• Tuberculosis and Respiratory Diseases
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• 제63권6호
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• pp.480-485
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• 2007

연구배경: 만성폐쇄성폐질환은 여러 중요한 사망 원인 중 전세계적으로 유일하게 유병률이 증가하고 있는 질환이다 만성폐쇄성폐질환은 폐 이외의 다른 장기에도 영향을 끼치는 전신 질환으로 이해되고 있다. 본 연구는 폐활량 검사에서 기류 폐쇄 유무에 따른 호흡기 증상 빈도와 검사실 성적에 대해 알아보고자 하였다. 방 법: 2001년 국민건강영양조사와 같이 시행된 국가 단위 만성폐쇄성폐질환 유병률 조사에 참여한 대상으로 연구가 수행되었다. 본 연구는 폐활량 검사를 실시하여 GOLD 진단 기준으로 기류 폐쇄가 있는 대상과 없는 대상으로 구분하여 총 콜레스테롤, 혈액요소질소, 크레아티닌, 혈색소, 적혈구용적율, 공복 혈당, 고밀도 콜레스테롤, 중성지방의 평균값의 차이가 있는지를 알아 보았고 설문 조사를 통한 호흡기 증상의 빈도를 확인하였다. 결 과: 총 2,217명이 연구대상에 포함되었다. 이 중 GOLD 진단 기준에 따라 기류 폐쇄가 있는 대상이 288명, 기류 폐쇄가 없는 대상이 1,929명이었다. 호흡곤란을 느낀 적이 있다고 대답하였으나 기류 폐쇄의 유무에 따른 차이는 없었다. 기류 폐쇄가 있는 연구 대상들은 기류 폐쇄가 없는 대상들보다 객담, 기침, 천명음 등의 증상을 더 많이 호소하였다. 폐기능이 나쁠수록 호흡기 증상을 호소하는 연구 대상이 통계적으로 유의하게 더 많았다. 혈색소, 적혈구용적률의 평균값은 기류 폐쇄가 있는 군에서 더 높게 측정 되었으며 고밀도 콜레스테롤의 평균값은 기류 폐쇄가 있는 군이 통계적으로 낮게 측정 되었다. 총콜레스테롤, 중성지방, 혈액요소질소, 크레아티닌, 공복 혈당의 평균값은 기류 폐쇄 유무에 상관 없이 양군간에 차이는 없었다. 결 론: 기류 폐쇄가 없는 연구 대상에 비해 기침, 객담, 천명음과 같은 호흡기 증상의 경험 빈도가 많았고 혈액 검사에서 혈색소, 적혈구용적률의 평균값은 컸으며 고밀도 콜레스테롤의 평균값은 낮았다. 운동시 호흡곤란의 빈도, 총 콜레스테롤, 중성지방, 공복 혈당, 총 콜레스테롤, 혈액요소질소, 크레아티닌의 평균값은 기류 폐쇄의 유무와 상관 없었다.

• Tuberculosis and Respiratory Diseases
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• 제59권1호
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• pp.5-13
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• 2005

COPD는 비가역적인 기류제한을 특징으로 하는 질병의 상태이다. 이러한 기류제한은 유해입자나 가스등에 대한 폐의 비정상적인 염증반응과 관련되어 있고 자연경과 중 지속적으로 진행하는 양상을 띤다. 비정상적인 염증반응 및 단백분해효소와 항단백분해효소간의 불균형과 산화 스트레스 등의 기전에 의해 점액의 과분비, 섬모의 기능장애, 소기도의 섬유화와 협착, 폐실질의 파괴, 폐혈관손상 등이 발생한다. 이러한 병리학적 변화에 의해 기류제한이 발생하고 가스교환 장애, 폐고혈압, 폐성심, 전신적인 염증이나 골격근의 기능장애 등이 유발된다. COPD 환자의 일반적인 증상인 기침, 객담, 호흡곤란 등은 이러한 병태생리학적 변화로 설명할 수 있다.

