• Journal of Preventive Medicine and Public Health
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• v.39 no.4
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• pp.309-316
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• 2006

Objectives: Korean epidemiological studies have used reduced samples according to the subject's characteristics, such as the health services provided, the historical note with asthma, and age, to examine the acute effect of air pollution on asthma using the Korean National Health Insurance records. However, there have been few studies on whether the effects shown in these reduced samples are different from those of all samples. This study compared the effects of air pollution on asthma attacks in three reduced samples with those of entire samples. Methods: The air pollution data for $PM_{10},\;CO,\;SO_2,\;NO_2,\;and\;O_3$, and weather conditions including temperature, relative humidity, and air pressure in Seoul, 2002, were obtained from outdoor monitoring stations in Seoul. The emergency hospital visits with an asthma attack in Seoul, 2002 were extracted from the Korean National Health Insurance records. From these, the reduced samples were created by health service, historical notes with asthma, and age. A case-crossover design was adopted and the acute effects of air pollution on asthma were estimated after adjusting for weather, time trend, and seasonality. The model was applied to each reduced sample and the entire sample. Results: With respect to the health service, the effects on outpatients were similar to those for the total sample but were different for inpatients. These similar effect sizes were also observed in the reduced samples according to the historical note with asthma and age. The relative risks of $PM_{10},\;CO,\;SO_2,\;NO_2,\;and\;O_3$, among the reduced and entire samples were 1.03, 1.04-1.05, 1.02-1.03, 1.04-1.06, and 1.10-1.17, respectively. Conclusions: There was no clear evidence to show a difference between the reduced samples and the entire samples.

• Molecules and Cells
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• v.44 no.8
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• pp.580-590
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• 2021

Patients with severe asthma have unmet clinical needs for effective and safe therapies. One possibility may be mesenchymal stem cell (MSC) therapy, which can improve asthma in murine models. However, it remains unclear how MSCs exert their beneficial effects in asthma. Here, we examined the effect of human umbilical cord blood-derived MSCs (hUC-MSC) on two mouse models of severe asthma, namely, Alternaria alternata-induced and house dust mite (HDM)/diesel exhaust particle (DEP)-induced asthma. hUC-MSC treatment attenuated lung type 2 (Th2 and type 2 innate lymphoid cell) inflammation in both models. However, these effects were only observed with particular treatment routes and timings. In vitro co-culture showed that hUC-MSC directly downregulated the interleukin (IL)-5 and IL-13 production of differentiated mouse Th2 cells and peripheral blood mononuclear cells from asthma patients. Thus, these results showed that hUC-MSC treatment can ameliorate asthma by suppressing the asthmogenic cytokine production of effector cells. However, the successful clinical application of MSCs in the future is likely to require careful optimization of the route, dosage, and timing.

• Tuberculosis and Respiratory Diseases
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• v.85 no.3
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• pp.227-236
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• 2022

Background: The use of low-dose inhaled corticosteroid-formoterol as reliever monotherapy has recently been recommended in the asthma treatment guidelines. However, the efficacy of this treatment strategy has not yet been determined during the stepping-down period in moderate asthma. This study aimed to evaluate the feasibility of reducing treatment to as-needed budesonide-formoterol (BFM) in moderate asthma with complete remission. Methods: We randomly assigned 31 patients (8 males and 23 females with a mean age of 57.2 years) with complete remission of asthma by inhaled BFM (160/4.5 ㎍) twice daily to receive BFM (160/4.5 ㎍) as needed (16 patients), or budesonide (BUD) (200 ㎍) twice daily (15 patients). The study was an open-label study done for 48 weeks, with the primary outcome as the cumulative percentages of patients with treatment failure (asthma exacerbation or loss of asthma control or lack of satisfaction after using medications) in the two groups. Results: Six patients (42%) using as-needed BFM had treatment failure, as compared with three patients (21.4%) using BUD maintenance (hazards ratio for as-needed BFM, 1.77; 95% confidential interval, 0.44-7.12; p=0.41). The changes in forced expiratory volume in 1 second were -211.3 mL with as-needed BFM versus -97.8 mL with BUD maintenance (difference, 113.5 mL; p=0.75) and the change in fractional exhaled nitric oxide was significantly higher in both groups, at 8.68 parts per billion (ppb) in the as-needed BFM group and 2.5 ppb. in the BUD maintenance group (difference, 6.18 ppb; p=0.049). Conclusion: Compared with BUD maintenance, there were no significant differences in treatment failure rate in patients who received as-needed BFM during the stepping down period in moderate asthma. However, they showed reduced lung function and relapsed airway inflammation. The results are limited by imprecision, and further large RCTs are needed.

