• Tuberculosis and Respiratory Diseases
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• 제68권3호
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• pp.125-139
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• 2010

Patients with chronic obstructive pulmonary disease (COPD) frequently complain of dyspnea on exertion and reduced exercise capacity, which has been attributed to an increase in the work of breathing and in impaired of gas exchange. Although COPD primarily affects the pulmonary system, patients with COPD exhibit significant systemic manifestations of disease progression. These manifestations include weight loss, nutritional abnormalities, skeletal muscle dysfunction (SMD), cardiovascular problems, and psychosocial complications. It has been documented that SMD significantly contributes to a reduced exercise capacity in patients with COPD. Ventilatory and limb muscle in these patients show structural and functional alteration, which are influenced by several factors, including physical inactivity, hypoxia, smoking, aging, corticosteroid, malnutrition, systemic inflammation, oxidative stress, apoptosis, and ubiquitin-proteasome pathway activation. This article summarizes briefly the evidence and the clinical consequences of SMD in patients with COPD. In addition, it reviews contributing factors and therapeutic strategies.

• Tuberculosis and Respiratory Diseases
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• 제81권3호
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• pp.228-232
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• 2018

Background: Chronic bronchitis (CB) is an important phenotype in chronic obstructive pulmonary disease (COPD). The purpose of this study is to evaluate different pattern of COPD assessment test (CAT) score between CB and non-CB patients. Methods: Patients were recruited from 45 centers in Korea, as part of the Korean COPD Subgroup Study cohort. CB was defined when sputum continued for at least 3 months. Results: Total 958 patients with COPD were eligible for analysis. Among enrolled patients, 328 (34.2%) were compatible with CB. The CAT score was significantly higher in patients with CB than non-CB, and each component of CAT score showed a similar result. CB was significantly associated with CAT score when adjusted with age, sex, modified Medical Research Council, and post-bronchodilator forced expiratory volume in 1 second. Each component of CAT score between patients with CB and non-CB showed different pattern according to Global Initiative for Chronic Obstructive Lung Disease grade. Conclusion: CAT score is significantly higher in patients with CB than non-CB. Each component of CAT score was significantly different between two groups.

• Tuberculosis and Respiratory Diseases
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• 제40권2호
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• pp.147-152
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• 1993

연구배경 : 만성폐쇄성폐질환에서 혈소판이 활성화되어 있는 근거가 있으며 이 질환의 예후 인자로 잘 알려진 폐동맥 고혈압이 활성화된 혈소판 및 손상된 내피세포가 관여하리라는 보고가 있다. 이에 만성폐쇄성폐질환에서 혈소판 활성화를 알아보고 혈소판 활성화가 폐동맥 고혈압에 미치는 영향을 알아보고자 연구를 시행하였다. 방법 : 대조군 및 만성폐쇄성폐질환의 폐동맥 정상혈압군과 고혈압군을 대상으로 혈소판 응집비 및 혈소판의 alpha-granule에 함유되어 있는 Platelet factor 4와 $\beta$-thromboglobulin을 측정하여 다음과 같은 결과를 얻었다. 결과: 1) Platelet aggregation ratio (PAR)는 대조군 $0.99{\pm}0.04$, 폐동맥 정상혈압군 $0.98{\pm}0.05$, 폐동맥 고혈압군 $0.89{\pm}0.08$으로 감소하는 추세를 보였으며, 폐동액 고혈압군에서 대조군보다 통계학적으로 의미 있게 감소 하였다(p<0.05) (Table 2, Fig. 1). 2) Platelet factor 4 (PF4, IU/ml)는 대조군 $4.7{\pm}1.2$, 폐동맥 정상혈압군 $18.6{\pm}4.9$, 폐동맥 고혈압군 $57.2{\pm}12.7$으로 만성폐쇄성폐질환에서 대조군보다 통계학적으로 의미 있게 증가 하였으며(p<0.01), 폐동맥 고혈압군에서 폐동맥 정상혈압군보다 통계학적으로 의미 있게 증가 하였다(p<0.01) (Table 2, Fig. 2). 3) Beta-thromboglobulin (${\beta}$-TG, IU/ml)은 대조군 $34.4{\pm}5.8$, 폐동맥 정상혈압군 $80.4{\pm}18.1$, 폐동맥 고혈압군 $93.0{\pm}14.0$으로 만성폐쇄성폐질환에서 대조군보다 통계학적으로 의미 있게 증가 하였으며(p<0.01) 폐동맥 고혈압군에서 폐동맥 정상혈압군보다 통계학적인 의미는 없지만 증가하는 경향을 보였다(Table 2, Fig.3). 4) 임상 소견과 PAR, PF4 및 ${\beta}$-TG 사이에는 상관 관계가 없었으나 PAR, PF4및 ${\beta}$-TG 사이에는 통계학적으로 의미 있는 상관관계를 보였다 (Table 3). 결론 : 만성폐쇄성폐질환에서 혈소판이 뚜렷이 활성화되어 있었으며 폐동맥 고혈압군에서 좀더 활성화되는 경향을 보였다. 따라서 만성폐쇄성폐질환에서 혈소판 활성화가 폐동맥 고혈압의 유발 및 유지에 관여할 것으로 사료되며 치료에 대한 연구가 필요할 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.116-122
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• 2018

