• 건강소식
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• v.32 no.4 s.353
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• pp.6-13
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• 2008

환절기만 되면 발작적 호흡곤란 때문에 고생을 하는 사람이 있다. 이들은 곤히 잠든 새벽녘에 천식발작을 일으켜 숨이 차서 밤을 꼬박 새우기도 한다. 천식은 기관지가 정상인보다 민감해서 작은 자극에도 쉽게 반응을 하기 때문에 생기는 병이다. 숨을 쉴 때 휘파람을 불 듯‘휘휘’소리가 나는 천명, 호흡곤란, 기침이 천식의 3대 증상이다. 발작이 일어나면 숨을 제대로 못 쉬기 때문에 안색이 창백해지고 입술이 파랗게 되는 등 고통이 심하지만 발작이 끝나면 거짓말처럼 깨끗이 낫는 게 특징이다.

• Journal of Acupuncture Research
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• v.24 no.5
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• pp.185-195
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• 2007

목적 : 부신피질 스테로이드약을 포함한 약물치료에도 조절되지 않았던 기관지천식 환자 6 증례에 대하여 침구치료를 행하여，연구방법의 하나인 조건반전법(N-of-1)을 이용하여 침치료의 효과를 검토하였다. 방법 : 연구디자인 : 조건반전법으로 침치료 기간(A기간)과 침치료 휴지기간(B기간)을 서로 반복하였다. A기간은 10주간으로 하고 1주간에 1회의 침치료를행하였다. 실시장소 : 메이지 침구대학부속병원 내과와 부속침구센터 대상 : 기관지천식의 표준적인 약물치료를 행하여도 천식발작이 충분히 개선되지 않았던 중등증에서 중증의 천식환자 6 증례를 대상으로 하였다. 평가 기관치천식에 대한 침치료의 효과를 아래의 항목을 이용하여 평가하였다. (1) 발작상태를 천식일지에 의해 평가 (2) 호흡곤란감을 VAS(Visual Analogue Scale)에 의해 평가 (3) 호흡기능검사 (4) 말초혈호산구수 (5) 스테로이드약의 투여량 (6) 중증도 효과 : A기간에 동시적으로 모든 예에서 천식발작과 호흡곤란감의 개선이 인정되었다. 한편 B기간에서는 6례 중 5례에서 천식발작의 재연이 확인되었다. 또한 천식발작의 개선에 수반하여 모든 예에서 중증도의 개선도 인정되었으며，6례 중 4례에서 스테로이드약의 감량이 가능하게 되었다. 결론 : 약물치료로 조절되지 않았던 기관지천식 환자에 대하여 침치료를 행한 결과, 환자의 천식발작, 자각증상, 호흡기능의 개선에 유효하였다고 생각된다.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.290-297
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• 1997

Background : Despite remarkable progress of understanding the pathophysiology and therapy of bronchial asthma, asthma morbidity and mortality are on the rise. Also hospitalization and attending rates of emergency department for asthma have been increasing gradually. We analyzed clinical characteristics and prognosis of patients who visited emergency room due to asthma attack in order to define clinical characteristics of these group of patients. Method : We reviewed 105 adult asthmatic patients who attended emergency department of Korea University Hospital between August 1995 and July 1996, retrospectively. Results : 103 patients(56 female, 47 males, mean age : 48.6 years) attended-68 self referral, 18 practitioner referral and 17 OPD transfer- and 86 patients(83.5%) were admitted. Attending emergncy department was clearly more frequent in December(13.6%) and May(12.6%). Time lag between onset of asthmatic attack and arrival at the hospital was $14.2{\pm}15.5$ hour and initial peak expiratory flow rate was $166.7{\pm}68.3L/min$.(43.3% predicted) The commonest cause for visiting emergency room was aggravation of asthma due to upper respiratory tract infection in mild asthmatics. About half of them had history of previous ER visits. Their prognosis was not bad, but after discharge, about half of patients escaped from OPD follow-up. Conclusion : As a group they merit detailed attention and follow up arrangement. Clinician need to monitor and review the treatment plans, the medications, the patient's management technique, and the level of asthma control. For this group, plans for longer term treatment, including asthma education program and adjustment of overall treatment plan should be made.

