• Tuberculosis and Respiratory Diseases
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• v.47 no.5
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• pp.629-641
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• 1999

Background: Corticosteroid is most potent and effective anti-inflammatory medication currently available and inhaled form has been used in the long-tenn control of asthma. Fluticasone propionate(Flixotide/Flovent: FP) is highly potent and topically active inhaled corticosteroid and has at least twice the potency of beclomethasone dipropionate(BDP) in the control of asthma. The aim of this study was to compare the efficacy of FP and BDP in several aspects. Method: Fifty patients with asthma were treated in a randomized, parallel group study of 4 weeks duration. During 2-week run-in period $\beta_2$-agonist was administered. After run-in period, FP $500{\mu}g/day$ was administered via Diskhaler or BDP $800{\mu}g/day$ via reservoir dry-power device. During the run-in and treatment period, morning and evening peak expiratory flow rate(PEFR) were measured daily. Daytime and nighttime asthma symptoms, daytime and night-time rescue bronchodilator use were checked daily. $FEV_{1.0}$ and FVC were measured biweekly in both groups. Results: Three patients treated with FP and seven patient treated with BDP were dropped out. Therefore forty patients completed the study. Morning and evening PEFR was increased and diurnal variation of PEFR decreased significantly in both groups. $FEV_{1.0}$ increased significantly in FP treatment group but not in BDP group. There were also improvements in daytime and night-time asthma symptoms, daytime and night-time rescue bronchodilator use in both groups after treatment There were no significant difference between groups in any of the efficacy parameters. Therapeutic effects were demonstrated earlier in patient treated with FP than BDP. Conclusion: In this study, $500{\mu}g/day$ fluticasone propionate was as effective as $800{\mu}g/day$ beclomethasone dipropionate in the control of asthma. Therapeutic effects were demonstrated earlier in patient treated with FP than BDP without adverse effect.

• The Journal of Pediatrics of Korean Medicine
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• v.15 no.1
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• pp.267-270
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• 2001

소아천식은 기도의 만성 염증 및 과민반응을 특징으로 나타내고 있어 염증을 일으키거나 알레르기 반응을 일으키는 물질로부터 차단하는 방법이 효과적임을 현대의학에서 이미 밝히고 있다. 한의학에서는 천증(喘證)에 본디 뿌리 깊은 근원(천유숙근(喘有夙根))이 있다고 간주하여 허약한 체질은 내적인 요인이고, 풍한침습(風寒侵襲)은 유발요인이며, 담음복폐(痰飮伏肺)와 신기휴허(腎氣虧虛)는 재발의 근본이라고 하였다. 본 연구에서는 소아 천식에 구마황(灸麻黃), 은행(銀杏), 건강(乾薑), 오미자(五味子), 백전(白前), 구백부(灸百部), 소자(蘇子) 등을 사용하였고, 경우에 따라 황기(黃?) 혹은 선령비(仙靈脾)를 추가하여 正氣(正氣)를 강화시키는 목적으로 사용하였다. 약리학적 연구에 따르면 마황과 건강, 오미자 등은 모두 기도의 염증세포 침윤(浸潤)를 억제하고 항알레르기 효과가 있으며, 건강과 오미자는 또한 히스타민에 대한 길항효과(拮抗效果)도 있는 것으로 알려져 있다. 은행 추출물은 혈소판 활성화 수용체에 대한 길항작용을 갖고 있으므로 이러한 물질들로 인한 기관지의 경련을 방지하여 천식증상을 왕화시킨다. 구백부(灸百部)는 지해(止咳)효과가 뛰어나다. 소아천식에 대한 치료는 표본동치(標本同治)의 원칙을 지키며, 증상이 완화된 단계에서도 중약 투여를 1-2개월 지속시키는 것이 중요하다. 소아에게 있어서 천식증상이 완화된 후 어혈(瘀血) 상태가 성인에 비해 심하지는 않지만, "구병필어(久病必瘀)"의 결과에 유의할 필요가 있다. 천식이 장기간 지속되면 필히 혈액순환 장애가 수반되므로 천궁(川芎)이나 단삼(丹蔘) 등의 활혈제(活血劑)를 가미하여 사용하면 효과를 높일 수 있다. 결론적으로 소아의 천식은 항염증, 평천(平喘), 화담(火痰), 지해(止咳)와 더불어 보신익기화어(補腎益氣化瘀)의 약물을 병행하여 사용하는 것이 바람직하며, 단순한 중약 투여는 일부 양약에 의한 소아성장에 미치는 영향을 피할 수 있어 더 많은 임상연구가 이어져야 한다.

