{"id":1326,"date":"2023-05-18T16:40:48","date_gmt":"2023-05-18T09:40:48","guid":{"rendered":"https:\/\/matenix.com\/?p=1326"},"modified":"2023-05-19T07:56:34","modified_gmt":"2023-05-19T00:56:34","slug":"dieu-tri-xuong-thang-cho-benh-nhan-hen-nhe-duoc-kiem-soat-tot-mot-kinh-nghiem-tu-benh-vien-dai-hoc-y-duoc-tp-ho-chi-minh","status":"publish","type":"post","link":"https:\/\/matenix.com\/dieu-tri-xuong-thang-cho-benh-nhan-hen-nhe-duoc-kiem-soat-tot-mot-kinh-nghiem-tu-benh-vien-dai-hoc-y-duoc-tp-ho-chi-minh\/","title":{"rendered":"\u0110I\u1ec0U TR\u1eca XU\u1ed0NG THANG CHO B\u1ec6NH NH\u00c2N HEN NH\u1eb8 \u0110\u01af\u1ee2C KI\u1ec2M SO\u00c1T T\u1ed0T: M\u1ed8T KINH NGHI\u1ec6M T\u1eea B\u1ec6NH VI\u1ec6N \u0110\u1ea0I H\u1eccC Y D\u01af\u1ee2C TP. H\u1ed2 CH\u00cd MINH"},"content":{"rendered":"<p style=\"font-weight: 400;\">Nguy\u1ec5n H\u1ed3 Lam<sup>1,2<\/sup>, Nguy\u1ec5n Th\u00e0nh Nam<sup>2<\/sup>, L\u00ea Th\u01b0\u1ee3ng V\u0169<sup>1,2<\/sup>, Nguy\u1ec5n Nh\u01b0 Vinh<sup>1,2<\/sup>, L\u00ea Th\u1ecb Tuy\u1ebft Lan<sup>1,2<\/sup><\/p>\n<p style=\"font-weight: 400;\"><em><sup>1<\/sup><\/em><em>Khoa th\u0103m d\u00f2 ch\u1ee9c n\u0103ng, B\u1ec7nh vi\u1ec7n \u0110\u1ea1i H\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh<\/em><\/p>\n<p style=\"font-weight: 400;\"><em><sup>2<\/sup><\/em><em>\u0110\u1ea1i H\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh<\/em><\/p>\n<p style=\"font-weight: 400;\"><strong>T\u00d3M T\u1eaeT<\/strong><\/p>\n<p style=\"font-weight: 400;\"><strong>\u0110\u1eb7t v\u1ea5n \u0111\u1ec1:<\/strong>\u00a0\u0110i\u1ec1u tr\u1ecb xu\u1ed1ng thang cho b\u1ec7nh nh\u00e2n hen nh\u1eb9 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c \u0111\u1ed1i v\u1edbi c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng. M\u1ed9t chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang s\u1eed d\u1ee5ng corticosteroid d\u1ea1ng h\u00edt li\u1ec1u th\u1ea5p \u2013 d\u00f9ng ng\u1eaft qu\u00e3ng \u0111\u1ec1u \u0111\u1eb7n \u0111\u00e3 \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng t\u1ea1i B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh (UMC), \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 chi\u1ebfn l\u01b0\u1ee3c \u201cUMC\u201d.<\/p>\n<p style=\"font-weight: 400;\"><strong>M\u1ee5c ti\u00eau:<\/strong>\u00a0Nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nh\u1eb1m \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang \u201cUMC\u201d \u1edf b\u1ec7nh nh\u00e2n hen nh\u1eb9 ki\u1ec3m so\u00e1t t\u1ed1t.<\/p>\n<p style=\"font-weight: 400;\"><strong>Ph\u01b0\u01a1ng ph\u00e1p:<\/strong>\u00a0Nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u, m\u00f4 t\u1ea3, \u0111\u1eddi th\u1ef1c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u1ea1i UMC t\u1eeb n\u0103m 2009\u00a0\u00a0\u0111\u1ebfn n\u0103m 2018. T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n hen (\u2265 12 tu\u1ed5i) \u0111i\u1ec1u tr\u1ecb v\u1edbi chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong nghi\u00ean c\u1ee9u n\u00e0y.<\/p>\n<p style=\"font-weight: 400;\"><strong>K\u1ebft qu\u1ea3:<\/strong>\u00a0Trong 2072 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC, ch\u1ec9 112 b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng ti\u00eau ch\u00ed ch\u1ecdn v\u00e0o. Tu\u1ed5i trung v\u1ecb l\u00e0 38,5; gi\u1edbi n\u1eef chi\u1ebfm 62,5%. Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m l\u1ea7n \u0111\u1ea7u t\u1ea1i trung t\u00e2m \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb hen b\u1eadc 4 (87,5%). Tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb theo chi\u1ebfn l\u01b0\u1ee3c UMC, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ki\u1ec3m so\u00e1t b\u1eb1ng fluticasone propionate 125 \u03bcg 1 nh\u00e1t\/ng\u00e0y, salmeterol\/fluticasone propionate 25\/125 \u03bcg 1 nh\u00e1t\/ng\u00e0y, v\u00e0 formoterol\/budesonide 4,5\/160 \u03bcg 1 h\u00edt\/ng\u00e0y. Sau khi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb theo chi\u1ebfn l\u01b0\u1ee3c UMC, t\u1ef7 l\u1ec7 hen ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n \u0111\u1ea1t t\u1eeb 67,6% \u0111\u1ebfn 91,1%. Trong su\u1ed1t 1 n\u0103m \u0111i\u1ec1u tr\u1ecb theo chi\u1ebfn l\u01b0\u1ee3c UMC, ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p \u0111\u01b0\u1ee3c duy tr\u00ec \u1ed5n \u0111\u1ecbnh v\u00e0 ch\u1ec9 c\u00f3 7 b\u1ec7nh nh\u00e2n (6,3%) xu\u1ea5t hi\u1ec7n \u0111\u1ee3t c\u1ea5p.<\/p>\n<p style=\"font-weight: 400;\"><strong>K\u1ebft lu\u1eadn:<\/strong>\u00a0Chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC cho b\u1ec7nh nh\u00e2n hen nh\u1eb9 &#8211; ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n cho th\u1ea5y hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u1ed1i trong vi\u1ec7c duy tr\u00ec ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng, \u1ed5n \u0111\u1ecbnh ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p, v\u00e0 gi\u1ea3m nguy c\u01a1 \u0111\u1ee3t c\u1ea5p.<\/p>\n<p style=\"font-weight: 400;\"><strong>T\u1eeb kho\u00e1:<\/strong>\u00a0Hen, Budesonide, Fluticasone propionate, Formoterol, Salmeterol<\/p>\n<p style=\"font-weight: 400;\"><strong>GI\u1edaI THI\u1ec6U<\/strong><\/p>\n<p style=\"font-weight: 400;\">T\u1ed5 ch\u1ee9c s\u00e1ng ki\u1ebfn to\u00e0n c\u1ea7u v\u1ec1 hen (GINA) khuy\u1ebfn c\u00e1o c\u00e1ch ti\u1ebfp c\u1eadn theo b\u1eadc \u0111\u1ec3 hi\u1ec7u ch\u1ec9nh \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n hen d\u1ef1a tr\u00ean t\u00ecnh tr\u1ea1ng ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng [1]. L\u00ean thang \u0111i\u1ec1u tr\u1ecb khi b\u1ec7nh nh\u00e2n hen kh\u00f4ng ki\u1ec3m so\u00e1t th\u00ec r\u00f5 r\u00e0ng nh\u01b0ng vi\u1ec7c xu\u1ed1ng thang \u0111i\u1ec1u tr\u1ecb \u1edf b\u1ec7nh nh\u00e2n ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n th\u00ec ph\u1ee9c t\u1ea1p h\u01a1n, \u0111\u1eb7c bi\u1ec7t khi b\u1ec7nh nh\u00e2n \u0111ang \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t b\u1eb1ng corticosteroid d\u1ea1ng h\u00edt li\u1ec1u th\u1ea5p (ICS) 1 nh\u00e1t h\u00e0ng ng\u00e0y ho\u1eb7c ICS li\u1ec1u th\u1ea5p\/\u0111\u1ed3ng v\u1eadn beta t\u00e1c d\u1ee5ng d\u00e0i (LABA) 1 nh\u00e1t h\u00e0ng ng\u00e0y [2 \u2013 4]. Ngo\u00e0i ra, vi\u1ec7c ng\u01b0ng ho\u00e0n to\u00e0n ICS (GINA \u0111\u00e3 kh\u00f4ng c\u00f2n khuy\u1ebfn c\u00e1o t\u1eeb n\u0103m 2015) c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 \u0111\u1ee3t c\u1ea5p [1, 5]. Do \u0111\u00f3, \u201c\u0111\u00e2u l\u00e0 b\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb ti\u1ebfp theo cho b\u1ec7nh nh\u00e2n hen ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n v\u1edbi ICS li\u1ec1u th\u1ea5p 1 nh\u00e1t h\u00e0ng ng\u00e0y ho\u1eb7c ICS\/LABA li\u1ec1u th\u1ea5p 1 nh\u00e1t h\u00e0ng ng\u00e0y\u201d l\u00e0 m\u1ed9t c\u00e2u h\u1ecfi l\u1edbn cho c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng tr\u00ean to\u00e0n c\u1ea7u bao g\u1ed3m c\u1ea3 Vi\u1ec7t Nam. M\u1ed9t s\u1ed1 chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t nh\u01b0 [6, 7]:<\/p>\n<ul>\n<li style=\"font-weight: 400;\">L\u1ef1a ch\u1ecdn 1: tu\u00e2n th\u1ee7 ICS li\u1ec1u th\u1ea5p, 1 nh\u00e1t h\u00e0ng ng\u00e0y<\/li>\n<li style=\"font-weight: 400;\">L\u1ef1a ch\u1ecdn 2: chuy\u1ec3n sang d\u00f9ng ICS li\u1ec1u th\u1ea5p nh\u1ea5t\/LABA, 1 nh\u00e1t h\u00e0ng ng\u00e0y<\/li>\n<li style=\"font-weight: 400;\">L\u1ef1a ch\u1ecdn 3: d\u00f9ng ICS m\u1ed7i khi c\u1ea7n d\u00f9ng \u0111\u1ebfn SABA ho\u1eb7c d\u00f9ng budesonide\/formoterol \u201ckhi c\u1ea7n\u201d<\/li>\n<\/ul>\n<p style=\"font-weight: 400;\">Nguy\u00ean nh\u00e2n khoa h\u1ecdc cho c\u00e1c l\u1ef1a ch\u1ecdn tr\u00ean xu\u1ea5t ph\u00e1t t\u1eeb m\u1ed9t nghi\u00ean c\u1ee9u c\u1ee7a American Lung Association Asthma Clinical Research Centers [8] v\u00e0 k\u1ebft qu\u1ea3 t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u SYGMA-1 v\u00e0 SYGMA-2 [2, 9]. Tuy nhi\u00ean, c\u00e1c l\u1ef1a ch\u1ecdn tr\u00ean \u0111\u1ec1u c\u00f3 h\u1ea1n ch\u1ebf ri\u00eang, v\u00ed d\u1ee5, b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb theo l\u1ef1a ch\u1ecdn 1 c\u00f3 m\u1ee9c \u0111\u1ed9 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb k\u00e9m do c\u00f3 \u00edt tri\u1ec7u ch\u1ee9ng. Trong khi \u0111\u00f3, v\u1edbi l\u1ef1a ch\u1ecdn 3, \u0111i\u1ec1u tr\u1ecb b\u1ecb \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u b\u1edfi nh\u1eadn th\u1ee9c ch\u1ee7 quan c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<p style=\"font-weight: 400;\">Ch\u00fang t\u00f4i \u0111\u00e3 ph\u00e1t tri\u1ec3n m\u1ed9t chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang d\u00e0nh cho b\u1ec7nh nh\u00e2n hen nh\u1eb9 ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n t\u1ea1i B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 chi\u1ebfn l\u01b0\u1ee3c UMC (li\u1ec7u ph\u00e1p s\u1eed d\u1ee5ng ICS li\u1ec1u th\u1ea5p ng\u1eaft qu\u00e3ng \u2013 \u0111\u1ec1u \u0111\u1eb7n \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 nh\u01b0\u00a0<strong>h\u00ecnh 1<\/strong>). B\u1ec7nh nh\u00e2n hen s\u1ebd \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb m\u1ed9t h\u00edt c\u00e1ch ng\u00e0y, ti\u1ebfp theo 2 h\u00edt m\u1ed7i tu\u1ea7n v\u00e0 s\u1ebd ti\u1ebfp t\u1ee5c gi\u1ea3m xu\u1ed1ng \u0111\u1ebfn m\u1ed9t h\u00edt m\u1ed7i tu\u1ea7n n\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u1ea1t ki\u1ec3m so\u00e1t hen ho\u00e0n to\u00e0n trong \u00edt nh\u1ea5t 3 th\u00e1ng sau m\u1ed7i b\u01b0\u1edbc (1 h\u00edt \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 ICS \u0111\u01a1n tr\u1ecb li\u1ec7u ho\u1eb7c ph\u1ed1i h\u1ee3p ICS\/LABA).