{"id":6972,"date":"2019-04-09T10:42:39","date_gmt":"2019-04-09T03:42:39","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=6972"},"modified":"2019-04-14T10:46:14","modified_gmt":"2019-04-14T03:46:14","slug":"lieu-phap-ket-hop-3-thuoc-cho-benh-nhan-copd","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/lieu-phap-ket-hop-3-thuoc-cho-benh-nhan-copd\/","title":{"rendered":"Li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p 3 thu\u1ed1c cho b\u1ec7nh nh\u00e2n COPD"},"content":{"rendered":"<h2>\u0110i\u1ec3m tin nghi\u00ean c\u1ee9u (NEJM): Li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p 3 thu\u1ed1c cho b\u1ec7nh nh\u00e2n COPD<\/h2>\n<p>Trong \u1ea5n b\u1ea3n NEJM Journal Watch (General Meidicne) Year in Review 2018, Editor David J. Amrol, MD. \u0111\u00e3 t\u1ed5ng h\u1ee3p k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u nh\u1eefng nghi\u00ean c\u1ee9u n\u1ed5i b\u1eadt trong n\u0103m 2018 v\u1ec1 li\u1ec7u ph\u00e1p<strong> 3 thu\u1ed1c trong ng\u0103n ng\u1eeba m\u1ed9t s\u1ed1 \u0111\u1ee3t c\u1ea5p \u1edf b\u1ec7nh nh\u00e2n t\u1eafc ngh\u1ebdn ph\u1ed5i m\u1ea1n t\u00ednh c\u00f3 nguy c\u01a1 cao.<\/strong><\/p>\n<p>C\u00e1c h\u01b0\u1edbng d\u1eabn khuy\u1ebfn c\u00e1o n\u00ean \u0111i\u1ec1u tr\u1ecb t\u1eebng b\u01b0\u1edbc cho b\u1ec7nh nh\u00e2n t\u1eafc ngh\u1ebdn ph\u1ed5i m\u1ea1n t\u00ednh (COPD) d\u1ef1a tr\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 nguy c\u01a1 xu\u1ea5t hi\u1ec7n c\u01a1n k\u1ecbch ph\u00e1t: b\u1eaft \u0111\u1ea7u v\u1edbi m\u1ed9t thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 muscarinic t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i (LAMA) ho\u1eb7c ch\u1ee7 v\u1eadn \u03b2 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i (LABA); ti\u1ebfp theo k\u1ebft h\u1ee3p LAMA v\u00e0 LABA; cu\u1ed1i c\u00f9ng th\u00eam m\u1ed9t corticosteroid d\u1ea1ng h\u00edt (ICS) n\u1ebfu ch\u01b0a ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c b\u1ec7nh. Tuy nhi\u00ean, tr\u01b0\u1edbc \u0111\u00e2y li\u1ec7u ph\u00e1p 3 thu\u1ed1c (t\u1ee9c LAMA + LABA + ICS) v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u k\u1ef9.<\/p>\n<p>Trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh tr\u00ean 1532 b\u1ec7nh nh\u00e2n COPD c\u00f3 tr\u00ean 2 c\u01a1n c\u1ea5p\/n\u0103m, so v\u1edbi li\u1ec7u ph\u00e1p k\u00e9p (indacaterol v\u00e0 glycopyrrolat), nh\u00f3m b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p 3 thu\u1ed1c (beclomethason, formoterol v\u00e0 glycopyrrolat) trong 1 n\u0103m \u0111\u00e3 ng\u0103n ng\u1eeba \u0111\u01b0\u1ee3c m\u1ed9t s\u1ed1 c\u01a1n c\u1ea5p trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng; c\u1ee9 11 b\u1ec7nh nh\u00e2n d\u00f9ng li\u1ec7u ph\u00e1p 3 thu\u1ed1c th\u00ec ng\u0103n ng\u1eeba \u0111\u01b0\u1ee3c 1 c\u01a1n c\u1ea5p (NEJM JW Gen Med ng\u00e0y 15\/3 v\u00e0 Lancet ng\u00e0y 17\/3; 391:1076).<\/p>\n<p>Trong m\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c c\u0169ng k\u00e9o d\u00e0i 1 n\u0103m tr\u00ean 10335 b\u1ec7nh nh\u00e2n COPD c\u00f3 nguy c\u01a1 cao, li\u1ec7u ph\u00e1p 3 thu\u1ed1c (vilanterol, umeclidinium v\u00e0 fluticason [Trelogy Ellipta]) \u0111\u00e3 ng\u0103n ng\u1eeba \u0111\u01b0\u1ee3c m\u1ed9t s\u1ed1 c\u01a1n c\u1ea5p trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng so v\u1edbi li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p LABA\/LAMA (vilanterol v\u00e0 umeclidinium [Anoro Ellipta]; 0.91 so v\u1edbi 1.21 c\u01a1n c\u1ea5p\/n\u0103m; NEJM JW Gen Med ng\u00e0y 15\/6 v\u00e0 N Engl J Med ng\u00e0y 3\/5; 378:1671).<\/p>\n<p>Cu\u1ed1i c\u00f9ng, k\u1ebft qu\u1ea3 ph\u00e2n t\u00edch g\u1ed9p 24 th\u1eed nghi\u1ec7m so s\u00e1nh gi\u1eefa li\u1ec7u ph\u00e1p 3 thu\u1ed1c v\u1edbi LAMA ho\u1eb7c k\u1ebft h\u1ee3p LAMA\/LABA cho th\u1ea5y nh\u00f3m s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p 3 thu\u1ed1c \u00edt x\u1ea3y ra c\u01a1n c\u1ea5p h\u01a1n (t\u1ec9 l\u1ec7 t\u1ea7n su\u1ea5t \u22480.75; NEJM JW Gen Med Dec ng\u00e0y 15\/12 BMJ 2018 ng\u00e0y 6\/11; 363:4388).