Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Effect of a New Spirometric Reference Equation on the Interpretation of Spirometric Patterns and Disease Severity

폐활량측정법의 새로운 정상예측식이 폐활량측정법 장애 양상 및 질병 중증도 해석에 미치는 영향

  • Oh, Yeon-Mok (Department of Internal Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Sang-Bum (Department of Internal Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shim, Tae Sun (Department of Internal Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Chae-Man (Department of Internal Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Younsuck (Department of Internal Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Woo Sung (Department of Internal Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Dong-Soon (Department of Internal Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won Dong (Department of Internal Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young Sam (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Lee, Sang Do (Department of Internal Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine)
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과, 만성기도폐쇄성질환 임상연구센터) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 호흡기내과, 만성기도폐쇄성질환 임상연구센터) ;
  • 심태선 (울산대학교 의과대학 서울아산병원 호흡기내과, 만성기도폐쇄성질환 임상연구센터) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 호흡기내과, 만성기도폐쇄성질환 임상연구센터) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 호흡기내과, 만성기도폐쇄성질환 임상연구센터) ;
  • 김우성 (울산대학교 의과대학 서울아산병원 호흡기내과, 만성기도폐쇄성질환 임상연구센터) ;
  • 김동순 (울산대학교 의과대학 서울아산병원 호흡기내과, 만성기도폐쇄성질환 임상연구센터) ;
  • 김원동 (울산대학교 의과대학 서울아산병원 호흡기내과, 만성기도폐쇄성질환 임상연구센터) ;
  • 김영삼 (연세대학교 의과대학 내과학교실) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과, 만성기도폐쇄성질환 임상연구센터)
  • Received : 2006.01.02
  • Accepted : 2006.02.02
  • Published : 2006.02.28
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Abstract

Background : A spirometric reference equation was recently developed for the general population in Korea. The applicability of the new Korean equation to clinical practice was examined by comparing it with the Morris equation, which is one of the most popular reference equations used for interpreting the spirometric patterns and for grading the disease severity in Korea. Methods : Spirometry was performed on 926 men and 694 women, aged 20 years or older, in November 2004 at the Asan Medical Center, Seoul, Korea. The subjects' age, gender, height, weight, and spirometric values ($FEV_1$ [forced expiratory volume in one second], FVC [forced vital capacity], and $FEV_1/FVC$) were obtained. The spirometric patterns and disease severity were evaluated using both equations, and the results of the Korean equation were compared with the Morris equation. The spirometric patterns were defined as normal, restrictive, obstructive, and undetermined according to the level of $FEV_1/FVC$ and FVC. The disease severity was defined according to the level of $FEV_1$ level for subjects with an airflow limitation, and according to the FVC level for those subjects without an airflow limitation. Results : Spirometric patterns were differently interpreted in 22.5% (208/926) of the men and 24.8% (172/694) of the women after the application of the Korean equation compared with the Morris equation. Of the subjects with airflow limitation, disease severity was differently graded in 30.2% (114/378) of the men and 39.4% (37/94) of the women after the application of the Korean equation. Of the subjects without airflow limitation, disease severity was differently graded in 27.9% (153/548) of the men and 30.2% (181/600) of the women after the application of the Korean equation. Conclusion : Achange in the reference equation for spirometry could have an effect on the interpretation of spirometric patterns and on the grading of disease severity.

연구 배경: 폐활량측정법 정상예측식이 한국인을 대상으로 개발되었다. 한국인 정상예측식을 실제 진료에 사용하기 위해서 그 동안 많이 사용하던 정상 예측식 중 하나인 Morris 예측식을 적용하였을 때와 한국인 예측식을 적용하였을 때 장애 양상 해석 및 질병 중증도 평가가 어떻게 달라지나 비교하고자 하였다. 방 법: 서울아산병원의 호흡기검사실에서 2004년도 11월 한 달간 폐활량측정법을 시행한 남자 926명과 여자 694명을 대상으로 하였다. 나이, 성, 키, 몸무게, 그리고 폐활량측정법으로 $FEV_1$ [forced expiratory volume in one second], FVC [forced vital capacity], $FEV_1/FVC$ 등을 구하였다. 한국인 예측식과 Morris 예측식을 사용하여 장애 양상 해석과 질병 중증도 평가를 하였고 그 차이를 비교하였다. 폐활량측정법 장애 양상은 $FEV_1/FVC$과 FVC 값에 따라서 정상, 제한성, 폐쇄성, 양상 미정 등으로 정의하였고 질병 중증도는 기류제한이 있는 환자는 $FEV_1$ 값에 따라서 기류제한이 없는 환자는 FVC값에 따라서 정의하였다. 결 과: Morris 예측식에서 한국인 예측식으로 바꾸어 적용하면 장애 양상 해석이 남자 환자의 경우 22.5% (208/926) 달라졌고 여자의 경우 24.8% (172/694) 달라졌다. 한국인 예측식을 적용하였을 때, 기류제한이 있는 환자의 경우 질병의 중증도가 남자에서 30.2% (114/378) 바뀌었고 여자에서 39.4% (37/94) 바뀌었다. 기류제한이 없는 환자의 경우는 질병의 중증도가 남자에서 27.9% (153/548) 바뀌었고 여자에서 30.2% (181/600) 바뀌었다. 결 론: 폐활량측정법 정상예측식이 바뀌면 장애 양상 해석과 질병 중증도 평가에 유의한 영향을 미칠 수 있다.

Keywords

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