<\/p>\n<p style=\"font-weight: 400;\">T\u1eeb n\u0103m 2003, ch\u00fang t\u00f4i \u0111\u00e3 nh\u1eadn th\u1ea5y hi\u1ec7u qu\u1ea3 c\u1ee7a chi\u1ebfn l\u01b0\u1ee3c UMC \u0111\u1ed1i v\u1edbi ki\u1ec3m so\u00e1t hen. Tuy nhi\u00ean, kh\u00f4ng c\u00f3 c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e1nh gi\u00e1 k\u1ebft c\u1ee5c c\u1ee7a nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb theo chi\u1ebfn l\u01b0\u1ee3c n\u00e0y trong \u0111i\u1ec1u ki\u1ec7n b\u1ec7nh vi\u1ec7n c\u1ee7a ch\u00fang t\u00f4i. Do \u0111\u00f3, nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC \u1edf \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n hen nh\u1eb9 &#8211; ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n.<\/p>\n<p style=\"font-weight: 400;\"><strong>PH\u01af\u01a0NG PH\u00c1P NGHI\u00caN C\u1ee8U<\/strong><\/p>\n<p style=\"font-weight: 400;\"><strong>Qu\u00e1 tr\u00ecnh ch\u1ecdn m\u1eabu<\/strong><\/p>\n<p style=\"font-weight: 400;\">M\u1ed9t nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u, m\u00f4 t\u1ea3, \u0111\u1eddi th\u1ef1c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n hen \u2265 12 tu\u1ed5i, \u0111\u1ebfn kh\u00e1m t\u1ea1i khoa th\u0103m d\u00f2 ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p, B\u1ec7nh vi\u1ec7n \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh, t\u1eeb n\u0103m 2009 \u0111\u1ebfn n\u0103m 2018. Ti\u00eau ch\u00ed ch\u1ecdn v\u00e0o nh\u01b0 sau:<\/p>\n<ul>\n<li style=\"font-weight: 400;\">B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n hen theo h\u01b0\u1edbng d\u1eabn GINA 2015 [1]. C\u1ee5 th\u1ec3, b\u1ec7nh nh\u00e2n c\u1ea7n c\u00f3 (1) m\u1ed9t trong c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p: ho, kh\u00f2 kh\u00e8, kh\u00f3 th\u1edf, n\u1eb7ng ng\u1ef1c v\u00e0 (2) m\u1ed9t k\u1ebft qu\u1ea3 h\u00f4 h\u1ea5p k\u00ed c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n (FEV1, VC ho\u1eb7c FVC t\u0103ng 200mL v\u00e0 12%).<\/li>\n<li style=\"font-weight: 400;\">B\u1ec7nh nh\u00e2n \u0111\u1ea1t \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t hen ho\u00e0n to\u00e0n v\u1edbi ICS li\u1ec1u th\u1ea5p 1 nh\u00e1t h\u00e0ng ng\u00e0y (fluticasone propionate 125 \u03bcg 1 nh\u00e1t h\u00e0ng ng\u00e0y) ho\u1eb7c ph\u1ed1i h\u1ee3p ICS\/LABA li\u1ec1u th\u1ea5p 1 h\u00edt h\u00e0ng ng\u00e0y (salmeterol\/fluticasone propionate 25\/125 \u03bcg 1 nh\u00e1t h\u00e0ng ng\u00e0y ho\u1eb7c formoterol\/budesonide 4,5\/160 \u03bcg 1 h\u00edt h\u00e0ng ng\u00e0y) trong \u00edt 3 th\u00e1ng tr\u01b0\u1edbc th\u1eddi \u0111i\u1ec3m T0. Ch\u00fang t\u00f4i \u0111\u1ecbnh ngh\u0129a T0 l\u00e0 th\u1eddi \u0111i\u1ec3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c nh\u1eadn v\u00e0o nghi\u00ean c\u1ee9u v\u00e0 b\u1eaft\u00a0\u0111\u1ea7u\u00a0\u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb xu\u1ed1ng thang theo chi\u1ebfn l\u01b0\u1ee3c UMC, c\u1ee5 th\u1ec3 nh\u01b0 sau:<\/li>\n<\/ul>\n<p style=\"font-weight: 400;\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Fluticasone propionate 125 \u03bcg 1 nh\u00e1t c\u00e1ch ng\u00e0y ho\u1eb7c<\/p>\n<p style=\"font-weight: 400;\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Salmeterol\/fluticasone propionate 25\/125 \u03bcg 1 nh\u00e1t c\u00e1ch ng\u00e0y ho\u1eb7c<\/p>\n<p style=\"font-weight: 400;\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Formoterol\/budesonide 4,5\/160 \u03bcg 1 nh\u00e1t c\u00e1ch ng\u00e0y.<\/p>\n<p style=\"font-weight: 400;\">Lo\u1ea1i thu\u1ed1c hen ki\u1ec3m so\u00e1t \u0111\u1ec3 kh\u1edfi \u0111\u1ea7u chi\u1ebfn l\u01b0\u1ee3c UMC s\u1ebd gi\u1ed1ng v\u1edbi lo\u1ea1i thu\u1ed1c ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng tr\u01b0\u1edbc \u0111\u00f3. V\u00ed d\u1ee5, n\u1ebfu b\u1ec7nh nh\u00e2n ki\u1ec3m so\u00e1t hen ho\u00e0n to\u00e0n v\u1edbi salmeterol\/fluticasone propionate 25\/125 \u03bcg 1 nh\u00e1t h\u00e0ng ng\u00e0y, anh \u1ea5y\/c\u00f4 \u1ea5y s\u1ebd \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng salmeterol\/fluticasone propionate 25\/125 \u03bcg 1 nh\u00e1t c\u00e1ch ng\u00e0y.<\/p>\n<ul>\n<li style=\"font-weight: 400;\">B\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ee7 th\u00f4ng tin \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a chi\u1ebfn l\u01b0\u1ee3c h\u1ea1 li\u1ec1u UMC trong 1 n\u0103m sau th\u1eddi \u0111i\u1ec3m T0 (\u00edt nh\u1ea5t 3 l\u1ea7n t\u00e1i kh\u00e1m trong 1 n\u0103m \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 ki\u1ec3m so\u00e1t hen v\u00e0 ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p).<\/li>\n<\/ul>\n<p style=\"font-weight: 400;\">B\u1ec7nh nh\u00e2n h\u00fat thu\u1ed1c l\u00e1 &gt; 10 g\u00f3i \u2013 n\u0103m ho\u1eb7c mang thai kh\u00f4ng \u0111\u01b0\u1ee3c nh\u1eadn v\u00e0o nghi\u00ean c\u1ee9u.<\/p>\n<p style=\"font-weight: 400;\">H\u00f4 h\u1ea5p k\u00fd \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi c\u00e1c k\u1ef9 thu\u1eadt vi\u00ean c\u00f3 &gt; 5 n\u0103m kinh nghi\u1ec7m, s\u1eed d\u1ee5ng m\u00e1y KOKO\u00aePFT (nSpire Health Inc., Longmont, CO, USA).\u00a0\u00a0S\u1ef1 chu\u1ea9n ho\u00e1 v\u00e0 l\u00fd gi\u1ea3i k\u1ebft qu\u1ea3 tu\u00e2n theo h\u01b0\u1edbng d\u1eabn 2005 c\u1ee7a Hi\u1ec7p h\u1ed9i L\u1ed3ng ng\u1ef1c Hoa K\u1ef3\/Hi\u1ec7p h\u1ed9i H\u00f4 h\u1ea5p Ch\u00e2u \u00c2u [10].<\/p>\n<p style=\"font-weight: 400;\">M\u1ee9c \u0111\u1ed9 ki\u1ec3m so\u00e1t hen \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 b\u1edfi b\u00e1c s\u0129 l\u00e2m s\u00e0ng theo h\u01b0\u1edbng d\u1eabn GINA [1]. Trong nghi\u00ean c\u1ee9u n\u00e0y, b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c \u0111\u1ed9 ki\u1ec3m so\u00e1t hen kh\u00f4ng ho\u00e0n to\u00e0n v\u00e0 ki\u1ec3m so\u00e1t m\u1ed9t ph\u1ea7n \u0111\u01b0\u1ee3c ph\u00e2n v\u00e0o nh\u00f3m kh\u00f4ng ki\u1ec3m so\u00e1t v\u00e0 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 c\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn s\u1ef1 m\u1ea5t ki\u1ec3m so\u00e1t hen nh\u01b0 li\u1ec1u thu\u1ed1c ki\u1ec3m so\u00e1t hen kh\u00f4ng \u0111\u1ee7, m\u1ee9c \u0111\u1ed9 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, nhi\u1ec5m khu\u1ea9n h\u00f4 h\u1ea5p, b\u1ec7nh \u0111\u1ed3ng m\u1eafc v\u00e0 k\u0129 thu\u1eadt d\u00f9ng d\u1ee5ng c\u1ee5 h\u00edt. N\u1ebfu b\u00e1c s\u0129 l\u00e2m s\u00e0ng x\u00e1c nh\u1eadn hen kh\u00f4ng ki\u1ec3m so\u00e1t c\u00f3 li\u00ean quan \u0111\u1ebfn li\u1ec1u kh\u00f4ng \u0111\u1ee7, chi\u1ebfn l\u01b0\u1ee3c l\u00ean thang s\u1ebd \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng theo h\u01b0\u1edbng ng\u01b0\u1ee3c l\u1ea1i chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng x\u1ea5u \u0111i ho\u1eb7c \u0111\u1ee3t c\u1ea5p trong th\u1eddi gian \u0111i\u1ec1u tr\u1ecb theo chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC, h\u1ecd s\u1ebd \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb theo h\u01b0\u1edbng d\u1eabn c\u1ee7a GINA [3] v\u00e0 \u0111\u01b0\u1ee3c n\u00e2ng li\u1ec1u thu\u1ed1c ki\u1ec3m so\u00e1t \u0111ang d\u00f9ng l\u00ean 1 h\u00edt d\u00f9ng h\u00e0ng ng\u00e0y trong 2 \u2013 4 tu\u1ea7n.