• Yonsei Medical Journal
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• 제59권9호
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• pp.1079-1087
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• 2018

Purpose: Obstructive sleep apnea and chronic obstructive pulmonary disease are independent risk factors of cardiovascular disease (CVD), and their coexistence is known as overlap syndrome (OS). Endothelial dysfunction is the initial stage of CVD; however, underlying mechanisms linking OS and CVD are not well understood. The aim of this study was to explore whether OS can lead to more severe inflammation and endothelial apoptosis by promoting endothelial dysfunction, and to assess the intervention effects of antioxidant tempol. Materials and Methods: Male Wistar rats (n=66) were exposed to normal oxygen [normal control (NC) group], intermittent hypoxia (IH group), cigarette smoke (CH group), as well as cigarette smoke and IH (OS group). Tempol intervention was assessed in OS group treated with tempol (OST group) or NaCl (OSN group). After an 8-week challenge, lung tissues, serum, and fresh blood were harvested for analysis of endothelial markers and apoptosis. Results: The levels of intracellular adhesion molecule-1, vascular cellular adhesion molecule-1, and apoptosis in circulating epithelial cells were the highest in OS group and the lowest in NC group. These levels were all greater in IH group than in CH group, and were lower in OST group than in OS and OSN groups (all p<0.001). Conclusion: Synergistic effects of IH with cigarette smoke-induced emphysema produce a greater inflammatory status and endothelial apoptosis. OS-related inflammation and endothelial cell apoptosis may play important roles in promoting cardiovascular dysfunction, and antioxidant tempol could achieve a partial protective effect.

• 한국임상수의학회지
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• 제39권5호
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• pp.240-245
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• 2022

A 15-year-old, neutered male, Shih-Tzu, was presented at the Chonnam National Veterinary Medical Teaching Hospital for evaluation of acute onset of persistent coughing, exercise intolerance, and abnormal heart sound. On thoracic auscultation, a split-second heart sound and a wheezing sound were detected on both sides of the chest walls. On physical examination, the dog's body condition score (BCS) was 7/9, and had stenotic nares. Thoracic radiographs revealed right-sided enlargement of the cardiac silhouette (vertebral heart score (VHS) 11.2; reference interval = 8.9-10.1), mild main pulmonary artery (MPA) bulging, mild interstitial infiltration, and hepatomegaly. The electrocardiogram showed right axis deviation, suggesting right ventricular hypertrophy. The echocardiographic study showed moderate pulmonary hypertension and moderate tricuspid regurgitation. There were no findings of a tracheobronchial disease, pulmonary thromboembolism, congenital shunt, left heart disease, or parasitic disease. Based on clinical signs and diagnostic findings, the dog was diagnosed with pulmonary hypertension secondary to brachycephalic syndrome. To rectify respiratory exacerbating factors, the dog was recommended weight control by restricting dietary intake and managing concurrent Cushing's syndrome. Treatments included sildenafil, pimobendan, furosemide, and ramipril. After five months of taking medications and weight control, the severity of pulmonary hypertension improved from moderate to mild. The clinical signs of the patient, including coughing and exercise intolerance, improved a lot. For 5 months of follow-up, the patient has not reported further recurrence of respiratory distress.

• 융합정보논문지
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• 제12권5호
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• pp.40-50
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• 2022

본 연구는 간호대학생이 시뮬레이션 실습 시 동료 팀의 만성폐쇄성폐질환 환자 시나리오 구현 동영상을 실시간으로 관찰하면서 구조화된 동영상 관찰 기록지에 기록한 간호술 영역의 내용을 분석한 질적 연구이다. 4개의 세부영역으로 구분하여 기록된 내용을 효과적, 비효과적 측면으로 구분한 후 내용분석 방법을 사용하여 분석하였다. 연구결과 절차의 정확성에 있어서 효과적 측면은 필요한 물품준비와 증상완화를 위한 중재, 비효과적인 측면은 원칙 미준수, 부적절한 처방 이행, 이론과 수행의 연계 미흡으로 나타났다. 무균술 준수에 있어 효과적 측면은 내과적 무균술 적용과 외과적 무균술 적용, 비효과적 측면은 내과적 무균술 미수행과 외과적 무균술 미수행이었다. 안전과 안위 고려에 있어 효과적 측면은 심리적 안위 고려과 물리적 안전 고려, 비효과적 측면은 안위에 대한 실재감 부족과 환자안전 인식 미흡으로 나타났다. 설명 및 교육의 효과적 측면은 목적 설명과 방법 교육, 비효과적 측면은 설명 부족과 환자수준 미고려이었다. 본 연구에서 간호대학생은 관찰을 통하여 얻은 시각적 정보를 기록하는 과정을 통해 학습에 집중하고 기억을 강화시킬 수 있었을 것으로 사료된다. 또한 본 연구는 시뮬레이션 기반 실습을 통한 간호술 교육의 효율성을 높일 수 있는 요소들을 제시하였다는 점에서 의의가 있다.

