutamol kh\u00ed dung b\u1eaft \u0111\u1ea7u trong v\u00f2ng 3 ph\u00fat, \u0111\u1ea1t \u0111inh sau 2,5 gi\u1edd v\u00e0 k\u00e9o d\u00e0i 4-6 gi\u1edd.<\/span><\/p>\n

+ Li\u1ec1u d\u00f9ng: phun kh\u00ed dung 0,15 mg\/kg\/l\u1ea7n, t\u1ed1i thi\u1ec1u 2,5 mg\/l\u1ea7n, t\u1ed1i \u0111a 5mg\/l\u1ea7n\u00a0<\/span><\/p>\n

+ T\u00e1c d\u1ee5ng ph\u1ee5: nh\u1ecbp tim nhanh, run chi, h\u1ea1 kali mau.<\/span><\/p>\n

SAMA (Short acting muscarinic antagonist): <\/b>t\u00e1c \u0111\u1ed9ng c\u1ee7a h\u1ec7 th\u1ea7n kinh ph\u00f3 giao c\u1ea3m l\u00ean th\u1ee5 th\u1ec3 muscarinic (M1-M5) th\u00f4ng qua ch\u1ea5t d\u1eabn truy\u1ec1n th\u1ea7n kinh acetylcholin g\u00e2y co th\u1eaft c\u01a1 tr\u01a1n ph\u1ebf qu\u1ea3n v\u00e0 t\u0103ng ti\u1ebft ch\u1ea5t nh\u1ea7y v\u00e0o l\u1ed9ng \u0111\u01b0\u1eddng th\u1edd.<\/span><\/p>\n

–<\/span> \u00a0 <\/span>Magie sulfat c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n ph\u1ebf qu\u1ea3n th\u00f4ng qua nhi\u1ec1u c\u01a1 ch\u1ebf nh\u01b0 l\u00e0 (1) \u1ee9c ch\u1ebf h\u1ea5p th\u1ee5 ion Ca<\/span>2+<\/span> c\u1ee7a t\u1ebf b\u00e0o c\u01a1 tr\u01a1n ph\u1ebf qu\u1ea3n g\u00e2y c\u1ea3n tr\u1edf qu\u00e1 tr\u00ecnh co c\u01a1, (2) tham gia v\u00e0o c\u00e1c ho\u1ea1t \u0111\u1ed9ng chuy\u1ec3n h\u00f3a c\u1ee7a t\u1ebf b\u00e0o, trong \u0111\u00f3 c\u00f3 chuy\u1ec3n h\u00f3a sinh cAMP, h\u1ed7 tr\u1ee3 t\u00e1c d\u1ee5ng c\u1ee7a SABA l\u00ean c\u01a1 tr\u01a1n ph\u1ebf qu\u1ea3n, (3) \u1ee9c ch\u1ebf s\u1ef1 ph\u00f3ng th\u00edch acetylcholine t\u1eeb th\u1ea7n kinh ph\u00f3 giao c\u1ea3m v\u00e0 (4) gi\u1ea3m ph\u00f3ng th\u00edch histamin t\u1eeb t\u1ebf b\u00e0o mast.<\/span><\/p>\n

+ Li\u1ec1u d\u00f9ng (ch\u1ec9 d\u00f9ng cho tr\u1ebb > 1 tu\u1ed5i): 25-75 mg\/kg\/li\u1ec1u duy nh\u1ea5t, truy\u1ec1n t\u00ecnh m\u1ea1ch trong 20-30 ph\u00fat<\/span><\/p>\n

+ T\u00e1c d\u1ee5ng ph\u1ee5: t\u1ee5t huy\u1ebft \u00e1p, gi\u1ea3m ph\u1ea3n x\u1ea1 g\u00e2n – x\u01b0\u01a1ng.<\/span><\/p>\n

Adrenalin ti\u00eam d\u01b0\u1edbi da: c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf ph\u00f3ng th\u00edch histamin t\u1eeb t\u1ebf b\u00e0o mast. + Li\u1ec1u d\u00f9ng: Adrenalin 0.1%\u00a0 0,01 mL\/kg\/l\u1ea7n, t\u1ed1i \u0111a 0,3 mL\/l\u1ea7n X 3 l\u1ea7n ti\u00eam d\u01b0\u1edbi da c\u00e1ch 20 ph\u00fat.<\/span><\/p>\n

