• Tuberculosis and Respiratory Diseases
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• 제51권3호
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• pp.248-259
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• 2001

연구배경 : 소아 기관지 천식 환자들의 진단이나 기도폐쇄 정도를 알기 위하여도 통상적으로 노력성 호기곡선이나 최대 호기류량곡선을 이용한 환기기능검사가 기본검사로 널리 사용된다. 그러나 호흡곤란이 있는 소아에서는 이러한 검사를 적절히 시행하는 것이 어려운 경우가 많다. 따라서 자가 치료를 하는 환자들의 경과관찰이나 응급실을 방문한 환자들은 검사가 비교적 용이하기 때문에 최고호기유링계로 최고호기유량(PEF)을 많이 측정한다. PEF는 절대값이나 증상이 없을 때의 최대치 혹은 추정정상치에 대한 백분율로 표시하는데 현재까지 국내에서 소아를 대상으로 최고호기유량계로 측정한 PEF에 관한 보고는 아직까지 없었다. 이에 건강한 소아에서 PEF의 추정정상치를 산출하고 이 값이 $FEV_1$을 비롯한 다른 환기기능검사를 어느 정도 정확하게 예측할 수 있는 지를 조사하였다. 방 법 : 호흡기 증상이나 기왕 병력이 없는 5세에서 16세 사이의 건강한 소아(남자 196명, 여자 152명)을 대상으로 mini-Wright 최대호기유량계(Clement Clarke International Ltd. England)를 이용하여 3회 이상 PEF를 측정하였다. 아울러 Microspiro HI-501 휴대용 폐활량측정계(Chest Co., Japan)로 노력성호기곡선, 최대호기류량곡선을 측정 분석하여 $FEV_1$, FVC, $FEV_1$/FVC, $FEF_{25-75%}$, $FEF_{25%}$, $FEF_{50%}$, $FEF_{75%}$와 $FEF_{max}$를 구하여 각각의 추정정상치를 나이와 신자율 변수로 히여 구하였다. 또한 PEF를 변수로 $FEV_1$ 및 $FEF_{max}$를 구하는 회귀방정식을 구하였다. 결 과 : 1. PEF(L/min)를 나이와 신장을 변수로 하여 구한 회귀방정식은 다음과 같다. 남자는 $12.6{\times}$age(year)+$3.4{\times}$height(cm)-263($R^2=0.85$), 여자는 $6{\times}$age(year)+$3.9{\times}$height(cm)-293($R^2=0.82$)이었다. 신장만을 변수로 하여 구한 회귀방정식은 남자는 $6.6{\times}$height(cm)-415($R^2=0.84$), 여자는 $5.1{\times}$height(cm)-382($R^2=0.82$)였다. 2. 최대호기류량곡선에서 산출한 $FEF_{max}$를 같은 단위로 환산하여 비교한 결과 PEF보다 평균 남자에서는 125(L/min), 여자에서는 118(L/min) 적였다. 3. PEF을 변수로 예측할 수 있는 $FEV_1$(m1) 값은 남자에서 $7.02{\times}$PEF(L/min)-550($R^2=0.82$), 여자에서는 $5.83{\times}$PEF(L/min)-146($R^2=0.81$)이었다. 결 론 : 건강한 소아 346명(남자 194명, 여자 152명)을 대상으로 최고호기유량계로 측정한 PEF의 추정정상치를 연령과 선장을 변수로 하여 구하였다. 여기서 측정한 PEF로 $FEV_1$ 및 $FEF_{max}$를 예측할 수 있는 수식을 구하였다. 그리고 측정기계 및 방법에 따라서 PEF값이 달라짐을 확인하였는데 이런 점을 유의한다변 PEF의 측정은 향후 환기기능 장애를 환자 진료에 많은 도움이 될 것으로 생각한다.

• Tuberculosis and Respiratory Diseases
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• 제54권3호
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• pp.330-337
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• 2003

