Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Utility of a forced expiratory flow of 25 to 75 percent as a predictor in children with asthma

소아 천식에서 최대호기중간유량의 기관지 과민성 예측인자로서의 의의

  • Kang, Jung Wan (Department of Pediatrics and Institute of Allergy, Brain Korea 21 Project for Medical Sciences Biomolecule Secretion Research Center, Yonsei University College of Medicine) ;
  • Kim, Kyung Won (Department of Pediatrics and Institute of Allergy, Brain Korea 21 Project for Medical Sciences Biomolecule Secretion Research Center, Yonsei University College of Medicine) ;
  • Kim, Eun Soo (Department of Pediatrics and Institute of Allergy, Brain Korea 21 Project for Medical Sciences Biomolecule Secretion Research Center, Yonsei University College of Medicine) ;
  • Park, Jun Young (Department of Pediatrics and Institute of Allergy, Brain Korea 21 Project for Medical Sciences Biomolecule Secretion Research Center, Yonsei University College of Medicine) ;
  • Sohn, Myung Hyun (Department of Pediatrics and Institute of Allergy, Brain Korea 21 Project for Medical Sciences Biomolecule Secretion Research Center, Yonsei University College of Medicine) ;
  • Kim, Kyu-Earn (Department of Pediatrics and Institute of Allergy, Brain Korea 21 Project for Medical Sciences Biomolecule Secretion Research Center, Yonsei University College of Medicine)
  • 강정완 (연세대학교 의과대학 소아과학교실) ;
  • 김경원 (연세대학교 의과대학 소아과학교실) ;
  • 김은수 (연세대학교 의과대학 소아과학교실) ;
  • 박준영 (연세대학교 의과대학 소아과학교실) ;
  • 손명현 (연세대학교 의과대학 소아과학교실) ;
  • 김규언 (연세대학교 의과대학 소아과학교실)
  • Received : 2007.05.03
  • Accepted : 2007.06.14
  • Published : 2008.03.15
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Abstract

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.

목 적 : 천식은 하부기도의 만성 염증으로 정의될 수 있으며, 기관지과민성은 천식의 병태생리적인 특징이다. 하부기도를 직접적으로 평가할 수는 없지만 최대호기중간유량(forced expiratory flow between 25 and 75 percent, $FEF_{25-75}$)이 하부기도의 직경을 비교적 잘 반영하는 것으로 알려져 있다. 본 연구에서는 1초간호기량(forced expiratory volume in 1 second, $FEV_1$)과 $FEF_{25-75}$를 이용하여 얻어진 이들의 차이(difference between $FEV_1$ and $FEF_{25-75}$, DFF)와 비(ratio between $FEV_1$ and $FEF_{25-75}$, RFF)를 분석하여 기관지과민성과의 연관성을 알아보고자 하였다. 방 법 : 만 6세에서 15세 사이의 583명을 대상으로 하였다. 전체 대상자에서 폐기능 검사, 메타콜린 흡입 유발시험을 시행하였고, 혈액 내 호산구수, 혈청 총 IgE 농도, 혈청 ECP 농도를 측정하였다. 메타콜린 흡입 유발시험으로 얻어진 $PC_{20}$을 기준으로 기관지과민성 양성군($PC_{20}$>16 mg/mL)과 음성군($PC_{20}=16mg/mL$)을 정의하였으며, 그 중증도에 따라 4군으로(Group 1: <1 mg/mL; Group 2: 1-4 mg/mL; Group 3: 4-16 mg/mL; Group 4: >16 mg/mL, by American Thoracic Society, 1999) 분류하여 분석하였다. 결 과 : DFF는 기관지과민성 양성군에서 4.0 (-6.0-13.0), 음성군에서 -5 (-18.0-6.0)로 양성군에서 음성군에 비해 유의하게 높게 나타났다 (P<.001). RFF도 기관지과민성 양성군에서 1.07 (0.93-1.21), 음성군에서 0.95 (0.84-1.07)로 양성군에시 음성군과 비교하여 의미있게 높았다(P<.001). 또한 기관지과민성 중증도에 따라 나눈 4군 사이에서도 DFF (P<.001)와 RFF (P<.001) 모두 유의한 차이를 나타내었다. $PC_{20}$은 DFF ($\gamma$=0.337, P< .001) 및 RFF ($\gamma$=0.337, P<.001)와 의미있는 음의 상관 관계를 보였다. 결 론 : $FEF_{25-75}$를 이용하여 얻어진 DFF와 RFF는 기관지과민성과 밀접한 연관성을 보였고 이를 반영하는 지표가 될 수 있는 가능성을 보여주었다.

Keywords

References

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