<\/p>\n<p style=\"font-weight: 400;\">Nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u1edbi s\u1ef1 ch\u1ea5p thu\u1eadn c\u1ee7a h\u1ed9i \u0111\u1ed3ng y \u0111\u1ee9c \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh, gi\u1ea5y ph\u00e9p ch\u1ea5p thu\u1eadn IRB No. 338\/HDDDDHYD. Nghi\u00ean c\u1ee9u tu\u00e2n theo c\u00e1c nguy\u00ean t\u1eafc c\u1ee7a tuy\u00ean ng\u00f4n Helsinki.<\/p>\n<p style=\"font-weight: 400;\"><strong>Thu th\u1eadp v\u00e0 ph\u00e2n t\u00edch d\u1eef li\u1ec7u<\/strong><\/p>\n<p style=\"font-weight: 400;\">Phi\u1ebfu thu th\u1eadp d\u1eef li\u1ec7u \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 thu th\u1eadp th\u00f4ng tin v\u1ec1 tu\u1ed5i, gi\u1edbi t\u00ednh, b\u1ec7nh \u0111\u1ed3ng m\u1eafc, tri\u1ec7u ch\u1ee9ng, b\u1eadc \u0111i\u1ec1u tr\u1ecb hen \u1edf th\u1eddi \u0111i\u1ec3m l\u1ea7n \u0111\u1ea7u \u0111\u1ebfn kh\u00e1m, c\u00e1c bi\u1ebfn s\u1ed1 kh\u00e1c nh\u01b0: lo\u1ea1i ICS (ICS\/LABA), m\u1ee9c \u0111\u1ed9 ki\u1ec3m so\u00e1t hen, h\u00f4 h\u1ea5p k\u00fd (FEV1, l\u01b0u l\u01b0\u1ee3ng \u0111\u1ec9nh th\u1edf ra [PEFR]), c\u00e1c y\u1ebfu t\u1ed1 g\u00e2y m\u1ea5t ki\u1ec3m so\u00e1t hen. D\u1eef li\u1ec7u \u0111\u01b0\u1ee3c thu th\u1eadp t\u1ea1i c\u00e1c th\u1eddi \u0111i\u1ec3m T0, 3 th\u00e1ng sau, 6 th\u00e1ng sau, 9 th\u00e1ng sau, 12 th\u00e1ng sau T0. Ngo\u00e0i ra, s\u1ed1 \u0111\u1ee3t c\u1ea5p n\u1eb7ng c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn (\u0111\u1ee3t c\u1ea5p n\u1eb7ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 tri\u1ec7u ch\u1ee9ng hen x\u1ea5u \u0111i c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticosteroid to\u00e0n th\u00e2n) trong su\u1ed1t 1 n\u0103m b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb theo chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC. Th\u00f4ng tin v\u1ec1 s\u1ed1 \u0111\u1ee3t c\u1ea5p \u0111\u01b0\u1ee3c thu th\u1eadp t\u1eeb d\u1eef li\u1ec7u trong h\u1ed3 s\u01a1 b\u1ec7nh \u00e1n.<\/p>\n<p style=\"font-weight: 400;\">D\u1eef li\u1ec7u b\u1ecb thi\u1ebfu \u1edf c\u00e1c bi\u1ebfn s\u1ed1 FEV1 v\u00e0 PEFR \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1, khuynh h\u01b0\u1edbng thi\u1ebfu d\u1eef li\u1ec7u \u1edf 2 bi\u1ebfn s\u1ed1 n\u00e0y ph\u00f9 h\u1ee3p v\u1edbi d\u1ea1ng thi\u1ebfu d\u1eef li\u1ec7u ng\u1eabu nhi\u00ean. Ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3 l\u1eadp \u201cMultiple imputation\u201d \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u1eed l\u00fd d\u1eef li\u1ec7u b\u1ecb thi\u1ebfu. Ph\u00e9p ki\u1ec3m\u00a0<em>t\u00a0<\/em>b\u1eaft c\u1eb7p \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 thay \u0111\u1ed5i v\u1ec1 ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p trong su\u1ed1t 1 n\u0103m theo d\u00f5i. Ch\u00fang t\u00f4i chia c\u1ee1 m\u1eabu th\u00e0nh 2 nh\u00f3m (kh\u00f4ng ki\u1ec3m so\u00e1t v\u00e0 ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n) v\u00e0 th\u1ef1c hi\u1ec7n ph\u00e9p ki\u1ec3m Chi b\u00ecnh ph\u01b0\u01a1ng \u0111\u1ec3 t\u00ecm s\u1ef1 kh\u00e1c bi\u1ec7t. D\u1eef li\u1ec7u \u0111\u01b0\u1ee3c ph\u00e2n t\u00edch b\u1eb1ng ph\u1ea7n m\u1ec1m SPSS phi\u00ean b\u1ea3n 16.0 (SPSS Inc., Chicago, IL, USA), gi\u00e1 tr\u1ecb\u00a0<em>p<\/em>\u00a0&lt; 0,05 \u0111\u01b0\u1ee3c xem l\u00e0 ng\u01b0\u1ee1ng kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea.<\/p>\n<p style=\"font-weight: 400;\"><strong>K\u1ebeT QU\u1ea2<\/strong><\/p>\n<p style=\"font-weight: 400;\">T\u1eeb n\u0103m 2009 \u0111\u1ebfn n\u0103m 2018, c\u00f3 2072 b\u1ec7nh nh\u00e2n hen \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb theo chi\u1ebfn l\u01b0\u1ee3c h\u1ea1 li\u1ec1u UMC, nh\u01b0ng ch\u1ec9 c\u00f3 112 b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng \u0111\u01b0\u1ee3c c\u00e1c ti\u00eau ch\u00ed ch\u1ecdn m\u1eabu kh\u1eaft khe c\u1ee7a nghi\u00ean c\u1ee9u. Qu\u00e1 tr\u00ecnh ch\u1ecdn m\u1eabu \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n \u1edf\u00a0<strong>h\u00ecnh 2<\/strong>. Trong 112 b\u1ec7nh nh\u00e2n; c\u00f3 33,9% s\u1ed1ng t\u1ea1i TP. H\u1ed3 Ch\u00ed Minh; 66,1% \u0111\u1ebfn t\u1eeb c\u00e1c \u0111\u1ecba ph\u01b0\u01a1ng kh\u00e1c. B\u1ec7nh nh\u00e2n &lt; 18 tu\u1ed5i chi\u1ebfm 25,0%. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a to\u00e0n b\u1ed9 c\u1ee1 m\u1eabu v\u00e0 m\u1ed7i nh\u00f3m theo lo\u1ea1i thu\u1ed1c ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n t\u1ea1i\u00a0<strong>b\u1ea3ng 1<\/strong>.<\/p>\n<p style=\"font-weight: 400;\"><strong>M\u1ee9c \u0111\u1ed9 ki\u1ec3m so\u00e1t hen<\/strong><\/p>\n<p style=\"font-weight: 400;\">To\u00e0n b\u1ed9 b\u1ec7nh nh\u00e2n \u0111\u1ea1t ki\u1ec3m so\u00e1t hen ho\u00e0n to\u00e0n trong \u00edt nh\u1ea5t 3 th\u00e1ng tr\u01b0\u1edbc khi b\u00e1c s\u0129 l\u00e2m s\u00e0ng quy\u1ebft \u0111\u1ecbnh xu\u1ed1ng thang theo chi\u1ebfn l\u01b0\u1ee3c UMC. Ph\u00e2n lo\u1ea1i theo thu\u1ed1c ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c d\u00f9ng t\u1ea1i th\u1eddi \u0111i\u1ec3m T0, c\u00f3 33,0% b\u1ec7nh nh\u00e2n d\u00f9ng Fluticasone propionate 125 \u03bcg, 26,8% d\u00f9ng Salmeterol\/fluticasone propionate 25\/125 \u03bcg, v\u00e0 40,2% d\u00f9ng Formoterol\/budesonide 4,5\/160 \u03bcg. M\u1ee9c \u0111\u1ed9 ki\u1ec3m so\u00e1t hen \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 m\u1ed7i 3 th\u00e1ng t\u1eeb th\u1eddi \u0111i\u1ec3m T0, t\u1ef7 l\u1ec7 ki\u1ec3m so\u00e1t hen ho\u00e0n to\u00e0n dao \u0111\u1ed9ng t\u1eeb 67,6% \u0111\u1ebfn 91,1%\u00a0<strong>(h\u00ecnh 3)<\/strong>. T\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u1ea1t ki\u1ec3m so\u00e1t hen ho\u00e0n to\u00e0n m\u00e0 kh\u00f4ng c\u00f3 b\u1ea5t k\u00ec l\u1ea7n n\u00e0o m\u1ea5t ki\u1ec3m so\u00e1t trong su\u1ed1t 1 n\u0103m chi\u1ebfm 37,5%. Kh\u00f4ng c\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa t\u00ecnh tr\u1ea1ng m\u1ea5t ki\u1ec3m so\u00e1t hen v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 nh\u00e2n ch\u1ee7ng h\u1ecdc (tu\u1ed5i, gi\u1edbi t\u00ednh), b\u1ec7nh \u0111\u1ed3ng m\u1eafc, b\u1eadc \u0111i\u1ec1u tr\u1ecb hen v\u00e0 ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p t\u1ea1i th\u1eddi \u0111i\u1ec3m ban \u0111\u1ea7u\u00a0<strong>(b\u1ea3ng 2)<\/strong>. C\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan v\u1edbi hen kh\u00f4ng ki\u1ec3m so\u00e1t g\u1ed3m: li\u1ec1u ICS kh\u00f4ng \u0111\u1ee7 chi\u1ebfm 62,7%, vi\u00eam m\u0169i d\u1ecb \u1ee9ng kh\u00f4ng ki\u1ec3m so\u00e1t chi\u1ebfm 26,7% v\u00e0 nhi\u1ec5m khu\u1ea9n h\u00f4 h\u1ea5p chi\u1ebfm 10,6%.<\/p>\n<p style=\"font-weight: 400;\"><strong>Hi\u1ec7u qu\u1ea3 c\u1ee7a \u0111i\u1ec1u tr\u1ecb xu\u1ed1ng thang l\u00ean ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p<\/strong><\/p>\n<p style=\"font-weight: 400;\">Ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n hen c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 khi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb theo h\u01b0\u1edbng d\u1eabn GINA so v\u1edbi th\u1eddi \u0111i\u1ec3m l\u1ea7n \u0111\u1ea7u \u0111\u1ebfn kh\u00e1m (<em>p<\/em>\u00a0&lt; 0.01). Khi \u0111i\u1ec1u tr\u1ecb v\u1edbi chi\u1ebfn l\u01b0\u1ee3c h\u1ea1 li\u1ec1u UMC, kh\u00f4ng ghi nh\u1eadn s\u1ef1 suy gi\u1ea3m ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p so v\u1edbi k\u1ebft qu\u1ea3 h\u00f4 h\u1ea5p k\u00fd t\u1ea1i th\u1eddi \u0111i\u1ec3m T0. B\u1ea3ng 3 th\u1ec3 hi\u1ec7n ch\u1ec9 s\u1ed1 FEV1 v\u00e0 PEFR \u0111\u00e1nh gi\u00e1 m\u1ed7i 3 th\u00e1ng sau th\u1eddi \u0111i\u1ec3m T0. Ch\u00fang t\u00f4i ch\u1ec9 ghi nh\u1eadn 7 b\u1ec7nh nh\u00e2n (6,3%) m\u1eafc \u0111\u1ee3t c\u1ea5p n\u1eb7ng trong 1 n\u0103m \u0111i\u1ec1u tr\u1ecb theo chi\u1ebfn l\u01b0\u1ee3c UMC.