N g h i e n cihi Y hoc V Hpc TP. Hb Chi Minh * Tap 21 * So 2 * 2017
DANH GIA KI THUAT SU" DUNG DUNG CIJ HIT CliA BENH NHAN HEN VA COPD TAI TRUNG TAM CHAM SOC HO HAP
- BENH VIEN DAI HOC Y DU'OC TP. HO CHI MINH
VH Trdn Thien Qudn*,Nguyen Tran Thanh True**, Phan Tuan Kiet**, Trinh Nguyen Hq Vi**, le Tan Nguyen Phdc**, Tran Minh Nh^**, Hodng Le TrungHieu**, Tran Hodng Nhait Linh**,
Pham Diem Thu***, le Thi Tuyet Lan*
TOMTAT
Dat van de: Co the nbi trong cdc berih ly hb hap phobim hien nay ihi hen vd COPD Id hai binh ly dugc quan tdm hdng ddu. Phuong phdp dieu tri bang cdc loqi thuoc hit trb nen phobien, gon nhe, tiin nghi, ldm idng hiiu qud dieu tri vd ldm gidm tdc dung phu cho binh nhdn. Tuy nhien, desie dung cdc dung cu hit ndy, binh nhdn can dugc hieang ddn ky ndng phoi hgp mot cdch thudn thuc vd chinh xdc detdng hieu qud diiu tri.
Miic tieu: Ddnh gid kieh thiic, ky ndng cita benh nhdn dm vbi viec sie dung cdc dung cu hit ca bdn: pMDI, Turbuhaler, Accuhaler.
Dot tugng vd phuang phdp n^ien citu: 88 doi tugng khdm tai Trung idm hb haip benh viin dqi hoc Y Dugc dang sie dung dung cu hit dieu tri hen vd COPD. Thbi gian thu thdp sd'lieu: thdng 07/2015 deh thdng 09/2015. Nghien deu tien deu, bdo cdo hdng loqt ca.
Kei qud: Tmg sobitih nhdn nghien cieu la 88 ngubi. Nam giai chimi 42 benh nhan (48%) ddn so nghiin cieu, tu^ trung binh dia ddn so nghiin deu Id 48,9 ± 16,1 tuoi. Binh nhdn hen chiim 74 ngubi (84,1%>), COPD 14 nguai (15,9%o). 29 (33%>) binh nhan da/dang su: dung nhiiu han 1 loqi dung cu hit. Loqi dung cu hit birth nhdn dang sie dung: 48 (54,6%>) binh nhan diing pMDI,36 (40,1%>) diing Tubuhaler, 6 (4,6%o) dung Accuhaler.
Ti li benh nhdn sie dung ddng la thudt bed 3 loqi dung cu la 90%o.
Kei luqn: Phdn lan binh nhdn trong nghien dm ndy thuc hiin tot ki thu&t su dung dung cti hit, nen ti&p tuc chucmg hinh hum luyin benh nhan sw* dung cdc loqi dung cu ndy.
Tit khoa: Hen, benh phoi tac nghen mqn tinh, COPD, dung cu hii ASBTRACr
INVESTIGATION OF INHALER TECHNIQUE OF ASTHMA AND COPD PATIENTS AT RESPIRATORY CARE CENTER OF UNIVERSITY MEDICAL CENTER HCMC
Vu Tran Thien Quan, Nguyen Tran Thanh True, Phan Tuan Kiet, Trinh Nguyen Ha Vi, Le Tan Nguyen Phuc, Tran Minh Nhut, Hoang Le Trung Hieu, Tran Hoang Nhat Unh, Pham Diem Thu, Le Thi Tuyet Lan
* Y Hoc TP. Ho Chi Minh * VoL 21 - No 2 - 2017:26 - 30 Background: Nowadays, asthma and COPD are unarguably two of the most popular diseases of the respiratory system. Treatment with inhaktion dru^ are now considered common, compact and user-friendly methods thai raise the ef^ctiveness of the medidne and reduce the side ejfecisfor patients. However, in order to correctly follow this treatment, patients need to be instructed and well-trained in how to use inhalers to guarantee maximal results.