연구배경 : 폐활량검사에서 노력성 폐활량(forced vital capacity, FVC)이 감소되었을 때 제한성 환기장애가 있다고 일반적으로 판단한다. 하지만 제한성 환기장애 판정의 정확한 기준은 총폐용량(total lung capacity, TLC)의 감소이다. 본 연구는 폐활량검사 결과에서 FVC가 감소되었을 때 TLC가 감소된 제한성 환기장애를 얼마나 정확히 예측할 수 있는가를 알아보고자 하였다. 대상 및 방법 : 1999년 1월부터 2000년 12월까지 2년간 폐기능검사실에서 폐활량검사와 폐용적검사를 동일한 날 시행한 성인 환자 1,371명의 폐기능검사 결과를 후향적으로 조사하였다. FVC, $FEV_1$, TLC는 측정값이 정상 예측값의 80% 미만일 때 감소하였다고 판정하였고, 1초간 노력호기폐활량의 노력성 폐활량에 대한 비($FEV_1$/FVC%)는 측정값이 70% 미만일 때 감소하였다고 판정하였다. 결 과 : 1,371례 중 FVC가 감소한 환자는 353례였으며 이 중 TLC가 감소된 경우는 186례로 양성예측률은 52.7%이었다. FVC가 정상인 1,018례 중 TLC가 감소한 경우는 45례로 음성예측률은 96.6%이었다. 폐활량검사에서 제한성 환기장애($FEV_1$/FVC 정상, FVC 감소)를 보인 196례 중 TLC가 감소된 경우는 148례로 양성예측률은 75.5%이었다. 폐활량검사에서 혼합성 환기장애($FEV_1$/FVC 감소, FVC 감소)를 보인 157례 중 TLC가 감소된 경우는 38례로 양성예측률은 24.2%이었다. 혼합성 환기장애를 보인 196례 중 FVC와 $FEV_1$의 예측값에 대한 비율이 15% 미만의 차이를 보인 60례에서 TLC의 감소를 보인 경우는 34례(56.7%)였다. 결 론 : 제한성 환기장애를 배제하는 데는 폐활량검사가 유용하다. 하지만 폐활량검사에서 FVC가 감소된 환자에서 제한성 환기장애의 유무는 TLC의 측정을 통해 확인하는 것이 필요하리라 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제80권1호
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• pp.52-59
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• 2017

Background: Inhaled indacaterol (Onbrez Breezhaler), a long-acting ${\beta}_2$-agonist, is approved in over 100 countries, including South Korea, as a once-daily bronchodilator for maintenance and treatment of chronic obstructive pulmonary disease (COPD). Here, we present an interim analysis of a post-marketing surveillance study conducted to evaluate the real-world safety and effectiveness of indacaterol in the Korean population. Methods: This was an open-label, observational, prospective study in which COPD patients, who were newly prescribed with indacaterol (150 or $300{\mu}g$), were evaluated for 12 or 24 weeks. Safety was assessed based on the incidence rates of adverse events (AEs) and serious adverse events (SAEs). Effectiveness was evaluated based on physician's assessment by considering changes in symptoms and lung function, if the values of forced expiratory volume in 1 second were available. Results: Safety data were analyzed in 1,016 patients of the 1,043 enrolled COPD patients receiving indacaterol, and 784 patients were included for the effectiveness analysis. AEs were reported in 228 (22.44%) patients, while 98 (9.65%) patients reported SAEs. The COPD condition improved in 348 patients (44.4%), while the condition was maintained in 396 patients (50.5%), and only 40 patients (5.1%) exhibited worsening of ailment as compared with baseline. During the treatment period, 90 patients were hospitalized while nine patients died. All deaths were assessed to be not related to the study drug by the investigator. Conclusion: In real-life clinical practice in South Korea, indacaterol was well tolerated in COPD patients, and can be regarded as an effective option for their maintenance treatment.

• Tuberculosis and Respiratory Diseases
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• 제69권4호
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• pp.243-249
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• 2010

Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and mortality worldwide. The aim of this study was to evaluate the risk factors associated with recurrent hospital admissions for exacerbation of COPD in Korea. Methods: A retrospective study of 77 consecutive patients hospitalized for exacerbation of COPD at Pusan National University Hospital during the time period January 2005 to May 2008 was performed. The information was collected from the hospitalization period: clinical information, spirometric measures, and laboratory variables. In addition, socioeconomic characteristics, co-morbidity, anxiety, and depression were reviewed. Frequent readmission was defined as 2 or more hospitalizations in the year following discharge. Results: During the 1-year period after discharge, 42 patients (54.6%) reported one hospital admission and 35 patients (45.4%) reported 2 or more hospital readmissions. Among the 35 frequent readmission patients, 4 had more than 10 readmissions. Univariate analysis showed that a body mass index (BMI) <$18.5kg/m^2$, duration >36 months, forced expiratory volume in 1 second ($FEV_1$) <50% predicted, arterial $CO_2$ partial pressure ($PaCO_2$) >40 mm Hg, and arterial oxygen saturation ($SaO_2$) <95% at discharge were associated significantly with frequent readmissions. The multivariate analysis revealed that BMI <$18.5kg/m^2$, $PaCO_2$ >40 mm Hg at discharge were independently associated with frequent readmissions for exacerbation of COPD. Conclusion: Frequent readmissions for exacerbation of COPD were associated with low BMI and hypercapnia at discharge.