• The Journal of Pediatrics of Korean Medicine
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• v.15 no.1
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• pp.39-45
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• 2001

본 논문은 척담(滌痰) 축어(逐瘀) 고본(固本)의 방법으로 천식을 완화시킨 치험에 관한 내용이다. 천식의 병인병기는 폐(肺) 비(脾) 신(腎) 삼장(三臟)의 본허(本虛)로 인한 알레르기성 체질이 내적인 근본요인으로 간주된다. 담어복폐(談瘀伏肺)는 천식의 병리적인 결과로서 증상유발의 요인이기도 하다. 즉 담어(痰瘀)는 천식의 병리적인 부산물이며, 동시에 천식을 일으키는 치병요인이 된다. 담어(痰瘀)가 내복(內伏)하여 철저히 제거되지 않으면 천식은 결코 완치될 수 없다. 이와 같은 한의학적인 관점은 현대의학에서 천식을 기도의 만성 염증에 의하여 유발된 증상으로 파악하고 있는 기전과 일맥상통하다. 또한 담(痰) 어(瘀) 허(虛)는 천식의 병리변화 과정에서 전반적으로 영향을 미치고 있다는 인식이 지배적이며, 이는 천식치료를 위한 처방구성에 이론적 근거를 제시하고 있다. 치료: 천식은 발작기와 완화기로 분류하여 치료하며, 발작기는 냉효(冷哮)와 열효(熱哮)로 구분된다. 냉효(冷哮)의 경우 치료원칙은 온폐산한(溫肺散寒), 척담평천(滌痰平喘), 화어행체(化瘀行滯)를 기본으로 한다. 처방은 구마황(灸麻黃) 행인(杏仁) 황금(黃芩) 세신(細辛) 계지(桂枝) 오미자(五味子) 당귀(當歸) 울김(鬱金) 목단피(牧丹皮) 지룡(地龍) 정력자(?歷子) 담남성(膽南星) 황기(黃?) 감초(甘草) 등을 기본적으로 사용한다. 열효(熱哮)의 경우 치료원칙은 청열사폐(淸熱瀉肺) 척담평천(滌痰平喘), 화어행체(化瘀行滯)를 근본으로 삼고, 처방으로는 구마황(灸麻黃) 행인(杏仁) 황금(黃芩) 목단피(牧丹皮) 적작약(赤芍藥) 당귀(當歸) 정력자(?歷子) 담남성(膽南星) 지룡(地龍) 어성초(魚腥草) 포공영(蒲公英) 황기(黃?) 감초(甘草) 등을 기본적으로 사용한다. 완화단계도 역시 두가지 유형으로 나누어지는데, 폐신음허형(肺腎陰虛型)은 익기양음(益氣養陰) 척담행어(滌痰行瘀)를 치료원칙으로 하고, 처방에는 남북사삼(南北沙蔘) 구자울(灸紫?) 및 관동화(款冬花) 당귀(當歸) 목단피(牧丹皮) 울김(鬱金) 정력자(?歷子) 세신(細辛) 오미자(五味子) 구기자(枸杞子) 산수황육(山茱黃肉) 황기(黃?) 감초(甘草) 등을 기본적으로 사용한다. 비신양허형(脾腎陽虛型)은 온보비신(溫補脾腎) 화어척담(化瘀滌痰)을 원칙으로 하며, 처방에는 구마황( 灸麻黃) 세신(細辛) 오미자(五味子) 당귀(當歸) 단삼(丹蔘) 울김(鬱金) 정력자(?歷子) 반하(半夏) 보골지(補骨脂) 선령비(仙靈脾) 태자삼(太子蔘) 황기(黃?) 감초(甘草) 등을 기본적으로 사용한다. 치험(治驗): (1) 천식의 실증(實證)은 치료를 한 뒤 완화단계에 접어들면서 허증(虛證)으로 전화되는데, 허천(虛喘)도 역시 천식이니 만큼 단순히 보법(補法)만 사용하여서는 안된다. 시종일관 천식치료에는 척담화어(滌痰化瘀)의 원칙을 지켜야 한다. 폐내(肺內)의 담어(痰瘀)가 철저하게 제거되어야 폐(肺)의 순환기능을 개선시켜 기도(氣道)의 염증을 신속히 흡수하고 치유할 수 있다. 이와 같은 치료과정은 약 3-6개월이 필요하다. 완화단계의 기간이 길어질수록 완치될 확률도 높아진다. (2) 급성기 천식은 폐(肺)를 다스려야 한다. 폐(肺)를 다스리는 방법에는 선폐(宣肺), 청폐(淸肺), 온폐(溫肺), 윤폐(潤肺) 및 척담거어(滌痰祛瘀) 등이 있다. (3) 증상이 완화되면 신(腎)을 다스린다. 천식은 신허(腎虛)가 근본적인 원인이므로 완화단계에서 심지어 발작기에도 보신제(補腎劑)를 추가하여 사용하면 배의 효과를 얻을 수 있다. (4) 비(脾)의 기능을 강화하여 근본을 채우는 부비배본(扶脾培本)도 중요하다. 후천의 수곡정미(水穀精微)로 선천을 충족시키고 자양하는 것은 질병에 대한 저항력을 키우고 재발을 경감시키거나 방지하는 효과를 기대할 수 있으므로 역시 천식치료의 중요한 방법 중 하나이다.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.844-852
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• 1997