* B6 mon Sinh ly, Khoa Y, Dai hoc Y Diroc TP.HCM **Dai hpc Y Dugc TP.HCM
"** Bp mon Sinh hoa, Khoa Dui/c, Tp.HCM
Tdc gid lien lac: ThS. Vu Tran Thien Quan DT: 0934041123 Email: [email protected]
Y Hoc TP. Hb Chi Minh * T$p 21 * S^ 2 * 2017 Nghien cuu Y hpc
Aim: We aim to assess the knowledge and technique erf the patients toward using three basic inhalers: pMDI, Turbuhaler and Accuhaler.
Subjects and Methods: 88 patients using inhalers, who attended outpatient's clinic at the Respiratory Care Center of University Medical Center, HCMC. Data was colleded between July 2015 and September 2015 Prospedive study, case series.
Results: A total of 88 patients participated, in which 42 (48%) were males. Mean age of studied population was 48.9 ± 16.1 years. 84.V/o had asthma (74/88) and 15.9%o had COPD (14/88). 29 patients (33%o) had been using more than 1 inhaler. Inhalers used in patients: 48 (54.6%) used pMDl, 36 (40.1%) used Turbuhaler, 6 (4.6%>) used Accuhaler. The proportion of correct users cf3 inhaler types was 90%o.
Cotwlusion: The majority of patients in this study used the inhalers correctly; therefore training programs for patients to use inhalers should be continued.
Keyword: asthma, COPD, inhaler, inhaler technique D A T V A N D E
Co the noi trong cac benh ly ho hap pho bi&i hien nay thi hen va COPD la hai benh ly dugc quan tam hang dau. Hien nay, hai can benh nay cung dang co xu huong gia tang va CO nhiing dien bien dang lo ngai'^-^. Tan suat luu hanh hen cy nguoi truang thanh Viet Nam nam 2010 la 4,1%, trong do ty le mic benh cao nhat a nhom tuoi > 80 (11,9%). Doi voi COPD, theo nghien cihi ciia Hoi Ho hap Chau A Thai Binh Duong, ti Ie mac COPD trung binh va nang 6 nguoi Viet Nam tren 35 tuoi la 6,7%, cao nhat khu vuc's), Theo Dinh Ngpc Si va cs, ti Ie COPD trong cpng dong dan cu Viet Nam tii 40 tuoi trd len la 4,2%i3-5).
Ngay nay, phucmg phap dfeu tri bang cac loai tiiuoc hit tro nen pho bien, gpn nhe, tien nghi, lam tang hieu qua dieu tri va lam giam tac dung phu cho benh nhan. Do la c^c loai bmh hit xjt dinh Ueu MDL Turbuhaler, Handihaler, Accuhaler. Tuy nhien, de sii dimg cac dyng cu hit nay, bfnh nhan can dupe huong dSn ky nang phoi hgp mot each thuan thuc va chinh xac de tang hieu qua dieu tri vi viec hat thuoc hit bam sai vj tri ngoai viec khong mang lai hifu qua con gay nhieu tac dung phu, gay lang phi thuoc'^'^'. Theo ghi nhan c^a BV Nhan Dan Gia Dinh, berJi nhan hen va COPD thuong xuyen phai nhap vien vi nhung con kho tho c^p tinh.
Cau hoi dupe dat ra la in sao benh nhan dupe dieu tri dung va du lieu thuoc ma van thuong len con kho tho? Mgt nghien ciiu tren 103 benh nhan COPD dupe khao sat thi eo den 77 bfnh nhan (ti Ie 74,8%) thiJrc hien sai 6 it nhat 1 buoc. Thong ke cho thay co nhieu nguyen nhSn dan den thyc trang nay, co the do trinh do ciia benh nhan, bai giang va each giang giai ciia nguoi huong dan, hay do y thiic, kha nang ciia nguoi benh trong viec thuc hien Ihao tac. Mot nghien cuu cho thay 60% benh nhan COPD va 92% benh nhan hen khong phoi hgp dpng tac tot va hit vao qua nhanh khi su dirng dung cu MDI;
so benh nhan hit vao khong dii manh va nhanh khi su dung binh hit bpt kho DPI la kha pho bi&i, ti le Ian lupt la Accuhaler 4,9%, Tiubohaler 14>2%, Handihaler 57%''').
Nhu vay, da co nhieu nghien ciiu ve van de ky thuat sii dung dung cu hit 6 benh nhan hen va COPD, nhung hau het la nghien ciiu ciia cac tac gia nuoc ngoai, cac nghien ciiu tai Viet Nam thuc su chua nhieu va co the chua thoa dang, phii hgp giiia cac vung mien.
