Relationship of serum lymphocyte with outcomes in chronic obstructive pulmonary disease

( Sung Woo Moon ),( Ah Young Leem ),( Young Sam Kim ),( Ji-hyun Lee ),( Tae-hyung Kim ),( Yeon Mok Oh ),( Sang Do Lee ),( Ji Ye Jung ),( Kold Study Group ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: The role of lymphocyte in the patients with chronic obstructive pulmonary disease (COPD) remains unclear. The purpose of this study was to evaluate the effect of the serum lymphocyte on several clinical parameters, such as lung function, exercise capacity, QOL, exacerbation and mortality in a Korean COPD cohort by repeated and simultaneous measurement of the serum lymphocyte and these clinical parameters. Methods: The study population comprised 451 patients with COPD from the KOLD cohort. Serum lymphocyte percentage (%) were measured every year along with various clinical parameters such as lung function, 6-min walking (6MW) distance, quality of life (CAT and SGRQ score), exacerbations and survival. Serum lymphocyte percentage less than 20% is considered as low lymphocyte. Follow-up data up to 9 years was used for analysis. Results: Among the 451 patients, 409 (90.7%) and 42 (9.3%) were the normal lymphocyte group and low lymphocyte groups at the time of enrollment, respectively. Clustered analysis showed that low lymphocyte group showed lower post-bronchodilator FEV1 (estimated mean=-5.70 % predicted; P=0.001), lower FVC (estimated mean=-5.63 % predicted; P=0.005), shorter 6MW distance (estimated mean=-41.31m; P<0.001), higher CAT score (estimated mean=2.62; P=0.013), and higher SGRQ score (estimated mean=10.10; P<0.001). However, serum lymphocyte % was not associated with frequent acute exacerbation and mortality. Conclusions: Patients with low serum lymphocyte showed low pulmonary function, low 6MW distance, and worse quality of life. Lymphocyte may be related with various conditions in COPD.

P-69 The prognostic role of the bronchiectasis in patients with COPD

김은경,이상민,이재승,김미애,이지현,오연목,이상도,( Kold Study Group ) 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.-

Background: The presence of bronchiectasis in patients with COPD is considered to be associated with severe airflow obstruction, frequent exacerbation and a higher degree of functional impairment. So, we evaluated the incidence of bronchiectasis on high-resolution computed tomography scan (HRCT) in a longitudinal cohort of COPD patients and its clinical characteristics and prognostic value. Methods: We analyzed 479 COPD patients enrolled in the Korean Obstructive Lung Disease (KOLD) cohort. Patients were divided into two groups based on the presence of bronchiectasis on HRCT. The severity of bronchiectasis was evaluated using the Bhalla score. Severe bronchiectasis was defined as Bhalla score ≥ 5.5. Results: Bronchiectasis was present in 187 (39.0%) patients. No differences were found between the groups for lung function, dyspnea, exacerbation, and mortality. However, COPD patients with severe bronchiectasis were older with lower BMI, lower serum albumin level, lower FEV1, lower diffusing capacity, higher MMRC and SGRQ score, higher emphysema index, and lower muscle mass. A multivariate Cox regression analysis revealed that age (p <0.001), Bhalla score (p = 0.036), and the number of ER visit (p = 0.033) were significant predictors for all-cause mortality. Conclusions: Our data support that severe bronchiectasis, not the presence of bronchiectasis was associated with severe airflow obstruction, higher emphysema index, nutritional and functional impairment. Severe bronchiectasis may be considered as a significant prognostic factor in patients with COPD.

만성폐쇄성폐질환 환자에서 EQ-5D로 측정한 삶의 질과 관련요인 분석

홍지영,김은영,정지예,박무석,강영애,김세규,장준,( Kold Study Group ),김영삼 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.0