<\/p>\n<p style=\"font-weight: 400;\"><strong>B\u00c0N LU\u1eacN<\/strong><\/p>\n<p style=\"font-weight: 400;\">Nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i \u0111\u00e3 ch\u1ec9 ra chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC c\u00f3 th\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n hen nh\u1eb9 \u0111\u1ea1t \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t hen ho\u00e0n to\u00e0n (67,6% &#8211; 91,1%) v\u00e0 duy tr\u00ec ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p \u1ed5n \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi khi d\u00f9ng ICS li\u1ec1u th\u1ea5p 1 nh\u00e1t h\u00e0ng ng\u00e0y ho\u1eb7c ICS\/LABA li\u1ec1u th\u1ea5p 1 nh\u00e1t h\u00e0ng ng\u00e0y. Ngo\u00e0i tr\u1eeb 6,3% b\u1ec7nh nh\u00e2n m\u1eafc \u0111\u1ee3t c\u1ea5p n\u1eb7ng trong su\u1ed1t 1 n\u0103m theo d\u00f5i. Nh\u1eefng d\u1eef li\u1ec7u n\u00e0y ch\u1ec9 ra t\u00ednh hi\u1ec7u qu\u1ea3 c\u1ee7a chi\u1ebfn l\u01b0\u1ee3c UMC trong qu\u1ea3n l\u00fd hen. H\u01a1n n\u1eefa, nghi\u00ean c\u1ee9u g\u1ee3i \u00fd khuy\u1ebfn c\u00e1o v\u1ec1 vi\u1ec7c gi\u1ea3m li\u1ec1u v\u00e0 t\u1ea7n su\u1ea5t s\u1eed d\u1ee5ng thu\u1ed1c \u0111\u1ec3 ph\u00f9 h\u1ee3p v\u1edbi m\u1ed1i quan t\u00e2m c\u1ee7a b\u1ec7nh nh\u00e2n v\u1ec1 t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c c\u0169ng nh\u01b0 kh\u1ea3 n\u0103ng dung n\u1ea1p v\u1edbi \u0111i\u1ec1u tr\u1ecb ICS trong th\u1eddi gian d\u00e0i [11, 12].<\/p>\n<p style=\"font-weight: 400;\">\u0110i\u1ec1u tr\u1ecb xu\u1ed1ng thang cho b\u1ec7nh nh\u00e2n hen ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n v\u1edbi ICS\/LABA 1 nh\u00e1t d\u00f9ng h\u00e0ng ng\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c nh\u1eafc \u0111\u1ebfn trong m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u, tuy nhi\u00ean v\u1eabn c\u00f2n m\u01a1 h\u1ed3 [6, 8]. Ng\u01b0ng LABA c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng k\u00e9m [13]. H\u01a1n n\u1eefa, trong tr\u01b0\u1eddng h\u1ee3p lo\u1ea1i LABA \u0111\u01b0\u1ee3c d\u00f9ng kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng nhanh l\u00ean th\u1ee5 th\u1ec3 beta 2 nh\u01b0 formoterol, th\u00ec khuy\u1ebfn c\u00e1o d\u00f9ng ICS\/LABA \u201ckhi c\u1ea7n\u201d tr\u1edf n\u00ean kh\u00f4ng ph\u00f9 h\u1ee3p. Nghi\u00ean c\u1ee9u n\u00e0y \u0111\u1ec1 xu\u1ea5t chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC (ICS\/LABA li\u1ec1u th\u1ea5p, d\u00f9ng c\u00e1ch ng\u00e0y ho\u1eb7c 2 l\u1ea7n trong m\u1ed9t tu\u1ea7n) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u.<\/p>\n<p style=\"font-weight: 400;\">S\u1eed d\u1ee5ng ICS li\u1ec1u th\u1ea5p h\u00e0ng ng\u00e0y cho hen nh\u1eb9 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn k\u00e9m tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb do b\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u00f3 \u00edt tri\u1ec7u ch\u1ee9ng trong giai \u0111o\u1ea1n \u1ed5n \u0111\u1ecbnh [14]. Chi\u1ebfn l\u01b0\u1ee3c UMC nh\u1ea5n m\u1ea1nh v\u1ea5n \u0111\u1ec1 c\u1ed1t l\u00f5i trong m\u1ed1i quan h\u1ec7 gi\u1eefa li\u1ec1u thu\u1ed1c, \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh v\u00e0 s\u1ef1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb. Qu\u00e1 tr\u00ecnh gi\u1ea3m d\u1ea7n li\u1ec1u thu\u1ed1c ki\u1ec3m so\u00e1t, nh\u01b0 trong chi\u1ebfn l\u01b0\u1ee3c UMC, c\u00f3 th\u1ec3 khuy\u1ebfn kh\u00edch s\u1ef1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n. V\u1ec1 kh\u00eda c\u1ea1nh li\u1ec1u ICS, khi \u00e1p d\u1ee5ng li\u1ec7u ph\u00e1p ICS li\u1ec1u th\u1ea5p h\u00e0ng ng\u00e0y (\u0111\u01a1n tr\u1ecb li\u1ec7u ho\u1eb7c ph\u1ed1i h\u1ee3p), b\u00e1c s\u0129 l\u00e2m s\u00e0ng v\u1eabn ch\u01b0a \u0111\u1ea1t \u0111\u01b0\u1ee3c li\u1ec1u ICS th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3, \u0111i\u1ec1u \u0111\u00e3 \u0111\u01b0\u1ee3c nh\u1eafc \u0111\u1ebfn trong c\u00e1c nghi\u00ean c\u1ee9u SYGMA (b\u1ec7nh nh\u00e2n hen c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ki\u1ec3m so\u00e1t b\u1eb1ng li\u1ec1u th\u1ea5p budesonide 57 \u03bcg and 66 \u03bcg, theo th\u1ee9 t\u1ef1 trong nghi\u00ean c\u1ee9u SYGMA 1 v\u00e0 2) [2]. V\u1edbi chi\u1ebfn l\u01b0\u1ee3c UMC, ch\u00fang t\u00f4i \u0111\u00e3 ki\u1ec3m so\u00e1t hen th\u00e0nh c\u00f4ng v\u1edbi li\u1ec1u ICS th\u1ea5p h\u01a1n 1 nh\u00e1t h\u00e0ng ng\u00e0y. Tuy nhi\u00ean, c\u1ea7n th\u1ef1c hi\u1ec7n nhi\u1ec1u nghi\u00ean c\u1ee9u h\u01a1n cho v\u1ea5n \u0111\u1ec1 n\u00e0y.<\/p>\n<p style=\"font-weight: 400;\">K\u1ebft qu\u1ea3 t\u1eeb nghi\u00ean c\u1ee9u SYGMA 1 v\u00e0 SYGMA 2 \u0111\u00e3 d\u1eabn \u0111\u1ebfn s\u1ef1 thay \u0111\u1ed5i quan tr\u1ecdng trong h\u01b0\u1edbng d\u1eabn GINA 2019 \u1edf b\u1eadc \u0111i\u1ec1u tr\u1ecb 1 v\u00e0 2, t\u1eadp trung v\u00e0o s\u1eed d\u1ee5ng d\u1ee5ng c\u1ee5 h\u00edt \u201ckhi c\u1ea7n\u201d d\u1ef1a tr\u00ean s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a tri\u1ec7u ch\u1ee9ng [4]. Tuy nhi\u00ean, kh\u00e1i ni\u1ec7m \u201ckhi c\u1ea7n\u201d l\u00e0 m\u01a1 h\u1ed3, ph\u1ee5 thu\u1ed9c v\u00e0o c\u1ea3m nh\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 ch\u1ecbu s\u1ef1 \u1ea3nh h\u01b0\u1edfng c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 kinh t\u1ebf, x\u00e3 h\u1ed9i v\u00e0 gia \u0111\u00ecnh. M\u1ed9t nghi\u00ean c\u1ee9u \u0111\u00e1nh gi\u00e1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb \u1edf c\u00e1c b\u1ec7nh nh\u00e2n hen Ch\u00e2u \u00c1 \u0111\u00e3 ch\u1ec9 ra nhi\u1ec1u kh\u00eda c\u1ea1nh g\u00e2y k\u00e9m tu\u00e2n th\u1ee7 nh\u01b0 d\u1ee5ng c\u1ee5 h\u00edt b\u1ea5t ti\u1ec7n, th\u00edch d\u00f9ng thu\u1ed1c u\u1ed1ng h\u01a1n, chi ph\u00ed \u0111i\u1ec1u tr\u1ecb, c\u00e1c g\u1ee3i \u00fd \u0111i\u1ec1u tr\u1ecb kh\u00e1c t\u1eeb ph\u00eda b\u1ea1n b\u00e8 v\u00e0 gia \u0111\u00ecnh c\u1ee7a b\u1ec7nh nh\u00e2n [11]. M\u1eb7c d\u00f9 b\u1ec7nh nh\u00e2n hen c\u00f3 th\u1ec3 hi\u1ec3u r\u00f5 t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u1ee7a h\u1ecd, c\u00e1c r\u00e0o c\u1ea3n n\u00e0y c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u1ee7a \u0111i\u1ec1u tr\u1ecb \u201ckhi c\u1ea7n\u201d khi xu\u1ed1ng thang [15]. Ch\u00fang c\u00f3 th\u1ec3 khi\u1ebfn b\u1ec7nh nh\u00e2n d\u00f9ng qu\u00e1 nhi\u1ec1u ho\u1eb7c qu\u00e1 \u00edt thu\u1ed1c theo c\u00e1ch kh\u00f4ng h\u1ee3p l\u00fd. Ngo\u00e0i ra, ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p c\u1ee7a b\u1ec7nh nh\u00e2n khi s\u1eed d\u1ee5ng thu\u1ed1c h\u00edt \u201ckhi c\u1ea7n\u201d th\u1ea5p h\u01a1n so v\u1edbi khi d\u00f9ng ICS h\u00e0ng ng\u00e0y [2, 9]. Trong khi \u0111\u00f3, chi\u1ebfn l\u01b0\u1ee3c h\u1ea1 li\u1ec1u UMC \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 \u1ed5n \u0111\u1ecbnh ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi \u0111i\u1ec1u tr\u1ecb ICS li\u1ec1u th\u1ea5p h\u00e0ng ng\u00e0y ho\u1eb7c ICS\/LABA li\u1ec1u th\u1ea5p h\u00e0ng ng\u00e0y. Do \u0111\u00f3, chi\u1ebfn l\u01b0\u1ee3c UMC \u0111\u00e3 cho th\u1ea5y m\u1ed9t qu\u00e1 tr\u00ecnh xu\u1ed1ng thang hi\u1ec7u qu\u1ea3 v\u00e0 r\u00f5 r\u00e0ng h\u01a1n, ph\u01b0\u01a1ng th\u1ee9c n\u00e0y c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p v\u1edbi b\u1ec7nh nh\u00e2n hen \u1edf Ch\u00e2u \u00c1 h\u01a1n.<\/p>\n<p style=\"font-weight: 400;\">T\u1ea7n su\u1ea5t \u0111\u1ee3t c\u1ea5p n\u1eb7ng trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i l\u00e0 6,3% trong su\u1ed1t 1 n\u0103m theo d\u00f5i (0,063 ng\u01b0\u1eddi \u2013 n\u0103m), th\u1ea5p h\u01a1n so v\u1edbi t\u1ea7n su\u1ea5t \u01b0\u1edbc \u0111o\u00e1n \u1edf b\u1ec7nh nh\u00e2n hen nh\u1eb9 (0,12 \u2013 0,77 ng\u01b0\u1eddi \u2013 n\u0103m) [14]. K\u1ebft qu\u1ea3 n\u00e0y cho th\u1ea5y chi\u1ebfn l\u01b0\u1ee3c UMC gi\u00fap gi\u1ea3m m\u1ed9t c\u00e1ch hi\u1ec7u qu\u1ea3 t\u1ea7n su\u1ea5t \u0111\u1ee3t c\u1ea5p trong d\u00e2n s\u1ed1 Vi\u1ec7t Nam. Tuy nhi\u00ean, k\u1ebft qu\u1ea3 n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c ph\u00e2n t\u00edch m\u1ed9t c\u00e1ch c\u1ea9n th\u1eadn khi x\u00e9t \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan v\u1edbi hen kh\u00f4ng ki\u1ec3m so\u00e1t. Trong nghi\u00ean c\u1ee9u c\u00f3 62,7% b\u1ec7nh nh\u00e2n m\u1ea5t ki\u1ec3m so\u00e1t do kh\u00f4ng \u0111\u1ee7 li\u1ec1u \u0111i\u1ec1u tr\u1ecb. Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n kh\u00f4ng ki\u1ec3m so\u00e1t li\u00ean quan y\u1ebfu t\u1ed1 n\u00e0y s\u1ebd \u0111\u01b0\u1ee3c n\u00e2ng li\u1ec1u thu\u1ed1c ki\u1ec3m so\u00e1t v\u01b0\u1ee3t ra ngo\u00e0i chi\u1ebfn l\u01b0\u1ee3c UMC \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n sau \u0111\u00f3. V\u1ea5n \u0111\u1ec1 n\u00e0y c\u00f3 th\u1ec3 \u0111\u00e3 g\u00f3p ph\u1ea7n v\u00e0o gi\u1ea3m t\u1ea7n su\u1ea5t \u0111\u1ee3t c\u1ea5p.