Chinh vi tam quan trpng ciia van de nay, chiing toi hen hanh khao sat ti le sii dung diing ki ihuat dimg dung cu hit trong dieu tri hen va COPD, tim hieu cac nguyen nhan dan den viec sii dung sai va huong khac phuc.
Nghien ciiu dupe thuc hifn tai Trung Tam Cham Soc Ho Hap - "
Dugc TPHCM.
- Benh Vien Dai Hpc Y
N g h i e n c u u Y hpc Y H o c TP. H b Chi M i n h * T a p 21 * So 2 * 2017
M u c tieu nghien d m
Danh gia Hen thire, ky nang ciia benh nhan doi voi vifc sii dung cac dung cu hit co ban;
pMDI, Turbuhaler, Accuhaler.
DdlluONG-PHl/ONGPHAPNGHIENCtltJ Doi hrpng nghien cihi
Cac doi tupng kham tai Trung tam ho hap benh vifn dai hgc Y Dupe dang sii d u i ^ dung cu hit dfeu trj hen va COPD. Thai gian thu thap so Ueu: thang 07/2015 d&i tiiang 09/2015.
Thiet k e nghien cuu
Nghien cihi tien cihi, bao cao hang loat ca Tieu chuan nhdn vdo
Cae doi tupng dang dieu tri hen va COPD bang cac loai dung cii hit xit trong nam vira qua se dupe thu nhan vao nghien ciiu neu dong y tham gia.Trung tam cham soc ho hap - Benh vifn Dai Hgc Y Dugc TP.HCM.
Co mdu
MSu thuan tien, chpn ngau nhien 88 benh nhan kham, dieu tri tai Trung tam cham soc ho hap - Benh vien Dai hgc Y Dupe TP.HCM trong it nhat 2 lan kham.
Cong cu nghien cOu
Sir dung bg cau hoi phong VEOI va checklist.
B&ih nhan se dugc phong van xac dinh loai dung cu hit bfnh nhan dang sir dung va k i ^ tra each sir dung dung eu hit nay.
Cdch thdc tim hdnh
Chuan bi bp cau hoi thu thap so Ueu.
Chuyen ngii cac bg cau hoi, checklisttheo khuy&i cao cua Hpi dong hen Uc ve kien thiic, ky nang ciia benh nhan doi voi viec sii dung 4 dung cu hit CO ban: pMDL Turbuhaler, Accuhaler, Handihaler.
Tong hgp, kiem tra, xem xet ve mat y khoa:
eae tir ngu y khoa co diing boi canh lam sang.
Thir nghiem tinh chap nhan va hifu chinh cac bg cau hoi.
Phong van tiiir 20 doi tupng tmh n g u y ^ tham gia sinh vien.
Chinh sua bp cau hoi tiiu thap so Ufu.
Thong nhat phuong thiic phong vaii bp cau hoi giiia eae phong van vien.
K E T Q U A
Tong so bfnh nhan tham gja vao nghien ciiu la 88 nguoi. Dac diein dan so hgc duge mo ta trong bang 1. Nam gioi chiem 42 berth nhan (48%) dan so nghien ciiu, tuoi trung binh aia dan so nghien a i u la 48,9 + 16,1 tuoi, tuoi nho nhat la 12 tuot Ion nhat la 78 tuoi.
Bdng 1: Ddc diim ddn so hgc ciia ddn so nghiin deu N=88
Nhom tuoi
HocvSn
Diroi 20 tuoi 21-40 tuoi 41-60 tu6i Tren 60 tuoi
MClCtlLf Biet Soc, biit Viet
CSpl C4p2 Cap 3 Cao dang
D^itipc
n(%) 6 (6,8%) 21 (23,9%) 37(42,0%) 24(27,3%) 1(1,1%) 1 (1,1%) 15 (17,0%) 25 (28,4%) 23 (26,1%) 4(4.5%) 19(21,6%) Trong nghien ciiu nay, benh nhan hen chian 74 nguoi (84,1%), bfnh nhan COPD chian 14 nguiri (15,9%). Thai gian dugc chan doan hen hoac COPD trung binh la 48,3 + 80,4 (thang). 27 (30,7%) bfnh nhan hay hi nhung dpt kho tho cap trong qua trinh dieu tri, 13 (14,8%) bfnh nhan timg CO con kho tho lam benh nhan phai nhap vifn. 100% benh nhan dang sir dung dung cu hit dJeu tri hen/COPD tai nha.
