HEN PHE QUAN - LS: cdc giai doan tai di tai lai: khd khé, khé thé, nang ngyc, ho; nhat la v8 dém va sing s6m - YTNC: tuong téc gitta gen va méi truvdng 1. Sinh bénh hoc © Qué trinh chi yéu; theo co ché Di ting - MD © Ca éhen di ting va hen k di ting ©. Tap trung bat thuéng cua céc TB viém tai dudng thé va cdc thanh phan TB: EOSO, duéng bao; Cytokine, PG, IL, Histamin, Leucotrien, AMPc... © Bp tng cua dung thé voi dj nguyén dac hiéu va k dac hiéu khac nhau -> EOlthataueng the © Tang min cim => mit cn bang giira hé Adrenergic va Cholinergic => wu thé thy thé a, B © Vila tinh trang viém man tinh ©. Tang sinh TB cé chn, xo hda duéi BM, tang kich thuéc va s6 lugng vi mach dui niém mac, tng sinh va phi dai co tron dudng thd, phi dai cdc tuyén dui niém mac 2. Yéu t6 khdi phat con HPQ cdp ~ RRIGGIWR: nguyén nhan ehGiveU) 80% © TREHAEARSVISIEUM, Rhinovirus (nghién cwtu gin day) © TRBISAERKINOVIUS (60%), Bali : EET. bui nha, phan hoa - Gang sire = Khoi thudc 14 - Onhiém méitrudng 179= Thay déi thai tiét - Yéu t6 tam ly: tram cam, lo sg, curdi, stress, bubn byc = Thuéc (aspirin, penicilin, sulfonamid) va héa chat 3. Phan loai mitc dé ning nhe Bac Trigu ching ban ngay Trigu ching | PEF [Dao dong ban dém PEF 1 (Nhe, cach | <21an/tuan <21an/thang | >80% | <20% quang) Cac con dét phat ngan Gira con tré bt 2 ae dai TS 2 Ran/tuan >2lan/thang | >80% | 20-30% ire) Con dét phat cé thé ah sinh hoat 3 (Trung binh, | 1 n/ngay >11&n/tuan | 60-80% | > 30% dai ding) SD thuéc cat con hang ngay Con d6t phat ah 2 [an/w va kéo dai cd ngay 4 (Nang, dai__| Ty.ch lién tuc. Gidi han hd hang ngay Thuong xuyén | <60% | >30% dang) Céc con d6t phat dién ra hung xuyén 3. Chan dodn a. Tré> Sy GINA 2011 - 1s © KhO kha thi thre (© Khd khé trong con hen thuéng kém fi (bat dau ho khan, sau xuat tiét nhigu dém dai trang), kho thas; dc biet la VEGSm) BSA SANE - Tiénsir RRBIRRG tai di tai lai ‘RROIERS tai ai tai lai HO nang lén vé dem ° ° © NSngingUte tai di tai lai ° ° cham, may day, cdc bénh di ting hoc bé me, anh chi em cé tin si hen - Dién bién © Xéy ra hodc nang lén V8ldém, HEOUa © Xay ra hoac nang lén khi: c6 cac yt khdi phat - BSpGAR voi thuéc Ben 180~ Ho khac dm > 106 ‘Do CNHH: danh gid mite 46 nang cua bénh, gidm CNHH, tac nghén dudng thé, chén dodn XD ° => ©. PEF: gidp chan dodn va quan ly hen © PEF: tng > 20% so v6i true khi ding thud glén PQ hose thay d6i > 20% trong ngay b. Tré $ Sy- GINA 2011 ~ RAOIRAE: xh truéc 3y o Tai di tdi lai: ARISUIRORMISA/AA © Ho hay kho khé xh Saulgang sue © Ho VEGEM ma k 6 biéu hién nhiém VR © Kha khe ° Ton tai sau 3 tui + Bap ting véi 8: SABA va ICS YTNC cao: bé me bi hen hod cc bénh di ting = YTNC yéu: o Ting EOSO (© Kho khé khi k nhiém VR © Viém mai di tng hn dodn phan biét + Bénh mili xoang man Lung trao nguygc da day thyc quan Nhiém VR dg hé hap dui tai di tai lai Loan san phdi - lao Dj dang dg the Dj vat dg thor = SGMD TBS a 181- Bénh quénh niém dich (xo nang) eee [ee 