Impact of PD-L1 Expression on the Development of EGFR TKI Resistance

( Junsu Choe ),( Sang-won Um ),( Sun Hye Shin ),( Byeong-ho Jeong ),( Kyungjong Lee ),( Hojoong Kim ) 대한결핵 및 호흡기학회 2023 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.136 No.0

Is the higher ADA in the pleural effusion associated with the higher probability of TB pleurisy?

( Junsu Choe ),( Byeong-ho Jeong ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: A high level of adenosine deaminase (ADA) in the pleural fluid is known to be associated with tuberculous pleurisy (TBP). However, there are few reports on whether the higher ADA in the pleural fluid is associated with the higher probability of TBP. We hypothesized that extremely high ADA in the pleural fluid suggests etiologies other than TBP. Methods: We retrospectively reviewed 504 patients with pleural effusion showing ADA > 40 IU/L at a tertiary-care hospital between January 2014 and December 2017. Results: The three most common causes of pleural effusion with ADA > 40 IU/L were complicated parapneumonic effusion (n = 198, 38.7%), TBP (n = 158, 31.4%), and malignant effusion (n = 107, 21.2%). The levels of ADA were significantly higher in complicated parapneumonic effusion (median 70, IQR 48- 128 IU/L) and TBP (median 83, IQR 62-103 IU/L) than in malignant effusion (median 57, IQR 48-89 IU/ L; P < 0.001). There were only 4 (6.3%) TBPs in the 63 pleural effusion with ADA greater than 150 IU/L, compared with 154 (34.9%) TBPs in 441 pleural effusion with ADA lower than 150 IU/L. In addition, of 49 patients with pleural effusion showing ADA > 180 IU/ L, there was no TBP (empyema = 38, lymphoma = 9, and lung cancer = 2). Conclusions: In cases of pleural effusion with very high level of ADA, malignancy or empyema should be considered rather than TBP.

Clinical Course of Patients With Mediastinal Lymph Node Tuberculosis and Risk Factors for Paradoxical Responses

Choe Junsu,Han Areum,Shin Sun Hye,Lee Kyungjong,Um Sang-Won,Kim Hojoong,Kim Tae Yeul,Huh Hee Jae,Choi Yoon-La,Han Joungho,Jeong Byeong-Ho 대한의학회 2023 Journal of Korean medical science Vol.38 No.47

Background: Paradoxical responses (PR) occur more frequently in lymph node tuberculosis (LNTB) than in pulmonary tuberculosis and present difficulties in differential diagnosis of drug resistance, new infection, poor patient compliance, and adverse drug reactions. Although diagnosis of mediastinal LNTB has become much easier with the development of endosonography, limited information is available. The aim of this study was to investigate the clinical course of mediastinal LNTB and the risk factors associated with PR. Methods: Patients diagnosed with mediastinal LNTB via endosonography were evaluated retrospectively between October 2009 and December 2019. Multivariable logistic regression was applied to evaluate the risk factors associated with PR. Results: Of 9,052 patients who underwent endosonography during the study period, 158 were diagnosed with mediastinal LNTB. Of these, 55 (35%) and 41 (26%) concurrently had pulmonary tuberculosis and extrapulmonary tuberculosis other than mediastinal LNTB, respectively. Of 125 patients who completed anti-tuberculosis treatment, 21 (17%) developed PR at a median of 4.4 months after initiation of anti-tuberculosis treatment. The median duration of anti-tuberculosis treatment was 6.3 and 10.4 months in patients without and with PR, respectively. Development of PR was independently associated with age < 55 years (adjusted odds ratio [aOR], 5.72; 95% confidence interval [CI], 1.81–18.14; P = 0.003), lymphocyte count < 800/μL (aOR, 8.59; 95% CI, 1.60–46.20; P = 0.012), and short axis diameter of the largest lymph node (LN) ≥ 16 mm (aOR, 5.22; 95% CI, 1.70–16.00; P = 0.004) at the time of diagnosis of mediastinal LNTB. Conclusion: As PR occurred in one of six patients with mediastinal LNTB during antituberculosis treatment, physicians should pay attention to patients with risk factors (younger age, lymphocytopenia, and larger LN) at the time of diagnosis.

