Ths.

H Th Thch Thy
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Ni dung

1. i cng
2. Thuc tr hen suyn

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i cng

Hen suyn
hi chng tt nghn h hp, thun nghch v ti din.
kh th, kh kh, ho, mt nhc.
ko di t 5 - 10 pht, hng gi, c ngy.
gim dn v ht hn bnh thng.

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i cng

Cht trung gian Ngun Tc ng

Protein kim Bch cu a Eosin Tn thng biu m

Co tht ph qun, ph,

Histamine Dng bo
tng tit dch
Dng bo, bch cu a base,
Leucotrien (LTB4, bch cu a eosin, bch cu Co tht ph qun, ph,
LTC4, LTD4, LTE4) trung tnh, i thc bo, bch cu vim
n nhn
Dng bo, bch cu a base,
Co tht ph qun, ph,
Yu t hot ha bch cu eosin, bch cu trung
vim, tng tit dch, qu
tiu cu (PAF) tnh, i thc bo, bch cu n
mn ph qun
nhn, tiu cu, t bo ni m
Prostaglandin Co tht ph qun, ph,
Dng bo, t bo ni m
(PGD2, PGE2) tng tit dch
Tiu cu, i thc bo, bch cu Co tht ph qun, tng tit
Thromboxan A2
n nhn dch 4
i cng

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i cng

Mt s dng hen suyn

Hen suyn ngoi sinh (extrinsic asthma)
Hen suyn ni sinh (intrinsic asthma)
Hen suyn ngh nghip
Bnh phi tt nghn mn tnh (chronic obstructive pulmonary
disease, COPD)

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Thuc tr hen suyn

Tr liu hen suyn

khng vim
gin ph qun
Mc ch s dng
ct cn hen cp tnh
ch vn 2 - adrenegic tc ng nhanh
khng cholinergic
aminophyllin (tim truyn tnh mch)
d phng thuc n nh dng bo (cromolyn, nedocromil...)
duy tr trng thi n nh
corticosteroid
ch vn 2 - adrenegic tc ng ko di
theophyllin
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Thuc tr hen suyn
Nhm Thuc

2 - adrenergic agonist terbutalin, salbutamol, bitolterol, pirbuterol,

salmeterol
dn cht xanthin theophyllin, aminophyllin, diprophyllin

muscarinic antagonist ipratropium, oxitropium, tiotropium

khng vim corticoid prednison, hydrocortison, prednisolon

n nh dng bo cromolyn, nedocromil

c ch tng hp leucotrien, zileuton, pranlukast, zafirlukast

thuc i khng leucotrien
khng IgE omalizumab

khng histamin H1 ketotifen

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Thuc tr hen suyn

Thuc ch vn 2 - adrenergic
Tc ng ngn, nhanh Tc ng di, chm
Hiu qu sau 3 - 5 pht Hiu qu sau 30 pht
Ko di 4 - 6 gi Ko di 12 gi
Lin kt vandervan, d nhanh Lin kt cng ha tr, cht ch
phn hy nga cn (ban m)
ct cn Thuc salmeterol, formoterol
Thuc salbutamol (albuterol), v bambuterol
terbutalin, bitolterol,
clenbuterol, fenoterol,
pirbuterol

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Thuc tr hen suyn

Thuc ch vn 2 - adrenergic
C ch tc ng
gn vo 2 - adrenergic receptor, hot ha adenylate cyclase, tng nng
cAMP gin c trn ph qun.

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Thuc tr hen suyn

Thuc ch vn 2 - adrenergic
Tc dng ph
ti ch: t tc dng ph
dng ung v dng tim
run, tng nhp tim, nhc u, hi hp, h kali huyt
quen thuc, nng cn hen, tng ng huyt, h kali huyt,
tng acid bo t do trong mu.

