• Tuberculosis and Respiratory Diseases
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• 제59권5호
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• pp.497-503
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• 2005

연구배경 : 호흡기 바이러스 감염은 천식 및 만성폐쇄성폐질환의 악화와 관련이 있다고 알려져 있지만 국내의 자료는 충분치 않다. 방 법 : 급성 악화로 한림대학교 성심병원에 내원한 천식환자 20명과 COPD 환자 24명을 대상으로 비강 분비물과 객담에서 PCR과 배양을 통해 호흡기 바이러스를 검출하였다. rhinovirus, coronavirus는 PCR을, influenza A, B, RSV, parainfluenza virus는 배양을 통해 바이러스를 검출하였다. 결 과 : 천식의 급성 악화로 내원한 환자의 평균 연령은 45.4(${\pm}16.7$)세였고, 평소 $FEV_1/FVC$는 1.9/2.9L(65.5%)였다. 급성 악화 시 13예(13/20, 65%)에서 바이러스가 검출되었으며 rhinovirus 9예, coronavirus 2예, influenza A 2예, RSV 1예, parainfluenza virus가 1예였다. rhinovirus와 coronavirus, rhinovirus와 RSV가 동시에 검출된 예가 각각 1예가 있었다. COPD 환자의 평균 연령은 71.5(${\pm}8.4$)세였으며, 평소 $FEV_1/FVC$는 1.1/2.6L(42.3%)였고, 악화 시 14예(14/24, 58.3%)에서 바이러스가 검출되었다. rhinovirus 10예, coronavirus 3예, influenza A가 4예였으며 2예에서 rhinovirus와 coronavirus가 동시에 검출되었고, 1예에서 rhinovirus와 influenza A가 동시에 검출되었다. 결 론 : 호흡기 바이러스 감염은 국내에서도 천식 및 COPD 악화의 주요한 요인이 될 것으로 생각되며, 천식 및 COPD 환자의 악화에서 치료에 있어서 항생제 사용에 주의하여야 할 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제61권5호
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• pp.433-439
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• 2006

연구배경: COPD 환자에서 천식을 동반한 환자들이 많이 있다고 보고 되어 있었고 기관지 과민성이 높은 비율로 보고되어 메타콜린 기관지유발검사가 이두 질환을 감별에 어떤 의의가 있는지 알아보았고, 치료에 대한 도움을 얻고자 연구하였다. 방 법: 전북대학교병원에서 2004년 1월부터 2004년 12월까지 메타콜린 기관지유발검사를 시행한 환자를 대상으로 전향적으로 연구하였다. 65명의 천식환자 23명의 COPD환자, 대조군에서 메타콜린 기관지유발검사를 분석하였다. 결 과: 각 군의 $PC_{20}$의 평균값은 천식군, COPD군 및 대조군에서 각각 $8.1{\pm}1.16$, $16.9{\pm}2.21$ 과 $22.0{\pm}1.47mg/mL$이고, 천식군, COPD군 및 대조군의 메타콜린 기관지유발검사의 양성율은 각각 65%, 30%와 9%였다. 메타콜린 기관지유발검사 양성 판정 기준을 $PC_{20}$ 16 mg/mL 이하로 가정할 때 천식군과 COPD군의 양성율은 80%와 30%이었고 민감도, 특이도, 양성예측률 및 음성예측률은 각각 80%, 75%, 78%와 78%였다. 결 론: 메타콜린 기관지유발검사의 양성기준을 $PC_{20}{\leq}16mg/mL$으로 하였을 때 천식 및 COPD가 동반된 천식과 순수한 COPD의 감별에 보다 많은 도움을 줄 것으로 예상되며 궁극적으로 COPD 환자들에게 보다 개별적이고 적절한 치료적 접근에 도달할 수 있도록 해주는 진단 방법 중 하나가 될 수 있다고 생각한다.