• Tuberculosis and Respiratory Diseases
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• v.86 no.3
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• pp.158-165
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• 2023

Asthma is a chronic inflammatory airway disease that is characterized by variable airflow obstruction. The Korean Asthma Study Group of the Korean Academy of Tuberculosis and Respiratory Diseases has recently updated the Korean Asthma Guideline. This review summarizes the updated Korean Asthma Guideline. Asthma prevalence is increasing worldwide, and in Korea. Variable airflow obstruction can be confirmed by bronchodilator response or other tests, and should be established prior to the controller medication. A low-dose inhaled corticosteroid-formoterol is used to alleviate symptoms in all treatment step, and it can be used as a controller as well as reliever in steps 3-5. This approach is preferred, because it reduces the risk of severe exacerbations, compared to the use of short-acting β2-agonist as reliever. In severe asthma, phenotype/endotype based on the underlying inflammation should be evaluated. For type 2 severe asthma, the biologics should be considered.

• Journal of Korean Society of Industrial and Systems Engineering
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• v.46 no.4
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• pp.32-38
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• 2023

This study investigates the influence of particulate matter concentrations on the incidence of asthma, focusing on the delayed onset of symptoms and subsequent medical consultations. Analysis incorporates a four-day lag from the initiation of fine dust exposure and compares asthma patterns before and after the World Health Organization's (WHO) classification of fine dust as a Group 1 carcinogen in November 2013. Utilizing daily PM10 data and asthma-related medical visit counts in Seoul from 2008 to 2016, the study additionally incorporates Google search frequencies and newspaper article counts on fine dust to assess public awareness. Results reveal a surge in search frequencies and article publications after WHO announcement, indicating heightened public interest. To standardize the long-term asthma occurrence trend, the daily asthma patient numbers are ratio-adjusted based on annual averages. The analysis uncovers an increase in asthma medical visits 2 to 3 days after fine dust events. Additionally, greater public awareness of fine dust hazards correlates with a significant reduction in asthma occurrence after such events, even within 'normal' fine dust concentrations. Notably, behavioral changes, like limiting outdoor activities, contribute to this decrease. This study highlights the importance of analyzing accumulated medical data over an extended period to identify general public behavioral patterns, deviating from conventional survey methods in social sciences. Future research aims to extend data collection beyond 2016, exploring recent trends and considering the potential impact of decreased fine dust awareness amid the COVID-19 pandemic.

• The Journal of Pediatrics of Korean Medicine
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• v.37 no.4
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• pp.70-90
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• 2023

Objective This study analyzed randomized clinical trials (RCTs) on pediatric asthma using traditional Chinese medicine (TCM) to determine its efficacy and safety. Methods We searched electronic databases in English, Chinese, Japanese, and Korean and evaluated 35 articles published up to December 28, 2022. Based on data from the literature, we analyzed treatments, results, composition of herbal medicine, frequency of medicinal herbs, and decoction. Results TCM for pediatric asthma was compared to supportive therapy, inhaled corticosteroids, and standardized treatments. Of the 35 studies, 32 showed that TCM treatments were effective in alleviating asthma symptoms. Furthermore, TCM treatment was considered safe compared to common asthma treatments. Among the TCM treatments for pediatric asthma, the most frequent decoctions were Gamisaganmahwangtang (加味射干麻黃湯) and Saganmahwangtang (射干麻黃湯). Ephedra Herba (麻黄), Armeniacae Semen (杏仁), Asiasari Radix et Rhizoma (細辛), Belamcandae Rhizoma (射干) were herbs that were frequently used for asthma in TCM decoctions. Conclusion This review showed that TCM is effective in treating pediatric asthma. More clinical RCTs are needed to confirm the efficacy and safety of TCM treatment.