• 지역사회간호학회지
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• 제29권3호
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• pp.290-299
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• 2018

Purpose: The purpose of the present study is to examine risk factors for unawareness of obstructive airflow limitation among adults with chronic obstructive pulmonary disease. Methods: Secondary data analysis was performed with the data from the 6th Korea National Health and Nutrition Examination Survey (KNHANES; 2013-2014). The data were analyzed with the IBM SPSS 22.0 version using frequency, percentage, odds ratio, and logistic regression. Results: Ninety-eight percent of subject with a pulmonary function test score of $FEV_1/FVC$<0.7 (N=833) did not recognize that their lung function was impaired. The heavy drink, absence of tuberculosis or asthma diagnosis, and no symptom of expelling phlegm were identified as major risk factors for unawareness of airflow limitation. Conclusion: In order to increase awareness of airflow limitation and to prevent the worsening of the condition, the pulmonary function screening test should be provided to community residents including those who do not show symptoms of respiratory illness.

• 대한의생명과학회지
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• 제20권1호
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• pp.8-13
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• 2014

Occupational long-term exposure to inorganic dusts may cause a variety of lung diseases such as pneumoconiosis and chronic obstructive pulmonary disease (COPD). Diagnosis of pneumoconiosis and COPD, however, is currently dependent on radiological findings and pulmonary test, which are both late diagnostic tools. Therefore, there is a need to identify novel biomarkers in pneumoconiosis and COPD. Hence, in this current study we investigated the serum concentrations of YKL-40, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-${\alpha}$) as biomarkers for pneumoconiosis and COPD in 161 retired male workers exposed to inorganic dusts. The serum concentration of YKL-40 was significantly increased with age, pneumoconiosis, and airflow limitation. The serum concentration of IL-6 was significantly higher in airflow limitation. These results suggest that serum concentration of YKL-40 is associated with age, pneumoconiosis, and airflow limitation. Also, serum concentration of IL-6 is associated with airflow limitation.

• 한국산업보건학회지
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• 제29권2호
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• pp.251-258
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• 2019

Objective: Chronic obstructive pulmonary disease(COPD) is characterized by persistent airflow limitations associated with chronic inflammatory response due to noxious particles or gases in the lung. Inflammation and oxidative stress are associated with COPD. The aim of this study was to evaluate the relationship among inflammation, oxidative stress, and airflow limitation severity in retired miners with COPD. Methods: The levels of serum high-sensitivity C-reactive protein(hsCRP) as a biomarker for inflammation, degree of reactive oxygen metabolites(dROMs) and biological antioxidants potential(BAP) in plasma as biomarkers for oxidative stress were measured in 211 male subjects with COPD. Degree of airflow limitation severity as determined by spirometry was divided into three grades grouped according to the classification of the Global Initiatives for Obstructive Lung Disease(GOLD)(1, mild; 2, moderate; $3{\leq}$, severe or more) using a fixed ratio, post- bronchodilator $FEV_1/FVC$ < 0.7. Results: Mean levels of dROMs significantly increased in relation to airflow limitation severity(GOLD 1, 317.8 U.CARR vs. GOLD 2, 320.3 U.CARR vs. GOLD $3{\leq}$, 350.9 U.CARR, p=0.047) and dROMs levels were correlated with serum hsCRP levels(r=0.514, p<0.001). Mean levels of hsCRP were higher in current smokers(non-smoker, 1.47 mg/L vs. smoker, 2.34 mg/L, p=0.006), and tended to increase with degree of airflow limitation severity(p=0.071). Mean levels of BAP were lower in current smokers(non-smoker, $1873{\mu}mol/L$ vs. smoker, $1754{\mu}mol/L$, p=0.006). Conclusions: These results suggest that inflammation and oxidative stress are related to airflow limitation severity in retired miners with COPD, and there was a correlation between inflammation and oxidative stress.

