HEN PH QUNHEN PH QUN

PGS. TS. Phan Quang on

- HPQ l hi chng vim mn tnh ng h hp- C s tham gia ca nhiu loi t bo gy vim + cc kchthch khc lm:+ Tng phn ng ph qun+ Co tht ph n, tng xut tit, tc nghn ph qun

Hu qu:Cn kh th kh kh, kh th ra.Cn t khi hoc do dng thuc

nh nghanh ngha- HPQ l hi chng vim mn tnh ng h hp- C s tham gia ca nhiu loi t bo gy vim + cc kchthch khc lm:+ Tng phn ng ph qun+ Co tht ph n, tng xut tit, tc nghn ph qun

Hu qu:Cn kh th kh kh, kh th ra.Cn t khi hoc do dng thuc

Nguyn nhn1. Nhm nguyn nhn vi khun- Cc loi bi: bi nh, th vin, cng nghip, v.v- Bi nh nguyn nhn chnh gy hen, v trong bi c ccloi bet khc nhau.

- C hai loi bet ch yu gy hen: D.pteronyssinus,D.Farinae.

- Bet sng trong chn, ga, gi, m.

1. Nhm nguyn nhn vi khun- Cc loi bi: bi nh, th vin, cng nghip, v.v- Bi nh nguyn nhn chnh gy hen, v trong bi c ccloi bet khc nhau.

- C hai loi bet ch yu gy hen: D.pteronyssinus,D.Farinae.

- Bet sng trong chn, ga, gi, m.

Nguyn nhn

D.Pteronyssinus

Phn hoa Lng V Thc n Thuc: Ch yu l Aspirin v cc cht chngvin non Steroid.

Nguyn nhn Phn hoa Lng V Thc n Thuc: Ch yu l Aspirin v cc cht chngvin non Steroid.

- Ngh nghip: Th dt, may, chn nui gia sc- Khi thuc l- nhim khng kh: SO2, NO2, ozon- nhim trong nh : Cht c s dng trongtrang tr ni tht, gas, du ho, khi than gin.

Nguyn nhn- Ngh nghip: Th dt, may, chn nui gia sc- Khi thuc l- nhim khng kh: SO2, NO2, ozon- nhim trong nh : Cht c s dng trongtrang tr ni tht, gas, du ho, khi than gin.

Nhm nguyn nhn nhim khun

- Cc loi vi khun, virus, KST, gy vim ng h hp.- Nhim virus: Rhinovirus, coronaviras, Influenza, virushp bo ng h hp d gy hen tr em.

- Cc loi nm: Penicillinum, Aspergilus, Alternaria,Cladosporium

Nhm nguyn nhn nhim khun

- Cc loi vi khun, virus, KST, gy vim ng h hp.- Nhim virus: Rhinovirus, coronaviras, Influenza, virushp bo ng h hp d gy hen tr em.

- Cc loi nm: Penicillinum, Aspergilus, Alternaria,Cladosporium

Cc nguyn nhn khc- Di truyn- Gng sc- Thay i thi tit- Stress

Cc nguyn nhn khc- Di truyn- Gng sc- Thay i thi tit- Stress

C ch hpqTheo c ch d ng loi hnh I (loi hnh phn v, loihnh reagin) theo phn loi ca Gell Coombs).

Qu trnh vim trong HPQ- Vim l qu trnh ch yu trong c ch bnh sinh caHPQ.

- Cc TB gy vim: T, BC a nhn, i kim, i toan,mast cell,

- Cc TB ny tit ra cc mediator: PGD2, PGF2, PGE2,v.v. Cc leucotriew (LT): LTC4, LTD4, Kinin, PAF.

- Nhiu Cytokines gy vim gii Phng t tromboxan A,TB, TBB nh IL4, IL5, IL6, v.v.. -> vim d di, co,ph n PQ.

Qu trnh vim trong HPQ- Vim l qu trnh ch yu trong c ch bnh sinh caHPQ.

- Cc TB gy vim: T, BC a nhn, i kim, i toan,mast cell,

- Cc TB ny tit ra cc mediator: PGD2, PGF2, PGE2,v.v. Cc leucotriew (LT): LTC4, LTD4, Kinin, PAF.

- Nhiu Cytokines gy vim gii Phng t tromboxan A,TB, TBB nh IL4, IL5, IL6, v.v.. -> vim d di, co,ph n PQ.

Qu trnh vim trong HPQ

- Cc DN vo c th + IgE trn mng mast cell -> giiPhng cc mediator gy vim.

- Cc eosinophils tit ra mediator: MBP, ECP -> trc binm PQ gii phng cc neopeptide gy vim: P,VIP,v.v

- Vai tr cc phn t kt dnh ICAM1 v VCAM-1(intercelle cell adhesion molicule v Vascular celladhesion molicule) -> vim.

Qu trnh vim trong HPQ

- Cc DN vo c th + IgE trn mng mast cell -> giiPhng cc mediator gy vim.