• Tuberculosis and Respiratory Diseases
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• 제83권1호
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• pp.42-50
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• 2020

Background: Fractional exhaled nitric oxide (FeNO) is regarded as a potential biomarker for identifying eosinophilic inflammation. We aimed to evaluate the clinical implication of FeNO and its influence on inhaled corticosteroids (ICS) prescription rate in Korean chronic obstructive pulmonary disease (COPD) patients. Methods: FeNO level and its association with clinical features were analyzed. Changes in the prescription rate of ICS before and after FeNO measurement were identified. Results: A total of 160 COPD patients were divided into increased (≥25 parts per billion [ppb], n=74) and normal (<25 ppb, n=86) FeNO groups according to the recommendations from the American Thoracic Society. Compared with the normal FeNO group, the adjusted odds ratio for having history of asthma without wheezing and with wheezing in the increased FeNO group were 2.96 (95% confidence interval [CI], 1.40-6.29) and 4.24 (95% CI, 1.37-13.08), respectively. Only 21 out of 74 patients (28.4%) with increased FeNO prescribed ICS-containing inhaler and 18 of 86 patients (20.9%) with normal FeNO were given ICS-containing inhaler. Previous exacerbation, asthma, and wheezing were the major factors to maintain ICS at normal FeNO level and not to initiate ICS at increased FeNO level. Conclusion: Increased FeNO was associated with the history of asthma irrespective of wheezing. However, FeNO seemed to play a subsidiary role in the use of ICS-containing inhalers in real-world clinics, which was determined with prior exacerbation and clinical features suggesting Th2 inflammation.

• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.123-131
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• 2018

Background: Chronic obstructive pulmonary disease (COPD) may cause changes in the shape of the thoracic cage by increasing lung volume and hyperinflation. This study investigated changes in thoracic cage dimensions and related factors in patients with COPD. Methods: We enrolled 85 patients with COPD (76 males, 9 females; mean age, $70.6{\pm}7.1years$) and 30 normal controls. Thoracic cage dimensions were measured using chest computed tomography at levels 3, 6, and 9 of the thoracic spine. We measured the maximal transverse diameter, mid-sagittal anteroposterior (AP) diameter, and maximal AP diameter of the right and left hemithorax. Results: The average AP diameter was significantly greater in patients with COPD compared with normal controls ($13.1{\pm}2.8cm$ vs. $12.2{\pm}1.13cm$, respectively; p=0.001). The ratio of AP/transverse diameter of the thoracic cage was also significantly greater in patients with COPD compared with normal controls ($0.66{\pm}0.061$ vs. $0.61{\pm}0.86$; p=0.002). In COPD patients, the AP diameter of the thoracic cage was positively correlated with body mass index (BMI) and 6-minute walk test distance (r=0.395, p<0.001 and r=0.238, p=0.028) and negatively correlated with increasing age (r=-0.231, p=0.034). Multiple regression analysis revealed independent correlation only between BMI and increased ratio of AP/transverse diameter of the thoracic cage (p<0.001). Conclusion: Patients with COPD exhibited an increased AP diameter of the thoracic cage compared with normal controls. BMI was associated with increased AP diameter in these patients.

• Tuberculosis and Respiratory Diseases
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• 제78권4호
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• pp.321-325
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• 2015