–<\/span> \u00a0 \u00a0 <\/span>Corticoid u\u1ed1ng\/ti\u00eam m\u1ea1ch c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng vi\u00eam to\u00e0n th\u00e2n m\u1ea1nh th\u00f4ng qua vi\u1ec7c \u1ee9c ch\u1ebf s\u1ef1 t\u1ed5ng h\u1ee3p c\u00e1c ph\u00e2n t\u1eed protein tham gia trong ph\u1ea3n \u1ee9ng vi\u00eam c\u1ee7a c\u01a1 th\u1ec3. Tuy nhi\u00ean, \u0111\u1ec3 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 n\u00e0y c\u1ea7n m\u1ea5t v\u00e0i gi\u1edd – v\u00e0i ng\u00e0y v\u00ec t\u00e1c \u0111\u1ed9ng l\u00ean th\u1ee5 th\u1ec3 trong nh\u00e2n \u201cgenomic\u201d y\u00e0 \u1ea3nh h\u01b0\u1eddng l\u00ean qu\u00e1 tr\u00ecnh sinh t\u1ed5ng h\u1ee3p protein c\u1ee7a t\u1ebf b\u00e0o. Trong khi \u0111\u00f3, corticoid h\u00edt li\u1ec1u cao c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng vi\u00eam nhanh t\u1ea1i ch\u1ed7 trong v\u00e0i gi\u00e2y – v\u00e0i ph\u00fat th\u00f4ng qua c\u01a1 ch\u1ebf \u201cnon-genomic\u201d g\u00e2y gi\u1ea3m t\u01b0\u1edbi m\u00e1u \u0111\u1ebfn bi\u1ec3u m\u00f4 ph\u1ebf qu\u1ea3n b\u1ecb vi\u00eam. Theo c\u01a1 ch\u1ebf n\u00e0y l\u01b0\u1ee3ng l\u1edbn corticoid g\u1eafn l\u00ean th\u1ee5 th\u1ec3 EMT (Extraneuronal Monoamine Transporter) t\u1ea1i m\u00e0ng t\u1ebf b\u00e0o c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u g\u00e2y c\u1ea3n tr\u1edf s\u1ef1 tho\u00e1i h\u00f3a norepinephrine h\u1eadu synap th\u1ea7n kinh – c\u01a1, gi\u00fap duy tr\u00ec hi\u1ec7u qu\u1ea3 c\u1ee7a norepinephrine tr\u00ean th\u1ee5 th\u1ec3 adrenergic c\u00f3 t\u00e1c d\u1ee5ng co m\u1ea1ch, d\u1eabn \u0111\u1ebfn gi\u1ea3m t\u01b0\u1edbi m\u00e1u \u0111\u1ebfn v\u00f9ng vi\u00eam, l\u00e0m gi\u1ea3m ph\u00f9 n\u1ec1 ni\u00eam m\u1ea1c ph\u1ebf qu\u1ea3n.<\/span><\/p>\n

+ Li\u00eau d\u00f9ng corticoid u\u00f4ng: prednisone\/prednisolone 1-2 mg\/kg\/ng\u00e0y X 3-5 ngay, t\u00f4i \u0111a 20mg (tr\u1ebb < 2 tu\u1ed5i), 30mg (tr\u1ebb 2-5 tu\u1ed5i), 40mg (tr\u1ebb > 5 tu\u1ed5i).<\/span><\/p>\n

+ Li\u1ec1u d\u00f9ng corticoid ti\u00eam m\u1ea1ch: Hydrocortisone 5 mg\/ kg m\u1ed7i 6 gi\u1edd ho\u1eb7c methylprednisolone 1-2 mg \/kg m\u1ed7i 12 gi\u1edd<\/span><\/p>\n

\u00a0<\/b><\/p>\n

2.2\u00a0 Thu\u1ed1c x\u1ecbt ng\u1eeba c\u01a1n hen<\/strong><\/p>\n

–<\/span>\u00a0 \u00a0 <\/span>Leukotriene modifiers: c\u00f3 lo\u1ea1i \u1ee9c ch\u1ebf men 5-lipoxygenase l\u00e0m gi\u1ea3m s\u1ea3n xu\u1ea5t leukotriene, ho\u1eb7c c\u00f3 lo\u1ea1i l\u00e0 ch\u1ea5t kh\u00e1ng th\u1ee5 th\u1ec3 cysteinyl leukotriene, c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf ph\u1ea3n \u1ee9ng vi\u00eam v\u00e0 co th\u1eaft ph\u1ebf qu\u1ea3n do leukotriene. Trong hen do si\u00eau vi ho\u1eb7c hen do g\u1eafng s\u1ee9c, nghi\u00ean c\u1ee9u ghi nh\u1eadn c\u00f3 s\u1ef1 t\u0103ng s\u1ea3n xu\u1ea5t leukotriene t\u1eeb qu\u00e1 tr\u00ecnh vi\u00eam do chuy\u1ec3n h\u00f3a acid arachidonic. V\u00ec v\u1eady, leukotriene modifiers th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng cho b\u1ec7nh nhi hen do si\u00eau vi ho\u1eb7c hen do g\u1eafng s\u1ee9c.<\/span><\/p>\n