• Tuberculosis and Respiratory Diseases
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• 제87권2호
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• pp.155-164
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• 2024

Background: Exercise capacity is associated with lung function decline in chronic obstructive pulmonary disease (COPD) patients, but a discrepancy between exercise capacity and airflow limitation exists. This study aimed to explore factors contributing to this discrepancy in COPD patients. Methods: Data for this prospective study were obtained from the Korean COPD Subgroup Study. The exercise capacity and airflow limitation were assessed using the 6-minute walk distance (6-MWD; m) and forced expiratory volume in 1 second (FEV₁). Participants were divided into four groups: FEV₁ >50%+6-MWD >350, FEV₁ >50%+6-MWD ≤350, FEV₁ ≤50%+6-MWD >350, and FEV₁ ≤50%+6-MWD ≤350 and their clinical characteristics were compared. Results: A total of 883 patients (male:female, 822:61; mean age, 68.3±7.97 years) were enrolled. Among 591 patients with FEV₁ >50%, 242 were in the 6-MWD ≤350 group, and among 292 patients with FEV₁ ≤50%, 185 were in the 6-MWD >350 group. The multiple regression analyses revealed that male sex (odds ratio [OR], 8.779; 95% confidence interval [CI], 1.539 to 50.087; p=0.014), current smoking status (OR, 0.355; 95% CI, 0.178 to 0.709; p=0.003), and hemoglobin levels (OR, 1.332; 95% CI, 1.077 to 1.648; p=0.008) were significantly associated with discrepancies in exercise capacity and airflow limitation in patients with FEV₁ >50%. Meanwhile, in patients with FEV₁ ≤50%, diffusion capacity of carbon monoxide (OR, 0.945; 95% CI, 0.912 to 0.979; p=0.002) was significantly associated with discrepancies between exercise capacity and airflow limitation. Conclusion: The exercise capacity of COPD patients may be influenced by factors other than airflow limitation, so these aspects should be considered when assessing and treating patients.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.35-41
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• 2019

Background: Pulmonary tuberculosis can result in anatomical sequelae, and cause airflow limitation. However, there are no treatment guidelines for patients with a tuberculosis-destroyed lung. Recently, indacaterol effectiveness in chronic obstructive pulmonary disease (COPD) patients with Tuberculosis history (INFINITY) study revealed indacaterol provided bronchodilation and symptom improvement in COPD patients with a tuberculosis-destroyed lung. Methods: We conducted a post-hoc subgroup analysis of the randomized controlled trial, the INFINITY study, to determine factors associated with indacaterol response in a tuberculosis-destroyed lung with airflow limitation. Data from 68 patients treated with inhaled indacaterol, were extracted and analyzed. Factors associated with the response of forced expiratory volume in one second ($FEV_1$) to indacaterol treatment, were determined using linear regression analysis. Results: Of 62 patients included, 68% were male, and 52% had history of cigarette smoking. Patients revealed mean $FEV_1$ of 50.5% of predicted value with mean improvement of 81.3 mL in $FEV_1$ after indacaterol treatment for 8 weeks. Linear regression analysis revealed factors associated with response of $FEV_1$ to indacaterol included a short duration of smoking history, and high short-acting bronchodilator response. When patients with history of smoking were excluded, factors associated with response of $FEV_1$ to indacaterol included high short-acting bronchodilator response, and poor health-related quality of life score as measured by St. George's Respiratory Questionnaire for COPD. Conclusion: In a tuberculosis-destroyed lung with airflow limitation, short-acting bronchodilator response and smoking history can play a critical role in predicting outcomes of indacaterol treatment.

• 대한의생명과학회지
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• 제15권4호
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• pp.309-317
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• 2009