• Journal of Chest Surgery
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• 제30권9호
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• pp.914-919
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• 1997

1990년부터 1995년까지 신촌 세브란스 병원에서 만성 농흉으로 늑막박피술을 시행받은 환자중 수술전 후에 폐기능 검사를 시행한 33례와 폐관류스캔을 동시에 시행한 11례를 대상으로 분석하였다. 1. 수술후 FEV1은 술전 2.30 L/sec에서 2.65 L/sec로 유의하게 증가하였다(p=0.008). 2. 연령별 수술전 후 FEV1의 변화는 20세 미만에서만 통계적으로 유의하게 증가하였으며(p-0.001), 그 이상의 연령군에선 유의성이 얼었다. 3. 만성 농흉의 원인을 결핵성과 비결핵성으로 나누어 수술 전후의 FEV1을 비교시 결핵성 농흉 에서 통계적 으로 유의하게 증가하였(p=0.008). 4. 추적관찰 기간에 따른 FEVI의 변화는 24개월 이전에선 유의한 변화가 없었으나 24개월 이후에서 통계적 으로 유의하게 증가하였다0=0.013). 5. 늑막박피술을 시행받은 폐의 관류량은 술전 21.5.%에서 술후 26.9%(p=0.046), FEVI은 술전 0.56 L/sec에서 술후 0.78 L/sec(p=0.071) 증가하였으며, 반대측 폐의 관류량은 술전 78.4%에서 술후 72.9%(p=0.042), FEVi 은 술전 2.04 L/sec에서 수술후 2.03 L/sec로 감소하였다.

• Clinical and Experimental Pediatrics
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• 제53권11호
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• pp.951-956
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• 2010

Purpose: To compare the profiles of the bronchodilator response (BDR) among children with asthma and/or allergic rhinitis (AR) and to determine whether BDR in these children is reduced by treatment with inhaled and/or nasal corticosteroid. Methods: Sixty-eight children with asthma (mean age, 10.9 years), 45 children with comorbid asthma and AR (mean age, 10.5 years), and 44 children with AR alone (mean age, 10.2 years) were investigated. After a 2-week baseline period, all children were treated with inhaled fluticasone propionate (either 100 or $250{\mu}g$ b.i.d., tailored to asthma severity) or nasal fluticasone propionate (one spray b.i.d. in each nostril) or both, according to the condition. Before and 2 weeks after starting treatment, all children were evaluated with spirometry and bronchodilator testing. BDR was calculated as a percent change from the forced expiratory volume in 1 second ($FEV_1$) at baseline. Results: The mean BDR was 10.3% [95% confidence interval (CI) 8.3-12.4%] in children with asthma, 9.0% (95% CI 7.3-10.9%) in subjects with asthma and AR, and 5.0% (95% CI 4.1-5.9%) in children with AR alone ($P$<0.001). After treatment, the mean BDR was reduced to 5.2% (95% CI 4.2-6.3%) ($P$<0.001) in children with asthma and to 4.5% (95% CI 3.5-5.5%) ($P$<0.001) in children with asthma and AR. However, children with rhinitis showed no significant change in BDR after treatment, with the mean value being 4.7% (95% CI 3.7-5.8%) ($P$=0.597). Conclusion: The findings of this study imply that an elevated BDR in children with AR cannot be attributed to nasal inflammation alone and highlights the close relationship between the upper and lower airways.

• 한국전문물리치료학회지
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• 제24권4호
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• pp.68-76
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• 2017

Background: Abdominal bracing exercise (ABE) and abdominal hollowing exercise (AHE) improve the lumbar flexibility and pulmonary function in various patients, yet the efficacy of ABE or AHE have not yet been evaluated. Objects: The purpose of this study was to compare the lumbar flexibility and pulmonary function during both ABE and AHE in healthy adults. Methods: The study included 40 healthy adults, who were randomly divided into the experimental group and control group, each with 20 subjects. All subjects performed ABE (experimental group) and AHE (control group). The lumbar flexibility such as trunk flexion test (sitting and standing position) and schober test and pulmonary function such as the spirometer including forced vital capacity (FVC) and force expiratory volume in one second ($FEV_1$) and chest circumference measurement (middle and lower chest) were measured, respectively. Two-way repeated analysis of variance was used to compare the lumbar flexibility and pulmonary function, respectively. Results: No significant effects of lumbar flexibility were observed on trunk flexion test from the sitting position (P=.478) and standing position (P=.096) in the ABE than in the AHE. However, the length of ABE was longer significantly than it of AHE (P=.024). No significant effects of lung function were observed on the FVC (P=.410) and $FEV_1$ (P=.072) in the ABE group than in the AHE group. And also, no significant effects of chest circumference measurement were observed on the inspiration (P=.468) and expiration (P=.563) in middle chest circumference and inspiration (P=.104) and expiration (P=.346) in lower chest circumference. Conclusion: This study indicated that the ABE is only more effective in lumbar flexibility by lumbar length difference than AHE in healthy adults.