배경: 만성폐쇄성폐질환(COPD)은 유병율과 사망률이 높은 질환으로, 삶의 질에 영향을 미치는 것으로 알려져 있다. 한국인 COPD 환자에서 EQ-5D로 측정한 삶의 질의 차이와 이에 영향을 미치는 요인에 대해 국민건강영양조사 자료를 이용하여 알아보고자 하였다. 방법: 제 4기와 5기 국민건강영양조사를 받은 대상군 중 연령별과 성별의 분포가 일치하도록 COPD 군 1,178명과 정상 폐기능군 1,178명씩 임의 추출하여 EQ-5D Visual Analogue Scale (EQ-V)과 EQ-5D Utility Score (EQ-U)를 비교하였다. COPD의 기도폐쇄 중증도는 FEV1 정상 예측치에 대한 비율에 따라 세 단계로 나누었으며 다변량선형회귀분석을 통해 삶의 질에 영향을 미치는 요인을 분석하였다. 결과: EQ-5D 수치는 정상 폐기능군(EQ-V: 73.5, EQ-U: 0.92)보다 COPD환자(EQ-V: 71.2, EQ-U:0.90)에서 더 낮았다. EQ-V 는 경증 COPD에서 72.8, 중등증에서 70.7, 중증에서 63.8이었다. EQ-U 는 경증 COPD 환자에서는 0.90, 중등증에서 0.89, 중증에서는 0.85였다. 나이, 성별, 동반질환의 개수, 체질량지수, 흡연 유무를 보정한 후에도 기도폐쇄가 심할수록 EQ-5D 점수는 감소하였다. 다변량회귀분석 결과 성별, 나이, 가구당 수입, 교육수준, 활동제한, 동반질환의 수, 2주 이상의 우울증세 유무가 삶의 질에 영향을 미치는 요인이었으며 체질량지수, 기도폐쇄의 유무와 중증도, 흡연력 등은 EQ-5D로 측정한 삶의 질과 관련이 없었다. 결론: COPD환자에서 EQ-5D로 측정한 삶의 질은 정상인에 비해 감소되어 있으며 기도폐쇄가 심해질수록 감소하였다. COPD 환자의 삶의 질을 향상시키기 위해서 사회경제적 요인을 개선하고 우울증과 동반질환을 잘 관리하는 등 다각적인 접근과 치료를 시행해야 한다. 본 연구는 보건복지부 보건의료연구개발사업(A102065)의 지원을 받아 시행함.

F-98 : Free Paper Presentation ; Correlation of Mediastinal Fat Mass and Lung Function in COPD Patients

박지수,이홍열,김세중,남성진,이연주,박종선,조영재,이재호,이춘택,오연목,이상도,( Kold Study Group ),윤호일 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

Background: Obesity has long been recognized as having correlation with lung function, the underlying mechanism of which is still uncertain. We hypothesized that mediastinal fat mass may be in a different relation to lung function from body mass index (BMI). Method: Medical records and multidetector computed tomography (MDCT) scans of patients from KOLD cohort and Seoul National University Airway Registry (SNU-AR) were reviewed. Mediastinal fat mass was quantified using Rapidia developed by INFINITT Co. at levels of upper and lower mediastinum. Results: Data of eighty-five patients were analyzed. BMI was in significant correlations with %FEV1, FEV1/FVC, %FEF25~75%, %PEF, %DLCO. No correlation was found between BMI and %FVC. Mediastinal fat mass was correlated with %FVC (β+SE -0.007±0.000, p-value 0.001), %TLC, and %ERV. Conclusion: Higher mediastinal fat mass was associated with decreased lung volume whereas higher BMI was mostly with parameters representing airway obstruction.Background: Obesity has long been recognized as having correlation with lung function, the underlying mechanism of which is still uncertain. We hypothesized that mediastinal fat mass may be in a different relation to lung function from body mass index (BMI). Method: Medical records and multidetector computed tomography (MDCT) scans of patients from KOLD cohort and Seoul National University Airway Registry (SNU-AR) were reviewed. Mediastinal fat mass was quantified using Rapidia developed by INFINITT Co. at levels of upper and lower mediastinum. Results: Data of eighty-five patients were analyzed. BMI was in significant correlations with %FEV1, FEV1/FVC, %FEF25~75%, %PEF, %DLCO. No correlation was found between BMI and %FVC. Mediastinal fat mass was correlated with %FVC (β+SE -0.007±0.000, p-value 0.001), %TLC, and %ERV. Conclusion: Higher mediastinal fat mass was associated with decreased lung volume whereas higher BMI was mostly with parameters representing airway obstruction.

Relationship of Vitamin D Binding Protein Polymorphisms to Lung Function Decline in Chronic Obstructive Pulmonary Disease

정지예,최동필,원성호,이영,김영삼,김세규,오연목,서일,이상도,( Kold Study Group ) 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Background: Multiple genetic factors are associated with the risk of developing COPD. One of the leading candidates is the gene encoding vitamin D binding protein (VDBP). We sought to investigate the types of VDBP variants in the Korean population and determine the association of VDBP variants with COPD and airflow deterioration. Methods: The study cohort consisted of 203 COPD patients and 157 control subjects. VDBP variants were genotyped by the RFLP method. All lung function data were analyzed using a linear mixed model. Results: GC1F variant was most frequently observed both in COPD (42.8%) and controls (38.6%). Genotype 1S-1S was more commonly detected in controls than in COPD (8.4% versus 3.4%, P=0.047). According to linear mixed model analysis, subjects with genotype 1S-1S had 0.427 L higher FEV1 than those with other genotypes (P=0.029). However, the genotype/smoking pack-year interaction was found to be particularly significant among subjects with genotype 1S-1S; FEV1 decreased by 0.014L per smoking pack-year (P=0.001). Conclusions: VDBP genotype 1S-1S was significantly associated with lung function decline in patients who smoke. Lung function decline in subjects with genotype 1S-1S was more prominent as the amount of pack-years increased compared to subjects with other genotypes (a grant of the Korea Healthcare technology R&D Project, Ministry of Health and Welfare (A102065), a grant of the Korea Centers for Disease Control and Prevention (2006-E71011-00), and a Faculty Research Grant of Yonsei University College of Medicine for 2011 (6-2011-0192)).

