The Korean Journal of Medicine

  • 제83권5호
  • /
  • Pages.598-605
  • /
  • 2012
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

경증 천식 치료 중 기도과민성 재검사의 필요성

Is It Necessary to Re-Evaluate Airway Hyperresponsiveness During Treatment of Mild Asthma?

  • 이종후 (제주대학교 의학전문대학원 내과학교실) ;
  • 이재천 (제주대학교 의학전문대학원 내과학교실)
  • Lee, Jong Hoo (Department of Internal Medicine, Jeju National University School of Medicine) ;
  • Lee, Jaechun (Department of Internal Medicine, Jeju National University School of Medicine)
  • 발행 : 2012.11.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 기도과민성은 천식의 대표적인 증상이지만, 경과에 대해서는 잘 알려져 있지 않다. 본 연구에서는 경증 천식 환자들에서 기도과민성의 호전 빈도를 확인하고, 임상 지표들과의 관련성을 알아보고자 하였다. 방법: 천식을 진단받고 약물치료 중 3개월 이상 천식 관련 증상이 없었던 환자를 대상으로 하였다. 기도과민성 호전 여부를 확인하기 위하여 메타콜린 기관지유발 검사를 이용하였고, 메타콜린 유발농도 25 mg/mL에서도 FEV1 수치가 20% 이상 감소하지 않았을 때 기도 과민성 음성으로 정의하였다. 기도 과민성 음성 전환군과 양성 유지군 사이의 임상적 특징을 확인하기 위하여 각종 임상 지표들을 후향적으로 조사하였다. 결과: 총 54명의 환자들 중에서 22명(40.7%)이 기도과민성이 음성으로 전환되었다. 기도 과민성이 양성으로 유지되는 인자로는 남성, 처음 진단 당시 호흡곤란 증상, 고용량 흡입용 스테로이드 및 지속형 기관지 확장제의 사용 여부였고, 연령, 호흡곤란 이외의 증상, 각종 혈액검사 소견, 폐기능검사 결과, 천식 진단 당시의 진단 방법, 천식 진단과 기도과민성 측정 간의 시간 간격 등은 양 군 간의 차이가 없었다. 다변량 분석에서는 남성 이외의 인자는 양 군 간의 차이가 없었다(p = 0.014). 결론: 경증 천식환자들 중 약 40%는 추적 메타콜린 기관 지유발 검사에서 기도과민성이 음성으로 전환되어 임상적 관해를 보였다. 경증 천식 환자에서 기도과민성이 호전 여부를 예측하기 어렵기 때문에 기도과민성을 재평가하여 천식 조절제 지속 여부를 확인할 필요가 있다.

Background/Aims: Airway hyperresponsiveness (AHR) is one of the typical characteristics of asthma. However, its natural course is unknown. The presence of AHR is often not assessed in asthmatics undergoing medical treatment. We investigated the changes of AHR as compared with clinical parameters in patients with mild asthma. Methods: We enrolled patients who were diagnosed with asthma, but were asymptomatic for > 3 months while undergoing medical treatment. AHR was measured using a methacholine bronchial provocation test after a 2-week washout period. AHR-negativity was defined as a $PC_{20}$ > 25 mg/mL. Clinical parameters were retrospectively compared between the AHR-negative and -positive patients. Results: Among 54 patients, 22 (40.7%) were AHR negative. Factors associated with the maintenance of AHR were male sex, presence of dyspnea, and high-dose inhaled corticosteroid plus long-acting beta agonists at initial presentation (respectively, p < 0.05). Age, symptoms other than dyspnea, blood tests, results of spirometry, diagnostic methods at presentation, and time from diagnosis to follow-up testing were not significantly different between AHR-negative and AHR-positive patients. Multivariate analyses failed to show a significant difference between the two groups, except for male sex (p = 0.014). Conclusions: Approximately 40% of patients with mild asthma show no AHR or clinical remission of the disease. Male sex may be a predictive factor for persistent AHR. However, altered AHR status is not predictable in patients with mild asthma undergoing medical treatment. Therefore, the cessation of regular controller might be advocated, and reassessment of AHR should be mandatory.