- Cc eosinophils tit ra mediator: MBP, ECP -> trc binm PQ gii phng cc neopeptide gy vim: P,VIP,v.v

- Vai tr cc phn t kt dnh ICAM1 v VCAM-1(intercelle cell adhesion molicule v Vascular celladhesion molicule) -> vim.

Qu trnh co tht PQ

- Hu qu qu trnh vim -> co tht PQ- Ri lon h TK t ng autonome giao cm -> tngcholin -> Cholinergic -> mediator -> co tht PQ.

- Leucotrienes co PQ rt mnh Postagladin, c bitPDG2, PAF do mast cell tit ra -> histamin -> co PQ.

Qu trnh co tht PQ

- Hu qu qu trnh vim -> co tht PQ- Ri lon h TK t ng autonome giao cm -> tngcholin -> Cholinergic -> mediator -> co tht PQ.

- Leucotrienes co PQ rt mnh Postagladin, c bitPDG2, PAF do mast cell tit ra -> histamin -> co PQ.

Gia tng tnh phn ng HPQ

- L trng thi bnh l khng c trng cho HPQ, cngp trong cc bnh khc.

- Tng phn ng PQ, gii thch s xut hin hen do gngsc, cc loi khi, kh lnh, phn hoa, v.v

Gia tng tnh phn ng HPQ

- L trng thi bnh l khng c trng cho HPQ, cngp trong cc bnh khc.

- Tng phn ng PQ, gii thch s xut hin hen do gngsc, cc loi khi, kh lnh, phn hoa, v.v

Phn loi hpqTheo nguyn nhn gy bnh

HPQ d ngHPQ khng d ng

Theo nguyn nhn gy bnh

HPQ d ngHPQ khng d ng

Phn loi theo din bin lm sngMc Triu chng lm sng Lu lng nh (PEF)

Bc 1(tng cn)

- Di 1 cn/ tun- Di 2 cn v m/ thng- Cn ngn, khng lin tc- Gia cc cn bnh thng

- PEF 80% tr s lthuyt

- Dao ng PEF > 20%

Bc 2(Nh ko di)

- Trn 1 cn/ tun nhng di 1 cn/ ngy- Trn 2 cn v m/ thng- nh hng n hot ng th lc v gic- ng- Phi dng thuc kch thch 2

- PEF 80% tr s l thuyt- Dao ng PEF20 30%

Bc 2(Nh ko di)

- Trn 1 cn/ tun nhng di 1 cn/ ngy- Trn 2 cn v m/ thng- nh hng n hot ng th lc v gic- ng- Phi dng thuc kch thch 2

- PEF 80% tr s l thuyt- Dao ng PEF20 30%

Bc 3(TB ko di)

- Cn xy ra mi ngy- Trn 1 cn v m/ tun- nh hng n th lc, gic ng- Phi Dng kch thch 2 v corticoid

- PEF : 60 80% tr s lthuyt

- Dao ng PEF > 30%

Bc 4(Nng ko di)

- Cn xy Ra thng xuyn- Cn v m thng xuyn- Th lc hn ch, km pht trin- Thng xuyn dng kch thch 2 v corticoid.

- PEF < 60% tr s lthuyt- Dao ng PEF 40%

Triu chng lm sng

- Cc du hiu bo trc: nga mt, mi, ho, tc ngcv,v

- Cn kh th- Cn hen nguy kch: th 30 ln/pht. Mch 110ln/pht- mch nghch o - phi im lng -tm ti - khng oc PEF.

- Cc du hiu bo trc: nga mt, mi, ho, tc ngcv,v

- Cn kh th- Cn hen nguy kch: th 30 ln/pht. Mch 110ln/pht- mch nghch o - phi im lng -tm ti - khng oc PEF.

Chn onChn on xc nh

- Tin s ho, kh kh, nng ngc, ti din- Ran rt, ngy.- Triu chng nng v m, tip xc DN, nhimkhun h hp, thi tit.

- Dao ng PEF sng, chiu 20%.- Test Salbutamol (+)

Chn on xc nh

- Tin s ho, kh kh, nng ngc, ti din- Ran rt, ngy.- Triu chng nng v m, tip xc DN, nhimkhun h hp, thi tit.

- Dao ng PEF sng, chiu 20%.- Test Salbutamol (+)

Chn on phn bit

- Vim ph qun- COPD- U ph qun, u phi, polip mi

Chn on phn bit

- Vim ph qun- COPD- U ph qun, u phi, polip mi

Chn on nguyn nhn- Khai thc TSD- Cc Test b- Test kch thch (Provocation test)- Cc phn ng in Vitro.

Chn on nguyn nhn- Khai thc TSD- Cc Test b- Test kch thch (Provocation test)- Cc phn ng in Vitro.

iu trDN - KT D - Mediators - Triu chng lm sng(I) (II) (III) (IV)

iu tr c hiu

- Gim mn cm c bit, hay liu phpmin dch (immunotherapy)

- Ch nh:+ Bit DN gy bnh+ Khng th loi b c DN.