Background: Chronic obstructive pulmonary disease (COPD) is a serious chronic condition with a global impact. Symptoms of COPD include progressive dyspnea, breathlessness, cough, and sputum production, which have a considerable impact on the lives of patients. In addition to the human cost of living with COPD and the resulting death, COPD entails a huge economic burden on the Chinese population, with patients spending up to one-third of the average family income on COPD management in some regions is clinically beneficial to adopt preventable measures via prudent COPD care utilization, monetary costs, and hospitalizations. Methods: Toward this end, this study compared the relative effectiveness of six indices in predicting patient healthcare utilization, cost of care, and patient health outcome. The six assessment systems evaluated included the three multidimensional Body mass index, Obstruction, Dyspnea, Exercise capacity index, Dyspnea, Obstruction, Smoking, Exacerbation (DOSE) index, and COPD Assessment Test index, or the unidimensional measures that best predict the future of patient healthcare utilization, cost of care, and patient health outcome among Chinese COPD patients. Results: Multiple linear regression models were created for each healthcare utilization, cost, and outcome including a single COPD index and the same group of demographic variables for each of the outcomes. Conclusion: We conclude that the DOSE index facilitates the prediction of patient healthcare utilization, disease expenditure, and negative clinical outcomes. Our study indicates that the DOSE index has a potential role beyond clinical predictions.

• Tuberculosis and Respiratory Diseases
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• 제87권1호
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• pp.80-90
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• 2024

Background: There are many methods of evaluating diaphragmatic function, including trans-diaphragmatic pressure measurements, which are considered the key rule of diagnosis. We studied the clinical usefulness of chest ultrasonography in evaluating stable chronic obstructive pulmonary disease (COPD) patients and those in exacerbation, focusing on diaphragmatic measurements and their correlation with spirometry and other clinical parameters. Methods: In a prospective case-control study, we enrolled 100 COPD patients divided into 40 stable COPD patients and 60 patients with exacerbation. The analysis included 20 age-matched controls. In addition to the clinical assessment of the study population, radiological evaluation included chest radiographs and chest computed tomography. Transthoracic ultrasonography (TUS) was performed for all included subjects. Results: Multiple A lines (more than 3) were more frequent in COPD exacerbation than in stable patients, as was the case for B-lines. TUS significantly showed high specificity, negative predictive value, positive predictive value, and accuracy in detecting pleural effusion, consolidation, pneumothorax, and lung mass. Diaphragmatic measurements were significantly lower among stable COPD subjects than healthy controls. Diaphragmatic thickness and excursion displayed a significant negative correlation with body mass index and the dyspnea scale, and a positive correlation with spirometry measures. Patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D showed lower diaphragmatic measurements (thickness and excursion). Conclusion: The TUS of COPD patients both in stable and exacerbated conditions and the assessment of diaphragm excursion and thickness by TUS in COPD patients and their correlations to disease-related factors proved informative and paved the way for the better management of COPD patients.

• 근관절건강학회지
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• 제23권3호
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• pp.159-168
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• 2016

Purpose: The purpose of this study was to identify the factors influencing health-related quality of life (HRQOL) of patients with chronic obstructive pulmonary disease (COPD). Methods: A sample of 108 Patients diagnosed with COPD was recruited from outpatients, at a university hospital. Data were collected from February to April in 2016 using the St. George's Respiratory Questionnaire, the Hospital Anxiety-Depression Scale, and the COPD Self-efficacy scale. Results: The average score of HRQOL was 47.56 in patients with COPD. Results of the regression analysis showed that dyspnea phase (${\beta}$=.34, p<.001) and presence or absence of oxygen (${\beta}$=.20, p=.009), anxiety (${\beta}$=.29, p<.001), $FEV_1$ % predicted (${\beta}$=-.15, p=.014) were statistically significant in patients' HRQOL. Conclusion: The research findings show that dyspnea phase and anxiety among psychological factors were the most powerful factors that explain the HRQOL of COPD patients when the demographic and disease characteristics were controlled. Identification of quality of life-related factors should be used to inform targeted interventions, in order to improve HRQOL and help patients' cope.

