• Tuberculosis and Respiratory Diseases
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• v.44 no.1
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• pp.146-153
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• 1997

Background : Chronic cough is commomly defined as a persistent or recurrent cough exceeding 3 week's duration. The prevalence of chroinc cough is reported to range from 14% to 23 % for nonsmoking adults. The post nasal drip syndrome has been determined to be the most common cause of chronic cough, followed by asthma, chronic bronchitis, gastroesophageal reflux and bronchiectasis. Cough can be the only manifestation of asthma. Bronchial provocation tests are useful in diagnosing cough variant asthma. We investigated the clinical or laboratory findings and the incidence of airway hyperresponsiveness and evaluated the etiology in patients with chronic cough. Method : We evaluated 46 patients with chronic cough. Methacholine challenge test were done. Results : The results were as follows : 1) Thirty - five percent(16/46) of the chronic cough patients and 44% of the post nasal drip syndrom(7/16) showed the positive responses to methacholine challenge test 2) The underlying causes of chronic cough were post nasal drip syndrome in 35%, bronchitis in 21.7%, cough-variant asthma in 17.4%, and unknown condition in 25.9%. 3) Airway hyperresponsiveness in chronic cough was not related to respiratory symptom, nasal symptom, post nasal drip, smoking, derangement of ventilatory function, atopy, or sinusitis. Conclusion : Airway hyperresponsivenss in patients with chronic cough increased in frequency when compaired with normal control, allergic rhinitis. Cough-variant asthma account for 17.4% of patients with chronic cough.

• Tuberculosis and Respiratory Diseases
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• v.39 no.2
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• pp.159-166
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• 1992

Background:Sulfiting agents are widely used as preservatives and antioxidants in foods, beverages and drugs including bronchodilators. There have been reports of sulfite-related reactions such as anaphylaxis, urticaria, angioedema, abdominal discomfortness as well as bronchospasm. Several investigators reported that sulfite-sensitive asthmatic patients comprised from 3.9% to 8.2% of all asthmatic patients and its prevalence was higher in steroid-dependent group than in steroid-independent group. Subjects and Method:We performed oral provocation test with sodium bisulfite and aspirin in 17 asthmatic patients who have experienced aggravation of their symptoms after administration of drugs or foods. All of them were steroid dependent asthmatics. We observed clinical symptoms and steroid requirements from 1 to 18 months. Result:Ten of them showed severe bronchoconstriction after the ingestion of sodium bisulfite (50 to 200 mg) within 30 minutes. Concurrent aspirin intolerance was noted by oral provocation test in four cases (40%). Three of them showed positive responses on skin prick test with sulfite (10 or 100 mg/ml). Mean total eosinophil counts was $844/mm^3$ at asthmatic attack. And there was no significant responses on skin prick test and IgE-RAST to common inhalant allergens. After complete avoidance from sulfite containing foods and drugs as well as antiasthmatic medication for 1 to 18 months, nine of them (90%) could stop or reduce the steroid requirements. ConcIusion:It was suggested that severe steroid dependent and intrinsic type of asthmatic patients should be evaluated for sulfite-sensitivity.

• Clinical and Experimental Pediatrics
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• v.51 no.8
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• pp.842-847
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• 2008