• Journal of radiological science and technology
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• v.18 no.2
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• pp.37-48
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• 1995

1) 천식 기관지 확장증에서는 기종상 음영이나 기관지가 확장된 상이 있고, 또한 미만성 범세기관지염 5예에서는 미세 반점상 음영이 전체 예에서 인정이 되었다. 2) 폐염에서는 기관지의 확장이나 점액이 고여 침윤음영이 전체 예에 나타나고 있었다. 한편, 간질성 폐염 29예에서는 반점상 음영(불균일 CT치의 상승과 내부에 작은 기관지 확장으로 작은 air상)이 보였다. 폐섬유증 19례에서는 기종상 농포상 음영이나 혈관 기관의 부정 확장, 반점상 음영이 15예로 79 %를 차지하고 있다. 만성 폐기종에서는 기종상, 다발성 농포상 음영, 고목상 혈관이 특징적인 소견이었다. 3) 속립성결핵에서는 작은 입상 음영, 폐결핵 15예에서는 공동 음영 7예, 원형의 융합음영 8예, 침윤음영, 다수의 석회화상, 혈관 기관의 부정 확장 등이 특징적이었다. Aspergillus증에서는 공동 음영 내부에 fungus ball이 보였다. 이상은 미만성 폐질환의 특징적인 CT의 이상 소견에 대해서 검토하였으나, 꼭 일치되는 것은 아니며, 기타 기초적 검사나 임상적인 경과관찰이 필요하였다. 끝으로, 대한방사선기술학회의 발전과 학회원 여러분의 건승을 기원합니다. 그리고 한국과 일본의 우호적인 학술교류가 지속되기를 희망합니다.

• Korean Journal of Psychosomatic Medicine
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• v.2 no.1
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• pp.34-45
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• 1994

The author reviewed psychosomatic aspects of bronchial asthma including psychological aspect of bronchial asthma, patients' reactions to illness, reactions of therapists and families, effect of bronchial asthma on mental function, psychotherapy and pharmacotherapy. The therapists' understanding of these aspects is likely to be helpful in their predicting and understanding the type of adaptation their asthmatic patients are making to their illness. Thus, the therapists need to recognize the asthmatics' psychological needs. They also should understand the vicious cycle of anxiety-hyperventilation-panic-fear-avoidance in patients with bronchial asthma and should try to break this cycle. To make it possible, the patients' panic-fear level should be assessed and sometimes it will require psychiatrists' advice. On the other hand, the asthmatics should be trained to be shaped to relate subjective feeling of pulmonary function with objective pulmonary measures, which will enable these patients to perceive their early symptoms and to cope with asthma attack effectively. The therapists need to pay attention to their emotion during evaluation and treatment of patients with bronchial asthma, because they are less likely to perceive stress and express their emotion.

• Korean Journal of Psychosomatic Medicine
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• v.1 no.1
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• pp.45-51
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• 1993

Stress perception was investigated in 53 outpatients with extrinsic type of bronchial asthma, using GARS scale and other questionnaires. 40% of the patients were found to be psychosomatic. The patients were more likely to consider their physical symptoms as severe than the allergist Severity of symptoms rated by the allergist had significantly positive correlation with scores of stress perception related to changes in relationship. However, no significant correlation was found between severity of symptoms rated by patients and scores of stress perception. Psychosomatic group was significantly higher in scores of stress perception related to illness and injury, financial burden, and change or no change in routine than non-psychosomatic group. Female. older age, higher education. presence of religion. and presence of psychological stressors at onset and/or aggravation of the illness were found to increase stress perception. These findings indicate ant extrinsic asthmatics an less likely to perceive psychological stress than physical symptoms, and that they are less vulnerable to psychological stressors than patients with other diseases.