Background: The adverse effects of the phosphodiesterase-4 inhibitor roflumilast, appear to be more frequent in clinical practice than what was observed in chronic obstructive pulmonary disease (COPD) clinical trials. Thus, we designed this study to determine whether adverse effects could be reduced by starting roflumilast at half the dose, and then increasing a few weeks later to $500{\mu}g$ daily. Methods: We retrospectively investigated 85 patients with COPD who had taken either $500{\mu}g$ roflumilast, or a starting dose of $250{\mu}g$ and then increased to $500{\mu}g$. We analyzed all adverse events and assessed differences between patients who continued taking the drug after dose escalation and those who had stopped. Results: Adverse events were reported by 22 of the 85 patients (25.9%). The most common adverse event was diarrhea (10.6%). Of the 52 patients who had increased from a starting dose of $250{\mu}g$ roflumilast to $500{\mu}g$, 43 (82.7%) successfully maintained the $500{\mu}g$ roflumilast dose. No difference in factors likely to affect the risk of adverse effects, was detected between the dose-escalated and the discontinued groups. Of the 26 patients who started with the $500{\mu}g$ roflumilast regimen, seven (26.9%) discontinued because of adverse effects. There was no statistically significant difference in discontinuation rate between the dose-escalated and the control groups (p=0.22). Conclusion: Escalating the roflumilast dose may reduce treatment-related adverse effects and improve tolerance to the full dose. This study suggests that the dose-escalated regimen reduced the rate of discontinuation. However, longer-term and larger-scale studies are needed to support the full benefit of a dose escalation strategy.

• Tuberculosis and Respiratory Diseases
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• 제86권2호
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• pp.111-119
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• 2023

Background: The objective of this study was to investigate whether alcohol consumption might affect the quality of life (QOL), depressive mood, and metabolic syndrome in patients with obstructive lung disease (OLD). Methods: Data were obtained from the Korean National Health and Nutrition Examination Survey from 2014 and 2016. OLD was defined as spirometry of forced expiratory volume in 1 second/forced vital capacity <0.7 in those aged more than 40 years. QOL was evaluated using the European Quality of Life Questionnaire-5D (EQ-5D) index. Patient Health Questionnaire-9 (PHQ-9) was used to assess the severity of depressive mood. Alcohol consumption was based on a history of alcohol ingestion during the previous month. Results: A total of 984 participants with OLD (695 males, 289 females, age 65.8±9.7 years) were enrolled. The EQ-5D index was significantly higher in alcohol drinkers (n=525) than in non-alcohol drinkers (n=459) (0.94±0.11 vs. 0.91±0.13, p=0.002). PHQ9 scores were considerably lower in alcohol drinkers than in non-alcohol drinkers (2.15±3.57 vs. 2.78±4.13, p=0.013). However, multiple logistic regression analysis showed that alcohol consumption was not associated with EQ-5D index or PHQ-9 score. Body mass index ≥25 kg/m², triglyceride ≥150 mg/dL, high-density lipoprotein <40 mg/dL in men and <50 mg/dL in women, and blood pressure ≥130/85 mm Hg were significantly more common in alcohol drinkers than in non-alcohol drinkers (all p<0.05). Conclusion: Alcohol consumption did not change the QOL or depressive mood of OLD patients. However, metabolic syndrome-related factors were more common in alcohol drinkers than in non-alcohol drinkers.

• Korean Journal of Radiology
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• 제20권4호
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• pp.631-640
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• 2019

Objective: To evaluate the value of airway computed tomography (CT) in patients with obstructive sleep apnea (OSA) as a predictor of cerebrocardiovascular disease (CCVD) clinically, by quantitatively analyzing carotid arterial calcification (CarAC). Materials and Methods: This study included 287 patients aged 40-80 years, who had undergone both polysomnography (PSG) and airway CT between March 2011 and October 2015. The carotid arterial calcium score (CarACS) was quantified using the modified Agatston method on each upper airway CT. The OSA severity was categorized as normal, mild, moderate, and severe using the PSG results. Clinical characteristics, comorbid diseases, and lipid profiles of all patients were analyzed, and the prevalence of CCVDs was investigated during the follow up period (52.2 ± 16.0 months). Results: CCVD occurred in 27 patients (9.3%) at the end of follow-up, and the CCVD-present groups showed a significantly older mean age (57.5 years vs. 54.2 years), higher prevalence of hypertension (59% vs. 34%) and CarAC (51.9% vs. 20.8%), whereas sex, other comorbid diseases, and severity of OSA were not significantly different from the CCVD-absent group. A univariate analysis showed that age, hypertension, incidence of CarAC, and CarACS were risk factors for the occurrence of CCVD events. In a multivariate analysis, the incidence of CarAC was the only independent risk factor for CCVD. Conclusion: CarAC is an independent risk factor for CCVD, whereas the severity of OSA is not a contributory risk factor in patients with OSA. Therefore, additional analysis of CarACS based on airway CT scans may be useful for predicting CCVD.