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Thuc tr hen suyn
Thuc ch vn 2-adrenergic tc dng nhanh dng ct cn

Hot cht Khi pht tc ng t tc ng Hm lng Liu/ngy

2,5mg; 5mg >12 tui: 2,5mg x 3

Vin nn: 1 gi 8-12 gi
<12 tui: 0,075 mg/kg x 3
ng ht phn liu (meter- >5 tui: 1-2 ln bm x 4
6 gi 250g/1 liu
dose inhaler): 3 pht
Terbutalin
>12 tui: 2,5-5mg x 4
5mg/2ml,10 <12 tui: 0,2mg/kgx 6
Xng kh dung 4-5 gi 6-
mg/2ml SC,
(nebuliser): 5 pht 12 gi >12 tui: 0,25-0,5mg x4
IV 1mg/2ml
<12 tui: 25g/kg
IV, SC: 5 pht 4 gi 8mg >12 tui: 8mg x 2

Vin nn: 1 gi 4 gi 200mg/liu 200-400mg x3-4

ng ht bt kh (dry-
4 gi 200 mg/5ml 100-200mg x 3-4
powder inhaler): 5 pht
Salbutamol
ng ht phn liu: 5 pht 4 gi 2,5mg/2,5ml 200mg (100mg) 3-42,5-5 mg x 4

Xng kh dung 5mg/2,5ml

6 gi >12 tui: 1-2 ln bm x 142
(nebuliser): 5 pht 370g/liu
Thuc tr hen suyn

Thuc ch vn 2-adrenergic tc dng nhanh dng ct cn

Khi pht tc t tc
Hot cht Hm lng Liu/ngy
ng ng

ng ht phn liu >12 tui: 2mgx 4

6-12 gi 2mg/ml
Bitolterol (meter-dose >12 tui: 1-2 ln bm
inhaler): 3 pht 6 gi 200g/liu
x 4
Xng kh dung
Pirbuterol (nebuliser): 5 6-8 gi 0,31mg/ml 6-11 tui: 0,31mg x 3
pht
ng ht phn liu
(meter-dose
Levalbuterol
inhaler): 5-10
(levo- >12 tui: 0,62mg x 3
phtXng kh
salbutamol)
dung (nebuliser):
5 pht
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Thuc tr hen suyn

Thuc ch vn 2-adrenergic tc dng chm, ko di dng d phng

ng ht phn liu >12 tui: 50 g x 2

Salmeterol (meter-dose 12 gi 25mg, 50mg
inhaler): 10-20 pht <12 tui: 25g x 2

ng ht bt kh
Formoterol (dry-powder 12 gi 12mg >12 tui: 12-24 g x 2
inhaler): 10-20 pht

>12 tui: 10-20mg x 1

Bambutero
Vin nn: 1 gi 24 gi 10mg 6-12 tui: 10mg x 1
l
2-5 tui: 5mg x 1

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Thuc tr hen suyn

Dn cht xanthin (Theophyllin)

Tc dng
gin ph qun
thn kinh: kch thch tnh to, run, bn chn
tim mch: tng nhp tim, gin mch
thn: li tiu nh (tng lc cu thn, gim ti hp thu ng
thn)
thuc theophyllin, mui ethylen - amino - theophyllin
(aminophyllin) dng tim truyn tnh mch.

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Thuc tr hen suyn

Dn cht xanthin (Theophyllin)

C ch tc ng
c ch
phosphodiesterase
i khng receptor
adenosin
gin c trn phi
gin ph qun

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Thuc tr hen suyn

Dn cht xanthin (Theophyllin)

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Thuc tr hen suyn

Dn cht xanthin (Theophyllin)

S dng tr liu
t c s dng.
hen cp tnh nng: aminophyllin tim truyn tnh mch
hen mn tnh: theophyllin ung dng phng thch ko di.
nng theophyllin huyt tng 10 - 15 g/ml bt buc
theo di nng huyt thanh theophyllin.
hiu chnh liu: tr em, ngi gi, suy thn, nghin thuc l,
bo ph

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Thuc tr hen suyn

Dn cht xanthin (Theophyllin)

Tc dng ph - c tnh
bun nn, nn ma
au u, mt ng
tim nhanh, lon nhp.
co git, ng kinh.
Tng tc thuc
Erythromycin, ciprofloxacin, norfloxacin, ofloxacin, allopurinol
tng nng theophyllin
Phenobarbital, phenytoin, rifampicin gim nng
theophyllin.

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Thuc tr hen suyn

Thuc khng cholinergic th th muscarinic

Tc dng
Ipratropium, oxitropium v tiotropium bn tng hp t atropin.
Khi pht tc dng chm v yu hn 2 - adrenergic agonist
phi hp 2 - adrenergic agonist
d phng cn hen.

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Thuc tr hen suyn

Thuc khng cholinergic th th muscarinic

C ch tc ng
i khng tng tranh
vi acetylcholine ti
receptor ngn tc
ng co ph qun ca
acetylcholine
gim tit dch t cc
tuyn tit dch nhy.
tc ng ti a t c
sau 30 pht v ko di 4
- 6 gi.