• Tuberculosis and Respiratory Diseases
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• 제81권3호
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• pp.228-232
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• 2018

Background: Chronic bronchitis (CB) is an important phenotype in chronic obstructive pulmonary disease (COPD). The purpose of this study is to evaluate different pattern of COPD assessment test (CAT) score between CB and non-CB patients. Methods: Patients were recruited from 45 centers in Korea, as part of the Korean COPD Subgroup Study cohort. CB was defined when sputum continued for at least 3 months. Results: Total 958 patients with COPD were eligible for analysis. Among enrolled patients, 328 (34.2%) were compatible with CB. The CAT score was significantly higher in patients with CB than non-CB, and each component of CAT score showed a similar result. CB was significantly associated with CAT score when adjusted with age, sex, modified Medical Research Council, and post-bronchodilator forced expiratory volume in 1 second. Each component of CAT score between patients with CB and non-CB showed different pattern according to Global Initiative for Chronic Obstructive Lung Disease grade. Conclusion: CAT score is significantly higher in patients with CB than non-CB. Each component of CAT score was significantly different between two groups.

• Journal of Korean Biological Nursing Science
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• 제19권1호
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• pp.38-47
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• 2017

Purpose: This study was undertaken to examine the relationship between airflow obstruction and subjective health status reported by stable patients with chronic obstructive pulmonary disease (COPD) residing in the community. Methods: A cross-sectional descriptive study was conducted with 78 stable COPD patients aged 69.7 years old on average and selected by a convenient sampling from an outpatient department of pulmonology in tertiary hospitals. They completed a constructed questionnaire including general characteristics, smoking history, dyspnea by modified medical research council (mMRC) scale, and health status by COPD assessment test (CAT). Anthropometric measurements were performed for body mass index (BMI) and pulse oxymetry for $O_2$ saturation (Sat $O_2$). Medical records were reviewed to obtain disease-related characteristics including duration of the disease, cardiovascular comorbidity, and forced expiratory volume in 1 second ($FEV_1$). Data were analyzed using PASW statistics 20.0. Results: Mean $FEV_1%$ and CAT scores were 55.11% and 17.73, respectively. Those in the lower stage of mMRC showed significantly higher $FEV_1$ and lower CAT. $FEV_1$ and CAT showed significant negative correlations; age and BMI with $FEV_1$, and Sat $O_2$ with CAT. Conclusion: The findings suggest that the less airway obstruction was, the better health status was, and provide the support for using subjective measures in clinical practices for COPD patients.

• Radiation Oncology Journal
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• 제35권1호
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• pp.55-64
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• 2017

Purpose: The outcomes and toxicities of locoregionally recurrent non-small-cell lung cancer (NSCLC) patients treated with curative radiotherapy were evaluated in the modern era. Materials and Methods: Fifty-seven patients receiving radical radiotherapy for locoregionally recurrent NSCLC without distant metastasis after surgery from 2004 to 2014 were reviewed. Forty-two patients were treated with concurrent chemoradiotherapy (CCRT), and 15 patients with radiotherapy alone. The median radiation dose was 66 Gy (range, 45 to 70 Gy). Lung function change after radiotherapy was evaluated by comparing pulmonary function tests before and at 1, 6, and 12 months after radiotherapy. Results: Median follow-up was 53.6 months (range, 12.0 to 107.5 months) among the survivors. The median overall survival (OS) and progression-free survival (PFS) were 54.8 months (range, 3.0 to 116.9 months) and 12.2 months (range, 0.8 to 100.2 months), respectively. Multivariate analyses revealed that single locoregional recurrence focus and use of concurrent chemotherapy were significant prognostic factors for OS (p = 0.048 and p = 0.001, respectively) and PFS (p = 0.002 and p = 0.026, respectively). There was no significant change in predicted forced expiratory volume in one second after radiotherapy. Although diffusing lung capacity for carbon monoxide decreased significantly at 1 month after radiotherapy (p < 0.001), it recovered to pretreatment levels within 12 months. Acute grade 3 radiation pneumonitis and esophagitis were observed in 3 and 2 patients, respectively. There was no chronic complication observed in all patients. Conclusion: Salvage radiotherapy showed good survival outcomes without severe complications in postoperative locoregionally recurrent NSCLC patients. A single locoregional recurrent focus and the use of CCRT chemotherapy were associated with improved survival. CCRT should be considered as a salvage treatment in patients with good prognostic factors.