Bdng 2: Ti li trd benh nhdn trd Ibi "Cb"
Ong/b^ CO su* dung dung cti hit de dang khong?
6ng/bS th4y vi?c SLH dyng diing cy hit nay c6 quan trgng floi v6i si>c Ithoe aia minh khong? 84 (95.5%)
86 (97.7%) Khi sir dyng, 6ng/ba co Ihliy hieu qua khfing?
Trong qua trinh sii dung, co b^t cCr mpt tac dyng phu khong mong mu6n nao xay ra?
Ong/t)a c6 hai I6ng vdi lo^i dung cu hit minh dang su- dyng khfing?
6ng/ba cfi mu6n J6l logi dyng cy khfe?
n(%)
84 (95.5%) 32(36,4%) 82(93,2%) 4 (4.5%)
Y Hpc TP. Hb Chi Minh * Tap 21 * So 2 * 2017 N g h i e n c u u Y hpc
Thoi gian sii dung dung cii hit; 34 (38,6 %) benh nhan sir diong Uen tuc duoi 1 nam, 12 (13,6) benh nhan sir dung Hen tuc tir 1 d&i 3 nam, 27 (30,7%) b&ih nhan sii dung Uen tuc tren 3 nam, 15 (17%) bfnh nhan sir dyng ngat quang. So lupng lieu thuoc xit moi ngay bfnh nhan sii dung: 53 (60,2%) bfnh nhan dimg 1-2 Ueu/ ngay, 28 (31,8%) benh nhan dimg 3-4 Heu/ ngay, 7 (8%)
Bdng 3: Ti li hinh nhdn co thuc hien dot vbi timg bubc sie dung cdc hqi dung cu hit
bfnh nhan dimg tren 4 Heu/ngay. 29 (33%) bfnh nhan da/dang sir dung nhieu hem 1 loai dung eu hit. Loai dung cu hit berth nhan dang sir dung:
48 (54,6%) bfnh nhan dimg pMDI, 6 (4,6%) benh nhan dimg Accuhaler, 3 (2,3%) bfnh nhan dimg Handihaler, 27 (30,7%) bfnh nhan khong biet dang dimg dung cu nao.
Sd liFQTig BN
48 b§nh nhan
36 b^nh nhSn
6 benh nJiSn DLing cy
pMDI
Accuhaler 1. Thao nap
2. Kilm tra "dose counter" (s6 lilu c6n lai trong dung cu) (nlu co the) 3. GiO dyng cu thing dii-ng va lac kt
4. Tho ra nhe nhSng, xa khoi dung cu hit
5. Du^ ong nggm vSo mi#ng. khong can ong ngim va giij' moi khep kin 6. Bit diu hit Vcio chgm bang mi§ng vh cung luc an dyng cu hit 7. Tilp tuc hit v^o ch^m vd sau
8. Nin tho' khoang 5 giay hoac cho \6ii khi cdn chiu diro'c 9. Trong khi nin tho. bo dyng cy khoi mieng 10. Ihir ra nh$ nhang, xa khoi dyng cu 1 i . Nlu d n them lilu, lap Igi tu' bu'dc 2-10 12. Thaynap
1 Van v i md nip a§y dung cy hit 2. Kilm tra sd lilu cdn Igi
3. Giu" dyng cy thing di>ng trong khi van nip 4. Vgn phin d l qua phai roi ngm^c Igi den khi nghe tilng dick 5. Tho ra nh$ nhang, xa khoi dung cu
6. Bat Ing ng^m vao mi^ng, khong can ong ngam va giu moi khep kin Khong che
^ng thdng hoi.
