Bệnh phổi tắc nghẽn mãn tính

BNH PHI TC NGHN MN TNH Ths Bs Lờ Th Huyn Trang B mụn Ni- HYD TPHCM MC TIấU nh ngha bnh phi tc nghn mn tớnh C ch bnh sinh BPTNMT Nguyờn nhõn BPTNMT Chn oỏn BPTNMT Phõn giai on BPTNMT Nhn bit t cp BPTNMT I CNG Trong nhng nm gn õy BPTNMT ngy cng c quan tõm vỡ tn sut mc bnh v t vong ngy cng tng cao T vong BPTNMT c xp hng th vo nm 1990, v s vt lờn hng th vo nm 2020 T l BPTNMT Vit Nam l 6.7%, cao nht khu vc Chõu - TBD NH NGHA COPD L mt tỡnh trng bnh lý ng hụ hp nh c trng bi tc nghn thụng khớ, s tc nghn ny tin trin, cú th tng ỏp ng ca ng hụ hp v cú phc hi phn Biu hin l tỡnh trng ho khc m kộo di, khú th gng sc v tc nghn thụng khớ (gim FEV1) Cú dng: pink puffer ( KPT) v blue bloater (VPQM) GOLD 2011 ng th bỡnh thng BIN I GII PHU BNH COPD C CH BNH SINH COPD fibroblast Fibrosis Proteases CD8+T cell Obstructive bronchiolitis Emphysema Mucus hypersecretion C CHấ BấNH SINH BPTNMT YấU Tễ GY ễC Yu t c a d b COPD 2) Mõt cõn bng tiờu huy chụng tiờu huy am 1) Viờm man BPTNMT 3) Mõt cõn bng oxy hoa chụng oxy hoa GOLD 2011 NGUYấN NHN GY VIấM Khoi thuục la (bui ụ nhiờm ?) Nhiờm siờu vi Bui ễ nhiờm ? VIấM MAN TINH VIấM TOAN THN Mõt iờu hoa chc nng antitrypsin BPTNMT (X hoa) GOLD 2011 Khi phờ thung (Huy mụ) CAC HOA CHT TRUNG GIAN GY VIấM TRONG BPTNMT Leukotriene B4 hoa hng ụng BCNTT IL 13 TGF-b1 kich thich phong thich MMPs va Cathepsins x hoa ng th nho VIấM Interleukin TNFa hoa hng ụng BCNTT, TB, n bao teo c, suy kiờt Endothelin Tai cõu truc mach mau phụi, gõy tng ap phụi GOLD 2011 HIU QU IU TR iu tr bng thuc giỳp gim triu chng gim tn sut v mc nng cn cp ci thin sc khe kh nng gng sc Khụng thuc no chng t cú th chn suy gim chc nng phi tin trin CHIN LC PHềNG NGA Ngng hỳt thuc lỏ Chng nga Giỏo dc bnh nhõn t chm súc iu tr LAMA ICS/LABA u n i vi t cp trung bỡnhnng v cú >1 t cp/ nm Can Respir J 2008; 15; 1A-8A GIO DC BNH NHN Cung cp cho bn kin thc c bn v COPD Giỳp bn kim soỏt tt triu chng bng cỏch dựng thuc ỳng Hng dn bn sng khe: cai thuc lỏ, dinh dng tt, luyn th lc Giỳp bn hiu v t cp v cú k hoch hnh ng Vũng xon bnh lý COPD COPD Lung inflammation Mucous hypersecretion Airway obstruction Exacerbation Continued smoking Impaired mucous clearance Exacerbation Submucousal gland hypertrophy Alveolar destruction Exacerbation Hypoxaemia DEATH From the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2008 Available from: http://www.goldcopd.org Hu qu ca t cp COPD Lm cht lng cuc sng xu i Tỏc ng lờn triu chng v CNHH t cp COPD Gim chc nng Phi Tng gỏnh nng kinh t Tng t vong T CP COPD An exacerbation of COPD is defined as an event in the natural course of the disease characterized by a change in the patients baseline dyspnea, cough, and/or sputum that is beyond normal daytoday variation GOLD 2011 T CP COPD Tam chng Anthonisen: Ho khc m tng m m Khú th tng Triu chng khỏc: th khũ khố, au ngc, triu chng cm lnh thụng thng NGUYấN NHN T CP Nhim trựng hụ hp ễ nhim khụng khớ 1/3 khụng cú nguyờn nhõn Bin chng ca bnh: Trn khớ mng phi Thuyờn tc phi NGUYấN NHN T CP Cỏc yu t lm thay i ngng xut hin t cp Yu t bờn trong: Suy chc nng hụ hp ang hỳt thuc Phn ng quỏ mc ca ph qun Suy gim cỏc c ch bo v Cỏc yu t khỏc: ln tui, bnh kốm theo NGUYấN NHN T CP Cỏc yu t lm thay i ngng xut hin t cp Yu t bờn ngoi: Vi khun ễ nhim khụng khớ Thay i nhit mụi trng Thay i iu tr COPD PHN LOI T CP NH (nhúm A) TRUNG BèNH ( Nhúm B) NNG (Nhúm C) Tam chng 1/3 2/3 C Tui Bt k Bt k > 65t CNHH lỳc u FEV1> 80% FEV1>50% FEV1