Purpose : Measurement of forced expiratory volume in 1 second ($FEV_1$) is usually difficult to obtain in children under six years of age because it requires active cooperation. This study evaluates the sensitivity of impulse oscillometry system (IOS) parameters for detecting airway obstruction in comparison with $FEV_1$. Methods : We studied 174 children who performed the lung function and methacholine challenge tests to diagnose asthma by IOS and spirometry. Children were divided into two subgroups according to their $PC_{20}$, which is a parameter for bronchial sensitivity. We compared IOS parameters with $FEV_1$ at the baseline, post-methacholine challenge, and evaluated their correlation. Results : At the baseline, reactance at 5 Hz (X5) and resistance at 5 Hz (R5) significantly differed between the $PC_{20}$ positive ($PC_{20}{\leq}16mg/mL$) group and $PC_{20}$ negative ($PC_{20}$ >16 mg/mL) group; however, $FEV_1$, $FEV_1$ % predicted, $FEV_1_-Zs$ (Z score) did not differ. $FEV_1$ is correlated with X5 (r=0.45, P<0.01) and R5 (r=-0.69, P<0.01). $FEV_1_-Zs$ is also correlated with X5_Zs (r=-0.26, P<0.01) and R5_Zs (r=-0.31, P<0.01). After the methacholine challenge test, dose-response slopes in $FEV_1$ and X5 significantly differed between the two subgroups (P<0.05). Conclusion : IOS parameters were more discriminative than $FEV_1$ for detecting decreased baseline lung function between two subgroups and have a good correlation with $FEV_1$.

• Tuberculosis and Respiratory Diseases
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• v.51 no.3
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• pp.232-239
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• 2001

Background : Asthmatic patients frequently suffer cold-weather-associated respiratory symptoms. The sensitivity, specificity, accuracy and diagnostic value of isocapnic hyperventilation of cold air(IHCA) using a multistep method, was investigated in patients suspected to have asthma. Method : One hundred and 29 adult patients who had an IHCA performed between july 1999 and December 2000, had an methacholine bronchoprovocation test because of a clinical suspicion of asthma. Results : According to strict criteria, 50 were defined as asthmatics and 79 as symptomatic nonasthmatics. There were no differences in age, sex and smoking state between the asthmatic and symptomatic nonasthmatic groups. There was a significant decrease in the percentage reduction in the forced expiratory volume in 1 second($FEV_1$) after the IHCA between the asthmatics($-10.0{\pm}6.8%$) and the symptomatic nonasthmatics($-2.3{\pm}2.5%)$. The factors associated with a reactivity to IHCA were $FEV_1$/FVC, $FEF_{25-75}$%/FVC and $FEV_1$(% of predicted). The accuracy was highest using a 7% fall in $FEV_1$ ; the sensitivity was 76% and the specificity 96%. Conclusion : IHCA is a specific, although not a sensitive, test for diagnosing asthma in adult patients. Furthermore, the diagnostic cut-off value of the different methods of IHCA need to be determined.

• Clinical and Experimental Pediatrics
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• v.52 no.6
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• pp.680-688
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• 2009

Purpose : Cysteinyl leukotrienes are important proinflammatory mediators in asthma. Recently, it was suggested that a promoter polymorphism in the genes encoding for leukotriene C4 synthase (LTC4S), a key enzyme in the leukotriene synthetic pathway, and cysteinyl leukotriene receptor 1 (CysLTR1) might be associated with aspirin-intolerant asthma. We investigated whether polymorphisms in LTC4S and CysLTR1 genes or their interactions were associated with the asthma phenotype, lung function, or bronchial hyperreactivity (BHR) in Korean children. Methods : A total of 856 asthmatic children and 254 non-asthmatic controls were enrolled; a skin prick test, lung function test and bronchial provocation test were performed. Of those enrolled, 395 children underwent exercise challenge tests. The LTC4S A(-444)C and CysLTR1 T(＋927)C were genotyped by polymerase chain reaction-restriction fragment length polymorphism analysis. Results : Of those enrolled, 699 children were classified as having atopic asthma and 277 children, as having exercise-induced asthma (EIA). LTC4S and CysLTR1 polymorphisms were not associated with atopic asthma, EIA, or asthma per se. Lung function and BHR were not significantly different between the wild type (AA or TT) and the variant (AC＋CC or TC＋CC) genotypes in asthmatics, atopic asthmatics, and EIA (＋) asthmatics, while total eosinophil counts were higher in the variant type of LTC4S than in the wild type in atopic asthmatics. There were no associations between the gene-gene interactions of LTC4S and CysLTR1 genotypes and the asthma phenotypes. Conclusion : LTC4S A(-444)C and CysLTR1 T(＋927)C polymorphisms and their gene-gene interactions are not associated with asthma phenotype, lung function, or BHR in Korean children.

