• Tuberculosis and Respiratory Diseases
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• v.46 no.3
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• pp.372-385
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• 1999

Background: The purpose of this study was to examine the causes and pathologic process of chronic non-productive cough as an isolated symptom with a normal spirometry and chest radiograph by investigating clinicopathologic findings. Method: We studied 25 adults with chronic non-productive cough over a 3-week period with a normal chest radiograph and pulmonary function tests without any other symptoms. Clinical assessment, cough score, chest and sinus radiograph, pulmonary function tests, methacholine challenge, allergic skin prick test, and bronchoscopy for bronchial biopsies were performed. Subjects were then treated with prednesolone 20 to 30 mg/day for 1 to 2 weeks. Results: The experimental group was divided into two subgroups-those infiltrated with eosinophils, and those infiltrated with lymphocytes depending on eosinophil and lymphocyte counts, both of which were respectively higher than those of the control group. Eosinophils infiltrated group had mean numbers of eosinophil of 89.8 $cells/mm^3$ while control group's mean was 0.4 $cells/mm^2$(p=0.005). Lymphocyte infiltrated group was 4 patients whose mean was 84.3 $cells/mm^2$ with 28.4 $cells/mm^2$ of control group(P=0.026). In addition, the mean thickness of the basement membrane of experimental group was $14.20{\pm}5.20{\mu}m$ in contrast of control group whose mean was $3.50{\pm}1.37{\mu}m$(P=0.001). With the methacholine challenge test, 7 of the 21 eosinophil infiltrated subjects were diagnosed with cough variant asthma ; the other 14 with eosinophilic bronchitis. Three subjects with eosinophilic bronchitis were atopic positive (21.4%) with the skin prick test In the lymphocyte dominant group, all four subjects were diagnosed with lymphocytic bronchitis. Cough score was improved after steroid treatment in 22 of 25 subjects in the experimental group (88.0%). Conclusion: These results suggest chronic non-productive cough as an isolated symptom with a normal spirometry and chest radiograph was associated with airway inflammation by eosinophil and lymphocyte infiltration. The causes for chronic non-productive cough were eosinophilic bronchitis, cough variant asthma, and lymphocytic bronchitis(written in frequency). They further suggest that therapeutic treatment with steroids can provide effective symptomatic relief.

• Tuberculosis and Respiratory Diseases
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• v.45 no.5
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• pp.1012-1021
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• 1998

Background : It is known that airway inflammation is present in most patients with asthma, but the relationship between symptoms and the severity and nature of airway inflammation has not been established. Cough variant asthma is defined as an asthma in which the dominant symptom is cough, and the condition can be successfully treated with inhaled steroids. This study was performed to evaluate the time course of bronchial responsiveness according to an inhaled anti-inflammatory therapy and the factors which affect the resolution of bronchial responsiveness, and an efficacy of nedocromil to cough asthma. Method: A prospective study for the investigation of bronchial responsiveness according to an inhaled anti-inflammatory treatment in sixty-one cough asthmatics was performed. Twenty-three entered budesonide ($400{\mu}g{\times}2/day$), twenty-two entered nedocromil ($4mg{\times}2/day$) and sixteen patients entered combined group. The bronchial hyperresponsiveness (BHR) was estimated by methacholine challenge test using counted breath method. The symptom was estimated by 'symptom score'. Reevaluation of BHR and symptom was performed at 2 month after treatment, and if BHR was not resoluted at this time, regarded as a non-responder, and then follow-up of BHR and symptom was performed at 4- and/or 6 month after treatment. Results: The improvement of BHR and symptom was significant in 2 month (p<0.05), but there was no change of them during follow-up period of 4- and/or 6 month in non-responders. In comparison of allergic markers such as serum total IgE, peripheral eosinophil count and skin test reactivity between responders and non-responders, there was no difference in each other. However, in comparison of other factors such as cumulative pack-years, symptom duration, age, gender, and the initial degree of PC20, there was a significant difference in each other(p<0.05). The percent of patients with the resolution of BHR in 2 month was not different in each group(p=0.95). There was no significant difference in the degree of improvement of BHR and symptom in each group. Conclusion: Bronchial responsiveness and symptom was not significantly improved in non-responders during follow-up period of 4- and/or 6 month. The effect of inhaled nedocromil was equivalent to that of inhaled steroid in cough asthmatics, and the response to combined treatment is not superior to that achieved by either of these agents used alone.

