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Peak Expiratory Flow Rate Underestimates Severity of Airflow Obstruction in Acute Asthma
(Inseon S. Choi),(Youngil I. Koh),(Ho Lim) 대한내과학회 2002 The Korean Journal of Internal Medicine Vol.17 No.3
N/A Background : Several investigators have demonstrated a considerable disagreement between FEV1 and PEFR to assess the severity of airflow obstruction. The purpose of this study was to examine whether the discrepancy between the two measurements affects the assessment in the severity of acute asthma. Methods : Thirty-five consecutive asthma patients measured both FEV1 and PEFR at 0, 1hr, 1, 3, 5, 7 days of an emergency room admission using a spirometer and a Ferraris PEFR meter. The degree of discrepancy between FEV1 and PEFR expressed as % predicted values was determined. Results : When predictive equations that recommended by the instrument manufacturers were used, PEFR measured with the PEFR meter (f-PEFR) was significantly higher than FEV1 at all time points, with 16.1% mean difference and unacceptable wide limits of agreement (-20.0∼52.3%). The classification in severity was significantly different between FEV1 and f-PEFR (p 0.001). The discrepancy was inter-instrumental in large part because f-PEFR was 10.1% higher than spirometric PEFR. Different predictive equations altered the degree of the differences but could not completely correct it. Conclusion : These results indicate that f-PEFR values underestimate the severity of airflow obstruction in acute asthma despite using recommended predictive equations. Therefore, these confounding factors should be considered when the severity of airflow obstruction is assessed with PEFR.
Effects of anti-asthma therapy on dyspnea perception in acute asthma patients
Choi, Inseon S.,Chung, Se-Woong,Han, Eu-Ryeong,Lim, Jeong-Hwan,Cho, Jeong-Seon,Lee, Yoon-Cheol,Cho, Seok,Jang, An-Soo Bailliere Tindall,in association with the British 2006 Respiratory medicine Vol.100 No.5
<P><B>Summary</B></P><P>Blunted perception of dyspnea may predispose patients to fatal asthma attacks. To examine whether this impaired perception of dyspnea in patients with acute asthma could be corrected by anti-asthma therapy, the medical records of 104 consecutive asthma patients who had been hospitalized as a result of asthma attacks were analyzed retrospectively. During the course of treatment with conventional asthma medications, the forced expiratory volume in 1s (FEV<SUB>1</SUB>) and the Borg scale-based dyspnea perception scores during breathing through an inspiratory muscle trainer were measured at least twice. The baseline Borg score measured just before discharge was significantly lower than from that measured initially, regardless of improvement in FEV<SUB>1</SUB>. In contrast, the Borg score at the highest resistance (HR; 3.12±0.26 vs. 5.03±0.53; <I>P</I><0.01) and the HR-induced ΔBorg score (1.68±0.20 vs. 4.47±0.54, <I>P</I><0.001) were increased significantly in the Poor Perceivers (Borg score ⩽ 5 at HR and HR-induced ΔBorg score ⩽3). Patient age (<I>r</I>=0.363, <I>P</I><0.001), blood eosinophil counts (<I>r</I>=−0.285, <I>P</I><0.01), and serum total IgE levels (<I>r</I>=−0.213, <I>P</I><0.05), but not FEV<SUB>1</SUB>, were significantly related to the effect of the treatment on the HR-induced ΔBorg scores. These findings suggest that anti-asthma treatments decrease dyspnea even without a concomitant improvement in lung function and correct the impaired perception of inspiratory resistive load in acute asthma, and that age and allergy influence the effect of treatment on impaired perception.</P>
( Inseon S. Choi ),( Seo Na Hong ),( Yeon Kyung Lee ),( Youngil I. Koh ),( An Soo Jang ),( Hyeon Cheol Lee ) 대한내과학회 2003 The Korean Journal of Internal Medicine Vol.18 No.2
Background: Airway hyperresponsiveness (AHR) to direct stimuli, such as methacholine (MCh), is observed not only in asthma but other diseases. AHR to indirect stimuli is suggested to be more specific for asthma. The purpose of this study was to determine
( Inseon S Choi ),( Ga Ram Kim ),( Jin Woo Wi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
In 2010, Lee et al. (Ann Allergy Asthma Immunol 2010;105:130) reported that intranasal ketorolac desensitization followed by rapid oral aspirin desensitization protocol was effective, safe, and less time-consuming than the standard oral one. Although they could perform successfully the protocol in out-patient clinics, their patients were given standard oral aspirin for maintenance. By the way, a 61 years-old woman with aspirin intolerance had been hospitalized 5 times due to her forgetfulness that she should take aspirin every day for maintaining the aspirin desensitization. Therefore, after the induction according to a modifi ed (last oral dose: 500 mg) protocol by Lee et al., she was given intranasal ketorolac for maintenance of desensitization. Because the effect of aspirin desensitization depends on the maintenance dose of aspirin, and because it is possible that the dose of intranasal ketorolac would not be enough to be effective, she was given additional oral aspirin 100 mg qd. Two weeks later, she was challenged with oral aspirin 250 mg followed by 500 mg 1.5 hr later without any symptoms. Other 5 patients also successfully induced, 4 of them did not respond to the challenge with oral aspirin 500 mg 2 weeks later, and one patient are now waiting the oral challenge. One patient with severe aspirin intolerance failed to induce the desensitization. The other 4 patients, who had received standard oral aspirin for a long time, changed their oral aspirin to combined intranasal ketorolac and low dose (100 mg) oral aspirin and 3 of them did not respond to oral aspirin 500 mg 2 weeks later. One patient discontinued low dose oral aspirin for his operation of intestinal hernia. Collectively, combined intranasal ketorolac and low dose oral aspirin seems to be effective and safe for maintaining aspirin desensitization.
( Inseon S Choi ),( Da Woon Sim ),( Seung Hoon Kim ),( Jin Woo Wi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: We reported previously that as much as 1/3 of hospitalized asthmatics treated with inhaled steroids (ICS) for average 4.5 years showed adrenal insuffi ciency in a dose-dependent manner. Because the result might be overestimated due to subject selection bias, this study examined adrenal function in out-patient asthmatics of a tertiary hospital. Methods: Twelve normal control and 135 consecutive adult asthmatics under ICS treatment for 6 months or more underwent a rapid ACTH stimulation test. Adrenal insuffi ciency was defi ned as a serum morning cortisol level < 3 ㎍/dL or failure in rising of the level to >18 ㎍/dL after an administration of 250 ㎍ ACTH. Results: The mean duration of ICS use in the patients were 8.30±0.43 years. Adrenal insuffi ciency was found in a manner dependent on the ICS daily doses [control 2/12 (16.7%), low 17/29 (58.6%), medium 34/54 (63.0%), and high 32/52 (61.5%); X²=4.23, P=0.04]. The total doses of nasal steroid (NCS) and ICS were signifi cantly related with each other (r=0.543, P=0.000). The number of NCS canisters (32.5±2.7 vs. 24.8±2.6, P=0.04), but not the duration/total dose of ICS, was signifi cantly higher in the patients with adrenal insuffi ciency than the other patients. Only the NCS dose seemed to relate with adrenal insuffi ciency [odds ratio: 1.016 (95% CI: 1.000-1.033); P=0.056]. Conclusion: Even low dose ICS seem to induce adrenal insuffi ciency in more than a half of asthmatics when it was administered for a very long time, especially in the patients used NCS together.