Body Mass Index and Fat Free Mass Index in Adults with COPD in Korea

( Sae Byol Kim ),( Joon Chang ),( Se Kyu Kim ),( Young Sam Kim ),( Moo Suk Park ),( Young Ae Kang ),( Song Yee Kim ),( Kyung Soo Jung ),( Kold Study Group ) 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Background: Body mass index (BMI) and fat free mass index (FFMI) is known to decrease in patients with chronic obstructive lung disease (COPD), and low BMI and FFMI are associated with worse lung function and poor prognosis. Data are limited on the relationship between BMI, FFMI and COPD in Asian countries. Method: We used the data in Korean National Health and Nutrition Survey (KNHANES) in year 2008 to 2010, 822 subjects with COPD and the same number control subjects were selected. Spirometry and Dual Energy X-Ray Absorptiometry (DXA) were done for the analysis. Results: Subjected with COPD had lower mean BMI and FFMI compared with control group (23.6 vs. 23.9 kg/m2 and 17.2 vs. 17.5 kg/m2, p=0.015 and p=0.013, respectively). The BMI and FFMI values decreased significantly in subjects with severe airway obstruction (p<0.001). The proportion of subjects who are underweight (BMI <18.5 kg/m2) or with low FFMI (FFMI <5 percentile) was higher in GOLD stage 3-4 group (p<0.001). The deficit of FFMI was more prominent in the lower ex-tremities, followed by the upper extremities and the trunk. Subjects who are underweight had lower FEV1 and FEV1/FVC values compared with each subgroups (p<0.001). Conclusion: BMI and FFMI decreased in adults with severe COPD, and FFMI deficit was more prominent in the lower extremities. We suggest that the assessment of BMI and body composition is necessary in patients with severe airway ob-struction, and active rehabilitation has to be considered to preserve FFM for those patients. 보건복지부 보건의료연구개발사업 지원(A102065).

Ground-Glass Opacity in Lung Metastasis from Breast Cancer: A Case Report

Sae Byol Kim,이수현,Myoung Ju Koh,In Seon Lee,Chan Soo Moon,Sungmo Jung,강영애 대한결핵및호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.74 No.1

A 43-year-old woman with breast cancer who was on neoadjuvant chemotherapy presented with cough, sputum and mild fever. High-resolution computed tomography showed diffuse ground glass opacities in bilateral lungs and subpleural patchy consolidations. Initially, she was thought to have pneumonia or interstitial lung diseases such as drug-induced pneumonitis and treated with antibiotics and steroids. She subsequently got breast cancer surgery because of disease progression, and concurrent thoracoscopic lung biopsy revealed metastatic carcinoma of the lung from breast cancer. The diagnosis of suspected interstitial lung disease can be made without lung biopsy, but malignancy should always be considered and lung biopsy should be performed in the absence of a definitive clinical diagnosis.

Ground-Glass Opacity in Lung Metastasis from Breast Cancer: A Case Report

Kim, Sae Byol,Lee, Soohyeon,Koh, Myoung Ju,Lee, In Seon,Moon, Chan Soo,Jung, Sung Mo,Kang, Young Ae The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.74 No.1

A 43-year-old woman with breast cancer who was on neoadjuvant chemotherapy presented with cough, sputum and mild fever. High-resolution computed tomography showed diffuse ground glass opacities in bilateral lungs and subpleural patchy consolidations. Initially, she was thought to have pneumonia or interstitial lung diseases such as drug-induced pneumonitis and treated with antibiotics and steroids. She subsequently got breast cancer surgery because of disease progression, and concurrent thoracoscopic lung biopsy revealed metastatic carcinoma of the lung from breast cancer. The diagnosis of suspected interstitial lung disease can be made without lung biopsy, but malignancy should always be considered and lung biopsy should be performed in the absence of a definitive clinical diagnosis.

