Associations of Moderate to Severe Asthma with Obstructive Sleep Apnea

변민광,박선철,장윤수,김영삼,김세규,김형중,장준,안철민,박무석 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.4

Purpose: This study aimed to evaluate the correlation between associating factors of moderate to severe asthma with obstructive sleep apnea (OSA). Materials and Methods: One hundred and sixty-seven patients who visited the pulmonary and sleep clinic in Severance Hospital presenting with symptoms of sleep-disordered breathing were evaluated. All subjects were screened with ApneaLink. Thirty-two subjects with a high likelihood of having OSA were assessed with full polysomnography (PSG). Results: The mean age was 58.8±12.0 years and 58.7% of subjects were male. The mean ApneaLink apnea-hypopnea index (AHI) was 12.7±13.0/hr. The mean ApneaLink AHI for the 32 selected high risk patients of OSA was 22.3±13.2/hr, which was lower than the sleep laboratory-based PSG AHI of 39.1±20.5/hr. When OSA was defined at an ApneaLink AHI ≥5/hr, the positive correlating factors for OSA were age, male gender, and moderate to severe asthma. Conclusion: Moderate to severe asthma showed strong correlation with OSA when defined at an ApneaLink AHI ≥5/hr.

P-73 History of pulmonary tuberculosis affects the severity and clinical outcomes of COPD

변민광,박혜정,김형중,안철민,김덕겸,김유일,오진영,윤형규,유광하,정기석 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Background: Although an association between pulmonary tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) has been suggested, studies on the effect of TB in COPD patients have not been conducted. We aimed to investigate the severity and clinical outcomes of COPD in patients with and without a history of TB. Methods: We retrospectively reviewed the data of 1784 patients with COPD in the KOCOSS cohort collected from December 2011 to January 2017 and followed up for 3 years. Results: Among the 1784 patients, the COPD assessment test (CAT) and total St George’s Respiratory Questionnaire for COPD (SGRQc) scores were significantly higher in the prior TB group (n = 468) than in the non-TB group (n = 1316). Lung function and exacerbation prevalence were significantly poorer and higher, respectively, in the prior TB group than in the non-TB group. In a small-sized follow-up study, CAT scores (n = 318), SGRQc scores (n = 295) and lung function (n = 182) remained poorer, and exacerbation prevalence (n = 256) remained higher in the prior TB group over 3 years. The forced expiratory volume in 1 s in the prior TB group declined (-0.57%/year), whereas it improved (+0.93%/year) in the non-TB group (P for changes between the groups = 0.076). In the prior TB group, patients showed poorer lung function compared with the non-TB group regardless of having lung lesions visible or not on chest radiographs. Conclusion: TB history negatively affected the severity of COPD, and a small-sized follow-up study showed that the changes were sustained were sustained for several years.

Clinical Features and Outcomes of Idiopathic Pulmonary Alveolar Proteinosis in Korean Population

변민광,김동순,김영환,정만표,심재정,차승익,어수택,박춘식,정성환,박용범,이홍렬,박무석 대한의학회 2010 Journal of Korean medical science Vol.25 No.3

Idiopathic pulmonary alveolar proteinosis (PAP) is a rare disorder in which lipoproteinaceous material accumulates within alveoli. There were few reports on Asian populations with idiopathic PAP. We retrospectively reviewed 38 patients with idiopathic PAP in Korea. We assessed clinical features, therapeutic efficacy and outcomes of whole lung lavage in patients with idiopathic PAP. The mean age at diagnosis was 52 yr. Eighty six percent of patients were symptomatic at diagnosis. Dyspnea and cough were the most common symptoms. Crackles were the most common physical examination finding. On pulmonary function test, a mild restrictive ventilatory defect was common, with a predicted mean forced vital capacity (FVC) of 77% and forced expiratory volume in one second (FEV1) of 84.6%. Diffusing capacity was disproportionately reduced at 67.7%. Arterial blood gas analysis revealed hypoxemia with a decreased PaO2 of 69.0 mmHg and an increased D(A-a)O2 of 34.2 mmHg. After whole lung lavage, PaO2, D(A-a)O2 and DLCO were significantly improved, but FVC and total lung capacity (TLC) were not different. This is the first multicenter study to analyze 38 Korean patients with idiopathic PAP. The clinical features and pulmonary parameters of Korean patients with idiopathic PAP are consistent with reports in other published studies. Whole lung lavage appears to be the most effective form of treatment.