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Thuc tr hen suyn

Thuc khng cholinergic th th muscarinic

S dng tr liu
ipratropium gim triu chng km cht ch vn 2 ht tc
dng ngn.
Thuc thay th cho bnh nhn khng dung np vi thuc gin
ph qun khc, p ng khng y vi cc cch tr liu
tiu chun khc
Tc dng ph
dng ht gy kh ming, v ng, to bn
lu gi nc tiu, tng nhn p
Thuc tr hen suyn

Dng bo ch Ipratropium Oxitropium Tiotropium

20 g 2, 3 ln/ngy
ng bm phn liu 200 g, 2-3 ln/ngy
<6 tui: 20 g, 3 ln/ngy

ng ht bt kh 40 g, 3-4 ln/ngy 22.5 g/ngy

>3 tui, ngi ln: 100-

Dung dch xng kh 500 g, 3-4 ln/ngy
1-2 mg, 2-3 ln/ngy
dung 1 thng-3 tui: 62.5-250
g, 3 ln/ngy

+ Albuterol
Dng phi hp
+ Fenoterol
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Thuc tr hen suyn

Corticoid
Phn loi
tc dng ton thn (ung hay tim chch)
tc dng ti ch (kh dung).
C ch tc ng
c ch phospholipase A2 trong chuyn ha acid arachidonic
ngn cn to leucotrien.
c ch to khng th, gim p ng min dch, gim hot
tnh t bo trong phn ng vim ti ch.
tng nhy cm receptor 2 adrenergic vi cc thuc ch
vn.

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Thuc tr hen suyn

Corticoid
S dng tr liu Corticoid cho tc dng ton thn
hydrocortison, prednison, prednisolon v methylprednisolon.
Suyn cp tnh nng: hydrocortison hay methylprednisolon IV
Suyn tin trin nng dn: (PO) 1 liu bui sng vi 1 trong
hai phng cch sau:
Prednison: 0,5 - 1mg/kg/ngy trong 7 ngy
Prednisolon: 0,5 - 1mg/kg/ngy, sau t ngy 7 - 10 gim
cn 5mg/ngy n khi ngng thuc
iu tr duy tr: dng cc liu ti thiu corticoid, chn loi t c
tc dng ph nht (prednisolone 2mg/kg/ngy, ti a
60mg/ngy).

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Thuc tr hen suyn

Corticoid
S dng tr liu Corticoid dng kh dung
Dn cht ca betamethason
Beclomethason, budesonid, flunisolid, fluticason, triamcinolon.
Bo ch dng ng bm phn liu hay ng ht bt kh.
Liu dng: liu thp dnh cho hen mc nh ( 2), liu
trung bnh (hen 3) v liu cao (hen 4).

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Thuc tr hen suyn

Corticoid
Hot cht Liu thp Liu trung bnh Liu cao

168-504 g 504-840 g >8404 g

Beclomethason
Tr em: 84-336 g Tr em: 336-672 g Tr em: >672 g

200-400 g 400-600 g >600 g

Budesonid
Tr em: 100-200 g Tr em: 200-400 g >400 g

500-1000 g 1000-2000 g >2000 g

Flunisolid
Tr em: 500-750 g Tr em: 1-1,25mg >1250 g
88-264 g 264-660 g >660 g
Fluticason
Tr em: 88-176 g Tr em: 176-440 g Tr em: >440 g
400-1000 g 1000-2000 g >2000 g
Triamcinolon
Tr em: 400-800 g Tr em: 800-1200 g Tr em: >1200 g
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Thuc tr hen suyn

Corticoid
Tc dng ph - c tnh
s dng corticoid ton thn ko di, gim dn trong nhiu
tun trc khi ngng thuc.
corticoid c tc dng ton thn: tng trng, tng ng huyt,
ph n, tng huyt p, xng xp, lu lnh so, d nhim
trng, mn, suy thng thn,
dng kh dung: kch ng ng h hp trn, au hng, khn
ting, nhin nm Candida, Aspergilus niger hng, thanh
qun v c ch hot ng ca trc vng di i - tuyn yn
- v thng thn

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Thuc tr hen suyn

Thuc n nh dng bo: Cromolyn, Nedocromil

Cromolyn Na (mui Na ca acid cromoglicic), nedocromil
c ch phng thch cht trung gian ha hc gy vim
Hiu lc cromolyn v nedocromil tr em r hn ngi ln,
thch hp hen suyn ngoi sinh hn ni sinh.
S dng kh dung d phng cn hen, iu tr hen suyn
mc nh v trung bnh.
Khng s dng trong cn hen cp tnh.
Tc dng ph: nga, au u, vim hng, bun nn,
mc nh v rt t xy ra.
Cht nga hen suyn an ton nht.