<\/p>\n<p style=\"font-weight: 400;\">C\u00f3 m\u1ed9t s\u1ed1 gi\u1edbi h\u1ea1n trong nghi\u00ean c\u1ee9u c\u1ee7a ch\u00fang t\u00f4i. Vi\u1ec7c thu th\u1eadp d\u1eef li\u1ec7u m\u1ed7i 3, 6, 9, 12 th\u00e1ng sau khi nh\u1eadn v\u00e0o nghi\u00ean c\u1ee9u c\u00f3 th\u1ec3 b\u1ecb gi\u1edbi h\u1ea1n so v\u1edbi vi\u1ec7c thu th\u1eadp d\u1eef li\u1ec7u li\u00ean t\u1ee5c. Nghi\u00ean c\u1ee9u \u0111\u00e3 kh\u00f4ng \u0111\u00e1nh gi\u00e1 t\u1ea7n su\u1ea5t \u0111\u1ee3t c\u1ea5p nh\u1eb9 v\u00e0 trung b\u00ecnh, \u0111\u00e2y c\u00f3 th\u1ec3 l\u00e0 th\u00f4ng tin quan tr\u1ecdng \u0111\u1ec3 k\u1ebft lu\u1eadn t\u00ednh hi\u1ec7u qu\u1ea3 c\u1ee7a chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang n\u00e0y. B\u00ean c\u1ea1nh \u0111\u00f3, x\u00e1c \u0111\u1ecbnh li\u1ec1u ICS t\u1ed1i thi\u1ec3u hi\u1ec7u qu\u1ea3 l\u00e0 r\u1ea5t quan tr\u1ecdng. Ch\u00fang t\u00f4i ghi nh\u1eadn li\u1ec1u trung v\u1ecb c\u1ee7a fluticasone propionate \u0111\u01a1n tr\u1ecb li\u1ec7u l\u00e0 49,1 \u03bcg, li\u1ec1u trung b\u00ecnh c\u1ee7a fluticasone propionate d\u1ea1ng ph\u1ed1i h\u1ee3p l\u00e0 48,0 \u03bcg, li\u1ec1u trung b\u00ecnh c\u1ee7a budesonide trong formoterol\/ budesonide l\u00e0 63,1 \u03bcg. Tuy nhi\u00ean, ch\u00fang t\u00f4i kh\u00f4ng c\u00f3 nh\u00f3m ch\u1ee9ng \u0111\u1ec3 so s\u00e1nh kh\u00e1c bi\u1ec7t th\u1ed1ng k\u00ea n\u00e0y. M\u1ed9t nghi\u00ean c\u1ee9u th\u1eed nghi\u1ec7m \u0111\u1ed1i ch\u1ee9ng ng\u1eabu nhi\u00ean l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 cung c\u1ea5p th\u00eam b\u1eb1ng ch\u1ee9ng cho chi\u1ebfn l\u01b0\u1ee3c n\u00e0y trong t\u01b0\u01a1ng lai g\u1ea7n.<\/p>\n<p style=\"font-weight: 400;\">K\u1ebft lu\u1eadn, chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t \u00e1p d\u1ee5ng cho b\u1ec7nh nh\u00e2n hen nh\u1eb9, ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y kh\u00f3 kh\u0103n khi \u00e1p d\u1ee5ng chi\u1ebfn l\u01b0\u1ee3c \u201ckhi c\u1ea7n\u201d ho\u1eb7c ng\u01b0\u1eddi \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n v\u1edbi ICS\/LABA li\u1ec1u th\u1ea5p h\u00e0ng ng\u00e0y v\u1edbi LABA kh\u1edfi ph\u00e1t hi\u1ec7u qu\u1ea3 gi\u00e3n ph\u1ebf qu\u1ea3n ch\u1eadm. C\u00e1c nghi\u00ean c\u1ee9u chuy\u00ean s\u00e2u h\u01a1n l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 cung c\u1ea5p th\u00eam b\u1eb1ng ch\u1ee9ng cho chi\u1ebfn l\u01b0\u1ee3c n\u00e0y.<\/p>\n<p style=\"font-weight: 400;\"><strong>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n<ol>\n<li style=\"font-weight: 400;\">Global Initiative for Asthma. Global Strategy for asthma management and prevention \u2013 Update 2015. Available from:\u00a0<a href=\"http:\/\/www.ginasthma.org\/\" target=\"_blank\" rel=\"noopener\">www.ginasthma.org<\/a>.<\/li>\n<li style=\"font-weight: 400;\">Bateman ED, Reddel HK, O\u2019Byrne PM, Barnes PJ, Zhong N, Keen C, et al. As needed budesonide-formoterol versus maintenance budesonide in mild asthma. N Engl J Med. 2018;378:1877\u201387.<\/li>\n<li style=\"font-weight: 400;\">Global Initiative for Asthma. Global strategy for asthma management and prevention 2018 [cited 2019 Apr 13]. Available from:\u00a0<a href=\"http:\/\/www.ginasthma.org\/\" target=\"_blank\" rel=\"noopener\">www.ginasthma.org<\/a>.<\/li>\n<li style=\"font-weight: 400;\">Muneswarao J, Hassali MA, Ibrahim B, Saini B, Ali IAH, Verma AK. It is time to change the way we manage mild asthma: an update in GINA 2019. Respiratory Research. 2019;20:183.<\/li>\n<li style=\"font-weight: 400;\">Rank MA, Hagan JB, Park MA, Podjasek JC, Samant SA, Volcheck GW, et al. The risk of asthma exacerbation after stopping low-dose inhaled corticosteroids: a systematic review and meta-analysis of randomized controlled trials. J Allergy Clin Immunol. 2013;131:724-9.<\/li>\n<li style=\"font-weight: 400;\">Chipps BE, Bacharier LB, Murphy KR, Lang D, Farrar JR, Rank M, et al. The asthma controller step-down yardstick. Ann Allergy Asthma Immunol. 2019;122:241-62.<\/li>\n<li style=\"font-weight: 400;\">Papi A, Canonica GW, Maestrelli P, Paggiaro P, Olivieri D, Pozzi E, et al. Rescue use of beclomethasone and albuterol in a single inhaler for mild asthma. N Engl J Med. 2007;356:2040\u201352.<\/li>\n<li style=\"font-weight: 400;\">Peters SP, Anthonisen N, Castro M, Holbrook JT, Irvin CG, Smith LJ, et al. Randomized comparison of strategies for reducing treatment in mild persistent asthma. N Engl J Med. 2007;356:2027\u201339.<\/li>\n<li style=\"font-weight: 400;\">O\u2019Byrne PM, FitzGerald JM, Bateman ED, Barnes PJ, Zhong N, Keen C, et al. Inhaled combined budesonide\u2013formoterol as needed in mild asthma. N Engl J Med. 2018;378:1865-76.<\/li>\n<li style=\"font-weight: 400;\">Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319-38.<\/li>\n<li style=\"font-weight: 400;\">Chiu KC, Boonsawat W, Cho SH, Cho JY, Hsu JY, Liam CK, et al. Patients\u2019 beliefs and behaviors related to treatment adherence in patients with asthma requiring maintenance treatment in Asia. J Asthma. 2014;51:652\u20139.<\/li>\n<li style=\"font-weight: 400;\">Boulet LP. Perception of the role and potential side effects of inhaled corticosteroids among asthmatic patients. Chest. 1998;113:587-92.<\/li>\n<li style=\"font-weight: 400;\">Fowler SJ, Currie GP, Lipworth BJ. Step-down therapy with low-dose fluticasone-salmeterol combination or medium-dose hydrofluoroalkane beclomethasone alone. J Allergy Clin Immunol. 2002;109:929e35.<\/li>\n<li style=\"font-weight: 400;\">Dusser D, Montani D, Chanez P, Blic Jd, Delacourt C, Deschildre A, et al. Mild asthma: an expert review on epidemiology, clinical characteristics and treatment recommendations. Allergy. 2007;62:591-604.<\/li>\n<li style=\"font-weight: 400;\">Lam NH. Barriers and solutions to stepping down asthma treatment. Open J Asthma. 2020;4:013-5.<\/li>\n<\/ol>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter size-full wp-image-1334\" src=\"https:\/\/matenix.com\/wp-content\/uploads\/2023\/05\/NghienCuuXuongThangBacHen-1.jpg\" alt=\"\" width=\"856\" height=\"571\" srcset=\"https:\/\/matenix.com\/wp-content\/uploads\/2023\/05\/NghienCuuXuongThangBacHen-1.jpg 856w, https:\/\/matenix.com\/wp-content\/uploads\/2023\/05\/NghienCuuXuongThangBacHen-1-300x200.jpg 300w, https:\/\/matenix.com\/wp-content\/uploads\/2023\/05\/NghienCuuXuongThangBacHen-1-768x512.jpg 768w\" sizes=\"(max-width: 856px) 100vw, 856px\" \/><\/p>\n<p style=\"font-weight: 400; text-align: center;\">H\u00ecnh 1:\u00a0L\u01b0u \u0111\u1ed3 chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang t\u1ea1i B\u1ec7nh vi\u1ec7n \u0110\u1ea1i H\u1ecdc Y D\u01b0\u1ee3c<\/p>\n<p><img decoding=\"async\" class=\"aligncenter size-full wp-image-1335\" src=\"https:\/\/matenix.com\/wp-content\/uploads\/2023\/05\/NghienCuuXuongThangBacHen-2.jpg\" alt=\"\" width=\"473\" height=\"583\" srcset=\"https:\/\/matenix.com\/wp-content\/uploads\/2023\/05\/NghienCuuXuongThangBacHen-2.jpg 473w, https:\/\/matenix.com\/wp-content\/uploads\/2023\/05\/NghienCuuXuongThangBacHen-2-243x300.jpg 243w\" sizes=\"(max-width: 473px) 100vw, 473px\" \/><\/p>\n<p style=\"font-weight: 400; text-align: center;\"><strong>H\u00ecnh 2:<\/strong>\u00a0L\u01b0u \u0111\u1ed3 tuy\u1ec3n b\u1ec7nh<\/p>\n<p><img decoding=\"async\" class=\"aligncenter size-full wp-image-1336\" src=\"https:\/\/matenix.com\/wp-content\/uploads\/2023\/05\/NghienCuuXuongThangBacHen-3.jpg\" alt=\"\" width=\"975\" height=\"548\" srcset=\"https:\/\/matenix.com\/wp-content\/uploads\/2023\/05\/NghienCuuXuongThangBacHen-3.jpg 975w, https:\/\/matenix.com\/wp-content\/uploads\/2023\/05\/NghienCuuXuongThangBacHen-3-300x169.jpg 300w, https:\/\/matenix.com\/wp-content\/uploads\/2023\/05\/NghienCuuXuongThangBacHen-3-768x432.jpg 768w\" sizes=\"(max-width: 975px) 100vw, 975px\" \/><\/p>\n<p style=\"font-weight: 400; text-align: center;\"><strong>H\u00ecnh 3:<\/strong>\u00a0T\u1ef7 l\u1ec7 112 b\u1ec7nh nh\u00e2n hen \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u00e0 ki\u1ec3m so\u00e1t v\u1edbi chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC (ICS \u0111\u01a1n tr\u1ecb v\u00e0 ICS\/LABA ph\u1ed1i h\u1ee3p). (A) B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi ti\u1ebfp c\u1eadn UMC. (B) B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi ICS \u0111\u01a1n tr\u1ecb. (C) B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi ICS\/LABA ph\u1ed1i h\u1ee3p.