• Title/Summary/Keyword: Exacerbation

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What Can We Apply to Manage Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure?

  • Kim, Deog Kyeom;Lee, Jungsil;Park, Ju-Hee;Yoo, Kwang Ha
    • Tuberculosis and Respiratory Diseases
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    • v.81 no.2
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    • pp.99-105
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    • 2018
  • Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.

MiR-146 and miR-125 in the regulation of innate immunity and inflammation

  • Lee, Hye-Mi;Kim, Tae Sung;Jo, Eun-Kyeong
    • BMB Reports
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    • v.49 no.6
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    • pp.311-318
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    • 2016
  • Innate immune responses are primary, relatively limited, and specific responses to numerous pathogens and toxic molecules. Protein expression involved in these innate responses must be tightly regulated at both transcriptional level and post-transcriptional level to avoid the development of excessive inflammation that can be potentially harmful to the host. MicroRNAs are small noncoding RNAs (∼22 nucleotides [nts]) that participate in the regulation of numerous physiological responses by targeting specific messenger RNAs to suppress their translation. Recent work has shown that several negative regulators of transcription including microRNAs play important roles in inhibiting the exacerbation of inflammatory responses and in the maintenance of immunological homeostasis. This emerging research area will provide new insights on how microRNAs regulate innate immune signaling. It might show that dysregulation of microRNA synthesis is associated with the pathogenesis of inflammatory and infectious diseases. In this review, we focused on miR-146 and miR-125 and described the roles these miRNAs in modulating innate immune signaling. These microRNAs can control inflammatory responses and the outcomes of pathogenic infections.

The review and treatment regarding on association between periodontitis and atherosclerotic cardiovascular diseases (임상가를 위한 특집 2 - 치주 질환과 동맥경화성 심혈관 질환의 관계성에 대한 고찰과 치주처치)

  • Lee, Hyo-Jung
    • The Journal of the Korean dental association
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    • v.51 no.9
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    • pp.501-510
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    • 2013
  • This paper reviews a current view regarding the association between periodontitis and atherosclerotic cardiovascular diseases (ACVD). Many evidences have suggested that there exist biological mechanisms by which periodontitis can lead to ACVD. Periodontal infection can lead to direct bacterial invasion into endothelial tissues through the blood stream, then the bacteria can activate the host inflammatory response followed by atheroma formation, maturation and exacerbation. Also, chronic periodontal infections may indirectly induce endothelial activation or dysfunction through a state of systemic inflammation as evidenced by elevated plasma acute proteins, IL-6 and fibrinogen as well. There is moderate evidence that periodontal treatment can reduce systemic inflammation and improvement of both clinical surrogate markers. But there is no periodontal intervention study available on primary ACVD prevention. There is consistent and strong epidemiologic evidence, including in vitro, animal and clinical studies, that periodontitis imparts increased risk for future ACVD. However, evidences from intervention trials to date are not sufficient to confirm the multi directional causality of periodontitis in ACVD etiology. Well-designed intervention trials on the impact of periodontal treatment on the prevention of ACVD outcomes are needed.

Acute Exacerbation with Severe Jaundice in Chronic Hepatitis B Patient (만성 B형 간질환 환자에서 심한 황달을 동반한 급성 악화)

  • Lee, Heon-Ju
    • Journal of Yeungnam Medical Science
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    • v.14 no.2
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    • pp.483-496
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    • 1997
  • 만성 B형 간염의 경과중 흔히 볼 수 있는 간기능의 이상은 대부분 심한 황달의 동반없이 혈청 AST와 ALT의 증가만 보이면서 악화되는 것이다. 저자는 심한 황달을 동반한 16명의 만성 B형 간염 악화 환자(연구군)와 심한 황달없이 AST와 ALT치만 증가된 13명의 환자(비교군)를 비교관찰하였다. PMC 제재를 복용했던 환자는 연구군에서 11명(68.8%), 대조군에서 1명(7.7.%)으로 나타났으며 PMC를 포함하여 각종 약제 및 알콜 섭취가 저명했던 환자가 연구군에서 15명(93.8%), 대조군에서는 2명(15.4%)이었다. 혈청 HBeAg 양성율은 급성 악화전에는 연구군에서 14명 중 7명(50.0%), 비교군에서는 13명 모두 (100%)에서 양성이었으며, 급성 악화 경과후에는 연구군에서는 변함없었고 비교군에서는 13명중 3명(23.1%)에만 양성이었다. 연구군 중 anti-HBe 양성화는 한 사람도 생기지 않았고 6명이 사망하였으며 대조군에서는 8명의 환자에서 anti-HBe 양성화가 생겼고 아무도 간기능 부전으로 사망하지 않았다. 만성 B형 간질환에서 심한 황달을 동반한 급성 악화와 관련있는 요인은 진행된 만성 활동성 간염, 간경변 등 근본적으로 진행된 간기능 저하와 동반된 부적절한 약제나 알콜 복용이 확실히 관계있을 것으로 사료되며 간기능 부전도 그리 드물지 않다. 반면에 간경변으로 진행되기 전 상대적으로 진행이 덜 된 비교군의 만성 B형 간염 환자에서는 황달의 저명한 증가없이 간기능이 갑자기 악화될 때는 자연적인 혈청 anti-HBe 양성전환의 동반이 흔한 것으로 나타났다.