+ Li\u1ec1u d\u00f9ng: montelukast 4 mg (tr\u1ebb 6 th\u00e1ng-5 tu\u1ed5i), 5mg (tr\u1ebb 6-14 tu\u1ed5i)<\/span><\/p>\n

+ T\u00e1c d\u1ee5ng ph\u1ee5: \u0111au \u0111\u1ea7u, \u0111au b\u1ee5ng, ti\u00eau ch\u1ea3y, ti\u1ec3u d\u1ea7m.<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 <\/span>ICS (inhaled corticosteroids): v\u1edbi ho\u1ea1t t\u00ednh kh\u00e1ng vi\u00eam m\u1ea1nh th\u00f4ng qua nhi\u1ec1u c\u01a1 ch\u1ebf, corticoid \u0111\u01b0\u1ee3c xem l\u00e0 s\u1ef1 l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u trong \u0111i\u1ec1u tr\u1ecb hen. Corticoid th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh apoptosis c\u1ee7a c\u00e1c t\u1ebf b\u00e0o vi\u00eam, gi\u1ea3m t\u1ed5ng h\u1ee3p c\u00e1c protein g\u1eafn k\u1ebft nh\u1eb1m h\u1ea1n ch\u1ebf s\u1ef1 x\u00e2m nh\u1eadp c\u1ee7a c\u00e1c t\u1ebf b\u00e0o vi\u00eam, \u1ee9c ch\u1ebf s\u1ef1 ph\u00f3ng h\u1ea1t t\u1eeb lysosome trong c\u00e1c t\u1ebf b\u00e0o vi\u00eam, \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p c\u00e1c protein vi\u00eam v\u00e0 t\u0103ng s\u1ea3n xu\u1ea5t c\u00e1c protein kh\u00e1ng vi\u00eam, th\u00fac \u0111\u1ea9y bi\u1ec3u hi\u1ec7n th\u1ee5 th\u1ec3 p2-adrenergic, gi\u1ea3m ti\u1ebft \u0111\u00e0m t\u1eeb tuy\u1ebfn nh\u1ea7y.<\/span><\/p>\n

–<\/span>\u00a0 \u00a0 <\/span>LABA (Long acting beta agonist): t\u00e1c \u0111\u1ed9ng gi\u00e3n ph\u1ebf qu\u1ea3n th\u00f4ng qua c\u01a1 ch\u1ebf t\u01b0\u01a1ng t\u1ef1 SABA nh\u01b0ng v\u00ec ho\u1ea1t ch\u1ea5t LABA c\u00f3 t\u00ednh \u00e1i m\u1edd cao cho ph\u00e9p thu\u1ed1c ng\u1ea5m v\u00e0o trong m\u00f4 \u0111\u01b0\u1eddng th\u1edf t\u1ea1i v\u00f9ng l\u00e2n c\u1eadn B<\/span>2<\/span>AR n\u00ean k\u00e9o d\u00e0i th\u1eddi gian t\u00e1c d\u1ee5ng \u0111\u1ebfn 12 gi\u1edd. LABA ch\u1ec9 d\u00f9ng \u1edf d\u1ea1ng k\u1ebft h\u1ee3p v\u1edbi ICS v\u00e0 ch\u1ec9 khuy\u1ebfn c\u00e1o d\u00f9ng cho tr\u1ebb > 6 tu\u1ed5i.<\/span>\u00a0<\/span><\/p>\n

