Korean Asthma Guideline 2014: Summary of Major Updates to the Korean Asthma Guideline 2014

김덕겸,박용범,오연목,정기석,유지홍,유광하,김관형,대한결핵및호흡기학회 대한결핵및호흡기학회 2016 Tuberculosis and Respiratory Diseases Vol.79 No.3

Asthma is a prevalent and serious health problem in Korea. Recently, the Korean Asthma Guideline has been updated by The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) in an effort to improve the clinical management of asthma. This guideline focuses on adult patients with asthma and aims to deliver up to date scientific evidence and recommendations to general physicians for the management of asthma. For this purpose, this guideline was updated following systematic review and meta-analysis of recent studies and adapting some points of international guidelines (Global Initiative for Asthma [GINA] report 2014, National Asthma Education and Prevention Program [NAEPP] 2007, British Thoracic Society [BTS/SIGN] asthma guideline 2012, and Canadian asthma guideline 2012). Updated issues include recommendations derived using the population, intervention, comparison, and outcomes (PICO) model, which produced 20 clinical questions on the management of asthma. It also covers a new definition of asthma, the importance of confirming various airflow limitations with spirometry, the epidemiology and the diagnostic flow of asthma in Korea, the importance and evidence for inhaled corticosteroids (ICS) and ICS/formoterol as a single maintenance and acute therapy in the stepwise management of asthma, assessment of severity of asthma and management of exacerbation, and an action plan to cope with exacerbation. This guideline includes clinical assessments, and treatment of asthma–chronic obstructive pulmonary disease overlap syndrome, management of asthma in specific conditions including severe asthma, elderly asthma, cough variant asthma, exercise-induced bronchial contraction, etc. The revised Korean Asthma Guideline is expected to be a useful resource in the management of asthma

Isoniazid 복용으로 발생한 여성형 유방 증례 보고

김덕겸,한성구,심영수,정희순 대한결핵 및 호흡기학회 2007 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.105 No.-

Vertebral osteophyte of pre-modern Korean skeletons from Joseon tombs

김덕겸,김명주,김이석,오창석,신동훈 대한해부학회 2013 Anatomy & Cell Biology Vol.45 No.4

Spinal osteophytic changes are known to be affected by differences in age, sex, population, and mechanical stress. We examined Joseon skeletons (n=87) to obtain vertebral osteophytosis data on a pre-modern Korean population. The mean osteophytic value (MOV) of vertebrae increased in the cervical-thoracic-lumbar order. More severe osteophytosis was found in the vertebrae (C5, T9, T10, and L4) farthest from the line of gravity, while the general pattern of vertebral osteophytosis appeared similar to those of previous reports on other skeletal series. More severe osteophytes were much more common in the males, possibly due to their engaging in more strenuous physical labor than that of females. We also observed MOV patterns seemingly unique to the Joseon people, and findings not typically reported in previous studies. Although a full explanation of the factors contributing to vertebral-osteophytic development in Joseon Koreans will require further studies, the present results are meaningful to anatomists and anthropologists interested in osteophytic patterns occurring in an East Asian population.

What Can We Apply to Manage Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure?

김덕겸,이정실,박주희,유광하 대한결핵및호흡기학회 2018 Tuberculosis and Respiratory Diseases Vol.81 No.2

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the longterm prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.

Synthesis of Modified-Clay by Plasticizer and Measurement of their physical Properties

김덕겸,유중환,김응수,최의석 한국공업화학회 2005 한국공업화학회 연구논문 초록집 Vol.2005 No.1

크리스탈 볼룸 2 : 일반연제 발표 ; 속립성폐결핵 환자의 불량한 예후 인자로 작용하는 영양결핍 관련 변수에 대한 분석

김덕겸,김현지,권성연,윤호일,이춘택,정희순,한성구,심영수,이재호 대한결핵 및 호흡기학회 2007 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.105 No.-

혈청학적 진단 Kit를 이용한 결핵 진단방법의 효용성

김덕겸,권성연,이석영,박계영,이춘택,유철규,김영환,한성구,심영수 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

실업고에 제공되는 대기업 지원금 전액을 세액 공제 해야

김덕겸 대한사립학교장회(구 대한사립중고등학교장회) 2005 私學 Vol.114 No.-

혈청학적 방법을 이용한 결핵 진단 방법의 효용성

김덕겸,권성연,이석영,박계영,정경해,이춘택,유철규,김영환,한성구,심염수,Kim, Deog-Kyeom,Kwon, Sung-Youn,Lee, Suk-Young,Park, Gye-Young,Jung, Kyung-Hae,Lee, Chun-Taek,Yoo, Churl-Gyoo,Kim, Young-Whan,Han, Sung-Koo,Shim, Yong-Soo 대한결핵및호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.47 No.5