• Tuberculosis and Respiratory Diseases
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• v.42 no.3
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• pp.342-350
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• 1995

Background: Although there are improvements of clinical symtoms after bronchodilator inhalation in COPD patients, it has been noted that there was no increase of $FEV_1$ in some cases. $FEV_1$ did not reflect precisely the improvement of ventilatory mechanics after bronchodilator inhalation in these COPD patients. The main pathophysiology of COPD is obstruction of airway in expiratory phase but in result, the load of respiratory system is increased in inspiratory phase. Therefore the improvement of clinical symptoms after bronchodilator inhalation may be due to the decrease of inspiratory load. So we performed the study which investigated the effect of bronchodilator on inspiratory response of vetilatory mechanics in COPD patients. Methods: In 17 stable COPD patients, inspiratory and expiratory forced flow-volume curves were measured respectively before bronchodilator inhalation. 10mg of salbutamol solution was inhaled via jet nebulizer for 4 minutes. Forced expiratory and inspiratory flow-volume curves were measured again 15 minutes after bronchodilator inhalation. Results: $FEV_1$, FVC and $FEV_1$/FVC% were $0.92{\pm}0.34L$($38.3{\pm}14.9%$ predicted), $2.5{\pm}0.81L$($71.1{\pm}21.0%$ predicted) and $43.1{\pm}14.5%$ respectively before bronchodilator inhalation. The values of increase of $FEV_1$, FVC and PIF(Peak Inspiratory Flow) were $0.15{\pm}0.13L$(relative increase: 17.0%), $0.58{\pm}0.38\;L$(29.0%) and $1.0{\pm}0.56L$/sec(37.5%) respectively after bronchodilator inhalation. The increase of PIF was twice more than $FEV_1$ in average(p<0.001). The increase of PIF in these patients whose $FEV_1$ was not increased after bronchodilator inhalation were 35.0%, 44.0% and 55.5% respectively. Conclusion: The inspiratory parameter reflected improvement of ventilatory mechanics by inhaled bronchodilater better than expiratory parameters in COPD patients.

• Tuberculosis and Respiratory Diseases
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• v.83 no.1
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• pp.31-41
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• 2020

Background: Chronic cough is defined as a cough lasting more than 8 weeks and socio-economic burden of chronic cough is enormous. The characteristics of chronic cough in Korea are not well understood. The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) published guidelines on cough management in 2014. The current study evaluated the clinical characteristics of chronic cough in Korea and the efficacy of the KATRD guidelines. Methods: This was a multi-center, retrospective observational study conducted in Korea. The participants were over 18 years of age. They had coughs lasting more than 8 weeks. Subjects with current pulmonary diseases, smokers, exsmokers with more than 10 pack-years or who quit within the past 1 year, pregnant women, and users of cough-inducing medications were excluded. Evaluation and management of cough followed the KATRD cough-management guidelines. Results: Participants with chronic cough in Korea showed age in the late forties and cough duration of more than 1 year. Upper airway cough syndrome was the most common cause of cough, followed by cough-variant asthma (CVA). Gastro-esophageal reflux diseases and eosinophilic bronchitis were less frequently observed. Following the KATRD cough-management guidelines, 91.2% of the subjects improved after 4 weeks of treatment. Responders were younger, had a longer duration of cough, and an initial impression of CVA. In univariate and multivariate analyses, an initial impression of CVA was the only factor related to better treatment response. Conclusion: The causes of chronic cough in Korea differed from those reported in other countries. The current Korean guidelines proved efficient for treating Korean patients with chronic cough.