6. Trigu chétng con hen cp is — a - Conang: x oo o Tien trigu Tea |For [onsets [ae = Hat hoi, ngira mii, ngat mii, chay mii Tem rang omg | Kh Kies ce = Chan &n, dau bung, nang nguc... a Rea lie ee ley ° Ho © Kho khe mF [naman =arc tng ae] f aning! S waieieaue revi con [aor 20F Ng o © Khac dem: trong, béng, dinh - Thyc thé © HPQ kéo dai cé thé ldng ngyc nhé ra truéc, bién dang © G6 phéi: Vanglhonibt © Nghe: Faleritiingay; RAOIRAS = RRPN am sac tré-nén rit = Thd ra manh va kéo dai = Mite d6 nang: ©. Sai: Dau higu Nhe Trung binh Nang Be doa tinh mang ¥ thie Tinh Tinh, it kich thich | Kich thich Uam, lan NOi Cau dai Cau ngan Tirng cum Ko néi duge Tu thé C6 thé nam duge | Thich ngdi hon nam | Ngdi gap minh ve phia truée Nhip tha Tang Tang > 30 an/p Kho khé Trung binh Nang Nang Phdi cam Co kéo co hé | Khong Khong Co kéo co hé hdp| Di dong ngye hp phy phy bung bat thudng Bao hda oxy | > 95% 90-95% < 90% Mach <100 100 - 120 >120 ‘Mach cham PEF > 50% gid tri dy |> 50% gid tri dy|< 50% gid tri dy doan hose tét hon | dodn hoac t6t hon | dodn hoac tdi hon o Bid: Dau hiéu Nhe ortrung binh | Nang or de doa tinh mang (1 dau higu) ¥ thie Tinh or kich thich Liblorudm 1822 Ko udng or ndi dugc H6 hap Kho the Rut l6m long ngyc Rut lm khoang lién sudn Bao hda oxy | 292% <92% Tim Ko Tim trung wong Kho khe Thay déi Phdi cam Mach $ 200 [n/p (0-3 tudi) | > 200 lan/p (0-3 tudi) S$ 180 l&n/p (4-5 tudi) | > 180 lan/p (4-5 tudi) cis Dom: trong, béng, dinh Méu: EAB EOSO, thurong SBR {gE thing ting Khi mau: c6 thé suy hé hap CNHH © EVA giém © TeStph¥ehOiphé quan |) FEV1 tang > 12% sau ding thudc gin phé quan © FEV1 ting > 12% sau 4 tuan diéu tri = thudc ch6ng viém (sdch Nhi mdi) © FCBiim © FEVA/EVCBISRI/IGSERRIERRIOR (binh thudng > 85%) Un ° Pak «Sig OH SGURITHSABA WOREISEDOB (se co Thay ‘Thay d6i>20% do vao busi sang = Gid tri trung binh dao dng > 13% (sich Nhi méi) XQ: gd dau bt; sau: ldng ngurc gidn rong, WRAL, xep phéi Diu tri Myc tiéu: ©. Han ché t6i da xuat hign tr.ch: gidm han cdc tr.ch nhat la cdc tr.ch vé dém © Han ché téi da céc dot hen cp: lam thua con hen © Gidm téi da cdc con hen nang phai dén BV cp citu ©. ft phai ding gidn PQ 183© Bao dam cc hoat d6ng binh thudng cho tré © PEF > 80% hodc PEF 24h chénh léch < 20% © Ko ho§cit ADR cia thudc Chi yéu can kh6ng ché 3 yéu t6 bénh sinh: © Viém nhiém phii né niém mac PQ. © Co that PQ © Tang tinh phan ting, tang tiét dich nh3y PQ Nguyén tac: © Dung SABALBm isn Pacho it atch nen © Tr nhé, khét dau phéng bénh bang ICS liéu thdp, montelukast © Hau hét tré HPQ fife -> dung SABA/Ge RhUvén|es0) Kolnéh dling thUSe phon hen KEOUGSI 3nhém chinh © Gidm tr.ch: gidn PQ © Phong bénh © Kiém soat bénh: ICS két hop thuéc khdng ché tr.ch trong 1 liu hit Thude gidn PQ: © SABA (Short acting beta 2 agonist) = Salbutamol (Ventolin) hoc Terbutaline (Bricanyl) * Co ché: gian co tron PQ = k.thich receptor beta 2 dg thd, hé co xuong, tim © Ipratropium Bromide = Khang