H hô h p
24
Hen ph qu n là gì?
Là b nh lí viêm mãn tính c a ph
qu n v i đ c trưng ch c năng hô
h p có th h i ph c.
Tri u ch ng
•
Th khò khè.
•
Khó th .
•
Ho.
Nh h i kĩ ti n s d ng c a BN,
s t, eczema.
Y u t kích thích
bao g m:
•
B i/Lông/Hơi nư c.
•
Xúc đ ng.
•
Thu c, ví d : ch n beta giao c m.
Xét nghi m
•
Đo lưu lư ng đ nh th ra:
lưu ý s bi n đ i trong ngày.
•
C y đ m
•
Khí máu đ ng m ch: trong
c p c u.
•
Đo hô h p kí: khi
thông khí t c ngh n.
•
Công th c máu: Tăng IgE,
BC.
•
XQ l ng ng c : tràn khí
màng ph i,
HC đông đ c .
Treatment
•
Conservative: patient education; advice on inhaler
technique and avoidance of triggering factors;
annual asthma review and influenza vaccine required.
•
Medical: refer to British Thoracic Society Guidelines:
○
Step 1: salbutamol (a short-acting beta-2
receptor agonist).
○
Step 2: step 1 + beclometasone (inhaled steroid).
○
Step 3: steps 1, 2 + salmeterol (a long-acting
beta-2 receptor agonist) + increased total dose
of inhaled steroid.
○
Step 4: steps 1–3 + increased dose of inhaled
steroid + consider adding additional therapy, e.g.:
- Theophylline (a xanthine derived bronchodilator
that inhibits phosphodiesterase).
- Montelukast (a leukotriene receptor antagonist).
○
Step 5: oral prednisolone (steroid) + high-dose
inhaled steroid; refer to specialist.
Complications
•
Death.
•
Disturbed sleep.
•
Persistent cough.
•
Side-effects of steroids:
○
Weight gain.
○
Thinning of the skin.
○
Striae formation.
○
Cataracts.
○
Cushing’s syndrome.
Treatment of acute asthma
Remember as O SHIT:
•
Oxygen.
•
Salbutamol.
•
Hydrocortisone.
•
Ipratropium.
•
Theophylline.
Sinh lí b nh
•
Tăng ti t đ m.
•
Viêm.
•
Co th t cơ ph qu n.
•
Interleukin (IL)-4: kính thích BC ưa acid and kích thích Lympho
B. Lympho B s n xu t IgE, làm dư ng bào v ra. Gi i phóng
Histamin, gây co th t ph qu n.
•
IL-5: kích thích BC ưa acid.
•
IL-13: kích thích ti t ch t nh y.
TB Th2
D nguyên
MAP 2.3 Asthma
Sơ đ 2.3 Hen ph qu n
Chapter_02.indd 24
06/12/14 2:52 AM