• Tuberculosis and Respiratory Diseases
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• v.39 no.5
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• pp.386-391
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• 1992

Background: Recently, bronchial provocation of the airway of atopic asthmatic subjects with inhaled allergen has been shown to produce an initial peripheral blood eosinopenia followed by an eosinophilia occurring approximately 12 to 18 hrs after the challenge. However there are few studies about the change of peripheral eosinophil count (PEC) after bronchial provocation with nonspecific stimuli such as histamine or methacholine. Interestingly our preliminary study demonstrated a notable change of PEC during bronhial provocation with inhaled histamine in some asthmatic subjects. This study was designed to reevaluate our preliminary data and to further investigate the change of PEC during as well as after bronchial provocation with inhaled histamine in bronchial asthma tics. Methods: Sixteen asthmatic subjects participated in this study. Bronchial provocation with inhaled histamine was done between 9 AM and 12 MD. Blood samplings for PEC were done with 5 minutes intervals during the procedure, and repeated at 1 hour, 2 hours, 4 hours, 8 hours, 24 hours, and 48 hours after the procedure. Results: The results were as follows; 1) The patients were divided into two groups characterized by each pattern in the change of PEC during the procedure. A group (11 of sixten, group I) showed an increasing pattern of PEC and another group (5 of sixteen, group II) showed a decreasing pattern of PEC during the procedure. 2) Group I demonstrated a tendency to maintain continuously higher level of PEC than the baseline value until 48 hours after the procedure. 3) Group II demonstrated a tendency to maintain continuously lower level of PEC than the baseline value until 48 hours after the procedure. 4) There were no significant differences in their clinical parameters including baseline eosinophil count, baseline $FEV_1$, $PC_{20}$ of histamine, and serum IgE level between group I and group II. Conclusion: Our results suggest that the change of PEC produced by inhaled histamine in asthmatic subjects is much different from that produced by inhaled allergen, and that each patient may have their individual characteristics in the change of PEC in response to bronchial provocation with inhaled histamine. Alternatively these findings suggest that eosinophils may be partially involved in the early asthmatic reaction.

• Clinical and Experimental Pediatrics
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• v.51 no.3
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• pp.323-328
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• 2008

Purpose : Asthma is defined as chronic inflammation of the lower small airways, and bronchial hyperreactivity (BHR) is a pathophysiologic feature of asthma. It has been proposed that although there is no direct variable capable of assessing the small airways, a forced expiratory flow of between 25 and 75 percent ($FEF_{25-75}$) might be considered a more sensitive early marker of small airway obstruction than the forced expiratory volume in 1 second ($FEV_1$). Thus, we proposed that the presence and degree of positive responses to bronchial methacholine testing were related to the difference (DFF) and ratio (RFF) between $FEV_1$ and $FEF_{25-75}$ in asthmatic children. Methods : The subjects were 583 symptomatic children, including 324 children with BHR and 259 controls. Pulmonary function tests, methacholine challenge tests, and skin prick tests were performed, and the total eosinophil count, total serum IgE, and serum eosinophil cationic protein level were measured in all subjects. From a concentration-response curve, the methacholine concentration required to produce a decrease of 20% from post-saline $FEV_1$ was calculated ($PC_{20}$). Results : The median DFF and RFF values decreased in controls compared to subjects with bronchial hyperresponsiveness, and this trend was found in groups ranked by its severity. $PC_{20}$ had a negative correlation with DFF and RFF. Cutoff values of 0.5 for DFF and 1.042 for RFF were identified, and sensitivity and specificity were calculated. Conclusion : This study revealed that DFF and RFF might be predictive of bronchial hyperresponsiveness in the context of normal $FEV_1$ in children.