<\/p>\n<p>Tuy nhi\u00ean trong h\u1ea7u h\u1ebft c\u00e1c th\u1eed nghi\u1ec7m, s\u1eed d\u1ee5ng ICS l\u00e0m t\u0103ng nguy c\u01a1 vi\u00eam ph\u1ed5i, m\u1eb7t kh\u00e1c, nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u01b0\u1ee3c h\u01b0\u1edfng l\u1ee3i nhi\u1ec1u nh\u1ea5t l\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan ho\u1eb7c m\u1eafc k\u00e8m hen ph\u1ebf qu\u1ea3n.<\/p>\n<p>Nhi\u1ec1u b\u1ec7nh nh\u00e2n b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p 3 thu\u1ed1c kh\u00f4ng ph\u00f9 h\u1ee3p ho\u1eb7c ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb khi kh\u00f4ng c\u00f2n c\u1ea7n thi\u1ebft. M\u1ed9t th\u1eed nghi\u1ec7m ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh tr\u00ean h\u01a1n 1000 b\u1ec7nh nh\u00e2n COPD trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng \u0111ang \u0111i\u1ec1u tr\u1ecb 3 thu\u1ed1c nh\u01b0ng v\u1eabn c\u00f3 nh\u1eefng \u0111\u1ee3t c\u1ea5p kh\u00f4ng th\u01b0\u1eddng xuy\u00ean, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c xu\u1ed1ng thang v\u1edbi m\u1ed9t thu\u1ed1c nh\u00f3m LABA\/LAMA, k\u1ebft qu\u1ea3 l\u00e0 s\u1ed1 \u0111\u1ee3t c\u1ea5p kh\u00f4ng nhi\u1ec1u h\u01a1n so v\u1edbi nh\u00f3m ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb 3 thu\u1ed1c, ngo\u1ea1i tr\u1eeb ph\u00e2n nh\u00f3m c\u00f3 t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan (NEJM JW Gen Med ng\u00e0y 15\/9 v\u00e0 Am J Respir Crit Care Med ng\u00e0y 1\/8; 198:329).<\/p>\n<p>C\u00f3 \u0111\u1ebfn 50% b\u1ec7nh nh\u00e2n COPD s\u1eed d\u1ee5ng ICS m\u1eb7c d\u00f9 ph\u1ea7n l\u1edbn \u0111\u1ec1u kh\u00f4ng c\u00f3 nguy c\u01a1 cao x\u1ea3y ra c\u00e1c \u0111\u1ee3t k\u1ecbch ph\u00e1t. Do l\u00e0m t\u0103ng chi ph\u00ed v\u00e0 t\u0103ng nguy c\u01a1 vi\u00eam ph\u1ed5i, li\u1ec7u ph\u00e1p 3 thu\u1ed1c ch\u1ec9 n\u00ean d\u00e0nh cho nh\u1eefng b\u1ec7nh nh\u00e2n th\u01b0\u1eddng xuy\u00ean x\u1ea3y ra \u0111\u1ee3t c\u1ea5p d\u00f9 \u0111\u00e3 s\u1eed d\u1ee5ng 2 thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i. Tuy nhi\u00ean b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng ch\u1ed3ng l\u1ea5p hen suy\u1ec5n\/COPD ho\u1eb7c t\u0103ng b\u1ea1ch b\u1ea7u \u00e1i toan ngo\u1ea1i vi \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi ICS.<\/p>\n<p>\u2014<\/p>\n<p>The 2018 GOLD guidelines are available at https:\/\/goldcopd.org\/wp-content\/uploads\/2016\/04\/GOLD-2018-WMS.pdf<\/p>\n<p>Ngu\u1ed3n: <a href=\"https:\/\/www.jwatch.org\/na48078\/2018\/12\/27\/nejm-journal-watch-general-medicine-year-review-2018\" rel=\"noopener\">https:\/\/www.jwatch.org\/na48078\/2018\/12\/27\/nejm-journal-watch-general-medicine-year-review-2018<\/a><\/p>\n<p>Ng\u01b0\u1eddi t\u1ed5ng h\u1ee3p: Nguy\u1ec5n Th\u1ecb Thu H\u00e0 &#8211; \u0110o\u00e0n Th\u1ecb Ph\u01b0\u01a1ng Th\u1ea3o<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110i\u1ec3m tin nghi\u00ean c\u1ee9u (NEJM): Li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p 3 thu\u1ed1c cho b\u1ec7nh nh\u00e2n COPD Trong \u1ea5n b\u1ea3n NEJM Journal Watch (General Meidicne) Year in Review 2018, Editor David J. Amrol, MD. \u0111\u00e3 t\u1ed5ng h\u1ee3p k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u nh\u1eefng nghi\u00ean c\u1ee9u n\u1ed5i b\u1eadt trong n\u0103m 2018 v\u1ec1 li\u1ec7u ph\u00e1p 3 thu\u1ed1c trong ng\u0103n ng\u1eeba [&#8230;]\n","protected":false},"author":1,"featured_media":6973,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-6972","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/6972","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=6972"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/6972\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/6973"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=6972"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=6972"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=6972"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}