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Thuc tr hen suyn

Thuc n nh dng bo: Cromolyn, Nedocromil

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Thuc tr hen suyn

Thuc n nh dng bo: Cromolyn, Nedocromil

Hot cht Bo ch Liu ngi ln Liu tr em

ng ht bt kh 20mg
20mg x 4/ngy
ng bm phn liu 20 mg x 4/ngy
1600-3200 g x
Cromolyn 800g 1600-3200 g x 4/ngy
4/ngy
Xng kh dung 5mg/ml, 20 mg x 4/ngy
20 mg x 4/ngy
10mg/ml

ng bm phn liu
Nedocromil 3,5 mg x 4/ngy 3,5 mg x 4/ngy
1,75mg

Amlexanox 25-50 mg x 3/ngy

Pemirolast 10mg x 2/ngy, tr em 1-4 tui: 2.5 mg x 2; 5-10 tui: 5 mg x 2
Tranilast 100 mg x 3, tr em: 5 mg/kg chia 2-3 ln/ngy
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Thuc tr hen suyn

Leucotrien antagonist
c ch tng hp leucotrien t acid arachidonic: thuc
zileuton: c ch 5 - lipoxygenase
i khng leucotrien trn leucotrien D4 (LTD4) receptor:
thuc pranlukast, zafirlukast
Leucotrien gy co tht ph qun mnh (hn histamine t
1000 - 10 000 ln) thuc c tc dng gin ph qun.
Dng ng ung (dng kh dung khng hiu qu, + hn ch
s dng glucocorticoid v tng hiu qu tr liu bng
glucocorticoid).
Dung np tt, t gy tc dng ph.

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Thuc tr hen suyn

Leucotrien antagonist

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Thuc tr hen suyn

Thuc khng IgE

Omalizumab: khng th ti t hp khng IgE.
Gn vo IgE IgE khng gn ln dng bo hay bch cu
a base ngn chn d ng
ng tim di da (liu 150 - 375mg) mi 2 - 4 tun. Sau
khi tim, thuc t nng nh trong mu sau 7 - 8 ngy, v
c th gn vi IgE vi t l 95%.
Ch nh: phng nga hen suyn do d ng.
Dung np tt, c th gy sng vng chch v phn ng
phn v (0,1%).
Khng dng cho tr di 12 tui.

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Thuc tr hen suyn

Thuc khng IgE

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Thuc tr hen suyn

Thuc khng histamin H1

Ketotifen c ch phng thch leucotrien, histamin t mast cell
v basophil tr hen suyn
ch d phng cn hen, + thuc gin kh qun
Thi gian tr liu: nhiu thng (hiu lc d phng n chm
sau vi tun; thuc khng tch ly).
Tng tc vi thuc tr i tho ng dng ung gim
tiu cu.
Liu dng d phng: vin 1mg 2 ln/ngy, vin c tc dng
ko di 2mg 1 ln/ngy (bui chiu).
Phi hp cc thuc tr hen suyn
Triu
Mc Ct cn Duy tr hng ngy
chng

2-agonist
1: nh 2 ln/tun tc ng Khng cn dng thuc khc
nhanh
Corticoid liu thp (ht)
2: nh, dai >2 ln/tun, 2-agonist Hay nedocromil, cromolyn
tc ng
dng 1 ln/ngy nhanh Hay theophyllin tc dng ko di
Hay Zafirlukast, Zileuton
2-agonist Corticoid liu trung bnh (kh dung) + 2-
3: trung bnh,
Hng ngy tc ng agonist tc ng chm hay theophyllin tc
dai dng
nhanh dng ko di
Corticoid liu cao (kh dung) + 2-agonist
2-agonist tc dng ko di hay theophylline tc dng
4: trm trng, ko di
Lin tc tc ng
dai dng
nhanh + Corticoid ung 2mg/kg /ngy, ti a
38
60mg/ngy