• Clinical and Experimental Pediatrics
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• v.48 no.3
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• pp.251-259
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• 2005

Atopy is a highly prevalent and serious health problem. The prevalence and severity of asthma and allergic diseases have increased over recent decades, particularly in industrialized nations. Early life infections may protect against the development of atopy and allergic diseases like asthma. The inverse relationship between the incidence of atopy and childhood infections has led to the 'hygiene hypothesis', which suggests that diminished exposure to childhood infections in modern society has led to decreased Th1-type responses. Th1 and Th2 responses are counter-regulatory. Reduced Th1 may lead to enhanced Th2-type inflammation, which is important in promoting asthma and allergic disease via up-regulation of IL-4, IL-5, and IL-13. It is now widely accepted that altered regulation of Th2 responses(and possibly the balance between Th1 and Th2 responses) is an important factor in the development of atopy. CpG DNA represent a novel class of drugs with substantial immunomodulatory properties. CpG DNA contain unmethylated motifs centered on the CpG dinucleotides, like bacterial DNA. These CpG DNA promote Th1 and regulatory type immune responses and suppress Th2 responses. In murine studies, CpG DNA are effective in prevention and treatment of asthma and allergic diseases. CpG DNA are just beginning to be tested in human asthma. While its precise mechanisms continue to be fully studied, CpG DNA offers considerable promise as a novel treatment for atopic inflammation. It may prove to be an important disease modifying therapy, or even curative therapeutic agent for asthma and allergic diseases.

• Korean Journal of Adult Nursing
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• v.16 no.4
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• pp.617-625
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• 2004

Purpose: The purpose of this study was to investigate the effect of the asthma management educational program given to the allergic asthmatics receiving immunotherapy due to house dust mite on the disease related to knowledge, stress, and self-efficacy. Method: The subjects of this study were the patients received immunotherapy to house dust mite at a week interval after being diagnosed for house dust mite allergic asthma at the respiratory center of a hospital affiliated to the university. They were divided into the experimental group of 29 patients who received asthma management education, the control group of 32 patients, and 61 patients in total. Experimental treatment, as an asthma management educational program, was the group education of one time and the reinforcement education of three times with environmental therapy and immunotherapy to house dust mite. Results: The results revealed that the improvement in disease related knowledge, the improvement in self-efficacy and the decrease in stress, were significantly higher in the experimental group than the control group. Conclusions: The asthma management educational program had an effect on improving the disease related knowledge and self-efficacy, and decreasing the stress of the patients asthmatics allergic to house dust mite.

• Korean Journal of Acupuncture
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• v.25 no.2
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• pp.87-94
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• 2008

Objectives : The aim of this study was to find out some rationales for using Hominis placental extract(HPE) pharmaco-acupuncture on asthmatic patients, and to suggest an appropriate clinical research of HPE pharmaco-acupuncture on asthma. Methods : Articles regarding immunologic experiments about HPE and clinical reports about HPE-contained pharmaco-acupuncture on asthmatic patients were reviewed by on-line and off-line searching. Results and Conclusions : HPE is suggested to have several pharmacological effects on allergic diseases including asthma as well as autoimmune diseases. There are some observational studies of HPE-contained pharmaco-acupuncture on asthmatic patients. However, the designs of these studies are not sufficient to investigate the exact effect of HPE pharmaco-acupuncture on asthma. To investigate HPE pharmaco- acupuncture as a novel asthma therapy, it will be needed to perform further experiments about HPE's pharmacological mechanism on asthma and to try further advanced clinical researches such as well-designed randomized controlled trial of HPE pharmaco-acupuncture.

• Tuberculosis and Respiratory Diseases
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• v.80 no.1
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• pp.11-20
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• 2017

Approximately one in four patients with chronic obstructive pulmonary disease (COPD) have asthmatic features consisting of wheezing, airway hyper-responsiveness or atopy. The Global initiative for Asthma/Globalinitiative for chronic Obstructive Lung Disease committee recently labelled these patients as having asthma-COPD overlap syndrome or ACOS. ACOS also encompasses patients with asthma, ${\geq}40$ years of age, who have been cigarette smokers (more than 5-10 pack years) or have had significant biomass exposure, and demonstrate persistent airflow limitation defined as a post-bronchodilator forced expiratory volume in 1 second ($FEV_1$)/forced vital capacity of <70%. Data over the past 30 years indicate that patients with ACOS have greater burden of symptoms including dyspnea and cough and show higher risk of COPD exacerbations and hospitalizations than those with pure COPD or pure asthma. Patients with ACOS also have increased risk of rapid $FEV_1$ decline and COPD mortality. Paradoxically, experimental evidence to support therapeutic decisions in ACOS patients is lacking because traditionally, patients with ACOS have been systematically excluded from therapeutic COPD and asthma trials to maintain homogeneity of the study population. In this study, we summarize the current understanding of ACOS, focusing on definitions, epidemiology and patient prognosis.