Tiến bộ trong điều trị COPD hiện nay - liệu pháp phối hợp thuốc giúp giảm tử vong=Current progress in COPD treatment - combination drug therapy helped to reduce mortality

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Tác giả: Văn Ngọc Trần

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.34-40

Bộ sưu tập: Metadata

ID: 245016

Thêm vào giỏ

Bệnh phổi tắc nghẽn mạn tính (COPD) là bệnh phổ biến ở Việt Nam và trên thới giới, tử suất không ngừng gia tăng hiện đứng hàng thứ 3 sau nhồi máu cơ tim và đột quỵ. Đây là bệnh rất phức tạp về cơ chế bệnh sinh và kiểu hình đa dạng nên cần có đánh giá toàn diện, điều trị hợp lý và đầy đủ nhằm giảm sự tiến triển nhanh của bệnh, giảm đợt cấp, giảm triệu chứng và tăng chất lượng cuộc sống. Bệnh nhân COPD với nhiều kiểu hình với những biểu hiện và tiến triển khác nhau, đòi hỏi phải đánh giá và điều trị tối ưu nhằm giảm tử vong đang gia tăng nhanh chóng hiện nay. Bên cạnh những phương pháp không dùng thuốc đã được chứng minh giảm tử vong như vật lý trị liệu, điều trị giảm thể tích phổi, chủng ngừa…, việc dùng thuốc giãn phế quản tối ưu chưa được chứng minh có hiệu quả giảm tử vong cho đến một hai năm gần đây khi ra đời 3 thuốc ICS/LABA/LAMA trong cùng một dụng cụ mới chứng minh giảm tử vong qua nghiên cứu IMPACT và ETHOS. Kết quả cho thấy tác dụng có lợi của liệu pháp bộ 3 liều cố định so với kết hợp LABA/LAMA về tử vong ở bệnh nhân COPD có triệu chứng và tiền sử các đợt cấp thường xuyên và/hoặc đợt cấp nặng, đã được điều trị duy trì bằng liệu pháp bộ 3, ICS/LABA hoặc thuốc giãn phế quản tác dụng kéo dài đơn hoặc kép. Tiên lượng COPD phụ thuộc vào sự tuân thủ điều trị thuốc và các biện pháp không dùng thuốc, sự tái phát các đợt cấp nặng cần nhập viện, dinh dưỡng và trạng thái tinh thần của bệnh nhân cũng như điều trị tối ưu các bệnh đồng mắc.COPD is a very common disease in Vietnam and around the world, with increasing death rate, ranking third after myocardial infarction and stroke. This is a very complex disease in pathogenesis and other phenotypes, so it is necessary to have a comprehensive assessment, apropriate treatment to improve the rapid progression of the disease, reduce exacerbations, reduce symptoms and improve quality of life. COPD have many phenotypes with different manifestations and progression, requiring optimal assessment and treatment to reduce the mortality. Besides non-pharmacological methods that have been proven to reduce mortality such as physical therapy, lung volume reduction, vaccination..., optimal use of bronchodilators has not been proven to effectively reduce mortality. Until the last two years when the 3 drugs ICS/LABA/LAMA were introduced in the same device to demonstrate mortality reduction through the IMPACT and ETHOS studies. The results showed a beneficial effect of fixed-dose triple therapy compared with the combination LABA/LAMA on mortality in symptomatic COPD patients with a history of frequent and/or severe exacerbations, maintenance treatment with triple therapy, ICS/LABA or single or dual longacting bronchodilators. COPD prognosis depends on compliance with medication and nonpharmacological measures, recurrence of severe exacerbations requiring hospitalization, patient nutrition and mental status, and optimal treatment of co-morbidities.

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