<\/p>\n<p style=\"font-weight: 400;\"><b><strong>B\u1ea3ng 1. \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a 112 b\u1ec7nh nh\u00e2n<\/strong><\/b><\/p>\n<table style=\"font-weight: 400;\">\n<tbody>\n<tr>\n<td width=\"142\">\u0110\u1eb7c \u0111i\u1ec3m<\/td>\n<td width=\"111\">T\u1ed5ng(n = 112)<\/td>\n<td width=\"79\">Fluticasone<br \/>\n(n = 37)<\/td>\n<td width=\"118\">Salmeterol\/fluticasone<br \/>\n(n = 30)<\/td>\n<td width=\"121\">Formoterol\/budesonide<br \/>\n(n = 45)<\/td>\n<td width=\"53\">p value<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Tu\u1ed5i (n\u0103m), trung v\u1ecb (IQR)<\/td>\n<td width=\"111\">38.5<br \/>\n(17.7\u201351.0)<\/td>\n<td width=\"79\">35.0<br \/>\n(16.0\u201348.0)<\/td>\n<td width=\"118\">39.5<br \/>\n(16.5\u201356.3)<\/td>\n<td width=\"121\">42.0<br \/>\n(28.0\u201351.0)<\/td>\n<td width=\"53\">0.526*<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Gi\u1edbi t\u00ednh (%)<\/td>\n<td width=\"111\">62.5<\/td>\n<td width=\"79\">73.0<\/td>\n<td width=\"118\">46.7<\/td>\n<td width=\"121\">64.4<\/td>\n<td width=\"53\">0.082<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Ti\u1ec1n c\u0103n gia \u0111\u00ecnh m\u1eafc hen (%)<\/td>\n<td width=\"111\">20.5<\/td>\n<td width=\"79\">29.7<\/td>\n<td width=\"118\">23.3<\/td>\n<td width=\"121\">11.1<\/td>\n<td width=\"53\">0.105<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">B\u1ec7nh \u0111\u1ed3ng m\u1eafc<\/td>\n<td width=\"111\"><\/td>\n<td width=\"79\"><\/td>\n<td width=\"118\"><\/td>\n<td width=\"121\"><\/td>\n<td width=\"53\"><\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Vi\u00eam m\u0169i d\u1ecb \u1ee9ng (%)<\/td>\n<td width=\"111\">55.4<\/td>\n<td width=\"79\">59.5<\/td>\n<td width=\"118\">60.0<\/td>\n<td width=\"121\">48.9<\/td>\n<td width=\"53\">0.528<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">GERD (%)<\/td>\n<td width=\"111\">19.6<\/td>\n<td width=\"79\">16.2<\/td>\n<td width=\"118\">26.7<\/td>\n<td width=\"121\">17.8<\/td>\n<td width=\"53\">0.519<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">B\u00e9o ph\u00ec (%)<\/td>\n<td width=\"111\">4.5<\/td>\n<td width=\"79\">2.7<\/td>\n<td width=\"118\">3.3<\/td>\n<td width=\"121\">6.7<\/td>\n<td width=\"53\">0.647<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Tri\u1ec7u ch\u1ee9ng l\u00fac \u0111\u1ea7u \u0111\u1ebfn kh\u00e1m<\/td>\n<td width=\"111\"><\/td>\n<td width=\"79\"><\/td>\n<td width=\"118\"><\/td>\n<td width=\"121\"><\/td>\n<td width=\"53\"><\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Ho (%)<\/td>\n<td width=\"111\">42.9<\/td>\n<td width=\"79\">51.4<\/td>\n<td width=\"118\">26.7<\/td>\n<td width=\"121\">46.7<\/td>\n<td width=\"53\">&lt;0.01<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Kh\u00f2 kh\u00e8 (%)<\/td>\n<td width=\"111\">31.3<\/td>\n<td width=\"79\">32.4<\/td>\n<td width=\"118\">46.7<\/td>\n<td width=\"121\">20.0<\/td>\n<td width=\"53\">&lt;0.01<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Kh\u00f3 th\u1edf (%)<\/td>\n<td width=\"111\">54.5<\/td>\n<td width=\"79\">54.1<\/td>\n<td width=\"118\">50.0<\/td>\n<td width=\"121\">57.8<\/td>\n<td width=\"53\">&lt;0.01<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">N\u1eb7ng ng\u1ef1c (%)<\/td>\n<td width=\"111\">1.8<\/td>\n<td width=\"79\">0.0<\/td>\n<td width=\"118\">6.7<\/td>\n<td width=\"121\">0.0<\/td>\n<td width=\"53\">N\/A<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">B\u1eadc hen l\u00fac \u0111\u1ea7u \u0111\u1ebfn kh\u00e1m<\/td>\n<td width=\"111\"><\/td>\n<td width=\"79\"><\/td>\n<td width=\"118\"><\/td>\n<td width=\"121\"><\/td>\n<td width=\"53\">0.038<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">B\u1eadc 4 (%)<\/td>\n<td width=\"111\">87.5<\/td>\n<td width=\"79\">94.6<\/td>\n<td width=\"118\">93.3<\/td>\n<td width=\"121\">77.8<\/td>\n<td width=\"53\"><\/td>\n<\/tr>\n<tr>\n<td width=\"142\">B\u1eadc 3 (%)<\/td>\n<td width=\"111\">12.5<\/td>\n<td width=\"79\">5.4<\/td>\n<td width=\"118\">6.7<\/td>\n<td width=\"121\">22.2<\/td>\n<td width=\"53\"><\/td>\n<\/tr>\n<tr>\n<td width=\"142\">H\u00f4 h\u1ea5p k\u00fd l\u00fac \u0111\u1ea7u \u0111\u1ebfn kh\u00e1m<\/td>\n<td width=\"111\"><\/td>\n<td width=\"79\"><\/td>\n<td width=\"118\"><\/td>\n<td width=\"121\"><\/td>\n<td width=\"53\"><\/td>\n<\/tr>\n<tr>\n<td width=\"142\">FEV1 (%), mean \u00b1 SD<\/td>\n<td width=\"111\">79.7 \u00b1 16.9<\/td>\n<td width=\"79\">79.2 \u00b1 14.1<\/td>\n<td width=\"118\">78.9 \u00b1 15.6<\/td>\n<td width=\"121\">81.1 \u00b1 19.1<\/td>\n<td width=\"53\">0.928\u2020<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">PEFR (%), mean \u00b1 SD<\/td>\n<td width=\"111\">74.9 \u00b1 20.8<\/td>\n<td width=\"79\">77.3 \u00b1 23.7<\/td>\n<td width=\"118\">74.7 \u00b1 18.1<\/td>\n<td width=\"121\">73.2 \u00b1 20.5<\/td>\n<td width=\"53\">0.713\u2020<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">H\u00f4 h\u1ea5p k\u00fd t\u1ea1i T0<\/td>\n<td width=\"111\"><\/td>\n<td width=\"79\"><\/td>\n<td width=\"118\"><\/td>\n<td width=\"121\"><\/td>\n<td width=\"53\"><\/td>\n<\/tr>\n<tr>\n<td width=\"142\">FEV1 (%), mean \u00b1 SD<\/td>\n<td width=\"111\">90.9 \u00b1 13.2<\/td>\n<td width=\"79\">90.8 \u00b1 10.6<\/td>\n<td width=\"118\">90.3 \u00b1 15.5<\/td>\n<td width=\"121\">91.4 \u00b1 13.7<\/td>\n<td width=\"53\">0.944\u2020<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">PEFR (%), mean \u00b1 SD<\/td>\n<td width=\"111\">88.6 \u00b1 15.1<\/td>\n<td width=\"79\">87.9 \u00b1 15.3<\/td>\n<td width=\"118\">86.7 \u00b1 16.6<\/td>\n<td width=\"121\">90.4 \u00b1 14.1<\/td>\n<td width=\"53\">0.576\u2020<\/td>\n<\/tr>\n<tr>\n<td colspan=\"6\" width=\"624\">S\u1ed1 b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c c\u00e1ch ng\u00e0y<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Sau 3 th\u00e1ng<\/td>\n<td width=\"111\">65<\/td>\n<td width=\"79\">20<\/td>\n<td width=\"118\">19<\/td>\n<td width=\"121\">26<\/td>\n<td width=\"53\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Sau 6 th\u00e1ng<\/td>\n<td width=\"111\">34<\/td>\n<td width=\"79\">13<\/td>\n<td width=\"118\">11<\/td>\n<td width=\"121\">10<\/td>\n<td width=\"53\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Sau 9 th\u00e1ng<\/td>\n<td width=\"111\">29<\/td>\n<td width=\"79\">10<\/td>\n<td width=\"118\">9<\/td>\n<td width=\"121\">10<\/td>\n<td width=\"53\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td colspan=\"6\" width=\"624\">S\u1ed1 b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c 2 ng\u00e0y \/ tu\u1ea7n<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Sau 3 th\u00e1ng<\/td>\n<td width=\"111\">37<\/td>\n<td width=\"79\">17<\/td>\n<td width=\"118\">6<\/td>\n<td width=\"121\">14<\/td>\n<td width=\"53\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Sau 6 th\u00e1ng<\/td>\n<td width=\"111\">44<\/td>\n<td width=\"79\">22<\/td>\n<td width=\"118\">6<\/td>\n<td width=\"121\">16<\/td>\n<td width=\"53\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Sau 9 th\u00e1ng<\/td>\n<td width=\"111\">30<\/td>\n<td width=\"79\">12<\/td>\n<td width=\"118\">5<\/td>\n<td width=\"121\">13<\/td>\n<td width=\"53\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td colspan=\"6\" width=\"624\">S\u1ed1 b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c 1 ng\u00e0y\/tu\u1ea7n<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Sau 6 th\u00e1ng<\/td>\n<td width=\"111\">6<\/td>\n<td width=\"79\">1<\/td>\n<td width=\"118\">2<\/td>\n<td width=\"121\">3<\/td>\n<td width=\"53\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td width=\"142\">Sau 9 th\u00e1ng<\/td>\n<td width=\"111\">15<\/td>\n<td width=\"79\">6<\/td>\n<td width=\"118\">4<\/td>\n<td width=\"121\">5<\/td>\n<td width=\"53\">&#8211;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"font-weight: 400;\"><i><em>IQR: kho\u1ea3ng t\u1ee9 ph\u00e2n v\u1ecb; GERD: b\u1ec7nh tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n; FEV1: th\u1ec3 t\u00edch th\u1edf ra g\u1eafng s\u1ee9c trong 1 gi\u00e2y; PEFR: l\u01b0u l\u01b0\u1ee3ng \u0111\u1ec9nh; SD: \u0111\u1ed9 l\u1ec7ch chu\u1ea9n. p &lt; 0.05, m\u1ee9c kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea. *Kruskal-Wallis test, \u2020 One-way analysis of variance<\/em><\/i><\/p>\n<p style=\"font-weight: 400;\"><b><strong>B\u1ea3ng 2. M\u1ed1i li\u00ean quan gi\u1eefa c\u00e1c y\u1ebfu t\u1ed1 v\u1edbi t\u00ecnh tr\u1ea1ng hen kh\u00f4ng ki\u1ec3m so\u00e1t\u00a0<\/strong><\/b><\/p>\n<table style=\"font-weight: 400;\" width=\"710\">\n<tbody>\n<tr>\n<td rowspan=\"2\" width=\"172\">Bi\u1ebfn s\u1ed1<\/td>\n<td colspan=\"2\" width=\"446\">T\u00ecnh tr\u1ea1ng ki\u1ec3m so\u00e1t hen trong 1 n\u0103m theo d\u00f5i<\/td>\n<td rowspan=\"2\" width=\"92\">p value<\/td>\n<\/tr>\n<tr>\n<td width=\"191\">Ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n<br \/>\n(n = 42)<\/td>\n<td