Occupational exposure to inorganic dusts such as coal and silica has been identified as a chronic obstructive pulmonary disease (COPD) risk factor. This risk factor causes lung inflammation and protease-antiprotease imbalance. This abnormal inflammatory response of the lung induces parenchymal tissue destruction and leads to progressive airflow limitation that is characteristics of COPD. The aim of this study was to determine the relationship of proteases such as neutrophil elastase (NE) and matrix metalloproteinase (MMP)-9 and antiproteases such as alpha-1 antitrypsin (AAT) and tissue inhibitors of metalloproteinase (TIMP)-1 with lung function. The study population contained 223 retired workers exposed to inorganic dusts. We performed lung function test, including percent of forced expiratory volume in one second ($%FEV_1$) predicted and $%FEV_1$/forced vital capacity (FVC). We analyzed serum MMP-9, AAT, TIMP-1 and plasma NE concentrations by sandwich enzyme immunoassay. NE, AAT, and TIMP-1 concentrations in workers, who had $%FEV_1$<80% predicted, were higher than those of workers who had $%FEV_1{\geq}80%$ (P<0.05). Both AAT and TIMP-1 concentrations in workers with airflow limitation were higher than those of workers with normal airflow (P<0.05). $%FEV_1$ predicted showed significant negative correlation with AAT (r=-0.255, P<0.0l), TIMP-1 (r=-0.232, P<0.01), and NE (r=-0.196, P<0.01). $%FEV_1$/FVC predicted showed significant negative correlation with NE (r=-0.172, P<0.05). From the results of stepwise multiple regression analysis about $%FEV_1$ and $%FEV_1$/FVC, significant independents were NE (r=-0.135, P=0.001) and AAT (r=-0.100, P=0.013) in $%FEV_1$, and NE (r=-0.160, P=0.014) in $%FEV_1$/FVC. In the present study, there were significant correlations between airflow limitation and protease concentration and between airflow limitation and antiprotease concentration. Serum protease and antiprotease concentrations, however, may be affected by the biological and inflammatory responses. It is necessary to evaluate specimens more reflected the effects of proteases and antiproteases in the lung such as lung tissue, bronchoalveolar lavage fluid, and exhaled breath condensate (EBC).

• Tuberculosis and Respiratory Diseases
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• 제86권2호
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• pp.71-81
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• 2023

Chronic obstructive pulmonary disease (COPD) affects close to 400 million people worldwide. COPD is characterized by significant airflow limitation on spirometry. Most patients with COPD are diagnosed in their fifth or sixth decades of life. However, the disease begins much earlier. By the time airflow limitation is detected on spirometry, patients with COPD have lost close to 50% of their small airways. Thus, identification of patients with early COPD, defined as persons with preserved spirometry, who demonstrate pathologic or functional hallmarks of COPD, is essential for disease modification and ultimately disease elimination. This paper provides an up-to-date overview of the current case definition of early COPD, its importance, the novel technologies required for its detection in young adults and future directions in therapeutics for treatment.

• Tuberculosis and Respiratory Diseases
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• 제59권4호
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• pp.374-379
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• 2005

배 경 : 폐확산능 ($D_LCO$)과 폐용적을 보정한 확산계수($D_LCO/VA$; KCO)는 폐포용적이 비 정상적인 경우 차이가 생긴다. 그러나, 기류제한으로 비 정상적인 폐포용적을 가지는 환자에서 이러한 차이의 의미는 연구되지 않았다. 본 연구는 기류제한이 있는 환자에서 기류제한의 호전에 따른 폐확산능과 확산계수의 변화를 연구하고자 한다. 방 법 : 기류제한이 있는 환자에서 기저 폐기능과 더불어 폐확산능을 측정하고, 일회호흡 $CH_4$ 희석법으로 폐포용적을 측정하였다. 기저치에 따라서 환자는 다음의 두 군으로 나누었다. 확산계수(예측치에 대한 백분율)와 확산능(예측치에 대한 백분율)의 비가 115%를 넘는 경우를 고차이군으로 하였고, 115% 미만인 경우를 저차이군으로 하였다. 기류제한을 치료 한 후 폐기능검사와 폐확산능을 반복해서 측정하였다. 결 과 : 고차이군과 저차이군의 기저 폐기능은 유의한 차이가 관찰되지 않았다. 두 군 모두 확산계수의 예측치에 대한 백분율은 평균 113%와 100%로 정상범위였다. 치료 후 추적 폐기능에서 $FEV_1$과 FVC는 저차이군에 비해 고차이군에서 증가하였다. 고차이군에서 치료 후 측정한 폐기능은 기저치에 비해 폐확산능과 폐포용적은 증가하였으나 저차이군에서는 유의한 차이는 관찰되지 않았다. 전폐용적과 잔기량은 치료 전후에 양군 모두에서 유의한 차이가 관찰되지 않았다. 결 론 : 기류제한이 있는 환자에서 확산계수는 정상 범위에 있지만 확산능이 감소한 경우 확산능이 감소하지 않은 환자에 비해 가역적인 기류폐색이 클 것으로 예측할 수 있다.