Background : Recent studies have documented increased release of endothelin(ET) during acute attack of asthma. The purpose of this study is to observe the link between plasma level and urinary excretion of each and changes during acute exacerbation. Method : Plasma and 24 hour urine were collected from sixteen asthmatics during acute exacerbation, twice ; first day of symptomatic exacerbation and two weeks after treatment. Controls were ten healthy normal subjects. All patients were treated with corticosteroid and beta-2 adrenergic agonist on admission. ET was determined by radioimmmunoassay and had 100% cross reactivity with ET-1, 67% with ET-2, 84% with ET-3, and 8% with Big-ET. Results : Plasma ETs were significantly elevated during acute attack of asthma compared with those in remission and controls.,However, there was no significant changes in urine ET concentrations or total ET amounts in 24 hour urine during exacerbation upto two weeks. Those levels of urine ET in asthmatics were still higher than controls. ET concentrations in plasma or urine were not correlated with pulmonary functional parameters and hypoxemia. Conclusion : The findings suggests that increased plasma ETs are related with exaggerated release during acute asthma. Urinary ET excretion is increased in asthma. However, urine ET changes during exacerbation should be observed in a larger and longer scale.

• 대한예방의학회:학술대회논문집
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• 2002.10a
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• pp.214-215
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• 2002

• Tuberculosis and Respiratory Diseases
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• v.52 no.5
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• pp.529-538
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• 2002

Background : Many clinicians are reluctant to prescribe systemic corticosteroids to manage an asthmatic attack because of many complications such as osteoporosis, cushing's syndrome, diabetes, hypertension and bleeding tendency. The use of nebulized budesonide may be of value in some infants, old men, and in particular adult asthmatic patients who complain of severe dyspnea. A clinical validation and steroid-sparing effect of nebulized budesonide in asthmatic adults and COPD were evaluated, and the short-term effects of budesonide use on the HPA axis were assessed. Materials and Methods : Study A was prospectively done with 41 patients diagnosed with pure asthma and 30 patients diagnosed with COPD (including asthmatic component) in Soonchunhyang Hospital, Chunan from June. 2000 to Sep. 2001. They were treated with nebulized budesonide including systemic steroids (Group 1), a budesonide tubuhaler including a systemic steroid (Group 2), or only the systemic steroid(Group 3). The peak flow rate, arterial blood gas in room air, pulmonary function test, symptom scoring, steroid amount and hospital stay were analyzed. Study B was conducted with 19 patients to evaluate the short-term effects on the HPA axis of treatment with nebulized budesonide 1mg twice daily and a budesonide turbuhaler 5 puffs twice daily. The adrenal function was assessed prior to budesonide inhalation and after 7 days of budesonide inhalation. Results : In the pure asthmatic patients, the mean value of the symptoms (dyspnea, wheezing, cough, night asthma) or the arterial BGAs, total amounts of steroid or hospital stay and the difference in the results of the pulmonary function tests or peak expiratory flow rate were similar in the three groups. In COPD with an asthmatic component, there were no significant differences among the three groups. Although nebulized budesonide suppressed HPA function,(p=0.006) the HPA responses from the nebulized budesonide and turbuhaler budesonide were similar (p=0.288) Conclusion : This result suggests that systemic steroid should only be made available for acute asthmatic patients irrespective of the inhaled budesonides. Nebulized budesonide at the therapeutic dose has similar effects on the HPA axis compared to that of turbuhaler budesonide.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.77-89
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• 1998