Cholinergic td cham hon SABA (30 - 60m) ® Han ché td néu ding hang ngay * Néu phéi hgp SABA thi co thé 8 con hen cp trung binh hoac nang © Theophyline = Chéng viém > gin PQ * K phai thudc dau tay = Nhigu ADR Phong bénh: olcs "Duy tri kiém sodt hen; gidm ti Ié ti vong do hen, gidm ti lé nh§p vién, nang cao chit lugng cudc s6ng Ding ICS sém 6 ng hen dai ding cé CNHH gidm gitip cai thién chirc nang phéi, phong ngira su tac nghén dg thé k hdi phuc 184* BDP-HFA: beclomethasone dipropionate-HFA; BUD: budesonide; FP: fluticasone propionate; CIC: Ciclesonide; M : Mometesone; T: Triamcinolone (© Leukotriene receptor antagonists (LTRAs) = Chidinh = Uudiém * Dung dudng uéng * Ding hang ngay ‘* Phong con hen khi gang site Montelukast sodium (Singuilair) vién 10 mg, 5 mg, 4 mg © Thuéc khang Ig © Omalizumab - Xolair + KT Gon dong khdng IgE * CB: @ hen dj tng thé trung binh & tré > 12y - Kiém soat tr.ch ° = Chéng co that PQ thir phat khi tiép xc di nguyén, chat k.thich k dac hiéu hoac gang strc = Thuong phéi hop ICS = Ting CNHH, cai thién tr.ch, con hen cap so véi ding ICS don thun - thuéc 8 phdi hyp ‘© Fluticasone + Salmeterol (Seretide); Budesonide + Eformoterol (Symbicort): chi dinh * Trigu ching va chifc ning hé h3p khéng cai thign véi ICS don thun = Mong muén lam giam liéu ICS ma van muén duy tri kiém soat hen * La thudc khéi phat dé @ hen trung binh hoc n3ng lam trigu chting hdi phuc nhanh 9. Dibu tri con hen c3p. - Nguyén tac: © Tré dang cé con hen Alani: ding ngay O2 va SABA co SABA dung RATMURE hoSc qua MOI(dang RiedinnINe0) © Steroid/dang U6ng: khi con hen mic 46 trling Binh hodc ABB, dung toi Singay 185© Adrenalin: CB néu tr.ch hen [a 1 biéu hién clia shock phan vé Con hen cép Ae: © Salbiitamol 6 nhat (tré B16) hose T2/Ahat (tré S6Y) © Kham lai sau mi 20 phut va nhac lai néu can hoc danh gid thay con hen mic d6 trung binh ho&c nang © KeiHRBE stv dung steroid dudng toan than (prednisolone aimiB/ke tdi 6ONiB/niBay) Con hen cép trung binh co Phai fhapwign © SaIBUtaMO! khdi phat = 6 nhat (tré <6 tudi), hodc 12 nhat (tré > 6 tudi) Nu liéu khéi phat chura dp ving, Hide lai mi6i 20;phut cho ti 2 lan nied > dune thee © Gidm sat bao hoa oxy. Cho thé Oxy néu can ©. Ding predhisolon Guting Une 1 me/ke/ngay cho toi SIHBSY Con hen cp Aang: © Nhap vién theo doi tai don vi hoi sue © Salbutaniel «= Khidung: 215'mg phun sung hodc 100 meg 2nhat = ng hit dinh libu * Ko dap ting, tiem TCHS inicE/ke/MOphit > 1 imce/ke/phut trayeATM Cung cp 6XY va gidm sat bao hod oxy. C6 thé lam khi mau © Cho €orticold toan than * Ding prednisolon durdng uéng 1m_/ke/ngay cho t6i 6Oma x5 nedy * Hoac Methyprednisolon IV 1mg/kg cho téi 60 mg méi 6 gir ngay 1 > méi 12 giérngay Ipratropium 2 nhat (tré < 6y) hose 4 nhat (tré > y) cho m6i 20 phat trong 1 giér du (3 li6u) Khi dung Ipratropium Ia 1 ligu phdp thay thé Aminophylline = Cho Gap elfl tai khoa hii sic + co SO mg/kg SV MRE 6285) no OT MRR er 53) ° 000 186