DN - KT D - Mediators - Triu chng lm sng(I) (II) (III) (IV)

iu tr c hiu

- Gim mn cm c bit, hay liu phpmin dch (immunotherapy)

- Ch nh:+ Bit DN gy bnh+ Khng th loi b c DN.

iu tr khng c hiu

- Thuc ct cn: cng 2 ngn (SABA: Short Acting 2Agonist)

- D phng Corticoid hit (inhaled corticosteroid ICS)- Kim sot triu chng: cng 2 di (LABA: LongActing 2 Agonist).

- Phi hp qun L + kim sot hen ICS + LABA.

iu tr khng c hiu

- Thuc ct cn: cng 2 ngn (SABA: Short Acting 2Agonist)

- D phng Corticoid hit (inhaled corticosteroid ICS)- Kim sot triu chng: cng 2 di (LABA: LongActing 2 Agonist).

- Phi hp qun L + kim sot hen ICS + LABA.

Mc tiu iu tr- Hn ch ti a triu chng (gim hn triu chng vm)

- Hn ch thp nht cc t hen cp- Gim ti a hen nng phi vo vin- Bo m hot ng bnh thng cho ngi bnh- PEF gn nh bnh thng (>80%)- Khng c tc dng ph ca thuc.

- Hn ch ti a triu chng (gim hn triu chng vm)

- Hn ch thp nht cc t hen cp- Gim ti a hen nng phi vo vin- Bo m hot ng bnh thng cho ngi bnh- PEF gn nh bnh thng (>80%)- Khng c tc dng ph ca thuc.

Thuc iu tr hen- Thuc cng 2 c 2 nhm:

SABA:- Salbutamol 2mg, 4mg: 2 4 vin/ ngy- Salbutamol 0,5mg tim di da, truyn T/M.- Salbutamol 5mg: kh dung- Salbutamol xt.Cc thuc khc: Bricanyl, Ventolin (vin, tim, KD,xt)

LABA: Formoterol (Foradil), Salmeterol (serevent):kim sot hen.

- Thuc cng 2 c 2 nhm: SABA:- Salbutamol 2mg, 4mg: 2 4 vin/ ngy- Salbutamol 0,5mg tim di da, truyn T/M.- Salbutamol 5mg: kh dung- Salbutamol xt.Cc thuc khc: Bricanyl, Ventolin (vin, tim, KD,xt)

LABA: Formoterol (Foradil), Salmeterol (serevent):kim sot hen.

- Thuc nhm Xanthin* Theophyllin 0,1g: 4 - 5 vin.* Theostat 100, 200, 300mg: 1- 3 vin.* Diaphyllin 4,8% + Glucose 5%: Truyn T/M.

- Thuc chng vim:Glucocorticoid dng vin, tim, ht (inhaledcorticosteroid ICS).

* Prednisolon 5mg, Medrol 4mg, 16mg* Pulmicort respules: KD, 0,5mg/ml.* Pulmicort turbuhaler: bt ht qua ming 100, 200mg:bnh xt 200 liu + u tra vo ming.

* Becotide (beclomethasone dipropionate): KD 50g liu bnh xt 200 liu.

- Thuc nhm Xanthin* Theophyllin 0,1g: 4 - 5 vin.* Theostat 100, 200, 300mg: 1- 3 vin.* Diaphyllin 4,8% + Glucose 5%: Truyn T/M.

- Thuc chng vim:Glucocorticoid dng vin, tim, ht (inhaledcorticosteroid ICS).

* Prednisolon 5mg, Medrol 4mg, 16mg* Pulmicort respules: KD, 0,5mg/ml.* Pulmicort turbuhaler: bt ht qua ming 100, 200mg:bnh xt 200 liu + u tra vo ming.

* Becotide (beclomethasone dipropionate): KD 50g liu bnh xt 200 liu.

- Thuc d phng kim sot hen: ICS + LABA

Seretide (Salmeterol + Fluticasone propionate)Cc hm lng: Seretide 25/50; 25/125 v 25/250 g.

Symbicort (Fromoterol + budesonide):Symbicort turbuhaler 100/4,5 g/liu.

- Thuc gim phn ng ph qun:

Clarityne 10mg x 1 vinZystec 10mg x 1 vinLaricetin 10mg x 1 vinTelfast 180mg x 1 vin.

- Thuc d phng kim sot hen: ICS + LABA

Seretide (Salmeterol + Fluticasone propionate)Cc hm lng: Seretide 25/50; 25/125 v 25/250 g.

Symbicort (Fromoterol + budesonide):Symbicort turbuhaler 100/4,5 g/liu.

- Thuc gim phn ng ph qun:

Clarityne 10mg x 1 vinZystec 10mg x 1 vinLaricetin 10mg x 1 vinTelfast 180mg x 1 vin.