Exhaled Nitric Oxide in Patients with Stable Chronic Obstructive Pulmonary Disease: Clinical Implications of the Use of Inhaled Corticosteroids

( Yong Suk Jo ),( Junsu Choe ),( Sun Hye Shin ),( Hyeon-kyoung Koo ),( Won-yeon Lee ),( Yu Il Kim ),( Seung Won Ra ),( Kwang Ha Yoo ),( Ki Suck Jung ),( Hye Yun Park ),( Yong-bum Park ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.1

Background: Fractional exhaled nitric oxide (FeNO) is regarded as a potential biomarker for identifying eosinophilic inflammation. We aimed to evaluate the clinical implication of FeNO and its influence on inhaled corticosteroids (ICS) prescription rate in Korean chronic obstructive pulmonary disease (COPD) patients. Methods: FeNO level and its association with clinical features were analyzed. Changes in the prescription rate of ICS before and after FeNO measurement were identified. Results: A total of 160 COPD patients were divided into increased (≥25 parts per billion [ppb], n=74) and normal (<25 ppb, n=86) FeNO groups according to the recommendations from the American Thoracic Society. Compared with the normal FeNO group, the adjusted odds ratio for having history of asthma without wheezing and with wheezing in the increased FeNO group were 2.96 (95% confidence interval [CI], 1.40-6.29) and 4.24 (95% CI, 1.37-13.08), respectively. Only 21 out of 74 patients (28.4%) with increased FeNO prescribed ICS-containing inhaler and 18 of 86 patients (20.9%) with normal FeNO were given ICS-containing inhaler. Previous exacerbation, asthma, and wheezing were the major factors to maintain ICS at normal FeNO level and not to initiate ICS at increased FeNO level. Conclusion: Increased FeNO was associated with the history of asthma irrespective of wheezing. However, FeNO seemed to play a subsidiary role in the use of ICS-containing inhalers in real-world clinics, which was determined with prior exacerbation and clinical features suggesting Th2 inflammation.

Diagnostic Performance of Radial Probe Endobronchial Ultrasound without a Guide-Sheath and the Feasibility of Molecular Analysis

Moon, Seong Mi,Choe, Junsu,Jeong, Byeong-Ho,Um, Sang-Won,Kim, Hojoong,Kwon, O Jung,Lee, Kyungjong The Korean Academy of Tuberculosis and Respiratory 2019 Tuberculosis and Respiratory Diseases Vol.82 No.4

Background: Radial probe endobronchial ultrasound (R-EBUS), is effective for tissue diagnosis of lung lesions. We evaluated the diagnostic performance of R-EBUS both a guide-sheath and fluoroscopy and identified factors associated with accurate diagnosis. The feasibility of molecular and genetic testing, using specimens obtained by R-EBUS, was also investigated. Methods: The study retrospectively reviewed 211 patients undergoing R-EBUS without a guide-sheath and fluoroscopy, June 2016-May 2017. After excluding 27 patients of which the target lesion was not reached, 184 were finally included. Multivariate logistic regression was used, to identify factors associated with accurate diagnosis. Results: Among 184 patients, R-EBUS-guided biopsy diagnosed malignancy in 109 patients (59%). The remaining 75 patients (41%) with non-malignant results underwent additional work-ups, and 34 were diagnosed with malignancy. Based on final diagnosis, diagnostic accuracy was 80% (136/170), and sensitivity and specificity for malignancy were 76% (109/143) and 100% (27/27), respectively. In multivariate analysis, peripheral location (adjusted odds ratio [aOR], 3.925; 95% confidence interval [CI], 1.203-12.811; p=0.023), and central position of the probe (aOR, 2.435; 95% CI, 1.424-7.013; p=0.035), were associated with accurate diagnosis of malignancy. Molecular and genetic analyses were successful, in all but one case, with inadequate specimens. Conclusion: R-EBUS-guided biopsy without equipment, is effective for tissue diagnosis. Peripheral location and central position of the radial probe, were crucial for accurate diagnosis. Performance of molecular and genetic testing, using samples obtained by R-EBUS, was satisfactory.

Diagnostic Performance of Radial Probe Endobronchial Ultrasound without a Guide-Sheath and the Feasibility of Molecular Analysis

( Seong Mi Moon ),( Junsu Choe ),( Byeong-ho Jeong ),( Sang-won Um ),( Hojoong Kim ),( O Jung Kwon ),( Kyungjong Lee ) 대한결핵 및 호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.4