Increased Prevalence of Asthma among Korean Adults: an Analysis of KNHANES I and IV Data

김송이,김은영,정지예,강영애,박무석,김세규,장준,김영삼,( Kold Study Group ) 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Background: Asthma is one of the most common chronic condition. However, there have been no studies to examine current asthma prevalence trends in Korea through the analysis of nationwide surveys. Patients and Methods: Data was acquired from aged 20-59 years who participated in the First Korean National Health and Nutritional Examination Surveys (KNHANES), which was conducted in 1998, and the second year of the Fourth KNHANES, which was conducted in 2008. To estimate the prevalence with age and gender standardization, we used data from the Population and Housing Census, which was conducted by Statistics Korea in 2005. Results: The prevalence of physician-diagnosed asthma increased from 1998 to 2008 (1998: 0.7%, 2008: 2.2%). The prevalence of asthma medication usage also increased from 1998 to 2008 (1998: 0.4%, 2008: 0.8%), however, the prevalence of wheezing decreased between 1998 and 2008 (1998: 13.5%, 2008: 6.36%). A similar trend was observed after estimating with age and gender standardisation. Allergic rhinitis might be the reason for the increased prevalence of physician-diagnosed asthma, while the observed decrease in wheezing could be related with the decrease in smoking or the increase in the use of asthma medication. Conclusions: The present study showed that the prevalence of both physician-diagnosed asthma and asthma medication usage increased from 1998 and to in Korea, despite the changing pattern in diagnosing asthma.

F-114 : 만성폐쇄성폐질환 환자에서 3제 치료 중 한 가지 흡입기의 중단이 폐기능 및 급성 악화에 미치는 영향

이지현,김은경,백승희,김태형,김우진,임성용,윤호일,이진화,유광하,서준범,이재승,오연목,이상도,( Kold Study Group ) 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

배경: 만성폐쇄성폐질환(COPD)은 진행성 질환이므로 치료를 시작하면 대부분 그대로 유지하거나, 증세 호전이 미미하거나 반복적인 악화가 발생할 경우 다른 약제를 추가하게 된다. 따라서 COPD 환자에서 triple therapy (tiotropium과 ICS+LABA combination 제제의 동시 사용)를 시작하게 되면 대부분의 경우 이를 유지하게 된다. 하지만 환자가 상당한 호전을 보이거나, 약제 부작용이 심각한 경우 두 가지의 흡입기 중 하나를 중단(step down) 하는 경우가 드물지 않게 발생하나, 이의 영향에 대해서는 알려진 바가 없어 KOLD cohort를 대상으로 이를 확인하고자 하였다. 방법: KOLD cohort 환자들의 투약력을 확인하고 2년 이상 triple therapy를 받았던 환자들(triple군)과, 1년 이상 triple therapy를 유지하 다가 한가지 흡입제를 중단하고 1년 이상 추적된 환자들(step down군)을 비교하였다. Step down군에서 약제를 중단한 시점을 index time (IT)으로 정의하였고, Triple군에서는 IT를 triple therapy 시작 시점으로부터 12개월로 임의로 정하였다. 결과: 총 380명의 COPD 환자 중 triple군은 101명, step down군은 27명이었다. Step down군의 IT은 40.3±18.9개월이었다. 두군 IT에서의 나이, 흡연갑년, 폐기능, MMRC, SGRQ, 폐기종 정도 및 동반 질환에는 차이를 보이지 않았으나, IT전 1년간의 악화 빈도는 triple군에서 0.85±1.10, step down군에서 0.56±0.75 (p=0.043)로 차이를 보였다. IT 전후의 시간에 따른 FEV1 값의 변화 및 IT 전후 1년간의 악화 횟수의 비교도 두 군간 차이를 보이지 않았다. Step down군 중 33%에 해당하는 9명의 환자에서 추적기간 중 triple로 다시 약제를 올렸으며 이시기는 IT 이후 평균 22.3개월이었다. 결론: Triple therapy를 유지하던 COPD 환자들에서 악화 횟수가 감소하는 등의 안정 양상을 보일 경우 조심스럽게 step down을 시도해 보아도 될 것으로 사료된다.

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).