• 대한영상의학회지
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• 제84권4호
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• pp.900-910
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• 2023

목적 정상으로 보이는 chest CT를 정량화 분석하여 흡연 및 폐쇄성 폐질환(chronic obstructive pulmonary disease; 이하 COPD) 여부에 따른 차이가 있는지 확인하고자 하였다. 대상과 방법 2013년 1월부터 2014년 12월까지 chest CT가 정상이면서 정량화 분석이 있는 90명의 남자 환자[COPD 없는 비흡연자(n = 38)와 흡연자(n = 45), COPD 흡연자(n = 7)]를 대상으로 하였다. COPD 흡연자 7명을 대상으로 나이를 추출하여 환자-대조군 연구도 하위 분석하였다. Pi10, 왜도, 첨도, 평균감쇠계수, 저감쇠영역%와 같은 정령화 변수를 분석하였다. 결과 COPD가 없는 환자 중에서 흡연자의 Pi10 (4.176 ± 0.282, n = 45)이 비흡연자에 비해 약 0.1 mm 정도 두꺼웠고(4.070 ± 0.191, n = 38, p = 0.047), 흡연자의 왜도와 첨도(2.628 ± 0.484 and 6.448 ± 3.427)가 비흡연자보다 낮았다(2.884 ± 0.624, p = 0.038 and 8.594 ± 4.944, p = 0.027). COPD가 있는 흡연자들의 Pi10 (4.427 ± 0.437, n = 7)이 COPD가 없는 비흡연자들보다 약 0.4 mm 두꺼웠다(4.001 ± 0.108, n = 14, p = 0.005). 그러나 평균감쇠계수와 저감쇠영역%에서는 유의한 차이가 없었다. 결론 정상 chest CT를 보이더라도 QCT로 COPD의 유무와 상관없이 흡연자들의 소기도가 두꺼운 것을 알 수 있으며 이는 폐실질 변화보다 더 선행한다.

• 대한한의학회지
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• 제34권3호
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• pp.54-68
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• 2013

Objectives: This study aimed to evaluate the effects of microparticles of Socheongryong-tang (SCRT) on chronic obstructive pulmonary disease (COPD) in a mouse model. Methods: The inhalable microparticles containing SCRT were produced by spray-drying with leucine as an excipient, and evaluated with respect to the aerodynamic properties of the powder by Andersen cascade impactor (ACI). Its equivalence to SCRT extract was evaluated using lipopolysaccharide (LPS) and a cigarette-smoking (CS)-induced murine COPD model. Results: SCRT microparticles provided desirable aerodynamic properties (fine particle fraction of $49.6{\pm}5.5%$ and mass median aerodynamic diameter of $4.8{\pm}0.3{\mu}m$). SCRT microparticles did not show mortality or clinical signs over 14 days. Also there were no significant differences in body weight, organ weights or serum chemical parameters between SCRT microparticle-treated and non-treated groups. After 14 days the platelet count significantly increased compared with the non-treated group, but the values were within the normal range. Inhalation of SCRT microparticles decreased the rate of neutrophils in blood, granulocytes in peripheral blood mononuclear cells (PBMC) and bronchoalveolar lavage fluid (BALF) and level of TNF-${\alpha}$ and IL-6 in BALF on COPD mouse model induced by LPS plus CS. This effect was verified by histological findings including immunofluorescence staining of elastin, collagen, and caspase 3 protein in lung tissue. Conclusions: These data demonstrate that SCRT microparticles are equivalent to SCRT extract in pharmaceutical properties for COPD. This study suggests that SCRT microparticles would be a potential agent of inhalation therapy for the treatment of COPD.

• Journal of Hospice and Palliative Care
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• 제20권2호
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• pp.81-92
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• 2017

만성 폐쇄성 폐질환은 비가역적, 점진적 기도 폐쇄가 특징인 주요 사망 원인중의 하나이다. 말기 폐쇄성 폐질환 환자는 다양한 신체적, 정서적, 사회적, 기능적 문제로 인해 호스피스 완화의료가 필요하다. 따라서, 완화의료의 목적은 증상 조절, 운동 능력 및 삶의 질 향상이며, 아울러 급성 악화 빈도를 줄이고 질병의 진행을 늦추는 효과를 기대할 수 있다. 다양한 진행 과정 때문에 말기 시점을 예측하기 어렵다. 호흡곤란 정도, 폐기능, 혈액학적 임상 지표를 이용하여 대상자를 선정하는 기준을 마련하고 적용시점을 논의해야 한다. 질환의 특성상 진단 후 초기에는 완치 목적의 치료가 중심이 되어 완화의료가 이를 보완하는 방식으로 적용되다가, 완치 목적의 치료를 위해 입 퇴원을 반복하거나 치료의 반응이 낮고 나쁜 예후가 예상될 때 완화의료 비중이 확대되는 것이 바람직하겠다. 폐쇄성 폐질환 환자에게 적극적으로 호흡재활을 적용하고, 환자의 의사결정을 존중하여 증상 악화 이전에 미리 대책을 마련하고 앞으로의 치료 목표를 논의하기 위한 완화의료 팀을 구성하고, 국내 현실에 맞는 진료 연계 체계를 마련하는 것이 필요하다. 제도가 잘 정착하기 위해서는 일차 의료 및 암환자 대상의 완화의료 전문 팀과의 협업이 중요하며, 우선 고려되어야 할 것이다.