Pleural fluid ADA level in tuberculous pleurisy can be low in old age, critically ill patients with multi-organ failure

( Sae Byol Kim ),( Beomsu Shin ),( Ji-ho Lee ),( Seok Jeong Lee ),( Myoung Kyu Lee ),( Won-yeon Lee ),( Suk Joong Yong ),( Sang-ha Kim ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Purpose: Adenosine deaminase (ADA) level in tuberculous pleural effusion (TPE) is typically elevated, but low ADA in TPE has been reported not infrequently. The characteristics of these patients are not well known. This can falsely negate the possibility of TPE, resulting in a delayed diagnosis. Method: We retrospectively reviewed patients with microbiologically or pathologically confirmed TPE between 2012 to 2018 in a tertiary hospital in South Korea. Patients were categorized into two groups: a high ADA (≥40 IU/L) and a low ADA (<40 IU/L) group. Clinical characteristics and the Sequential Organ Failure Assessment (SOFA) score were obtained and analysed. Result: A total of 192 patients with TPE were included and 36 (18.8%) had ADA <40 IU/L with a mean ADA level of 20.9 (±9.2) IU/L. Patients with low ADA were older (75.3 vs. 62.0 years, p<0.001) and showed lower lymphocyte percentage (47.6% vs. 69.9%, p<0.001) than those with high ADA. Patients in the low ADA group had significantly higher SOFA score (2.31 vs. 0.68, p<0.001), and patients with organ dysfunction were significantly more common in the low ADA group (p<0.001). Patients with 2 or ≥3 organ dysfunctions involved were 19.4% and 13.9% in the low ADA group, and 7.1% and 1.3% in the high ADA group (p<0.001). Multivariate logistic regression analysis showed that age (OR=1.030, 95% CI 1.002-1.060, p=0.038) and SOFA score (OR=1.598, 95% CI 1.239-2.060, p<0.001) were significantly associated with low ADA level in TPE. Conclusion: ADA level in TPE can be low in elderly, critically ill patients with multiorgan failure. Low ADA level cannot completely exclude the diagnosis of TPE, and physicians should be careful in interpreting pleural fluid exams.

Ground-Glass Opacity in Lung Metastasis from Breast Cancer : A Case Report

Sae Byol Kim,Soo Hyeon Lee,Myoung Ju Koh,In Seon Lee,Chan Soo Moon,Sung Mo Jung,Young Ae Kang 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.74 No.1

A 43-year-old woman with breast cancer who was on neoadjuvant chemotherapy presented with cough, sputum and mild fever. High-resolution computed tomography showed diffuse ground glass opacities in bilateral lungs and subpleural patchy consolidations. Initially, she was thought to have pneumonia or interstitial lung diseases such as drug-induced pneumonitis and treated with antibiotics and steroids. She subsequently got breast cancer surgery because of disease progression, and concurrent thoracoscopic lung biopsy revealed metastatic carcinoma of the lung from breast cancer. The diagnosis of suspected interstitial lung disease can be made without lung biopsy, but malignancy should always be considered and lung biopsy should be performed in the absence of a definitive clinical diagnosis.

Microorganisms in patients with endobronchial tuberculosis

( Sae Byol Kim ),( Ji-ho Lee ),( Seok Jeong Lee ),( Myoung Kyu Lee ),( Sang-ha Kim ),( Won-yeon Lee ),( Suk Joong Yong ),( Beomsu Shin ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Purpose: Endobronchial tuberculosis (EBTB) is a chronic inflammatory disease characterized by destruction of tracheobronchial tree due to Mycobacterium tuberculosis (MTB). MTB can inhibit mucociliary clearance, destroy respiratory epithelium and produce biofilms. It affects the airways’ microenvironment. However, little is known about the respiratory microorganisms in patients with EBTB. Method: We retrospectively reviewed data for pathologically confirmed EBTB patients diagnosed at a tertiary referral hospital in South Korea between Jan 2013 and Jan 2019. Bronchoscopy and bacterial culture of the bronchial washing fluids were done in every patient. Result: A total of 216 patients with EBTB were included. The median age of the patients was 73 years, 142 (65.7%) were female, and 32 (14.8%) had a history of previous tuberculosis treatment. By bronchoscopic classification of EBTB, actively caseating, edematous-hyperemic, and fibrostenotic types were observed in 114 (52.8%), 32 (14.8%), and 33 (15.3%), respectively. Bacterial culture of the bronchial washing fluids showed microorganisms in 42 (19.4%) patients. Among them, 6 (2.8%) had multiple microbial species. The most common microorganisms identified were Staphylococcus aureus isolated in 14 patients (33.3%), followed by Klebsiella species in 12 (28.6%, 10 Klebsiella pneumoniae, 2 Klebsiella oxytoca), Streptococcus species in 5 (11.9%), Enterobacter species in 4 (9.5%), and Pseudomonas aeruginosa in 3 (7.1%). Conclusion: Variety of microorganisms were isolated in the bronchial washing fluids, these changes in the composition of microorganisms take place in the airways of patients with EBTB. Further studies are needed to investigate its clinical significance.