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Acute Exacerbation with Severe Jaundice in Chronic Hepatitis B Patients (만성 B형 간질환 환자에서 심한 황달을 동반한 급성 악화)

  • Lee, Heon-Ju
    • Journal of Yeungnam Medical Science
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    • v.14 no.2
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    • pp.329-336
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    • 1997
  • 만성 B형 간염의 경과중 흔히 볼 수 있는 간기능의 이상은 대부분 심한 황달의 동반없이 혈청 AST와 ALT의 증가만 보이면서 악화되는 것이다. 저자는 심한 황달을 동반한 16명의 만성 B형 간염 악화 환자(연구군)와 심한 황달없이 AST와 ALT치만 증가된 13명의 환자(비교군)를 비교관찰하였다. PMC 제재를 복용했던 환자는 연구군에서 11명(68.8%), 대조군에서 1명(7.7%)으로 나타났으며 PMC를 포함하여 각종 약제 및 알콜 섭취가 저명했던 환자가 연구군에서 15명(93.8%), 대조군에서는 2명(15.4%)이었다. 혈청 HBeAg 양성율은 급성 악화전에는 연구군에서 14명 중 7명(50.0%), 비교군에서는 13명 모두(100%)에서 양성이었으며, 급성 악화 경과후에는 연구군에서는 변함없었고 비교군에서는 13명 중 3명(23.1%)에서만 양성이었다. 연구군 중 anti-HBe 양성화는 한 사람도 생기지 않았고 6명이 사망하였으며 대조군에서는 8명의 환자에서 anti-HBe 양성화가 생겼고 아무도 간기능 부전으로 사망하지 않았다. 만성 B형 간질환에서 심한 황달을 동반한 급성 악화와 관련있는 요인은 진행된 만성 활동성 간염, 간경변 등 근본적으로 진행된 간기능 저하와 동반된 부적절한 약제나 알콜 복용이 확실히 관계있을 것으로 사료되면 간기능 부전도 그리 드물지 않다. 반면에 간경변으로 진행되기 전 상대적으로 진행이 덜 된 비교군의 만성 B형 간염 환자에서는 황달의 저명한 증가없이 간기능이 갑자기 악화될 때는 자연적인 혈청 anti-HBe 양성 전환의 동반이 흔한 것으로 나타났다.

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Summary of the Chronic Obstructive Pulmonary Disease Clinical Practice Guideline Revised in 2014 by the Korean Academy of Tuberculosis and Respiratory Disease

  • Yoon, Hyoung Kyu;Park, Yong-Bum;Rhee, Chin Kook;Lee, Jin Hwa;Oh, Yeon-Mok;Committee of the Korean COPD Guideline 2014
    • Tuberculosis and Respiratory Diseases
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    • v.80 no.3
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    • pp.230-240
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    • 2017
  • Chronic obstructive pulmonary disease (COPD) results in high morbidity and mortality among patients both domestically and globally. The Korean clinical practice guideline for COPD was revised in 2014. It was drafted by the members of the Korean Academy of Tuberculosis and Respiratory Diseases, as well as participating members of the Health Insurance Review and Assessment Service, Korean Physicians' Association, and Korea Respiration Trouble Association. This revised guideline covers a wide range of topics, including the epidemiology, diagnosis, assessment, monitoring, management, exacerbation, and comorbidities of COPD in Korea. We drafted a guideline on COPD management by performing systematic reviews on the topic of management with the help of a meta-analysis expert. We expect this guideline will be helpful medical doctors treating patients with respiratory conditions, other health care professionals, and government personnel in South Korea.

The Disease Management Experience of Patients with Asthma: Grounded Theory Approach (천식 환자의 질병관리 경험: 근거이론접근)

  • Kim, Bohye;Kim, Oksoo
    • Journal of Korean Academy of Nursing
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    • v.50 no.5
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    • pp.714-727
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    • 2020
  • Purpose: The aim of this study was to develop a situation-specific theory to explain the disease management experience of patients with asthma. Methods: Twenty participants with asthma were selected using the theoretical sampling method. The data were acquired through in-depth interviews conducted from June to October 2018 and analyzed using the grounded theory approach of Strauss and Corbin. Results: In total, 69 concepts, 30 subcategories, and 13 categories were generated to explain the disease management experience of patients with asthma. The core category of the disease management experience of patients with asthma was 'management of the disease to prevent aggravation of symptoms over the lifetime'. The disease management process of asthma patients included three steps: the 'cognition phase', the 'adjustment phase', and the 'maintenance phase'. However, some patients remained in the 'stagnation phase' of disease management, which represents the result of the continual pursuit of risky health behavior. There were three types of disease management experiences among patients with asthma: 'self-managing', 'partially self-managing', and 'avoidant'. Conclusion: This study shows that patients with asthma must lead their disease management process to prevent exacerbation of their symptoms. It is imperative to develop nursing strategies and establish policies for effective disease management of patients with asthma based on their individual disease management processes and types.