• Tuberculosis and Respiratory Diseases
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• v.52 no.3
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• pp.265-270
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• 2002

Vocal cord dysfunction (VCD) is respiratory disorder characterized by paradoxical closure of the vocal cord during the respiratory cycle leading to obstructive airway symptoms. The clinical presentation of VCD is often dramatic and its misdiagnosis as asthma or exercise-induced brochospasm(EIB) has led to inappropriate treatment including high dose corticosteroids, intubation, and tracheostomy. Many VCD patients are asymptomatic at rest and require exercise challenge to elicit symptoms and vocal cord abnormalities. The "gold standard" for the diagnosis of VCD remains laryngoscopy or bronchoscopy with direct visualization of paradoxical adduction of the vocal cords. We report a case of exercise-induced Vocal cord masqueraded as exercise-induced asthma unresponsive to corticosteroids. And bronchodilator confirmed by typical bronchoscopic findings with paradoxial adduction of the vocal cords.

• Korean Journal of Acupuncture
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• v.25 no.1
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• pp.131-138
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• 2008

목적 : 본 연구의 목적은 폐열해수, 장열번갈, 습열사리, 황달, 옹종정창등의 치료효능이 있는 연교약침액이 사람 기관지 상피세포주인 A549에 TNF-${\alpha}$ 및 IL-4를 투여하여 나타나는 케모카인의 발현에 미치는 영향을 관찰하고자 하는 것이다. 방법 : A549 세포주에 연교약침액을 농도별로 (0, 0.5, 1, 5, 10, 50 ${\mu}g/ml$) 전처치한 후, TNF-${\alpha}$ 및 IL-4를 투여하여 RANTES, eotaxin 및 TARC의 분비를 유도하고, 케모카인 분비량을 ELISA법을 이용하여 측정하였다. 실험에 사용한 연교약침액의 농도에 따른 세포 독성 유무를 관찰하고자 MTT assay를 수행하여 세포생존율을 측정하였다.결과 : 연교약침액의 농도가 세포내에서 독성을 일으키는지 MTT assay로 측정한 결과 세포독성은 관찰되지 않았으며, 연교약침액은 TNF-${\alpha}$ 및 IL-4투여로 인하여 증가된 RANTES, eotaxin 및 TARC의 분비를 통계학적으로 유의하게 감소시킴을 관찰하였다. 결론 : 연교약침액은 천식과 알레르기 질환에 관련이 있는 케모카인의 효과적인 감소를 이끌어 냄을 확인하였으며, 이러한 결과는 연교약침액이 천식 및 알레르기 환자에 대해 효과적인 임상 활용이 가능할 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• v.49 no.4
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• pp.486-494
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• 2000