• Tuberculosis and Respiratory Diseases
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• 제40권5호
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• pp.532-539
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• 1993

임상에서 환자의 생존율을 평가하는 것은 순간순간 당면하는 치료를 결정함에 있어 중요하다. 특히 만성 폐쇄성 폐질환에서 급성 호흡부전증은 대부분의 환자들이 궁극적으로 겪게 되는 질병의 경과로 여겨지고 있고 이들을 치료하는 과정에서 질병 자체의 비가역적인 특성과 기계호흡 자체의 부작용으로 인하여 중환자실에서 인공호흡기의 부착여부에 대한 논란이 계속되고 있으나, 아직 이에 대한 뚜렷한 기준이 없는 상태이다. 이에 본 연구에서는 입원 첫 24시간이내에 측정가능한 14개의 임상지표를 이용하여(Simplified Acute Physiology Score, 이하 SAPS) 환자의 중증도와 사망률을 예측해 보는 것이었다. 대상환자는 1980년부터 1992년까지 중앙대학 부속병원에서 입원치료를 받은 74명의 만성 폐쇄성 폐질환에 동반된 급성 호흡부전증 환자들에 대한 후향성 연구로 시행하였고, 결과는 다음과 같다. 1) 사망율은 34%(25/74), 생존율은 66%(49/74)였으며, 나이가 많을수록 유의하게 사망율이 높았다. 2) 기저 폐기능 검사치에 따른 사망율의 차이는 없었다. 3) SAPS는사망군에서 10.8, 생존군에서 6.5로 유의한 차이가 있었고, SAPS와 사망율 사이에는 유의한 상관관계가 있었다. 4) SAPS에 포함되는 14개의 임상지표 이외에 입원당시 악액질, 뇌병증, 혈중 Phosphate와 Creatinine 농도에 따라 유의한 사망율의 차이가 있었다. 결론적으로, SAPS는 만성 폐쇄성 폐질환에 동반된 급성 호흡부전증 환자의 예후와 중증도 평가에 유용하며, 이러한 환자군에서 SAPS에 포함되는 14개의 임상지표 이외에도 혈중 Creatinine 농도, 혈중 Phosphate 농도, 입원 당시 악액질유무, 뇌병변에 의한 신경학적 증상의 유무가 예후에 중요한 영향을 미친다고 사료되며, 적극적인 치료와 인공호흡기 치료의 결정에서 SAPS의 사용이 타당하리라 여겨지나, 향후 대단위 전향적 연구가 필요하리라 여겨진다.

• Tuberculosis and Respiratory Diseases
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• 제48권6호
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• pp.944-955
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• 2000

연구배경 : 만성폐성심을 시사하는 심전도 소견 유무에 따른 만성 폐쇄성 폐질환 환자의 예후를 평가하고 이 심전도 소견이 폐기능검사 성적 및 동맥혈가스분석 소견등과 연관되어 예후에 어떤 영향을 미치는 가에 대해서 알아 보고자 하였다. 방법 : 만성폐쇄성 폐질환의 급성악화로 입원한 61명의 환자를 대상으로 심전도, 동맥혈가스분석 및 폐기능검사 성적을 비교하였다. 폐성심을 시사하는 심전도 소견은 우심방부하, 우각차단, 우심실비대 low-voltage QRS로 하였으며 심전도상 이상소견이 없는 1군은 36명이었고, 이상소견이 하나 이상인 2군은 25명 이었다. 결과 : 다변량분석 결과 나이 (risk ratio=1.13, 95% confidence interval 1.05-1.23), DLco % pred. (risk ratio=0.97, 95% confidence interval 0.94-0.99), $PaO_2$ (risk ratio=0.95, 95% confidence interval 0.90-0.99), 심전도상 우심방부하(risk ratio=5.27, 95% confidence interval 1.40-19.85) 가 만성폐쇄성 폐질환 환자에서 각각 독립적으로 생존율에 영향을 미치는 인자로 나타났다. 심전도상 우심방부하의 소견이 없는 경우에서는 1년, 2년, 5년 생존율이 각각 95.4%, 81.4%, 50.0% 인데 비해 우심방부하 소견이 있는 경우는 각각 82.4%, 70.6%, 27.5% 로 유의한 차이가 있었다. 결론 : 이상의 결과로 만성폐쇄성 폐질환 환자에서 폐성심을 시사하는 심전도 소견, 특히 우심방부하를 나타내는 심전도 소견은 중요한 예후예측 인자일 것으로 생각된다.