• 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.

• 한국산업보건학회지
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• 제31권3호
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• pp.286-293
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• 2021

Objectives: Inorganic dust is known to be a risk factor for chronic obstructive pulmonary disease (COPD) regardless of smoking and pneumoconiosis. Adaptive and innate immunity, including lymphocyte infiltrate, are involved in the pathogenesis of COPD. The purpose of this study was to analyze the lymphocyte subsets in the blood of workers exposed to inorganic dust and confirm the influencing factors. Methods: The general characteristics of the subjects (n=107) were analyzed through a personal questionnaire. Diagnosis of COPD was established according to pulmonary function tests with FEV₁/FVC post bronchodilator lower than 70%, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. For lymphocyte analysis, blood was stained with a fluorescent CD marker and analyzed by flow cytometry. Results: The increase in CD4⁺ T lymphocytes was associated with a decrease in age (𝛽=-0.273, p=0.008) and an increase in the cumulative smoking amount (𝛽=0.205, p=0.034). The increase in NK cells was associated with an increase in age (𝛽=0.325, p=0.001) and a decrease in cumulative smoking (𝛽=-0.220, p=0.019). The period of exposure to dust, %FVC predicted and %FEV₁/FVC, and the relative population of peripheral blood lymphocytes did not show a statistically significant relationship. Conclusions: CD4⁺ T lymphocytes and CD56⁺CD16⁺ NK cells in peripheral blood were more related to age and cumulative smoking than the duration of dust exposure. Age and smoking are major risk factors for the development of COPD, so it can be predicted that peripheral blood CD4⁺ T lymphocytes and CD56⁺CD16⁺ NK cells are related to the development of COPD in workers exposed to inorganic dust.

• 한국산업보건학회지
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• 제29권1호
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• pp.42-49
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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. Iron deficiency is associated with chronic inflammation, such as COPD. The aim of this study was to evaluate the relationship among iron deficiency, iron homeostasis, and inflammation in retired miners with COPD. Methods: The serum levels of ferritin, soluble transferrin receptor(sTfR), and transferrin saturation(TSat) as biomarkers for iron deficiency and high-sensitivity C-reactive protein(hsCRP) as a biomarker for inflammation and hepcidin as a biomarker for iron homeostasis were measured in 93 male subjects. Iron deficiency was defined as any one or more of (1) sTfR>28.1 nmol/L, (2) TSat<16%, and (3) ferritin< $12{\mu}g/L$. Results: Iron deficiency was found 28% of the study subjects. Median levels of serum hsCRP was significantly increased related to airflow limitation of COPD(GOLD 1, $0.09{\mu}g/dL$ vs. GOLD 2, $0.17{\mu}g/dL$ vs. GOLD $3{\leq}$, $0.30{\mu}g/dL$, p=0.010), and was positively correlated with hepcidin(p=0.009). Mean level of serum hepcidin was lower in COPD subjects with iron deficiency(p=0.004) and serum levels of hepcidin was negatively correlated with %$FEV_1$ predicted(p=0.030). Conclusions: These results suggest that high serum levels of hepcidin are related to severe airflow limitation or inflammation and can decrease iron availability, regardless of iron status.

• 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.

• 수면정신생리
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• 제16권1호
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• pp.22-27
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• 2009

Regulation of respiration differs significantly between wakefulness and sleep. Respiration during wakefulness is influenced by not only automatic control but also voluntary and behavioral control. Sleep is associated with definite changes in respiratory function. With the onset of sleep, voluntary control of ventilation that overrides automatic control during wakefulness becomes terminated. Also ventilatory response to various stimuli including hypoxemia and hypercapnia is decreased. With these reasons respiration during sleep becomes fragile and unstable so that marked hypoxemia can be happened in patients with lung disease especially during REM sleep. Obstructive sleep apnea may also be developed if upper airway resistance is increased in addition to these blunted ventilatory responses.

• Tuberculosis and Respiratory Diseases
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• 제39권3호
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• pp.278-281
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• 1992

Air fluid level in a large ring shadow poses a diagnostic problem. But a new development of fluid level in preexisting bullous lesion is another problem. A 60 year old man with chronic obstructive lung disease was noticed to have multiple bullae. A few years later fluid level was newly developed in some of the bullae. Fluid level persisted for several months and later completely filled the space. Surgical exploration revealed pus collection in the bullae and epidermoid carcinoma in the nearby bronchi.

• 인터넷정보학회논문지
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• 제18권5호
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• pp.55-60
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• 2017

The pulmonary function test (PFT) is an essential data source for evaluating the effect of drugs on the lungs or the status of lung function. However, the numeric values of PFT cannot be easily used for clinical studies without labor-intensive manual efforts, because PFTs are usually recorded as image files. This study was aimed at constructing a de-identified, open-access PFT database with various clinical information. For constructing the PFT database, optical character recognition (OCR), regular expression, and the parsing technique were used to extract alphanumeric data from the PFT images in a Korean tertiary teaching hospital. This longitudinal observational database contains 413,000 measurements of PFT from 183,000 patients.