B\u00e0ng . Li\u1ec1u corticoid h\u00edt<\/span><\/p>\n\n\n\n\n\n\n\n\n\n
Thu\u1ed1c<\/span><\/td>\nTu\u1ed5i<\/span><\/td>\nLi\u1ec1u d\u00f9ng (mcg\/ng\u00e0y)<\/span><\/td>\n<\/tr>\n
Th\u1ea5p<\/span><\/td>\nTrung b\u00ecnh<\/span><\/td>\nCao<\/span><\/td>\n<\/tr>\n
Fluticasone propionate<\/span><\/td>\n<5<\/span><\/td>\n100<\/span><\/td>\n> 200-500<\/span><\/td>\n>500<\/span><\/td>\n<\/tr>\n
\u00a0<\/span><\/td>\n6-11<\/span><\/td>\n100-200<\/span><\/td>\n> 250-500<\/span><\/td>\n>500<\/span><\/td>\n<\/tr>\n
\u00a0<\/span><\/td>\n> 12<\/span><\/td>\n100-250<\/span><\/td>\n\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n<\/tr>\n
Budesonide kh\u00ed dung<\/span><\/td>\n<5<\/span><\/td>\n500<\/span><\/td>\n\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n<\/tr>\n
\u00a0<\/span><\/td>\n6-11<\/span><\/td>\n250-500<\/span><\/td>\n> 500-1000<\/span><\/td>\n> 1000<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u0110i\u1ec1u tr\u1ecb ph\u00f2ng ng\u1eeba hen theo b\u1eadc (B\u1ed9 Y t\u1ebf 2020)\u00a0<\/span><\/p>\n

\u00a0<\/span><\/p>\n\n\n\n\n\n\n\n\n\n
\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\nB\u1eadc 5<\/span><\/td>\n<\/tr>\n
\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\n\u00a0<\/span><\/td>\nB\u1eadc 4<\/span><\/td>\nLi\u1ec1u cao <\/span>ICS\/LABA<\/span>
\n<\/span> Chuy\u1ec3n tuy\u1ebfn <\/span>tr\u00ean \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ki\u1ec3u h\u00ecnh \u00b1 \u0111i\u1ec1u tr\u1ecb c\u1ed9ng th\u00eam nh\u01b0 <\/span>Tiotropium, <\/span>anti-IgE, <\/span>anti-IL5, anti-IL5R, anti-IL4R<\/span><\/td>\n<\/tr>\n
\u00a0<\/span><\/td>\nB\u1eadc 1<\/span><\/td>\nB\u1eadc 2<\/span><\/td>\nB\u1eadc 3<\/span><\/td>\nLi\u1ec1u trung<\/span>
\n<\/span> b\u00ecnh<\/span>
\n<\/span> ICS\/LABA<\/span><\/td>\n<\/tr>\n
THU\u1ed0C<\/b>
\n<\/b> KI\u1ec2M<\/b>
\n<\/b> SO\u00c1T<\/b>
\n<\/b> HEN \u01afU TI\u00caN<\/b><\/td>\n		Li\u1ec1u th\u1ea5p<\/span>
\n<\/span> ICS\/FOR<\/span>
\n<\/span> khi c\u1ea7n<\/span><\/td>\n		Li\u1ec1u th\u1ea5p<\/span>
\n<\/span> ICS m\u1ed7i<\/span>
\n<\/span> ng\u00e0y ho\u1eb7c<\/span>
\n<\/span> li\u1ec1u th\u1ea5p<\/span>
\n<\/span> ICS\/FOR<\/span>
\n<\/span> khi c\u1ea7n<\/span><\/td>\n		Li\u1ec1u th\u1ea5p<\/span>
\n<\/span> ICS\/LABA<\/span><\/td>\n<\/tr>\n
Thu\u1ed1c<\/span>
\n<\/span> ki\u1ec3m<\/span>
\n<\/span> so\u00e1t hen <\/span>\u00a0<\/b>kh\u00e1c<\/span>\u00a0<\/span><\/td>\n		Li\u1ec1u th\u1ea5p<\/span>
\n<\/span> ICS khi<\/span>
\n<\/span> c\u1ea7n d\u00f9ng<\/span>
\n<\/span> SABA<\/span>\u00a0<\/span><\/td>\n		LTRA<\/span>
\n<\/span> ho\u1eb7c<\/span>
\n<\/span> li\u1ec1u th\u1ea5p<\/span>
\n<\/span> ICS khi<\/span>
\n<\/span> c\u1ea7n d\u00f9ng<\/span>
\n<\/span> SABA<\/span>\u00a0<\/span><\/td>\n		Li\u1ec1u trung<\/span>
\n<\/span> b\u00ecnh ICS<\/span>
\n<\/span> ho\u1eb7c<\/span> li\u1ec1u th\u1ea5p<\/span>
\n<\/span> ICS+LTRA<\/span>\u00a0<\/span><\/td>\n		Li\u1ec1u cao<\/span>
\n<\/span> ICS +<\/span>
\n<\/span> tiotropium<\/span>
\n<\/span> ho\u1eb7c li\u1ec1u<\/span>
\n<\/span> cao ICS +<\/span>
\n<\/span> LTRA<\/span>\u00a0<\/span><\/td>\n		Th\u00eam corticoid <\/span>u\u1ed1ng li\u1ec1u th\u1ea5p, <\/span>nh\u01b0ng c\u00e2n nh\u1eafc<\/span>
\n<\/span> t\u00e1c d\u1ee5ng ph\u1ee5<\/span>\u00a0<\/span><\/td>\n<\/tr>\n
THU\u1ed0C<\/span>
\n<\/span> C\u1eaeT<\/span>
\n<\/span> C\u01a0N<\/span>
\n<\/span> HEN \u01afU<\/span>
\n<\/span> TI\u00caN<\/span>\u00a0<\/span><\/td>\n		Li\u1ec1u th\u1ea5p ICS\/formoterol khi c\u1ea7n<\/span><\/p>\n