• Tuberculosis and Respiratory Diseases
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• 제59권2호
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• pp.164-169
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• 2005

연구배경 : ICS/LABA는 천식에서 효과가 입증되었으나 COPD에서는 덜 알려져 있다. 최근 COPD 환자에서 고용량의 ICS/LABA의 사용시 급성악화를 줄인다고 보고되고 있다. 본 연구는 중등도와 고용량의 ICS/LABA사용시 용량에 차이에 따른 COPD의 급성악화를 비교하였다. 방 법 : 2001년 1월 1일부터 2004년 8월 31일 사이에 고대안암병원에 내원하여 진단된 46명의 중등증 이상의 COPD 환자를 대상으로 하였다. flu/sal $250{\mu}g/50{\mu}g$ 하루 2번 사용한 군(A군)과 flu/sal $500{\mu}g/50{\mu}g$ 하루 2번 사용한 군(B군)으로 나누어 1년 기간 동안 급성악화의 횟수 및 입원 횟수, 처음악화까지 걸린 기간을 분석하였다. 결 과 : A 군 26명중 11명에서 급성악화를 경험하였고, 평균 악화 횟수는 0.96회, 입원횟수는 0.15 회였다. B군 20명중 11명에서 급성 악화를 경험하였고 평균 악화 횟수는 1.05회, 입원횟수는 0.30 회였다. 두 군간에 통계적으로 유의한 차이가 없었고 처음악화까지 걸린 시간도 차이가 없었다. 결 론 : 중등증 이상의 COPD 환자에서 ICS 와 LABA 복합제제를 사용 할 때 고농도와 중등도 용량에서 급성 악화에 미치는 영향은 통계적으로 차이가 없었다. 향후 COPD 에서 ICS/LABA 사용시 효과적인 용량에 대한 연구가 좀 더 필요할 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제71권3호
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• pp.195-201
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• 2011

Background: Osteopontin (Opn) is recognized as an important adhesive bone matrix protein and a key cytokine involved in immune cell recruitment and tissue repair and remolding. However, serum levels of osteopontin have not been evaluated in patients with chronic obstructive pulmonary disease (COPD). Thus, the aim of this study was to evaluate and compare the serum levels of osteopontin in patients experiencing COPD exacerbations and in patients with stable COPD. Methods: Serum samples were obtained from 22 healthy control subjects, 18 stable COPD patients, and 15 COPD with exacerbation patients. Serum concentrations of osteopontin were measured by the ELISA method. Results: Serum levels of osteopontin were higher in patients with acute exacerbation than with stable COPD and in healthy control subjects ($62.4{\pm}51.9ng/mL$, $36.9{\pm}11.1ng/mL$, $30{\pm}11ng/mL$, test for trend p=0.003). In the patients with COPD exacerbation, the osteopontin levels when the patient was discharged from the hospital tended to decrease compared to those at admission ($45{\pm}52.1ng/mL$, $62.4{\pm}51.9ng/mL$, p=0.160). Osteopontin levels significantly increased according to patient factors, including never-smoker, ex-smoker and current smoker ($23{\pm}5.7ng/mL$, $35.5{\pm}17.6ng/mL$, $58.6{\pm}47.8ng/mL$, test for trend p=0.006). Also, osteopontin levels showed a significantly negative correlation with forced expiratory volume in one second ($FEV_1$%) predicted in healthy controls and stable COPD patients (r=-0.389; p=0.013). C-reactive protein (CRP) was positively correlated with osteopontin levels in patients with COPD exacerbation (r=0.775; p=0.002). Conclusion: The serum levels of osteopontin increased in patients with COPD exacerbation and tended to decrease after clinical improvement. These results suggest the possible role of osteopontin as a biomarker of acute exacerbation of COPD.