Background: Genetic and environmental factors are known to affect the incidence and severity of asthma. Stimulation of $\beta_2$-Adrenergic Receptor ($\beta_2$AR) results in smooth muscle relaxation, leading to decrease in resistance of airflow. The gene encoding the $\beta_2$AR has recently been seguenced. The $\beta_2$AR genotype at the polymorphic loci of codons 16, 27, 34, and 164 was known to cause changes in the amino acids. The relationships between the structure of the $\beta_2$AR and its functions are being elucidated. Purpose : The gene encoding the $\beta_2$AR was carried out to assess the frequency of polymorphisms in bronchial asthma, to determine wheather these polymorphisms have any relation to the severity, or nocturnal symptoms in bronchial asthma. Methods: The subjects studied were 103 patients with bronchial asthma, which consisted of 30 mild episodic, 32 mild persistent, 17 moderate, and 24 severe asthma patients. The polymorphisms of the $\beta_2$AR gene were detected by mutated allele specific amplification (MASA) method at the codons 16,27,34, and 164. Results: The most frequent polymorphism was arginine 16 to glycine. The other two polymorphisms, valine 34 to methionine and glutamine 27 to glutamic acid occured in 11 and 6 patients respectively. The polymorphism of threonine 164 to isoleucine was not found in our enrolled patients. The homozygous polymorphism of $\beta_2$AR gene was found in only arginine 16 to glycine (12.6%). The heterozygous polymorphisms of $\beta_2$AR gene were in arginine 16 to glycine, valine 34 to methionine, and glutamine 27 to glutamic acid, as 65.1 %,10.7%, and 5.8% respectively in asthma patients. The presence of agrginine 16 to glycine heterozygous or/and homozygous polymorphism was associated in severe asthma (p=0.015), but there was no association between the other three polymorphisms and the severity of asthma. The frequency of the $\beta_2$AR gene polymorphisms was no relation in nocturnal asthma as compared with non-nocturnal asthma. Conclusion: The arginine 16 to glycine polymorphism of the $\beta_2$AR gene is the most frequently found in asthma patients and association with severe asthma. But there was no association between the polymorphism of the $\beta_2$AR gene and nocturnal asthma.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.815-821
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• 1997

Background : Salmeterol, a new ${\beta}_2$-adrenergic receptor agonist, is a long-acting bronchodilator and benefits patients with asthma who have nocturnal symptoms. We wished to assess the efficacy of inhaled salmeterol ($50{\mu}g$ bid) compared to inhaled salbutamol ($200{\mu}g$ qid) for the treatment of bronchial asthma, particularly nocturnal asthma. Method : We randomly assigned 35 patients (25 female and 10 male patients, 15 to 50 years old) to one of two treatment groups : one group received $50{\mu}g$ of salmeterol twice daily and another did $200{\mu}g$ salbutamol four times per day. And this study was performed as an open-label and the 6 weeks inhalation period. Results : Analysis of symptam score ; Day and night time symptom score showed significant difference between salmeterol and salbutamol Group (p<0.05). Number of days for additional bronchodilator requirements; The number of days and puffs for additional bronchodilator were lower in the salmeterol group in either day and night time (p<0.05). Pulmonary function test ; $FEV_1$ showed significant increase in salmeterol group compared to salbutamol group after 2 and 4 weeks inhalation period. Adverse effects ; We found no evidence of tolerance to the bronchodilating effects of salmeterol, and adverse reactions to all the treatments were infrequent and mild. Conclusion : For the management of bronchial asthma, salmeterol given twice daily is superior to salbutamol given four times daily.

• Tuberculosis and Respiratory Diseases
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• v.51 no.6
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• pp.530-539
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• 2001

Background : Bronchial asthma is an inflammatory disease of the airways that is associated with airway remodeling. The vascular endothelial growth factor (VEGF) is a potent, multifunctional cytokine that contributes to angiogenesis and inflammation. Matrix metalloproteinase-9 (MMP-9) is a major proteolytic enzyme that in duces bronchial remodeling in asthma. However, there is no data available on the possible role of the VEGF or on the potential relationship between the VEGF and MMP-9 in acute asthma. Therefore, the VEGF was studied to determine whether or not it participates in airway inflammation during acute asthma. An additional aim of this study was to determine whether or not the VEGF levels correlated with the MMP-9 levels in the sputum of acute asthma patients. Methods: Both the VEGF and MMP-9 levels were measured by an enzyme immunoassay and zymographic analysis in the sputum of patients with either stable asthma or with acute asthma. The VEGF and MMP-9 levels were also evaluated during a spontaneous asthma attack. Results : The VEGF levels were significantly higher in the sputum of acute asthmatic patients than in either the stable patients the control subjects. The VEGF levels in the sputum during asthma exacerbation were significantly higher than those on the remission days, and those levels decreased after asthma therapy. In acute asthmatic patients, the VEGF levels in the sputum correlated with the number of neutrophils and eosinophils. In addition, a significant correlation was established between the VEGF and MMP-9 levels in the sputum. Conclusion : These results suggest that VEGF overproduction is associated with airway inflammation during acute asthma and is related to the MMP-9 function.