27
H hô h p
Bi n ch ng
• B nh tim ph i m n: suy tim
ph i d n đ n tăng áp l c đ ng
m ch ph i mãn tính
• Ung thư ph i
• Nhi m trùng: đi u tr v i
kháng sinh Macrolide
• Tràn khí màng ph i.
• Đa HC.
• Suy hô h p
Xét nghi m
•
Ch n đoán xác đ nh b ng đo ch c năng
ph i, giá tr FEV1 <80% so v i tr s lí
thuy t và
FEV1/FVC <0.7.
•
XQ l ng ng c: Hình nh căng giãn ph i,
hình nh khí ph thũng, vòm hoành d t.
•
Công th c máu: T ng phân tích TB máu,
nư c ti u và d ch đi n gi i, BC, t c đ máu
l ng, CRP, n ng đ alpha-1 antitrypsin .
•
Đi n tim: Đánh giá b nh tim ph i m n c a
BN.
•
C y đ m.
Thang đi m
GOLD
đánh giá m c đ tr m
tr ng c a COPD:
M c đ I: COPD nh
M c đ II: COPD trung bình
M c đ III: COPD n ng
M c đ IV: COPD r t n ng
What is COPD?
This is a chronic obstructive airway disease
that is characterised by its irreversibility.
It is closely linked to smoking.
It is made up of:
•
Chronic bronchitis: cough with sputum
production for at least 3 months in
2 consecutive years.
•
Emphysema: this encompasses permanently
dilated airways distal to the terminal
bronchioles with alveolar destruction and
bullae formation. It is defined histologically
and is associated with alpha-1 antitrypsin
deficiency and increased elastase activity.
Causes
Remember this as GASES:
•
Genetics: alpha-1 antitrypsin
deficiency results in the loss of
protection against proteases.
•
Air pollution.
•
Smoking.
•
Exposure through occupation,
e.g. coal mining.
•
Secondhand smoke exposure.
Pathophysiology
•
Chronic bronchitis: chronic infection
results in the chronic infiltration of
the respiratory submucosa by
inflammatory cells. This results in
mucous gland hyperplasia and
smooth muscle hypertrophy,
causing bronchial lumen narrowing.
‘Blue bloaters’ are patients where
this pathology dominates.
•
Emphysema: alveolar walls are
destroyed resulting in bullae
formation and the fusion of adjacent
alveoli. This ultimately results in a
decreased surface area for gas
exchange and decreased elastic
recoil with subsequent air trapping.
‘Pink puffers’ are patients where
this pathology dominates.
Đi u tr
Li u pháp oxy và ph c h i ch c năng
hô h p
•
Thu c kháng Cholinergics, e.g.
ipratropium.
•
Thu c giãn PQ, e.g. salmeterol.
•
Corticosteroids.
•
B t bu c ph i ng ng hút thu c.
•
Li u pháp Oxy: Li u pháp oxy dài h n
(LTO) ho c thông khí không xâm l n
(NIV).
MAP 2.4 Chronic Obstructive
Pulmonary Disease (COPD)
Sơ đ 2.4 B nh ph i t c ngh n mãn tính (COPD)
Chapter_02.indd 27
06/12/14 2:52 AM