• Tuberculosis and Respiratory Diseases
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• 제57권6호
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• pp.567-572
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• 2004

배 경 : 인공 호흡기 치료 중 auto-PEEP을 보이는 환자에게 PEEP을 적용할 경우에 폐 용적에 미치는 영향은 일정하지 않다. COPD와 같이 동적 호기류 제한이 있는 경우에 auto-PEEP 수치의 85%에 해당하는 PEEP까지는 안전하게 적용할 수 있으나, 동적 호기류 제한이 없으면 낮은 PEEP에서도 폐 용적의 증가가 나타난다. 이에 저자들은 auto-PEEP이 있는 환자에서 임상진단에 의한 질환별로 PEEP적용의 효과에 차이가 있는지 보고자 하였다. 대상 및 방법 : 인공 호흡 중 auto-PEEP을 보인 환자 16명을 대상으로 병력, 임상 증상 및 흉부방사선 소견을 기준으로 천식, COPD, 결핵성 변화군 등 3가지 환자 군으로 분 류한 뒤 각각 auto-PEEP 수치의 25, 50, 75, 100%에 해당하는 PEEP을 적용하고 포획 가스용적을 측정하여 폐 용적의 증가를 비교하였다. 결 과 : 천식 환자 군에서는 75% PEEP부터 폐 용적의 증가가 의미 있게 나타났다. COPD 군에서는 100% PEEP에서 폐 용적이 증가 하였다. 결핵성 변화 군에서는 낮은 PEEP에서도 폐 용적이 증가하는 경향을 보였으나 통계적으로 의미 있는 증가는 100% PEEP에서만 나타났다. 결 론 : Auto-PEEP을 보이는 환자에서 폐 용적에 대한 PEEP의 효과는 폐의 병리 상태에 따라 달랐다. 천식 환자 군에서는 auto-PEEP 수치의 50%이상에 해당하는 PEEP 적용은 포획 가스 용적의 증가를 가져올 수 있다.

• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.123-131
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• 2018

Background: Chronic obstructive pulmonary disease (COPD) may cause changes in the shape of the thoracic cage by increasing lung volume and hyperinflation. This study investigated changes in thoracic cage dimensions and related factors in patients with COPD. Methods: We enrolled 85 patients with COPD (76 males, 9 females; mean age, $70.6{\pm}7.1years$) and 30 normal controls. Thoracic cage dimensions were measured using chest computed tomography at levels 3, 6, and 9 of the thoracic spine. We measured the maximal transverse diameter, mid-sagittal anteroposterior (AP) diameter, and maximal AP diameter of the right and left hemithorax. Results: The average AP diameter was significantly greater in patients with COPD compared with normal controls ($13.1{\pm}2.8cm$ vs. $12.2{\pm}1.13cm$, respectively; p=0.001). The ratio of AP/transverse diameter of the thoracic cage was also significantly greater in patients with COPD compared with normal controls ($0.66{\pm}0.061$ vs. $0.61{\pm}0.86$; p=0.002). In COPD patients, the AP diameter of the thoracic cage was positively correlated with body mass index (BMI) and 6-minute walk test distance (r=0.395, p<0.001 and r=0.238, p=0.028) and negatively correlated with increasing age (r=-0.231, p=0.034). Multiple regression analysis revealed independent correlation only between BMI and increased ratio of AP/transverse diameter of the thoracic cage (p<0.001). Conclusion: Patients with COPD exhibited an increased AP diameter of the thoracic cage compared with normal controls. BMI was associated with increased AP diameter in these patients.

• Tuberculosis and Respiratory Diseases
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• 제69권4호
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• pp.243-249
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• 2010

Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and mortality worldwide. The aim of this study was to evaluate the risk factors associated with recurrent hospital admissions for exacerbation of COPD in Korea. Methods: A retrospective study of 77 consecutive patients hospitalized for exacerbation of COPD at Pusan National University Hospital during the time period January 2005 to May 2008 was performed. The information was collected from the hospitalization period: clinical information, spirometric measures, and laboratory variables. In addition, socioeconomic characteristics, co-morbidity, anxiety, and depression were reviewed. Frequent readmission was defined as 2 or more hospitalizations in the year following discharge. Results: During the 1-year period after discharge, 42 patients (54.6%) reported one hospital admission and 35 patients (45.4%) reported 2 or more hospital readmissions. Among the 35 frequent readmission patients, 4 had more than 10 readmissions. Univariate analysis showed that a body mass index (BMI) <$18.5kg/m^2$, duration >36 months, forced expiratory volume in 1 second ($FEV_1$) <50% predicted, arterial $CO_2$ partial pressure ($PaCO_2$) >40 mm Hg, and arterial oxygen saturation ($SaO_2$) <95% at discharge were associated significantly with frequent readmissions. The multivariate analysis revealed that BMI <$18.5kg/m^2$, $PaCO_2$ >40 mm Hg at discharge were independently associated with frequent readmissions for exacerbation of COPD. Conclusion: Frequent readmissions for exacerbation of COPD were associated with low BMI and hypercapnia at discharge.