• Tuberculosis and Respiratory Diseases
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• 제71권4호
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• pp.254-258
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• 2011

Background: Although the aging process and features of chronic obstructive pulmonary disease (COPD) have several similarities, the relationship between aging and COPD pathogenesis remains incompletely understood. The klotho gene was found to be related to premature aging and emphysematous changes in an animal model. We investigated whether klotho gene polymorphisms are related to COPD susceptibility and emphysema severity. Methods: A total of 219 COPD subjects from the Korean Obstructive Lung Disease Cohort and 305 control subjects were genotyped for two single nucleotide polymorphisms (SNPs) of the klotho gene associated with coronary artery disease. Logistic regression was performed to determine the association of these SNPs with COPD susceptibility and linear regression was performed to investigate their association with emphysema severity in COPD subjects. Results: The mean age of the COPD subjects was 66 years and their mean FEV1 was 1.46 L. There were no associations between either SNP or COPD susceptibility (p=0.6 and 0.2, respectively) and there were no associations with emphysema severity. Conclusion: Genetic polymorphisms of the klotho gene were not associated with COPD in a Korean population.

• IMMUNE NETWORK
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• 제10권4호
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• pp.109-114
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• 2010

The molecular mechanisms involved in the pathogenesis of chronic obstructive pulmonary disease (COPD) are poorly defined. Accumulating evidences indicate that chronic inflammatory responses and adaptive immunity play important roles in the development and progression of the disease. Recently, it has been shown that IL-17 producing CD4 T cells, named Th17 cells, which have been implicated in the pathogenesis of several inflammatory and autoimmune diseases, are involved in airway inflammation and COPD. In addition, we and others suggest that autoimmunity may play a critical role in the pathogenesis of COPD. Here, we will review the current understanding of roles of Th17 cells and autoimmune responses in COPD.

• Korean Journal of Radiology
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• 제20권4호
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• pp.683-692
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• 2019

Objective: We aimed to evaluate correlations between computed tomography (CT) parameters and pulmonary function test (PFT) parameters according to disease severity in patients with chronic obstructive pulmonary disease (COPD), and to determine whether CT parameters can be used to predict PFT indices. Materials and Methods: A total of 370 patients with COPD were grouped based on disease severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) I-IV criteria. Emphysema index (EI), air-trapping index, and airway parameters such as the square root of wall area of a hypothetical airway with an internal perimeter of 10 mm (Pi10) were measured using automatic segmentation software. Clinical characteristics including PFT results and quantitative CT parameters according to GOLD criteria were compared using ANOVA. The correlations between CT parameters and PFT indices, including the ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) and FEV₁, were assessed. To evaluate whether CT parameters can be used to predict PFT indices, multiple linear regression analyses were performed for all patients, Group 1 (GOLD I and II), and Group 2 (GOLD III and IV). Results: Pulmonary function deteriorated with increase in disease severity according to the GOLD criteria (p < 0.001). Parenchymal attenuation parameters were significantly worse in patients with higher GOLD stages (P < 0.001), and Pi10 was highest for patients with GOLD III (4.41 ± 0.94 mm). Airway parameters were nonlinearly correlated with PFT results, and Pi10 demonstrated mild correlation with FEV1/FVC in patients with GOLD II and III (r = 0.16, p = 0.06 and r = 0.21, p = 0.04, respectively). Parenchymal attenuation parameters, airway parameters, EI, and Pi10 were identified as predictors of FEV₁/FVC for the entire study sample and for Group 1 (R² = 0.38 and 0.22, respectively; p < 0.001). However, only parenchymal attenuation parameter, EI, was identified as a predictor of FEV₁/FVC for Group 2 (R² = 0.37, p < 0.001). Similar results were obtained for FEV₁. Conclusion: Airway and parenchymal attenuation parameters are independent predictors of pulmonary function in patients with mild COPD, whereas parenchymal attenuation parameters are dominant independent predictors of pulmonary function in patients with severe COPD.

• 대한간호학회지
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• 제33권1호
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• pp.9-16
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• 2003

Purpose : The objective of this study was the development and validation of a scale to measure the self-care of patients with chronic obstructive pulmonary disease(COPD) in Korea. Method: Self-care scale was developed based on the self-care activities patients had to carry out in order to manage their COPD. The original scale contained 34 items rated along a five-point Likert scale and was reviewed by 18 professional nurses and 10 Korean patients with COPD for content validity. Subsequently, patients with COPD were asked to complete this 23-item scale and further tests were done with the 125 useable responses. Result: Factor analysis identified eight factors-'maintaining a clean air way', 'taking medication', 'support from family', 'preventing infection', 'managing symptoms', 'breathing exercising', and 'taking in nutrition'. The internal consistency of the total scale was Cronbach's α=0.7226. These eight factors explained 60.8% of total variance. There was correlation among Korean Self-Care Scale score, administration level, and knowledge level but there was no correlation to patients' satisfaction with medical services. Conclusion: The 23 item questionnaire positively identified 8 areas defined important for COPD patients. Further studies are required to see how these can be integrated into patient education.