• Tuberculosis and Respiratory Diseases
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• v.39 no.3
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• pp.219-227
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• 1992

Background: Acute and chronic airway inflammation are important in the pathogenesis of bronchial asthma. Corticosteroids have proved to be very effective in the management of asthma. Although the mechanism by which they produce this effect is still debated, suppression of the inflammatory response is thought to be the most likely. Although inhaled steroids are known to be safe and have less side effects than oral steroids, the extent which inhaled steroids have beneficial and the detrimental effects in the treatment of asthma has remained open to question. Budesonide is a recently developed corticosteroid for inhalation treatment with a strong local effect combined with rapid inactivation in the systemic circulation. We set out to look in more detail at the time course of change in bronchial reactivity, clinical symptoms and the effects on the adrenal function during 6 weeks of treatment with budesonide (800 ug per day). Methods: Clinical symptoms, pulmonary function test, histamine $PC_{20}$, serum ACTH and cortisol (8 AM and 4 PM) were measured in 23 allergic asthmatic patients before and after 6 weeks of treatment with budesonide. Results: 1) Pulmonary function test; PEFR, FEV1 and FVC after 6 weeks of treatment with budesonide were higher than those before treatment. 2) Clinical symptoms; Clinical symptoms were significantly improved after 3 weeks and 6 weeks of treatment with budesonide. 3) Histamine provocation; Histamine $PC_{20}$ after 6 weeks of treatment with budesonide was significantly higher than that before treatment. 4) Adrenal function; 6 weeks of budesonide therapy did not significantly affect the level of serum ACTH and cortisol. Conclusion: From these results, it is concluded that budesonide therapy improved the clinical symptoms, pulmonary function and bronchial hyperreactivity after 3 weeks of treatment and the improvement after 6 weeks of treatment was higher than that after 3 weeks of treatment. During 6 weeks of treatment with budesonide, the inhibitory effect on the adrenal function was not obvious.

• Tuberculosis and Respiratory Diseases
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• v.52 no.3
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• pp.251-259
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• 2002

Background : Reduced lung compliance and increased lung resistance are the primary lung mechanical abnormalities in acute respiratory distress syndrome (ARDS). Although there is little information regarding the mechanisms responsible for the increases in the respiratory resistance of ARDS, bronchodilators have been frequently administered in mechanically ventilated ARDS patients. To determine the effect of a bronchodilator on the respiratory mechanics depending on the level of applied positive end-expiratory pressure (PEEP), the changes in the respiratory mechanics by salbutamol inhalation was measured under the variable PEEP level in patients with ARDS. Materials and Methods : Fifteen mechanically ventilated paralyzed ARDS patients (14 of male, mean age 57 years) were enrolled in this study. The respiratory system compliance, and the maximum and minimum inspiratory resistance were obtained by the end-inspiratory occlusion method during constant flow inflation using the CP-100 pulmonary monitor (Bicore, Irvine, CA, USA). The measurements were performed at randomly applied 8, 10 and 12 cm $H_2O$ PEEP before and 30 mins after administrating salbutamol using a meter-dose-inhaler (100ug${\times}$6). Results : 1) The maximum inspiratory resistance of the lung was higher than the reported normal values due to an increase in the minimal inspiratory resistance & additional resistance. 2) The maximum inspiratory resistance and peak airway pressure were significantly higher at 12cm $H_2O$ of PEEP compared with those at 10cm $H_2O$ of PEEP. 3) Salbutamol induced a significant decrease in the maximum and the minimum inspiratory resistance but no significant change in the additional resistance only was observed at 12cm $H_2O$ of PEEP(from $15.66{\pm}1.99$ to $13.54{\pm}2.41$, from $10.24{\pm}2.98$ to $8.04{\pm}2.34$, and from $5.42{\pm}3.41$ to $5.50{\pm}3.58cm$ $H_2O$/L/sec, respectively). 4)The lung compliance did not change at the applied PEEP and salbutamol inhalation levels. Conclusion : The bronchodilator response would be different depending on the level of applied PEEP despite the increased respiratory resistance in patients with ARDS.