• Tuberculosis and Respiratory Diseases
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• 제80권3호
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• pp.230-240
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• 2017

Chronic obstructive pulmonary disease (COPD) results in high morbidity and mortality among patients both domestically and globally. The Korean clinical practice guideline for COPD was revised in 2014. It was drafted by the members of the Korean Academy of Tuberculosis and Respiratory Diseases, as well as participating members of the Health Insurance Review and Assessment Service, Korean Physicians' Association, and Korea Respiration Trouble Association. This revised guideline covers a wide range of topics, including the epidemiology, diagnosis, assessment, monitoring, management, exacerbation, and comorbidities of COPD in Korea. We drafted a guideline on COPD management by performing systematic reviews on the topic of management with the help of a meta-analysis expert. We expect this guideline will be helpful medical doctors treating patients with respiratory conditions, other health care professionals, and government personnel in South Korea.

• 대한간호학회지
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• 제51권6호
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• pp.720-731
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• 2021

Purpose: The purpose of this study was to identify the knowledge structure of health information (HI) for chronic obstructive pulmonary disease (COPD). Methods: Keywords or meaningful morphemes from HI presented on five health-related websites (HRWs) of one national HI institute and four hospitals, as well as HI needs among patients presented in nine literature, were reviewed, refined, and analyzed using text network analysis and their co-occurrence matrix was generated. Two networks of 61 and 35 keywords, respectively, were analyzed for degree, closeness, and betweenness centrality, as well as betweenness community analysis. Results: The most common keywords pertaining to HI on HRWs were lung, inhaler, smoking, dyspnea, and infection, focusing COPD treatment. In contrast, HI needs among patients were lung, medication, support, symptom, and smoking cessation, expanding to disease management. Two common sub-topic groups in HI on HRWs were COPD overview and medication administration, whereas three common sub-topic groups in HI needs among patients in the literature were COPD overview, self-management, and emotional management. Conclusion: The knowledge structure of HI on HRWs is medically oriented, while patients need supportive information. Thus, the support system for self-management and emotional management on HRWs must be informed according to the structure of patients' needs for HI. Healthcare providers should consider presenting COPD patient-centered information on HRWs.

• Physical Therapy Rehabilitation Science
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• 제12권3호
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• pp.229-239
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• 2023

Objective: Patients with chronic obstructive pulmonary disease (COPD) may experience reduced physical activity and quality of life (QoL) due to decreased pulmonary function. The purpose of this study was to investigate the level of pulmonary function, physical activity, and QoL of COPD patients. Design: Cross-sectional observational study. Methods: This study examined the published data of the Korea National Health and Nutrition Examination Survey in 2015-2019. Among 39,759 subjects who participated for 5 years, data from 151 patients diagnosed with COPD were analyzed separately. For the pulmonary function, the results of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV6, forced expiratory flow 25-75%, and peak expiratory flow were observed. Physical activity was identified as frequency and duration. For the QoL, EQ-5D-3L evaluation results were examined, and the frequency and index of the Korean version were investigated. Results: In pulmonary function, all variables were found to be lower than age and weighted matched normal values. COPD patients showed to perform very low levels of high/medium physical activity and sitting time was confirmed to be more than 8 hours a day. In QoL, it was found that the highest reporting rate of some problems was the "pain and discomfort" and "mobility". Conclusions: It was found that COPD patients showed that the prevalence of circulatory disease was relatively high, lowered pulmonary function, and QoL. These can be improved through regular physical activity, and it is thought that this can be achieved through optimization of pulmonary rehabilitation.