Risk of nontuberculous mycobacterial infection from the use of inhaled corticosteroid in obstructive lung disease

( Ji-hoon Kim ),( So-jin Kwak ),( Sae Byol Kim ),( Beomsu Shin ),( Seok Jeong Lee ),( Myoung Kyu Lee ),( Sang-ha Kim ),( Won-yeon Lee ),( Suk Joong Yong ),( Ji-ho Lee ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Purpose: While inhaled corticosteroid (ICS) is an effective drug for the treatment of obstructive lung disease (OLD), there has been a concern for the occurrence of side effect, such as pneumonia. However, it was not fully investigated whether use of ICS is associated with the development of nontuberculous mycobacteria (NTM) lung disease. This study aimed to find the association between the ICS and NTM disease in OLD. Method: We performed a population based case-control study using Korean National Health Insurance database. Among population taken national health checkups at least 2 times during 2009 to 2012, those with new diagnosis of OLD and treated with respiratory medicine during 2009 to 2012 were regarded as having OLD. They consisted of asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO). NTM was defined as new diagnosis of NTM plus at least 2 times of medication prescribed for NTM during 2013 to 2017. Result Total patients with OLD were 91,066 (asthma 35.5%, COPD 57.3% and ACO 7.2%, respectively). Among them, ICS user were 21,828 (24.0%) and non-ICS user were 69,238 (76.0%). NTM case were identified in 219 patients. Risk of NTM decreased with the presence of asthma (Odds ratio 0.34, 95% CI 0.24-0.49), but increased with the presence of COPD (1.85, 1.38-2.48), ACO (1.91, 1.28-2.84), bronchiectasis (8.39, 6.24-11.27) and prior tuberculosis history (15.95, 11.69-21.76). In all patients with OLD, NTM increased in ICS user compared to non-ICS user (2.15, 1.37-3.35). While ICS did not increase the risk of NTM in asthma (1.60, 0.59-4.35) and ACO (1.24, 0.34-4.50), ICS was significantly associated with the development of NTM in COPD (3.86, 2.21-6.76). Conclusion: ICS use is associated with the development of NTM disease. When ICS is prescribed for patients with COPD in particular, the risk of NTM should be considered with caution.

한국인에서 혈청 페리틴 농도와 흡연 및 폐기능과의 관계

김서윤 ( Seo Yun Kim ),이수환 ( Su Hwan Lee ),이인선 ( In Seon Lee ),김샛별 ( Sae Byol Kim ),문찬수 ( Chan Soo Moon ),정성모 ( Sung Mo Jung ),김세규 ( Se Kyu Kim ),김영삼 ( Young Sam Kim ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.2

Background: Cigarette smoke induced release of iron could alter iron metabolism in the lungs of chronic smokers and contribute to the increase in the total oxidative burden on the lungs of smokers. In previous studies, ferritin levels of bronchoalveolar lavage fluid in smokers were elevated. The aim of the present study was to investigate the relationship between serum ferritin concentration, smoking and lung function in Korean people. Methods: This study was based on the data acquired in the second year (2008) of the Forth National Health and Nutrition Examination Survey that was conducted from 2007 to 2009. The analysis included 2,244 subjects who were older than 20 years and had complete data from both lung function test and serum ferritin concentration. Among participants, 1,076 were male and 1,168 were female. Results: Mean serum ferritin concentrations in males were 120.3±80.1μg/L and 47.9±39.8μg/L in females. There were no differences in serum ferritin concentrations between non-smokers and smokers after adjusting for age, body mass index, and amounts of alcohol. Serum ferritin concentrations were associated with smoking amounts by simple linear regression but not associated with smoking amounts after adjustment with age, body mass index, and amounts of alcohol in both males and females. Lung function was not associated with serum ferritin concentrations. Conclusion: Our data suggested that serum ferritin concentrations are not related with smoking and lung function.