• Tuberculosis and Respiratory Diseases
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• v.55 no.6
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• pp.570-578
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• 2003

Background : Ambient particles during Asian dust events are usually sized less than $10{\mu}m$, known to be associated with the adverse effects on the general populations. But, there has been no considerable evidence linking these particles to the adverse effects on airways. The objectives of this study was to investigate the possible adverse effects of Asian dust events on respiratory function and symptoms in subjects with bronchial asthma. Patients and Methods : From march to June 2002, Asthmatic patients who were diagnosed with bronchial challenge test or bronchodilator response were enrolled. We divided them into three groups; mild, moderate, and severe, according to the severity. Subjects with other organ insufficiency such as heart, kidney, liver, and malignancy were excluded. All patients completed twice daily diaries and recorded peak flow rate, respiratory symptom, and daily activity. Daily and hourly mean pollutant levels of particulate matter < $10{\mu}m$ in diameter($PM_{10}$), nitrogen dioxide($NO_2$), sulphur dioxide($SO_2$), ozone($O_3$) and carbon monoxide(CO) were measured at the 10 different monitoring sites. Results : Dust events occured 14 times during the study period. Daily averages of 4 air pollutant were measured with an increased level of $PM_{10}$, decreased level of $NO_2$ and $SO_2$, and no change in CO during dust days compared to those during control days. An increase in $PM_{10}$ concentration was associated with an increase of subjects with PEF variability of >20% (p<0.05), night time symptom(p<0.05), and a decrease in mean PEF (p<0.05), which were calculated by the longitudinal data analysis. Otherwise, there was no association between $PM_{10}$ level and bronchodialtor inhaler, and daytime respiratory symptoms. Conclusion : This study shows evidence that ambient air pollution, especially $PM_{10}$, during Asian dust events, could be one of the many aggravating factors at least in patients with airway diseases. This data can be used as a primary source to set up a new policy on air environmental control and to evaluate the safety of air pollution index. We also expect that this research will help identify precise components of dust, which are more linked to the adverse effects.

• Tuberculosis and Respiratory Diseases
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• v.60 no.6
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• pp.653-662
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• 2006

Background: The changes in the pulmonary function observed in burn patients with an inhalation injury are probably the result of a combination of airway inflammation, chest wall and muscular abnormalities, and scar formation. In addition, it appears that prolonged ventilatory support and an episode of pneumonia contribute to the findings. This study investigated the changes in the pulmonary function in patients with inhalation injury at the early and late post-burn periods. Methods: From August 1, 2002, to August 30, 2005, surviving burn patients who had an inhalation injury were enrolled prospectively. An inhalation injury was identified by bronchoscopy within 48hours after admission. Spirometry was performed at the early phase during admission and the recovery phase after discharge, and the changes in the pulmonary function were compared. Results: 37 patients (M=28, F=9) with a total burn surface area (% TBSA), ranging from 0 to 18%, were included. The initial $PaO_2/$FiO_2$ratio and COHb were $286.4{\pm}129.6mmHg$ and $7.8{\pm}6.6%$. Nine cases (24.3%) underwent endotracheal intubation and 3 cases (8.1%) underwent mechanical ventilation. The initial X-ray findings revealed abnormalities in, 18 cases (48.6%) with 15 (83.3%) of these being completely resolved. However, 3 (16.7%) of these had residual sequela. The initial pulmonary function test, showed an obstructive pattern in 9 (24.3%) with 4 (44.4%) of these showing a positive bronchodilator response, A restrictive pattern was also observed in 9 (24.3%) patients. A lower DLco was observed in only 4 (17.4%) patients of which 23 had undergone DLco. In the follow-up study, an obstructive and restrictive pattern was observed in only one (2.7%) case each. All the decreased DLco returned to mormal. Conclusions: Most surviving burn patients with an inhalation injury but with a small burn size showed initial derangements in the pulmonary function test that was restored to a normal lung function during the follow up period.