• Tuberculosis and Respiratory Diseases
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• v.54 no.4
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• pp.386-394
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• 2003

Background : ATS(American Thoracic Society) defined new guidelines for COPD(chronic obstructive lung disease) in April 2001, following the results of the global initiative for chronic obstructive lung disease. The most important concept of COPD is an airflow limitation which is not fully reversible compared to bronchial asthma(BA). The criteria for COPD are postbronchodilator $FEV_1$ less than 80% of the predicted value and an $FEV_1$ per FVC ratio less than 70%. The global initiative for asthma(GINA) study defined asthma, which included immune-mediated chronic airway inflammatory airway disease, and found that airflow limitation was wide spread, variable and often completely reversible. Taken together COPD and BA may be combined in airflow limitation. This study was designed to evaluate the prevalence of BA in patients with COPD of moderate to severe airflow limitation. Methods : COPD was diagnosed by symptoms and spirometry according to ATS guidelines. Enrolled subjects were examined for peak flow meters(PFM), sputum eosinophils and eosinophil cationic protein(ECP) levels, serum total IgE with allergy skin prick test, and methacholine bronchial provocation test(MBPT). Results : About 27% of COPD patients with moderate to severe airflow limitation were combined with BA. There was significantly decreased response to PFM in severe COPD. However, there was no significant relationship between BA and COPD according to the degree of severity. The BA combined with COPD group showed significantly high eosinophil counts and ECP level in induced sputum. However, neutrophil counts in induced sputum showed significant elevation in the pure COPD group. Conclusion : Twenty-seven percent of COPD patients with moderate to severe ventilation disorder were combined with BA, but there were no significant differences according to the degree of severity.

• Tuberculosis and Respiratory Diseases
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• v.46 no.1
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• pp.44-52
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• 1999

Background : Airway infiltration by inflammatory cells, particularly of eosinophils, is one of the characteristic features of asthma. Several mechanisms for the recruitment of eosinophil is focused on the CD4+ T lymphocyte for the preferential production of Th2-c1erived cytokines. Interleukin-10(IL-10) is identified cytokine with potent antiinflammatory activity. This molecule has been shown to inhibit the release of cytokine from inflammatory cells including Th2 cell, and also to inhibit eosinophil survival. We therefore attempted to determine whether decreased synthesis of IL-10 in the lung of bronchial asthma may contribute to inflammation that is characteristics of this dease. Method: Subjects were patients with bronchial asthma(n=23) and normal controls(n=11). IL-10 produced from peripheral mononuclear cell(PBMC) and in bronchoalveolar lavage(BAL) fluid was measured by ELISA method. Degree of bronchial inflammation was assessed by total cell counts and eosinophil percents in BAL fluid, eosinophil infiltration on bronchial biopsy tissue and $PC_{20}$ for methacholine. Results: The IL-10 level produced by PBMC and in BAL fluid from patient with bronchial asthma were not different with normal controls(respectively, $901.6\pm220.4$ pg/ml, $810.9\pm290.8$ pg/ml for PBMC, $24.5\pm9.5$ pg/mL $30.5\pm13.5$ pg/ml for BAL fluid p>0.05). There were significant negative correlation between IL-10 in BAL fluid and eosinophil percents in BAL fluid or degree of eosinophil infiltration in bronchial biopsy (respectively r=-0.522, r=-0.4486 p<0.05). However there was no difference of IL-10 level according to $PC_{20}$ for methacholine. There were no correlation between IL-10 production by PBMC and peripheral blood eosinophil counts or serum eosinophilic cationic protein levels(respectively r=0.1146, r=0.0769 p>0.05). Conclusion: These observation suggest that IL-10 may participate but not acts the crucial role in regulation of the airway inflammation in bronchial asthma.