The relationship between body energy balance and problems of obesity and its effects on health (비만이 체내 대사에 미치는 영향)

  • 한정순
    • Journal of Applied Tourism Food and Beverage Management and Research
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    • v.10
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    • pp.219-238
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    • 1999
  • Obestity, characterized by an excess accumulation of fat, is a detriment to good health and wellbeing. It is easy for individuals to take on excess fat as soon as enough food and leisure are available in a society, causing an imbalance between energy intake and energy expenditure. Although there has been disagreement as to which side of this energy equation is more important in th epidemic of obesity, both sides are certainly involved. I think the prevalence of obesity begins with infancy. It seems to be relatively constant throughout childhood. Some retrospective studies have suggested that there is a direct progression from a fat chile to a fat adult. Obesity has been associated with excess mortality in many studies. The effect of obesity on cardiovascular disease has not always been an independent one, but has generally been through exacerbation of other rish factors such as hypertention, diabetes, hyperlipedmia, galbladder disease, gout and cancer of the grease and endometrium. The weights of identical twins raised in separate homes have been reported to be similar, thereby suggesting that heredity contributes significantly to weight. Overweight and obesity are by far greater health problems for many people in our society. Therefore in this paper we consider the relationship between body energy balance and problems of obesity. Whatever the weight of the person, the goal of the nutritionist and health care workers is to find solutions that will allow persons to feel better about themselves.

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Depolarizing Effectors of Bradykinin Signaling in Nociceptor Excitation in Pain Perception

  • Choi, Seung-In;Hwang, Sun Wook
    • Biomolecules & Therapeutics
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    • v.26 no.3
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    • pp.255-267
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    • 2018
  • Inflammation is one of the main causes of pathologic pain. Knowledge of the molecular links between inflammatory signals and pain-mediating neuronal signals is essential for understanding the mechanisms behind pain exacerbation. Some inflammatory mediators directly modulate the excitability of pain-mediating neurons by contacting the receptor molecules expressed in those neurons. For decades, many discoveries have accumulated regarding intraneuronal signals from receptor activation through electrical depolarization for bradykinin, a major inflammatory mediator that is able to both excite and sensitize pain-mediating nociceptor neurons. Here, we focus on the final effectors of depolarization, the neuronal ion channels, whose functionalities are specifically affected by bradykinin stimulation. Particular G-protein coupled signaling cascades specialized for each specific depolarizer ion channels are summarized. Some of these ion channels not only serve as downstream effectors but also play critical roles in relaying specific pain modalities such as thermal or mechanical pain. Accordingly, specific pain phenotypes altered by bradykinin stimulation are also discussed. Some members of the effector ion channels are both activated and sensitized by bradykinin-induced neuronal signaling, while others only sensitized or inhibited, which are also introduced. The present overview of the effect of bradykinin on nociceptor neuronal excitability at the molecular level may contribute to better understanding of an important aspect of inflammatory pain and help future design of further research on the components involved and pain modulating strategies.

Clinical considerations on Factors related the Acne (여드름 관련 인자에 대한 임상적 고찰)

  • Lee, Hyung-Kee;Ok, Young-Kil;Choi, Yong-Hun;Kim, Jung-Ho
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.28 no.2
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    • pp.13-22
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    • 2015
  • Objective : To investigate how general characteristics and life habits of patients affect severity of acne which was determined by Korean Acne Grading system(KAGS). To adress correlation between the severity of acne and subjective stresses from which patients suffer. Methods : 86 patients answered to questionaire sheet on their general characteristics and life habits and rated their level of stresses as a number in the range between 0 and 10. Then an oriental medical doctor evaluated subject's acne grades, based of KAGS, through observations on papules, nodules, and scars before (medical) treatments. All data (collected) were analyzed using SPSS 22 (software for windows). To clearly demonstrate association of subjects general characteristics, life habits with KAGS grades, Chi-square tests were performed. The correlation between the KAGS grades and the level of stresses was determined using one-way ANOVA followed by Scheffe's post-hoc analysis. Results & Conclusion : Majority of subjects were women, students between 15 and 25 years old, and patients with normal range of Body Mass Index(BMI). Dysmenorrhea presence and premenstrual exacerbation of acne had statistically significant relationship, suggesting their potential influences on KAGS grades as major factors.