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유광하 대한의사협회 2013 대한의사협회지 Vol.56 No.7
Chronic airway diseases (asthma and chronic obstructive lung disease) are common and their prevalence is increasing worldwide. The most effective method for drug delivery for the treatment of patients with chronic airway diseases is via an inhaler device. The guidelines on asthma and chronic obstructive pulmonary disease (COPD) recommend inhaler medication for the treatment of these patients. Inhaled medications have several advantages, including faster onset of action, a lower dose of medicine, and reduced adverse effects. To maximize the effect of inhaled medication, patients must use the inhaler device correctly; thus patients should receive training and education in the use of the device. There are now many kinds of inhaler devices on the market, such that the appropriate choice of inhaler device for each patient plays a crucial role in achieving a good outcomes from treatment. Correct use of inhalation devices will maximize the beneficial effects of therapy. A detailed assessment of the patient’s coordination and inspiratory flow patterns could allow for the correct use of the most suitable inhaler medication for each patient. Successful inhalation therapy can increase the possibility of controlling airway diseases.
Economic Burden and Epidemiology of Pneumonia in Korean Adults Aged over 50 Years
유광하,유철규,김세규,정지예,이명구,어수택,심태선,전경만,심재정,이흥범,정치량,정기석 대한의학회 2013 Journal of Korean medical science Vol.28 No.6
This study was performed to estimate the direct medical costs and epidemiology of pneumonia in adults of Korea. We conducted a multi-center, retrospective, observational study and collected data targeting for community-acquired pneumonia patients ( ≥ 50 yr)from 11 hospitals. Costs attributable to the treatment of pneumonia were estimated by reviewing resource utilization and epidemiology data (distribution of pathogen, hospital length of stay, overall outcome) were also collected. A total 693 patients were included;average 70.1 ( ± 10.5) aged, 57.3% male and average 1.16 CURB-65 (confusion, blood urea nitrogen, respiratory rate, blood pressure, age > 65 yr) scored. The pathogen was identified in the 32.9% (228 patients); Streptococcus pneumoniae accounted for 22.4%(51 patients) of identified pathogens. The hospital mortality was 3.2% (especially, for S. pneumoniae was 5.9%) and average length of stay was 9 days. The mean total cost for the treatment of pneumonia was US dollar (USD) 1,782 (SD: USD 1,501). Compared to the cost of all caused pneumonia, that of pneumococcal pneumonia was higher, USD 2,049( ± USD 1,919), but not statistically significant. Charge of hospitalization accounted the greatest part of total medical costs. The economic burden of pneumonia was high in Korea, and the prevention of pneumonia should be considered as effective strategy.
전국적 COPD Cohort 연구 기초 자료(KOCOSS 연구 Cohort)
유광하,정기석,김영삼,박용범,신경철,윤형규,이상엽,이진국,이진화,( Kocoss Cohort ) 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.0
배경: 국내 COPD 유병률이 40세 이상 성인의 경우 13% 이상이지만 전국적 규모의 COPD 환자에 대한 역학 자료는 거의 없는 실정이다. 이에 제주도를 포함한 전국적 규모의 COPD cohort를 구축하여 국내 COPD 환자의 phenotype을 확인하고 그 위험인자를 밝혀 임상적인 활용과 함께 기초 연구 자료로 활용한 목적으로 COPD cohort 연구를 진행하였다. 방법: 전국적으로 43개 병원 61명의 공동 연구자와 함께 COPD 환자 1,000명을 목표로 cohort를 구축하여 후향적으로 5년간 경과 관찰을 할 예정이다. 결과: 2012년 9월까지 221명의 COPD 환자가 입적되었다. 평균 나이는 68.6±8.2이며 남성이 89%를 차지하였다. 약 40%에서 비 흡연력을 가지고 있으며 평균 22년값을 흡연력이 있었다. 폐기능에 따른 중증도는 FEV1≥80% pred., 50%≤ and <80% pred., 30%≤ and <50%pred., FEV1<30%이 각 각 6.5%, 46.8%, 36.0%, 10.8%였다. 평균 CAT 점수는 16.27±8.36, 6분 보행 검사의 평균은 401.71±104.95M였다. 평균 BMI는 22.99±3.38 였으며 평균 3.7개의 호흡기 약물을 사용하였다. 결론: 본 연구는 국내 COPD 역학 연구에 중요한 기본 자료를 제공할 것으로 예상되며 표현형을 확인하고 그 위험 요소를 관리 함으로써 환자의 경과를 바꿀 수 있는 지를 확인할 수 있는 중요한 기초 자료가 될 것으로 기대한다.
유광하,오연목,박용범,윤형규,이진국,이진화,김진희,김유리,김경주 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.0
Background: This study was conducted to estimate the current burden and health care utility status for newly diagnosed chronic obstructive pulmonary disease (COPD) patients in Korea in 2009. Methods: We retrospectively analyzed the Health Insurance Review and Assessment Service (HIRA) data in 2009. We defined newly diagnosed COPD patients who had the first ICD code of COPD (j41-j44, except j430), and who have been prescribed one kind of COPD medication at least two times in 2009. Results: Among the 249,140 new diagnosed COPD patients included in the 2009 HIRA data, 60% are men and the mean age is 68.9 (±10.7). 8.5% and 20.9% of these COPD patients visited Emergency department (ED) and hospitalized respectively. 72.8% of the patients received methyxanthine, 27.5%, 25.9%, 23.7% received ICS+LABA, systemic steroid, LAMA respectively. The mean of the direct total medical cost per patient is 2,866 (±996.5) US dollars per year. Most of these direct costs are from hospitalization. The mean number of the OPD visit is 6.5 times per year and the mean duration of hospitalization is 17.8 days per year. The most common co-morbidities are hypertension (27.7%), diabetes mellitus (13.0%) and ischemic heart disease (8.3%). Conclusion: According to this survey, most of COPD patients stillsuffer from the economic burden in Korea. We need more optimal strategies to treat COPD patients to minimize their personal and economic burden. This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health and Welfare(A102065).
Customized Asthma Control Test with Reflection on Sociocultural Differences
유광하,정재원,윤호주,장석일,문희범,최병휘,김유영,조상헌 대한의학회 2010 Journal of Korean medical science Vol.25 No.8
We evaluated the utility and feasibility of customizing Asthma Control Test (ACT) items to generate a Korean Asthma Control Test (KACT) specific for Korean patients. We surveyed 392 asthma patients with 19 items, selected to reflect the Korean sociocultural context. Guideline ratings were integrated with the evaluations of specialists (i.e., using both guide base rating together with specialist’s rating), and items with the greatest discriminating validity were identified. Stepwise regression methods were used to select items. KACT scale scores showed significant differences between the asthma control ratings generated by integrating ratings (r=0.77, P<0.001), by specialist’s evaluations (r=0.54, P<0.001), or by FEV1 percent predicted (r=0.39, P<0.001). Specialist’s and guideline ratings detected 56%and 48.6% of patients with well-controlled asthma, respectively. However, the integrated ratings indicated that only 34.3% of the patients in the test sample were well controlled. The overall agreement between KACT and the integrated rating ranged from 45% to 78%,depending on the cut-off points used. It is possible to formulate a valid, useful countryspecific diagnostic tool for the assessment of asthma patients based on the original ACT that reflect differences in sociocultural context.