width=\"255\">T\u1ed5ng kh\u00f4ng ki\u1ec3m so\u00e1t t\u00edch lu\u1ef9<br \/>\n(n = 70)<\/td>\n<\/tr>\n<tr>\n<td width=\"172\">Tu\u1ed5i\u00a0 (n\u0103m), trung v\u1ecb (IQR)<\/td>\n<td width=\"191\">37.5 (19.3\u201352.0)<\/td>\n<td width=\"255\">39.5 (17.0\u201351.0)<\/td>\n<td width=\"92\">0.801*<\/td>\n<\/tr>\n<tr>\n<td width=\"172\">Gi\u1edbi n\u1eef\u00a0 (%)<\/td>\n<td width=\"191\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 54.8<\/td>\n<td width=\"255\">67.1<\/td>\n<td width=\"92\">0.134<\/td>\n<\/tr>\n<tr>\n<td width=\"172\">Vi\u00eam m\u0169i d\u1ecb \u1ee9ng (%)<\/td>\n<td width=\"191\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 47.6<\/td>\n<td width=\"255\">60.0<\/td>\n<td width=\"92\">0.140<\/td>\n<\/tr>\n<tr>\n<td width=\"172\">GERD (%)<\/td>\n<td width=\"191\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 19.1<\/td>\n<td width=\"255\">20.0<\/td>\n<td width=\"92\">0.554<\/td>\n<\/tr>\n<tr>\n<td width=\"172\">B\u00e9o ph\u00ec (%)<\/td>\n<td width=\"191\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 7.1<\/td>\n<td width=\"255\">2.9<\/td>\n<td width=\"92\">0.271<\/td>\n<\/tr>\n<tr>\n<td width=\"172\">B\u1eadc 4 l\u00fac \u0111\u1ea7u \u0111\u1ebfn kh\u00e1m (%)<\/td>\n<td width=\"191\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 90.5<\/td>\n<td width=\"255\">85.7<\/td>\n<td width=\"92\">0.335<\/td>\n<\/tr>\n<tr>\n<td width=\"172\">FEV1 (%), mean \u00b1 SD<\/td>\n<td width=\"191\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 80.3 \u00b1 18.1<\/td>\n<td width=\"255\">79.3 \u00b1 16.3<\/td>\n<td width=\"92\">0.767<\/td>\n<\/tr>\n<tr>\n<td width=\"172\">PEFR (%), mean \u00b1 SD<\/td>\n<td width=\"191\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 78.8 \u00b1 22.7<\/td>\n<td width=\"255\">72.5 \u00b1 19.4<\/td>\n<td width=\"92\">0.147<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"font-weight: 400;\"><i><em>IQR: kho\u1ea3ng t\u1ee9 ph\u00e2n v\u1ecb; FEV1: th\u1ec3 t\u00edch th\u1edf ra g\u1eafng s\u1ee9c trong 1 gi\u00e2y; PEFR: l\u01b0u l\u01b0\u1ee3ng \u0111\u1ec9nh; SD: \u0111\u1ed9 l\u1ec7ch chu\u1ea9n. p &lt; 0.05, m\u1ee9c kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea. *Mann-Whitney U test.<\/em><\/i><\/p>\n<p style=\"font-weight: 400;\"><b><strong>B\u1ea3ng 3. Ch\u1ec9 s\u1ed1 h\u00f4 h\u1ea5p k\u00fd trong 1 n\u0103m \u0111i\u1ec1u tr\u1ecb theo chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC<\/strong><\/b><\/p>\n<table style=\"font-weight: 400;\">\n<tbody>\n<tr>\n<td rowspan=\"2\">Th\u1eddi gian th\u1ef1c hi\u1ec7n h\u00f4 h\u1ea5p k\u00fd<\/td>\n<td rowspan=\"2\">S\u1ed1 b\u1ec7nh nh\u00e2n<\/td>\n<td>FEV1(%)<\/td>\n<td><\/td>\n<td colspan=\"2\">PEFR (%)<\/td>\n<\/tr>\n<tr>\n<td>Mean \u00b1 SD<\/td>\n<td>p value<\/td>\n<td>Mean \u00b1 SD<\/td>\n<td>p value<\/td>\n<\/tr>\n<tr>\n<td>B\u1eaft \u0111\u1ea7u (T0)<\/td>\n<td>112<\/td>\n<td>90.9 \u00b1 13.2<\/td>\n<td>&lt;0.01\u2020<\/td>\n<td>88.6 \u00b1 15.1<\/td>\n<td>&lt;0.01\u2020<\/td>\n<\/tr>\n<tr>\n<td>Sau 3 th\u00e1ng<\/td>\n<td>71<\/td>\n<td>91.6 \u00b1 13.4<\/td>\n<td>0.438\u2021<\/td>\n<td>89.8 \u00b1 15.1<\/td>\n<td>0.283\u2021<\/td>\n<\/tr>\n<tr>\n<td>Sau 6 th\u00e1ng<\/td>\n<td>75<\/td>\n<td>89.1 \u00b1 13.2<\/td>\n<td>0.125\u2021<\/td>\n<td>87.1 \u00b1 15.6<\/td>\n<td>0.073\u2021<\/td>\n<\/tr>\n<tr>\n<td>Sau 9 th\u00e1ng<\/td>\n<td>98<\/td>\n<td>88.3 \u00b1 12.9<\/td>\n<td>0.164\u2021<\/td>\n<td>86.2 \u00b1 13.9<\/td>\n<td>0.337\u2021<\/td>\n<\/tr>\n<tr>\n<td>Sau 12 th\u00e1ng<\/td>\n<td>94<\/td>\n<td>87.9 \u00b1 14.0<\/td>\n<td>0.647\u2021<\/td>\n<td>86.7 \u00b1 18.3<\/td>\n<td>0.507\u2021<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"font-weight: 400;\"><i><em>p &lt; 0.05; \u2020 Paired samples test, so s\u00e1nh v\u1edbi ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p l\u1ea7n \u0111\u1ea7u \u0111\u1ebfn kh\u00e1m. \u2021 Paired samples test, so s\u00e1nh v\u1edbi ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p t\u1ea1i th\u1eddi \u0111i\u1ec3m T0.<\/em><\/i><\/p>\n<div style=\"background-color: #dff0d8; padding: 30px;\">\n<p style=\"text-align: center;\">C\u1ed8NG H\u00d2A X\u00c3 H\u1ed8I CH\u1ee6 NGH\u0128A VI\u1ec6T NAM<br \/>\n\u0110\u1ed9c l\u1eadp \u2013 T\u1ef1 do \u2013 H\u1ea1nh ph\u00fac<\/p>\n<p style=\"text-align: center;\">B\u1ea2N NH\u1eacN X\u00c9T B\u00c0I B\u00c1O KHOA H\u1eccC\u00a0D\u1ef0 KI\u1ebeN \u0110\u0102NG TR\u00caN WEB TP.HCM<\/p>\n<p><strong>T\u00ean b\u00e0i b\u00e1o: \u0110I\u1ec0U TR\u1eca XU\u1ed0NG THANG CHO B\u1ec6NH NH\u00c2N HEN NH\u1eb8 \u0110\u01af\u1ee2C KI\u1ec2M SO\u00c1T T\u1ed0T: M\u1ed8T KINH NGHI\u1ec6M T\u1eea B\u1ec6NH VI\u1ec6N \u0110\u1ea0I H\u1eccC Y D\u01af\u1ee2C TP. H\u1ed2 CH\u00cd<\/strong><br \/>\n<strong>MINH<\/strong><\/p>\n<p>T\u00ean t\u00e1c gi\u1ea3: Nguy\u1ec5n H\u1ed3 Lam, Nguy\u1ec5n Th\u00e0nh Nam, L\u00ea Th\u01b0\u1ee3ng V\u0169, Nguy\u1ec5n Nh\u01b0 Vinh, L\u00ea Th\u1ecb Tuy\u1ebft Lan<\/p>\n<p>T\u00ean ng\u01b0\u1eddi nh\u1eadn x\u00e9t: Nguy\u1ec5n v\u0103n Th\u00e0nh.<br \/>\n\u0110\u01a1n v\u1ecb c\u00f4ng t\u00e1c: C\u00e1n b\u1ed9 gi\u1ea3ng \u0110HY-D C\u1ea7n Th\u01a1<\/p>\n<p><strong>T\u00ednh th\u1eddi s\u1ef1, v\u00e0 \u00fd ngh\u0129a khoa h\u1ecdc c\u1ee7a b\u00e0i b\u00e1o:<\/strong><br \/>\n1) \u0110\u1ec1 t\u00e0i c\u00f3 xu\u1ea5t ph\u00e1t t\u1eeb nhu c\u1ea7u th\u1ef1c ti\u1ec5n, kh\u00f4ng tr\u00f9ng l\u1eafp v\u1edbi c\u00e1c \u0111\u1ec1 t\u00e0i \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng\u00a0b\u1ed1 m\u00e0 ng\u01b0\u1eddi nh\u1eadn x\u00e9t bi\u1ebft.<br \/>\n2) \u0110\u1ed9 tin c\u1eady v\u00e0 t\u00ednh hi\u1ec7n \u0111\u1ea1i c\u1ee7a b\u00e0i b\u00e1o (d\u1ea1ng original article): T\u1ed1t<br \/>\n3) Gi\u00e1 tr\u1ecb v\u00e0 nh\u1eefng \u0111\u00f3ng g\u00f3p c\u1ee7a c\u00e1c k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u: Mang t\u00ednh tham kh\u1ea3o v\u00ec ch\u01b0a \u0111\u1ee7\u00a0b\u1eb1ng ch\u1ee9ng \u0111\u1ec3 k\u1ebft lu\u1eadn (tham kh\u1ea3o th\u00eam c\u00e1c \u00fd ki\u1ebfn trao \u0111\u1ed5i b\u00ean d\u01b0\u1edbi)<br \/>\n4) Nh\u1eefng \u01b0u &#8211; nh\u01b0\u1ee3c \u0111i\u1ec3m: Vi\u1ebft trong m\u1ee5c sau.<br \/>\n&#8211; \u01afu :<br \/>\n&#8211; Nh\u01b0\u1ee3c :<\/p>\n<p><strong>C\u00e1c \u0111i\u1ec3m c\u1ea7n s\u1eeda ch\u1eefa , b\u1ed5 sung :<\/strong><\/p>\n<p>5) K\u1ebft lu\u1eadn:<br \/>\n\u0110\u1ed3ng \u00fd cho \u0111\u0103ng<\/p>\n<p><strong>M\u1ed9t s\u1ed1 \u00fd ki\u1ebfn g\u00f3p \u00fd v\u00e0 trao \u0111\u1ed5i:<\/strong><br \/>\n1. H\u00ecnh th\u1ee9c: B\u00e0i b\u00e1o ch\u01b0a c\u00f3 m\u1ee5c T\u00e0i li\u1ec7u tham kh\u1ea3o. C\u1ea7n vi\u1ebft m\u1ee5c K\u1ebft lu\u1eadn th\u00e0nh m\u1ee5c\u00a0ri\u00eang. V\u1eabn c\u00f2n m\u1ed9t s\u1ed1 l\u1ed7i ch\u00ednh t\u1ea3 trong b\u00e0i.<\/p>\n<p>2. L\u01b0u \u0111\u1ed3 (h\u00ecnh 2) c\u1ea7n vi\u1ebft l\u1ea1i cho d\u1ec5 hi\u1ec3u. Nh\u1eefng m\u0169i t\u00ean sang ph\u1ea3i \u0111\u01b0\u1ee3c hi\u1ec3u l\u00e0 s\u1ed1 l\u01b0\u1ee3ng v\u00e0\u00a0l\u00fd do b\u1ec7nh nh\u00e2n lo\u1ea1i tr\u1eeb kh\u1ecfi nghi\u00ean c\u1ee9u (excluded). M\u0169i t\u00ean \u0111\u1ea7u ti\u00ean tr\u00ean s\u01a1 \u0111\u1ed3 sang ph\u1ea3i l\u00e0\u00a02.072 b\u1ec7nh nh\u00e2n. \u0110\u00e2y ch\u00ednh l\u00e0 m\u1eabu \u0111\u1ec3 t\u1eeb \u0111\u00f3 ch\u1ecdn \u0111\u01b0\u1ee3c 112 b\u1ec7nh nh\u00e2n v\u00e0o nghi\u00ean c\u1ee9u. Nh\u01b0\u00a0v\u1eady 112 b\u1ec7nh nh\u00e2n nghi\u00ean c\u1ee9u s\u1ebd \u0111\u01b0\u1ee3c ch\u1ecdn t\u1eeb \u0111\u00e2u?<\/p>\n<p>3. N\u1ed9i dung \u0111\u1ecbnh ngh\u0129a b\u1ec7nh nh\u00e2n trong nghi\u00ean c\u1ee9u (m\u1ee5c ch\u1ecdn m\u1eabu): \u201cB\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n hen theo h\u01b0\u1edbng d\u1eabn GINA 2015. C\u1ee5 th\u1ec3, b\u1ec7nh nh\u00e2n c\u1ea7n c\u00f3 (1) m\u1ed9t trong c\u00e1c tri\u1ec7u ch\u1ee9ng\u00a0h\u00f4 h\u1ea5p: ho, kh\u00f2 kh\u00e8, kh\u00f3 th\u1edf, n\u1eb7ng ng\u1ef1c v\u00e0 (2) m\u1ed9t k\u1ebft qu\u1ea3 h\u00f4 h\u1ea5p k\u00ed c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c\u00a0gi\u00e3n ph\u1ebf qu\u1ea3n (FEV1, VC ho\u1eb7c FVC t\u0103ng 200mL v\u00e0 12%)\u201d.