7. Hit vdo mgnh vd siu
8 Nin tho trong khoang 5 giay hay cho to'i khi chju dyng duoc 9 Liy dyng CIJ ra khoi mieng
10. Tho ra nhe nhang, xa khoi dung cy 11. Nlu cin them lilu, Igp lai tii bu'oc 2-10 12. Thay nap diy
1. Kilm tra so lilu con Igi 2. Mo nap bang ngfin cai
3. D l dyng cu nam ngang, ISn nong din khi nghe teng dick 4. Tho ra nh? nhing. xa khoi dyng cy hit
5. Dat ong ng^m vio mi?ng. giir mfii khep kin, d l dung cu nam ngang 6 Hit vao til'tif va sau
7. Nin tho h-ong khoang 5 giay hay din khi con ciiiu dung 6ufac 8. Trong khi nin tho, lay dung cy khoi mieng
9. Tho- ra nhe nhang. xa khoi dung cy hit
10. Nlu d n them lilu (thu^q khonq duwc khuyin cao), lap Igi bircrc 3-9 11. D§y nap Igi de khoi nfing
n(%) 48(100%) 21 (43,8%) 44 (91,7%) 35 (72,9%) 46 (95,8%) 44 (91,7%) 40 (83,3%) 40 (83,3%) 46 (95.8%) 46 (95,8%) 41 (85.4%) 38 (79,2%) 36 (100%) 29 (80,6%) 33(91,7%) 35 (97,2%) 27 (75%) 35 (97.2%) 32 (88.9%) 29 (80,6%) 35 (97,2%) 33(91.7%) 28 (77.8%) 31 (86.1%) 5 (83.3%) 6(100%) 6(100%) 5 (83.3%) 6(100%) 5 (83.3%) 6(100%) 6 (100%) 6 (100%) 4 (66,7%) 6 (100%)
B A N LUAN
Trong nghien cuu nay, eae doi tugng tiiam gia nghien ciru phan Ion hoan thanh day dii eae
buoc sir dung cac loai dung cu hit. Day co Ihe duge xem la thanh qua eiia ehuong tiinh giao due bfnh nhan sir dung cac loai dung cu hit tai Trung tam cham soc ho hap - Bfnh vien Dai hoe
N g h i e n c u u Y hpc Y Hoc TP. Hb Chi Minh * Tap 21 * So 2 * 2017
Y dugc. Tuy nhien, cae doi tugng trong nghien eiiu ciia chiing toi la benh nhan ngoai tru, phan Ion trong gjai doan on dinh eiia benh nen co the chua dai dien eho toan bg cae doi tugng mae hen/COPD, dae bift cac benh nhan nang phai nhap vien. Trong nhimg nghien eiiu toi can khao sat tren nhiing doi tugng benh nhan nay. Ngoai ra, nen sii dting nhiing bang kiem ki thuat sii dimg dung eu hit eho bfnh nhan hen/COPD de giiip danh gia khach quan'^*.
KETLUAN
Phan Ion bfnh nhan trong nghien eiiu nay thue hien tot la thuat sir dung dung cu hit, nen tiep tue ehuong trinh huan luyfn benh nhan su dtmg cac loai dung cu nay.
TAI U E U THAM KHAO
1 Basheti IA, Reddel HK, Aimour CL, & Bosnic-Anticevid) SZ (2005). Counselmg at)out tuibuhaler technique: needs assessment and eSective strategies foi community phaimadsts.
RfiSpiV Care, 50(5), 617-*23.
Basheti IA, Reddel HK, Armour CL, &. Bosnic-Antioevich SZ (2007) Improved astimia outcomes with a simple inhaler technique intervention by community jAarmadsts. J Allergy Om Immunol, 119(6), 1537-1538. doi: 10.1016^ jacL2007.0Z037 D m h Ngoc Sy, & Nguyin Viei Nhung. pOll). Thth hinh didi^
feftih phoi tdc nghen man tinh iqi Viet Nam. Paper presented at Ihe Ki yeii Hgi nghj Noi khoa toan quoc n a m 2011 GINA. P015). Global Initiative for Asthma.
Regional COPD Working Group. {2003}. COPD prevalence in 12 Asia-Padfic countries and regions: prt^ections based on the COPD prevalence estunation m o d e l Respimbgy, S(2), 192-198.
Ronmark E, Jogi R, Lindqvist A, Haugen T, Meren M, Loit HM, et al (2005). Correct use of three powder inhalers, companson between Diskus, Turbuhaler, and EasyhaJer. J Asthma. 42(3), 173- 178.
The Global initiative for chronic Obstructive Lung Disease (GOLD). (2014). Global Strategy for Diagtvosis, Management, and Prevention o£ COPD Available at httpK//www goldcopd.org/gmdelines-global-strategy-for- diagnosis-managementhtml. Ngay tmy c§p: 30/08/2014
Ngdy nhdn bdi bdo. 18/11/2016 Ngdy phdn bien rihan xet hdi bdo: 17/11/2016 Ngdy bdi bdo duac ddng: 01/03/2017