Urine Cotinine for Assessing Tobacco Smoke Exposure in Korean: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES)

Jung, Sungmo,Lee, In Seon,Kim, Sae Byol,Moon, Chan Soo,Jung, Ji Ye,Kang, Young Ae,Park, Moo Suk,Kim, Young Sam,Kim, Se Kyu,Chang, Joon,Kim, Eun Young The Korean Academy of Tuberculosis and Respiratory 2012 Tuberculosis and Respiratory Diseases Vol.73 No.4

Background: The level of urine cotinine is an indicator of tobacco smoke exposure. The purpose of this study is to investigate urine cotinine for the purpose of assessing the smoking status of Korean smokers and non-smokers exposed to tobacco smoke. Methods: The subjects were identified from the 2007-2009 and the 2010 data sets of the Korea National Health and Nutrition Examination Survey (KNHANES). They were assigned as non-smokers, current smokers and ex-smokers. Non-smokers were also divided into three subset groups according to the duration of smoke exposure. Each group was stratified by gender prior to analysis. Results: The median value of urine cotinine in the male current smokers was 1,221.93 ng/mL which was the highest among all groups. The difference between levels of urine cotinine for male and the female groups was statistically significant (p<0.01). In the female group, passive smoke exposure groups reported higher urine cotinine levels than non-exposure groups (p=0.01). The cutoff point for the discrimination of current smokers from non-smokers was 95.6 ng/mL in males and 96.8 ng/mL in females. The sensitivity and specificity were 95.2% and 97.1%, respectively, in males, 96.1% and 96.5% in females. However, the determination of urine cotinine level was not useful in distinguishing between passive smoke exposure groups and non-exposure groups. Conclusion: Urine cotinine concentration is a useful biomarker for discriminating non-smokers from current smokers. However, careful interpretation is necessary for assessing passive smoke exposure by urine cotinine concentration.

Urine Cotinine for Assessing Tobacco Smoke Exposure in Korean: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES)

( Sungmo Jung ),( In Seon Lee ),( Sae Byol Kim ),( Chan Soo Moon ),( Ji Ye Jung ),( Young Ae Kang ),( Moo Suk Park ),( Young Sam Kim ),( Se Kyu Kim ),( Joon Chang ),( Eun Young Kim ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.73 No.4

Background: The level of urine cotinine is an indicator of tobacco smoke exposure. The purpose of this study is to investigate urine cotinine for the purpose of assessing the smoking status of Korean smokers and non-smokers exposed to tobacco smoke. Methods: The subjects were identified from the 2007-2009 and the 2010 data sets of the Korea National Health and Nutrition Examination Survey (KNHANES). They were assigned as non-smokers, current smokers and ex-smokers. Non-smokers were also divided into three subset groups according to the duration of smoke exposure. Each group was stratified by gender prior to analysis. Results: The median value of urine cotinine in the male current smokers was 1,221.93 ng/mL which was the highest among all groups, The difference between levels of urine cotinine for male and the female groups was statistically significant (p<0.01). In the female group, passive smoke exposure groups reported higher urine cotinine levels than non-exposure groups (p=0.01). The cutoff point for the discrimination of current smokers from non-smokers was 95.6 ng/mL in males and 96.8 ng/mL in females. The sensitivity and specificity were 95.2% and 97.1%, respectively, in males, 96.1% and 96.5% in females. However, the determination of urine cotinine level was not useful in distinguishing between passive smoke exposure groups and non-exposure groups. Conclusion: Urine cotinine concentration is a useful biomarker for discriminating non-smokers from current smokers. However, careful interpretation is necessary for assessing passive smoke exposure by urine cotinine concentration.