Background: Radial probe endobronchial ultrasound (R-EBUS), is effective for tissue diagnosis of lung lesions. We evaluated the diagnostic performance of R-EBUS both a guide-sheath and fluoroscopy and identified factors associated with accurate diagnosis. The feasibility of molecular and genetic testing, using specimens obtained by R-EBUS, was also investigated. Methods: The study retrospectively reviewed 211 patients undergoing R-EBUS without a guide-sheath and fluoroscopy, June 2016-May 2017. After excluding 27 patients of which the target lesion was not reached, 184 were finally included. Multivariate logistic regression was used, to identify factors associated with accurate diagnosis. Results: Among 184 patients, R-EBUS-guided biopsy diagnosed malignancy in 109 patients (59%). The remaining 75 patients (41%) with non-malignant results underwent additional work-ups, and 34 were diagnosed with malignancy. Based on final diagnosis, diagnostic accuracy was 80% (136/170), and sensitivity and specificity for malignancy were 76% (109/143) and 100% (27/27), respectively. In multivariate analysis, peripheral location (adjusted odds ratio [aOR], 3.925; 95% confidence interval [CI], 1.203-12.811; p=0.023), and central position of the probe (aOR, 2.435; 95% CI, 1.424-7.013; p=0.035), were associated with accurate diagnosis of malignancy. Molecular and genetic analyses were successful, in all but one case, with inadequate specimens. Conclusion: R-EBUS-guided biopsy without equipment, is effective for tissue diagnosis. Peripheral location and central position of the radial probe, were crucial for accurate diagnosis. Performance of molecular and genetic testing, using samples obtained by R-EBUS, was satisfactory.

Stable clinical course of COPD patients in the era of dual bronchodilator therapy: the real-world data

( Noeul Kang ),( Sun Hye Shin ),( Hyunkyu Cho ),( Junsu Choe ),( Yeonseok Choi ),( Hyun-il Gil ),( Jiyeon Kang ),( Hye Yun Park ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Introduction: Inhaled corticosteroids (ICS) use has increased substantially in the last decade. About 50% of chronic obstructive pulmonary disease (COPD) patients eventually progress to receive triple therapy including ICS within three years of initial diagnosis, resulting in overuse of inhaled corticosteroid (ICS) in real world practice. With recent introduction of dual bronchodilators, this study aimed to investigate the duration of dual bronchodilator therapy maintenance without adding ICS and to explore factors affecting the addition of ICS. Methods: This is a retrospective cohort study at single referral hospital. COPD was defined as post-bronchodilator forced expiratory volume in 1 second (FEV1)/ forced vital capacity (FVC) < 0.7 and age ≥ 40 years. Between January 2015 and December 2018, consecutive patients who have ever used dual bronchodilator therapy were included in this study. Primary outcome was addition of ICS, regardless of the reason. Results: Among 299 patients who received dual bronchodilator, 236 (78.9%) patients maintained bronchodilator therapy without adding ICS during median follow-up of 12.1 (5.6 - 21.3) months. In univariate analysis, previous history of ICS use [HR, 2.04; 95% CI, 1.23 - 3.36], mMRC dyspnea grade ≥ 2 [HR, 2.27; 95% CI, 1.37 - 3.76], and COPD assessment test score ≥ 10 [HR, 1.94; 95% CI, 1.01- 3.71] were significantly associated with adding ICS to the dual bronchodilator therapy. However, post bronchodilator FEV1 < 50% predicted [HR, 1.61; 95% CI, 0.90 - 2.88] was not associated with adding ICS to the dual bronchodilator therapy. Conclusions: Add-on ICS therapy could be delayed in COPD patients with dual bronchodilator therapy.

Effect of long-term azithromycin therapy in COPD patients with or without bronchiectasis

( Yeonseok Choi ),( Sun Hye Shin ),( Hyunkyu Cho ),( Noeul Kang ),( Junsu Choe ),( Jiyeon Kang ),( Hyun-il Gil ),( Hye Yun Park ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Purpose: Long-term azithromycin treatment is recommended for chronic obstructive pulmonary disease (COPD) patients with frequent exacerbation. Bronchiectasis (BE) is a common comorbid condition in patients with COPD, for which long-term azithromycin is effective in preventing exacerbation. This study aimed to compare the effect of long-term azithromycin in COPD patients according to the coexisting BE. Methods: COPD patients who received azithromycin for more than 12 weeks were retrospectively identified at single referral hospital. COPD was defined as post-bronchodilator FEV1/FVC < 0.7 and BE was determined using computed tomography. Clinical characteristics and the treatment outcome of long-term azithromycin were compared between COPD with BE and COPD without BE. Results: Of total 59 patients, 43 had COPD with BE and 16 had COPD without BE. Compared to the group without BE, those with BE were more likely to be younger, female, and never-smokers. Median duration of azithromycin was 451 (IQR 230-755) days and only 3 (5.1%) patients experienced adverse event. At 12 months of azithromycin treatment, development of acute exacerbation was significantly lower in group with BE than those without BE (46.5% vs. 87.5%, p = 0.005). COPD assessment test (CAT) score also significantly improved in group with BE than those without BE (-4.0 vs. +1.5, p = 0.055). Conclusions: In COPD patients with frequent exacerbation, those with coexisting BE could benefit more from long-term azithromycin treatment, in terms of exacerbation prevention and quality of life improvement.