Background : The dominant innervation of airway smooth muscle is parasympathetic fibers which are carried in the vagus nerve. Activation of these cholinergic nerves releases acetylcholine which binds to $M_3$ muscarinic receptors on the smooth muscle causing bronchocontraction. Acetylcholine also feeds back onto neuronal $M_2$ muscarinic receptors located on the postganglionic cholinergic nerves. Stimulation of these receptors further inhibits acetylcholine release, so these $M_2$, muscarinic receptors act as autoreceptors. Loss of function of these $M_2$ receptors, as it occurs in animal models of hyperresponsiveness, leads to an increase in vagally mediated hyperresponsiveness. However, there are limited data pertaining to whether there are dysfunctions of these receptors in patients with asthma. The aim of this study is to determine whether there are dysfunction of $M_2$ muscarinic receptors in asthmatic patients and difference of function of these receptors according to severity of asthma. Method : We studied twenty-seven patients with asthma who were registered at Pulmonology Division of Korea University Hospital. They all met asthma criteria of ATS. Of these patients, eleven patients were categorized as having mild asthma, eight patients moderate asthma and eight patients severe asthma according to severity by NAEPP Expert Panel Report 2(1997). All subjects were free of recent upper respiratory tract infection within 2 weeks and showed positive methacholine challenge test ($PC_{20}$<16mg/ml). Methacholine provocation tests were performed twice on separate days allowing for an interval of one week. In the second test, pretreatment with the $M_2$ muscarinic receptor agonist pilocarpine($180{\mu}g$) through inhalation was performed be fore the routine procedures. Results : Eleven subjects with mild asthma and eight subjects with moderate asthma showed significant increase of $PC_{20}$ from 5.30$\pm$5.23mg/ml(mean$\pm$SD) to 20.82$\pm$22.56mg/ml(p=0.004) and from 2.79$\pm$1.51mg/ml to 4.67$\pm$3.53mg/ml(p=0.012) after pilocarpine inhalation, respectively. However, in the eight subjects with severe asthma significant increase of $PC_{20}$ from l.76$\pm$1.50mg/ml to 3.18$\pm$4.03mg/ml(p=0.161) after pilocarpine inhalation was not found. Conclusion : In subjects with mild and moderate asthma, function of $M_2$ muscarinic receptors was normal, but there was a dysfunction of these receptors in subjects with severe asthma. ηlese results suggest that function of $M_2$ muscarinic receptors is different according to severity of asthma.

• Tuberculosis and Respiratory Diseases
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• v.47 no.6
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• pp.786-796
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• 1999

Background: It has been anticipated that the amount and composition of mucin are changed in patients with chronic airway diseases. We evaluated whether RTO3(mAb against rat tracheal mucins) could quantify the amount of mucin from the airway in the patients with chronic airway diseases. Methods and results; 1) RTO3 was bound to high molecular weight of mucin based on Western blot in sputum and BALF from patients with chronic airway diseases. 2) The goblet cells and submucosal glands in main bronchus from human were observed by PAS stain. And immunohistochemical stain with RTO3 showed immunoreactivity on some goblet cells. 3) The amount of mucin was more increased in patients with chronic airway diseases compared to those in normal subjects. 4) In the exacerbation of asthmatics, mucin amounts were more increased than stable asthmatics. Conclusion: We suggested that secreted mucin in chronic airway diseases can be quantified by ELISA with RTO3.

• Tuberculosis and Respiratory Diseases
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• v.63 no.2
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• pp.145-153
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• 2007

Background: Asthma is a syndrome that is characterized by a variable degree of airflow obstruction, bronchial hyperresponsiveness, and airway inflammation. Colchicine is an inexpensive and safe medication with unique anti-inflammatory properties. IL-1Ra (Interleukin-1 receptor antagonist) mediates the anti-inflammatory effect in human inflammatory diseases, including asthma. This study examined whether IL-1Ra mediates the anti-inflammatory effect of colchicine in normal human bronchial epithelial cells (NHBE), RAW 264.7 cells (murine macrophage cell line), and a mouse lung. Methods: NHBE, RAW 264.7 cells and BALB/c mice were stimulated with colchicine, and the increase in the IL-1Ra level was estimated by ELISA, Western analysis and RT-PCR analysis. Results: Colchicine stimulated NHBE and RAW 264.7 cells to release IL-1Ra into the supernatant in a dose-and time-dependent manner. The major isoform of IL-1Ra in NHBE and RAW 264.7 cells is type I icIL-1Ra, and sIL-1Ra, respectively. IL-1Ra up-regulation was blocked by PD98059, a specific inhibitor in MAPK pathways. Colchicine also stimulated the secretion of IL-1Ra into the bronchoalveolar lavage (BAL) fluid of BALB/c mouse. Conclusion: Colchicine stimulates an increase in the IL-1Ra level both in vivo and in vitro, and might have an anti-inflammatory effect.