<\/p>\n<p>GINA 2015 vi\u1ebft: \u201dHen l\u00e0 m\u1ed9t b\u1ec7nh kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t, th\u01b0\u1eddng \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng vi\u00eam\u00a0m\u1ea1n t\u00ednh \u0111\u01b0\u1eddng th\u1edf. Hen \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi ti\u1ec1n s\u1eed c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p nh\u01b0 th\u1edf kh\u00f2 kh\u00e8,\u00a0kh\u00f3 th\u1edf, t\u1ee9c ng\u1ef1c v\u00e0 ho thay \u0111\u1ed5i theo th\u1eddi gian v\u00e0 c\u01b0\u1eddng \u0111\u1ed9, c\u00f9ng v\u1edbi t\u00ecnh tr\u1ea1ng t\u1eafc ngh\u1ebdn\u00a0lu\u1ed3ng kh\u00ed th\u1edf ra c\u00f3 t\u00ednh thay \u0111\u1ed5i\u201d. Nh\u01b0 v\u1eady, ch\u1ec9 c\u1ea7n n\u00f3i r\u1eb1ng b\u1ec7nh nh\u00e2n trong nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c\u00a0\u0111\u1ecbnh ngh\u0129a hen theo GINA 2015 l\u00e0 \u0111\u1ee7, kh\u00f4ng c\u1ea7n vi\u1ebft th\u00eam n\u1ed9i dung \u201cC\u1ee5 th\u1ec3, b\u1ec7nh nh\u00e2n c\u1ea7n\u00a0c\u00f3 (1) m\u1ed9t trong c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p: ho, kh\u00f2 kh\u00e8, kh\u00f3 th\u1edf, n\u1eb7ng ng\u1ef1c v\u00e0 (2) m\u1ed9t k\u1ebft qu\u1ea3\u00a0h\u00f4 h\u1ea5p k\u00ed c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c gi\u00e3n ph\u1ebf qu\u1ea3n (FEV1, VC ho\u1eb7c FVC t\u0103ng 200mL v\u00e0 12%)\u201d.<\/p>\n<p>4. Thi\u1ebft k\u1ebf nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u ch\u1ecdn m\u1eabu thu\u1eadn ti\u1ec7n \u0111\u00e3 t\u1ea1o ra sai l\u1ec7ch (bias) trong ch\u1ecdn m\u1eabu.\u00a0Trong 2.072 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi chi\u1ebfn l\u01b0\u1ee3c xu\u1ed1ng thang UMC, ch\u1ec9 c\u00f3 112 b\u1ec7nh nh\u00e2n\u00a0\u0111\u00e1p \u1ee9ng ti\u00eau ch\u00ed ch\u1ecdn v\u00e0o (chi\u1ebfm 5.4%). Sai l\u1ec7ch l\u1ef1a ch\u1ecdn n\u00e0y l\u00e0 r\u1ea5t l\u1edbn, r\u1ea5t nhi\u1ec1u kh\u1ea3 n\u0103ng c\u00f3\u00a0chi ph\u1ed1i k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u v\u00e0 \u0111i\u1ec1u n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn trong ph\u1ea7n B\u00e0n lu\u1eadn v\u00e0 K\u1ebft lu\u1eadn.<\/p>\n<p>5. \u0110\u1ec3 hi\u1ec3u th\u00eam v\u1ec1 t\u00ednh khoa h\u1ecdc c\u1ee7a nghi\u00ean c\u1ee9u n\u00e0y, t\u00f4i \u0111\u00e3 search tr\u00ean trang t\u00ecm ki\u1ebfm\u00a0Pubmed v\u1edbi n\u1ed9i dung \u201cxu\u1ed1ng thang \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n hen ki\u1ec3m so\u00e1t t\u1ed1t\u201d (Stepping down\u00a0therapy for well controlled asthma). Sau \u0111\u00e2y l\u00e0 m\u1ed9t s\u1ed1 k\u1ebft lu\u1eadn t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u c\u00f3 trong t\u00ecm\u00a0ki\u1ebfm tr\u00ean:<\/p>\n<p>M\u1ed9t ph\u00e2n t\u00edch Cochrane (1) cho r\u1eb1ng kh\u00f4ng \u0111\u1ee7 b\u1eb1ng ch\u1ee9ng m\u1ea1nh \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh xem gi\u1ea3m li\u1ec1u\u00a0ICS c\u00f3 l\u1ee3i hay c\u00f3 h\u1ea1i \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n hen ng\u01b0\u1eddi l\u1edbn ki\u1ec3m so\u00e1t t\u1ed1t. C\u1ea7n c\u00f3 th\u00eam b\u1ed5 sung c\u00e1c\u00a0nghi\u00ean c\u1ee9u RCT \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf t\u1ed1t v\u1edbi th\u1eddi gian d\u00e0i h\u01a1n \u0111\u1ec3 c\u00f3 th\u1ec3 k\u1ebft lu\u1eadn cho th\u1ef1c h\u00e0nh l\u00e2m\u00a0s\u00e0ng li\u00ean quan t\u1edbi chi\u1ebfn l\u01b0\u1ee3c gi\u1ea3m d\u1ea7n ICS cho b\u1ec7nh nh\u00e2n hen \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t. Ch\u01b0a c\u00f3\u00a0b\u1eb1ng ch\u1ee9ng RCT v\u1ec1 vi\u1ec7c ng\u01b0ng LABA cho tr\u1ebb em hen \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t b\u1eb1ng ICS-LABA\u00a0(2). Vi\u1ec7c ng\u01b0ng LABA tr\u00ean hen ki\u1ec3m so\u00e1t t\u1ed1t ti\u1ec1m \u1ea9n nguy c\u01a1 l\u00e0m gi\u1ea3m FEV1 (3,4). Kh\u00f4ng c\u00f3\u00a0b\u1eb1ng ch\u1ee9ng ch\u1ee9ng minh s\u1ef1 kh\u00f4ng thua k\u00e9m c\u1ee7a tr\u1ecb li\u1ec7u gi\u1ea3m ICS \/ LABA so v\u1edbi ICS \/ LABA\u00a0\u1ed5n \u0111\u1ecbnh (4).<\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o cho c\u00e1c k\u1ebft lu\u1eadn tr\u00ean:<\/p>\n<table border=\"1\" cellpadding=\"3\">\n<tbody>\n<tr>\n<td style=\"width: 42px;\">1.<\/td>\n<td style=\"width: 744.333px;\">Stepping down the dose of inhaled corticosteroids for adults with asthma.<br \/>\nCrossingham I, Evans DJ, Halcovitch NR, Marsden PA. Cochrane Database Syst Rev.\u00a02017 Feb 1;2(2):CD011802. doi:10.1002\/14651858.CD011802.pub2.PMID: 28146601 Free PMC article. Review.<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 42px;\">2.<\/td>\n<td style=\"width: 744.333px;\">Stopping long-acting beta2-agonists (LABA) for children\u00a0with asthma well controlled on LABA and inhaled corticosteroids.<\/p>\n<p>Kew KM, Beggs S, Ahmad S. Cochrane Database Syst Rev. 2015 May 21; 2015(5): CD011316. doi: 10.1002\/14651858. PMID: 25997166 Free PMC article. Review.<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 42px;\">3.<\/td>\n<td style=\"width: 744.333px;\">Stepping down from combination asthma therapy: The predictors of outcome.<\/p>\n<p>Koskela HO, Purokivi MK, Kokkarinen J. Respir Med. 2016 Aug;117:109-15. doi: 10.1016\/j.rmed.2016.06.010. Epub 2016 Jun 9.PMID: 27492520 Free article. Clinical\u00a0Trial.<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 42px;\">4.<\/td>\n<td style=\"width: 744.333px;\">Step-Down Therapy for Asthma Well Controlled on Inhaled Corticosteroid and Long\u00a0Acting Beta-Agonist: A Randomized Clinical Trial.<\/p>\n<p>Linda Rogers , Elizabeth A Sugar, Kathryn Blake , Mario Castro , Emily\u00a0Dimango , Nicola A Hanania , Kyle I Happel , Stephen P Peters , Joan Reibman , Joy\u00a0Saams , W Gerald Teague , Robert A Wise , Janet T Holbrook . American Lung\u00a0Association Airways Clinical Research Centers.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>Ng\u00e0y 9 th\u00e1ng 3 n\u0103m 2021<br \/>\nNg\u01b0\u1eddi nh\u1eadn x\u00e9t<br \/>\n(H\u1ecd t\u00ean v\u00e0 k\u00fd)<br \/>\nNguy\u1ec5n V\u0103n Th\u00e0nh (\u0111\u00e3 k\u00fd)<\/p>\n<\/div>\n<p>&nbsp;<\/p>\n<p><a class=\"at_url\" title=\"Download this file (9996APA_apa-11-e9(1).pdf)\" href=\"http:\/\/www.hoihohaptphcm.org\/index.php?option=com_attachments&amp;task=download&amp;id=877\" target=\"_blank\" rel=\"noopener\">9996APA_apa-11-e9(1).pdf<\/a><\/p>\n<p><a class=\"at_url\" title=\"Download this file (Bai-Dich_Nghien-Cuu-Xuong-Thang-Cho-Hen-Nhe_L-edited-1.pdf)\" href=\"http:\/\/www.hoihohaptphcm.org\/index.php?option=com_attachments&amp;task=download&amp;id=876\" target=\"_blank\" rel=\"noopener\">Bai-Dich_Nghien-Cuu-Xuong-Thang-Cho-Hen-Nhe_L-edited-1.pdf<\/a><\/p>\n<p><a class=\"at_url\" title=\"Download this file (B\u1ea2N NH\u1eacN X\u00c9T.pdf)\" href=\"http:\/\/www.hoihohaptphcm.org\/index.php?option=com_attachments&amp;task=download&amp;id=878\" target=\"_blank\" rel=\"noopener\">B\u1ea2N NH\u1eacN X\u00c9T.pdf<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nguy\u1ec5n H\u1ed3 Lam1,2, Nguy\u1ec5n Th\u00e0nh Nam2, L\u00ea Th\u01b0\u1ee3ng V\u01691,2, Nguy\u1ec5n Nh\u01b0 Vinh1,2, L\u00ea Th\u1ecb Tuy\u1ebft Lan1,2 1Khoa th\u0103m d\u00f2 ch\u1ee9c n\u0103ng, B\u1ec7nh vi\u1ec7n \u0110\u1ea1i H\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh 2\u0110\u1ea1i H\u1ecdc Y D\u01b0\u1ee3c TP. H\u1ed3 Ch\u00ed Minh T\u00d3M T\u1eaeT \u0110\u1eb7t v\u1ea5n \u0111\u1ec1:\u00a0\u0110i\u1ec1u tr\u1ecb xu\u1ed1ng thang cho b\u1ec7nh nh\u00e2n hen nh\u1eb9 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":1334,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[72],"tags":[],"class_list":["post-1326","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-chuyen-de"],"_links":{"self":[{"href":"https:\/\/matenix.com\/wp-json\/wp\/v2\/posts\/1326"}],"collection":[{"href":"https:\/\/matenix.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/matenix.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/matenix.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/matenix.com\/wp-json\/wp\/v2\/comments?post=1326"}],"version-history":[{"count":8,"href":"https:\/\/matenix.com\/wp-json\/wp\/v2\/posts\/1326\/revisions"}],"predecessor-version":[{"id":1339,"href":"https:\/\/matenix.com\/wp-json\/wp\/v2\/posts\/1326\/revisions\/1339"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/matenix.com\/wp-json\/wp\/v2\/media\/1334"}],"wp:attachment":[{"href":"https:\/\/matenix.com\/wp-json\/wp\/v2\/media?parent=1326"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/matenix.com\/wp-json\/wp\/v2\/categories?post=1326"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/matenix.com\/wp-json\/wp\/v2\/tags?post=1326"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}