\u00a0<\/span><\/td>\n

Li\u1ec1u th\u1ea5p ICS\/formoterol khi c\u1ea7n cho b\u1ec7nh\u00a0 nh\u00e2n d\u00f9ng li\u1ec7u ph\u00e1p v\u1eeba duy tr\u00ec v\u00e0 v\u1eeba c\u1eaft c\u01a1n trong m\u1ed9t b\u00ecnh h\u00edt<\/span><\/td>\n<\/tr>\n
Thu\u1ed1c<\/span>
\n<\/span> c\u1eaft c\u01a1n<\/span>
\n<\/span> hen kh\u00e1c<\/span>\u00a0<\/span><\/td>\n		SABA khi c\u1ea7n cho b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng ICS ho\u1eb7c ICS\/LABA duy tr\u00ec\u00a0 trong m\u1ed9t b\u00ecnh h\u00edt ri\u00eang<\/span><\/p>\n

\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u00a0T\u00e0i li\u1ec7u tham kh\u1ea3o:\u00a0<\/strong><\/p>\n

    \n
  • Gi\u00e1o tr\u00ecnh Nhi khoa _\u0110HYD TPHCM – 2020.<\/span><\/li>\n
  • \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecbhen ph\u1ebf qu\u1ea3n ng\u01b0\u01a1\u0300 i l\u01a1\u0301 n v\u00e0 tr\u1ebb em ><\/span>\u00a0<\/span>12 tu\u1ed5i\u201d – B\u1ed9 Y t\u1ebf 2020<\/span><\/li>\n<\/ul>\n

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

    X\u1ecbt hen l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u00a0cung c\u1ea5p thu\u1ed1c d\u01b0\u1edbi d\u1ea1ng kh\u00ed dung \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u1eaft c\u01a1n v\u00e0 \u0111i\u1ec1u tr\u1ecb duy tr\u00ec d\u1ef1 ph\u00f2ng hen ph\u1ebf qu\u1ea3n. Hen ph\u1ebf qu\u1ea3n l\u00e0 b\u1ec7nh l\u00fd vi\u00eam m\u1ea1n t\u00ednh ph\u1ebf qu\u1ea3n g\u00e2y ra s\u1ef1 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf thay \u0111\u1ed5i r\u1ea5t nhanh ch\u00f3ng m\u1ed9t c\u00e1ch t\u1ef1 ph\u00e1t hay […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"\nX\u1ecbt hen t\u1ef1 nhi\u00ean: l\u1ef1a ch\u1ecdn an to\u00e0n cho b\u1ec7nh nh\u00e2n hen suy\u1ec5n - Vinmec<\/title>\n<meta name=\"description\" content=\"X\u1ecbt hen l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u00a0cung c\u1ea5p thu\u1ed1c d\u01b0\u1edbi d\u1ea1ng kh\u00ed dung \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u1eaft c\u01a1n v\u00e0 \u0111i\u1ec1u tr\u1ecb duy tr\u00ec d\u1ef1 ph\u00f2ng hen ph\u1ebf qu\u1ea3n.\" \/>\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=\"X\u1ecbt hen t\u1ef1 nhi\u00ean: l\u1ef1a ch\u1ecdn an to\u00e0n cho b\u1ec7nh nh\u00e2n hen suy\u1ec5n - 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