키워드

참고문헌

  1. The Global Initiative for Asthma. GINA Report: global strategy for asthma management and prevention [Internet]. The Global Initiative for Asthma, c2011 [cited 2011 December 28]. Available from: http://www.ginasthma.org.
  2. O'Byrne PM, Barnes PJ, Rodriguez-Roisin R, et al. Low dose inhaled budesonide and formoterol in mild persistent asthma: the OPTIMA randomized trial. Am J Respir Crit Care Med 2001;164(8 Pt 1):1392-1397.
  3. Haahtela T, Jarvinen M, Kava T, et al. Effects of reducing or discontinuing inhaled budesonide in patients with mild asthma. N Engl J Med 1994;331:700-705. https://doi.org/10.1056/NEJM199409153311103
  4. Selroos O, Pietinalho A, Löfroos AB, Riska H. Effect of early vs late intervention with inhaled corticosteroids in asthma. Chest 1995;108:1228-1234. https://doi.org/10.1378/chest.108.5.1228
  5. Stoloff SW, Stempel DA, Meyer J, Stanford RH, Carranza Rosenzweig JR. Improved refill persistence with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies. J Allergy Clin Immunol 2004;113:245-251. https://doi.org/10.1016/j.jaci.2003.10.011
  6. Boushey HA, Sorkness CA, King TS, et al. Daily versus as-needed corticosteroids for mild persistent asthma. N Engl J Med 2005;352:1519-1528. https://doi.org/10.1056/NEJMoa042552
  7. Jeon BH, Lee JC, Kim JH, Kim JW, Lee HS, Lee KH. Atopy and sensitization rates to aeroallergens in children and teenagers in Jeju, Korea. Korean J Asthma Allergy Clin Immunol 2010;30:14-20.
  8. Cockcroft DW. Direct challenge tests: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest 2010;138(2 Suppl):18S-24S.
  9. O'Byrne PM, Gauvreau GM, Brannan JD. Provoked models of asthma: what have we learnt? Clin Exp Allergy 2009;39:181-192. https://doi.org/10.1111/j.1365-2222.2008.03172.x
  10. Ramsdale EH, Roberts RS, Morris MM, Hargreave FE. Differences in responsiveness to hyperventilation and methacholine in asthma and chronic bronchitis. Thorax 1985;40:422-426. https://doi.org/10.1136/thx.40.6.422
  11. Verma VK, Cockcroft DW, Dosman JA. Airway responsiveness to inhaled histamine in chronic obstructive airways disease: chronic bronchitis vs emphysema. Chest 1988;94:457-461. https://doi.org/10.1378/chest.94.3.457
  12. Cockcroft DW, Murdock KY, Berscheid BA, Gore BP. Sensitivity and specificity of histamine PC20 determination in a random selection of young college students. J Allergy Clin Immunol 1992;89(1 Pt 1):23-30.
  13. Cockcroft DW, Davis BE. Mechanisms of airway hyperresponsiveness. J Allergy Clin Immunol 2006;118:551-559. https://doi.org/10.1016/j.jaci.2006.07.012
  14. Busse WW. The relationship of airway hyperresponsiveness and airway inflammation: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest 2010;138(2 Suppl):4S-10S.
  15. Sont JK, Willems LN, Bel EH, van Krieken JH, Vandenbroucke JP, Sterk PJ. Clinical control and histopathologic outcome of asthma when using airway hyperresponsiveness as an additional guide to long-term treatment: the AMPUL Study Group. Am J Respir Crit Care Med 1999;159(4 Pt 1):1043-1051.
  16. Koh YY, Kang EK, Kang H, Yoo Y, Park Y, Kim CK. Bronchial hyperresponsiveness in adolescents with longterm asthma remission: importance of a family history of bronchial hyperresponsiveness. Chest 2003;124:819-825. https://doi.org/10.1378/chest.124.3.819
  17. Hanxiang N, Jiong Y, Yanwei C, et al. Persistent airway inflammation and bronchial hyperresponsiveness in patients with totally controlled asthma. Int J Clin Pract 2008;62:599-605.
  18. Park S, Lee YW, Park JW, Hong CS. Clinical characteristics of bronchial asthmatics who showed negative conversion of airway hyperreactivity in the methacholine provocation test. Korean J Asthma Allergy Clin Immunol 2008;28:20-25.

피인용 문헌

  1. Is It Necessary to Re-Evaluate Airway Hyperresponsiveness During Treatment of Mild Asthma?: Is It Beneficial in Real Practice? vol.83, pp.5, 2012, https://doi.org/10.3904/kjm.2012.83.5.596
  2. 알레르기 검사의 실제 vol.15, pp.1, 2012, https://doi.org/10.22730/jmls.2018.15.1.1