• Journal of the Korean Society of Radiology
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• v.84 no.5
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• pp.1191-1196
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• 2023

Bronchial artery aneurysm (BAA) is a rare disease, and multiple aneurysms of a single bronchial artery are rarer. Regardless of the size of the lesion, it is at risk of rupture and can cause massive hemoptysis or severe pain. We report a rare case of bronchial artery embolization (BAE) of multiple aneurysms of a single bronchial artery. During medical examination, a 64-year-old female was diagnosed with multiple BAAs and endobronchial lesions in the right lower lung on CT 10 years prior to presentation to our hospital. Further evaluation of the lesions was recommended; however, the patient was lost to follow-up. The patient complained of dyspnea and visited our hospital, and the size of the BAA had increased on CT. BAE was done successfully using N-butyl-2-cyanoacrylate and detachable coils. Follow up CT after BAE showed significant decrease in extent of inflammatory lesion in the right lung.

• Tuberculosis and Respiratory Diseases
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• v.48 no.2
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• pp.203-209
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• 2000

Background: Exercise is a very common precipitant of asthma. Bronche-constriction associated with exercise can occur in 75~90% of individuals with asthma The estimated prevalence(30~85%) of gastroesophageal reflux(GER) in patients with asthma is significantly higher than in general population. We performed pH monitoring during the exercise in order to evaluate whether exercise induced asthma(EIA) could be related to GER and acid reflux-induced esophagobronchial reflex-mediated bronchospasm might be a factor for EIA. Method: Following an overnight fast, 18 patients with a suspected EIA(6 men, 12 women) were studied. Monitoring of intraesophageal pH, ECG and spirometry was done for 1 hour before treadmill exercise. After baseline monitoring, subjects underwent symptom-limited treadmill exercise with Bruce protocol and continuous monitoring for 60 min after exercise. Spirometry was done at baseline prior to exercise, and repeated every 10 min after full exercise for 60 min. Results: Exercise-induced bronchoconstriction was noted in 15 patients, who performed MBPT and 12 patients confirmed for bronchial asthma and 3 patients were diagnosed exercise-induced astham. Five of 15 EIA patients demonstrated a pathologic degree of GER. Conclusion: We suggest that GER may be one of pathophysiologic factors of EIA and evoke further concentration on the GER in the EIA patients.

• Tuberculosis and Respiratory Diseases
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• v.50 no.2
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• pp.196-204
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• 2001

Background : Bronchial asthma is characterized by a reversible airway obstruction, airway hyperresponsiveness, and eosinophilic airway inflammation. The bronchodilator response(BDR) after short acting beta agonist inhalation and PC20 with methacholine inhalation are frequently used for diagnosing bronchial asthma. However, the relationship between the presence of a bronchodilator response and the degree of airway hyperresponsiveness is uncertain. Therefore, the availability of a eosinophil cationic protein (ECP) and a correlation ECP with a bronchodilator response and airway hyperresponsiveness was investigated. Method : A total 71 patients with a moderate to severe degree of bronchial asthma were enrolled and divided into two groups. 31 patients with a positive bronchodilator response and 38 patients with a negative bronchodilator response were evaluated. In both groups, the serum ECP, peripheral blood eosinophil counts, and total IgE level were measured and the methacholine bronchial provocation test was examined. Results : There were no differences observed in age, sex, atopy, and baseline spirometry in both groups. The peripheral eosinophil counts showed no difference in both groups, but the ECP level in group 1 (bronchodilator responder group) was higher than in group 2(non-bronchodilator responder group) ($22.4{\pm}20.7$ vs $14.2{\pm}10.4$, mean$\pm$SD). The PC20 in group 1 was significantly lower than in group 2 ($1.14{\pm}1.68$ vs $66{\pm}2.98$). There was a significant positive correlation between the BDR and ECP, and a negative correlation between the bronchial hyperresponsiveness and ECP. Conclusion : The bronchodilator response significantly correlated with the bronchial hyperresponsiveness and serum ECP in the moderate to severe asthma patients. Hence, the positive bronchodilator response is probably related with active bronchial inflammation and may be used as a valuable index in treatment, course and prognosis of bronchial asthma.