Nontuberculous Mycobacterial Lung Diseases Caused by Mixed Infection with <i>Mycobacterium avium</i> Complex and <i>Mycobacterium abscessus</i> Complex

Shin, Sun Hye,Jhun, Byung Woo,Kim, Su-Young,Choe, Junsu,Jeon, Kyeongman,Huh, Hee Jae,Ki, Chang-Seok,Lee, Nam Yong,Shin, Sung Jae,Daley, Charles L.,Koh, Won-Jung American Society for Microbiology 2018 Antimicrobial Agents and Chemotherapy Vol.62 No.10

<P>Mycobacterium avium complex (MAC) and M. abscessus complex (MABC) comprise the two most important human pathogen groups causing nontuberculous mycobacterial lung disease (NTM-LD). However, there are limited data regarding NTM-LD caused by mixed NTM infections. This study aimed to evaluate the clinical characteristics and treatment outcomes in patients with NTM-LD caused by mixed infection with these two major NTM pathogen groups. Seventy-one consecutive patients who had been diagnosed with NTM-LD caused by mixed infection with MAC (M. avium or M. intracellulare) and MABC (M. abscessus or M. massiliense) between January 2010 and December 2015 were identified. Nearly all patients (96%) had the nodular bronchiectatic form of NTM-LD. Mixed infection with MAC and M. massiliense (n = 47, 66%) was more common than mixed infection with MAC and M. abscessus (n = 24, 34%), and among the 43 (61%) patients who were treated for NTM-LD for more than 12 months, sputum culture conversion rates were significantly lower in patients infected with MAC and M. abscessus (25% [3/12]) than in patients infected with MAC and M. massiliense (61% [19/31, P = 0.033]). Additionally, M. massiliense and M. abscessus showed marked differences in clarithromycin susceptibility (90% versus 6%, P = 0.001). Of the 23 patients who successfully completed treatment, 11 (48%) redeveloped NTM lung disease, with mycobacterial genotyping results indicating that the majority of cases were due to reinfection. Precise identification of etiologic NTM organisms could help predict treatment outcomes in patients with NTM-LD due to mixed infections.</P>

Clinical characteristics according to CAT score level in COPD patients: cross-sectional study

( Hyun-il Gil ),( Sungmin Zo ),( Jiyeon Kang ),( Noeul Kang ),( Hyunkyu Cho ),( Yeonseok Choi ),( Junsu Choe ),( Hye Yun Park ),( Sun Hye Shin ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Purpose: Chronic obstructive pulmonary disease (COPD) assessment test (CAT) is widely used to measure quality of life in COPD. This tool is also one of determinants of COPD severity to guide COPD management. This study aimed to investigate the clinical characteristics of COPD patients according to CAT score level measured at baseline. Method: COPD patients with CAT score measured at baseline were retrospectively identified from COPD registry of Samsung Medical Center between February 2016 and April 2019. COPD was defined as post-bronchodilator forced expiratory volume in 1 second (FEV1)/ forced vital capacity (FVC) < 0.7 and age ≥ 40 years. Patients were grouped into quintiles of CAT score level. Baseline clinical characteristics and lung function parameters were compared according to CAT score quintiles. Result: A total of 725 patients were included and median (interquartile range [IQR]) CAT score was 17 (11 - 24). Median (IQR) of each CAT score quintile were 6 (4 - 8), 13 (11 - 14), 18 (17 - 19), 23 (22 - 25), and 30 (28 - 34). Age, sex, smoking history and Charlson comorbidity index score did not differ according to CAT score quintiles. Dyspnea of modified medical research council (mMRC) grade ≥ 2 and the previous history of any exacerbation significantly increased across CAT score quintiles, while post bronchodilator FEV1 and diffusing capacity of lung for carbon monoxide (DLco) significantly decreased across CAT score quintiles. Conclusion: Among the clinical characteristics of COPD patients, dyspnea, previous history of any exacerbation, post bronchodilator FEV1 and DLco were significantly associated with CAT score level.