연구배경: 객담 도말 및 배양 검사나 방사선학적 검사 등의 기존의 결핵 진단 방법은 낮은 민감도와 진단까지 소요되는 기간이 길다는 단점이 있어서 결핵의 조기 진단 및 치료에 제한점이 있었다. 최근에 혈청학적 진단 방법의 하나로 개발된 immunochromatographic assay 기구들이 소개되고, 외국에서 비교적 높은 진단율를 보여, 결핵 유병율이 높은 국내에서 그 유용성을 평가하고, 질병 양상에 따른 차이점을 조사하여, 기존의 결핵 진단 방법들의 문제점을 해결할 수 있는지 알아보고자하였다. 연구방법: 환자군을 폐결핵 환자군(36명), 폐외결핵 환자군(3명) 및 두 가지 모두 이환된 군(22명)으로 나누었으며, 대조군은 과거 결핵 병력이 있는 비활동성 결핵환자(17명), 결핵이외의 폐질환자(16명) 및 폐질환이 없는 심장 환자(14명)를 대상으로 38kDa 항체를 포함한 ICT tuberculosis 또는 BioSign$^{TM}$TB를 이용하여 혈청화적 검사를 시행하였다. 결 과: ICT tuberculosis를 사용한 경우, 환자군 56명 및 대조군 47명에 대하여 64.3%의 민감도 및 91.5%의 특이도를 나타내었으며, 폐결핵만 있는 환자군에서 76.5%의 민감도를 보여, 폐외 결핵만 있는 환자군(33.3%)나 두 가지 모두 이환된 군(47.4%)에 비하여 더 높은 민감도를 나타내었다(p=0.039). BioSign$^{TM}$TB를 이용한 경우, 환자군 43명 및 대조군 43 명에 대하여 74.4%의 민감도 및 95.3%의 특이도를 보였으며, 폐질환이 없는 환자군에서는 100%의 특이도를 나타내었다. 환자군중에서 초발환자 및 과거 폐결핵 병력이 있는 환자군 사이에는 민감도에 차이가 없었으며, 공동성 폐결핵 환자와 비공동성 폐결핵 환자사이에 검사상 민감도 차이는 통계적으로 유의하지 않았다(73.3% vs. 69.6%, p>0.05). 결 론: 혈청학적 방법의 하나인 immunochromatographic assay 기구는 높은 특이도와 양성 예측도를 보여 임상적 유용성이 기대되나, 상대적으로 낮은 민감도와 음성 예측도를 고려할 때, 단독 사용보다는 기존 방법과의 상보적 사용이 결핵진단에 더 도움이 될 것으로 생각된다. Background: Many diagnostic tests have developed to diagnose tuberculosis and other mycobacterial diseases but the diagnosis of tuberculosis relies largely on radiological findings and acid-fast staining of sputum and/or culture. Recently, new serologic diagnostic methods, which are safe and easy to use have been introduced into Korea. In this study, the usefulness of serologic diagnosis for tuberculosis and the disease pattern induced variation of the test were evaluated. Methods: Serological assay was performed upon 108 patients with two test kits, the ICT tuberculosis and the BioSign$^{TM}$TB, which are based upon a rapid immunochromatographic assay technique, capable of being interpreted within 15 minutes. The case groups consisted of 61 patients with active pulmonary tuberculosis(36 patients), extrapulmonary tuberculosis(3 patients), or both(22 patients). Control groups consisted of 47 patients with inactive old pulmonary tuberculosis(17 patients), nontuberculous pulmonary disease(16 patients) and nonpulmonary cardiac disease(14 patients). Results : The diagnostic sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of the ICT tuberculosis were 64.3%, 91.5%, 90.0% and 68.3% respectively. The diagnostic sensitivity, specificity, PPV and NPV of the BioSign$^{TM}$TB were 76.5%, 95.3%, 94.1 % and 78.8% respectively. Differences in sensitivity were not significant between patients with previous history of tuberculosis or patients without prior history of tuberculosis. The ICT tuberculosis test showed higher sensitivity in pulmonary tuberculosis patients(76.5%) than extrapulmonary tuberculosis patients(33.3%). There was no difference in sensitivity between patients with or without cavitary lesion by chest X-ray. Conclusion: Considering high specificity and PPV, serologic diagnosis using a rapid immunochromatographic assay device is another helpful diagnostic method in the diagnosis of tuberculosis, when combined with previous diagnostic methods such as chest X-ray, microbiologic study but it has limitation in terms of confirming the diagnosis for tuberculosis as the only diagnostic method because of relatively low sensitivity and NPV.

전자담배 과연 무해한가?

김덕겸 대한내과학회 2017 대한내과학회 춘계학술대회 Vol.2017 No.-

· 전자담배는 단순한 증기 흡입이 아니며, 기존 담배 흡연보다 낮은 수준이기는 하나 니코틴 독성, 중독성이 여전히 존재하며, 향료 및 발암 물질을 포함하여 안전성이 확인되지 않은 다양한 물질을 포함함. · 청소년, 비흡연자, 임산부 등에서는 절대 권고되는 사항이 아님. · 금연 보조제로서의 효과를 측정한 무작위대조군연구는 매우 부족한 상황이며, 코호트 연구, 단면 연구 및 메타 분석에서 금연 효과에 대해서는 일관되지 않은 결과를 보임. · 흡연자에게는 1차적으로 절대 금연을 권고해야 하며, 전자담배의 잘못된 활용으로 흡연기간을 늘리거나 흡연과 전자담배를 병용하여 위험에 더 노출시킬 수 있는 상황은 피해야 함. · 흡연자로서 금연에 실패하거나 금연을 거부하는 경우 전자담배로 변경하여 금연을 시도하는 것을 고려해 볼 수 있으나, 전자담배의 위해성 및 이중 흡연은 피하도록 해야함. · 현재까지 CDC, WHO, AHA를 비롯한 대부분의 유관 기관에서는 전자 담배가 담배를 대체해 금연에 도움이 된다는 근거가 명확치 않고 위해 인자가 존재하기 때문에 권장 하지는 않고 있음.