신이식 환자에서 발생한 전이성 폐 석회화증

변민광,정우영,한창훈,강신명,박무석,김세규,장준,김성규,김영삼 대한내과학회 2005 대한내과학회 추계학술대회 Vol.2005 No.1

Efficacy of Surgical Treatment for Brain Metastasis in Patients with Non-Small Cell Lung Cancer

변민광,김상영,홍창기,김태훈,홍제범,박철환,장윤수,김형중,안철민 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.1

Purpose: Patients with non-small cell lung cancer (NSCLC) and simultaneously having brain metastases at the initial diagnosis, presenting symptoms related brain metastasis, survived shorter duration and showed poor quality of life. We analyzed our experiences on surgical treatment of brain metastasis in patients with NSCLC. Materials and Methods: We performed a single-center, retrospective review of 36 patients with NSCLC and synchronous brain metastases between April 2006 and December 2011. Patients were categorized according to the presence of neurologicalsymptoms and having a brain surgery. As a result, 14 patients did not show neurological symptoms and 22 patients presented neurological symptoms. Symptomatic22 patients were divided into two groups according to undergoing brain surgery (neurosurgery group; n=11, non-neurosurgery group; n=11). We analyzed overall surgery (OS), intracranial progression-free survival (PFS), and quality of life. Results: Survival analysis showed there was no difference between patients with neurosurgery (OS, 12.1 months) and non-neurosurgery (OS, 10.2 months; p=0.550). Likewise for intracranial PFS, there was no significant difference betweenpatients with neurosurgery (PFS, 6.3 months) and non-neurosurgery (PFS, 5.3 months; p=0.666). Reliable neurological one month follow up by the Medical Research Council neurological function evaluation scale were performed in symptomatic22 patients. The scale improved in eight (73%) patients in the neurosurgerygroup, but only in three (27%) patients in the non-neurosurgery group (p=0.0495). Conclusion: Patients with NSCLC and synchronous brain metastases,presenting neurological symptoms showed no survival benefit from neurosurgicalresection, although quality of life was improved due to early control of neurologicalsymptoms.

혈관주위세포종의 폐전이 1례

변민광 ( Min Kwang Byun ),이정은 ( Jung Eun Lee ),정우영 ( Woo Young Jung ),박무석 ( Moo Suk Park ),문진욱 ( Jin Wook Moon ),한창훈 ( Chang Hoon Hahn ),강신명 ( Shin Myung Kang ),임범진 ( Bum Jin Im ),박영년 ( Young Nyun Park ) 대한결핵 및 호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.59 No.5

Asthma-COPD Overlap Shows Favorable Clinical Outcomes Compared to Pure COPD in a Korean COPD Cohort

박혜정,변민광,김형중,안철민,이진화,신경철,어수택,나승원,유광하,정기석 대한천식알레르기학회 2017 Allergy, Asthma & Immunology Research Vol.9 No.5

Purpose: Comparisons of the characteristics of chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACOS) have been the focus of several studies since the diseases were defined by the Global Initiative for Asthma and Global Initiative for Chronic Obstructive Lung Disease guidelines. However, no consensus is available yet. In this study, we aimed to compare the characteristics of asthma-COPD overlap (ACO) and COPD. Methods: We retrospectively reviewed 1,504 patients with COPD in a Korean COPD Subtype Study cohort. The occurrence of ACO was defined as a positive response to a bronchodilator (an increase in forced expiratory volume in 1 second [FEV1] of 12% and 200 mL). Results: Among 1,504 patients with COPD, 223 (14.8%) were diagnosed with ACO. Men (95.5%) and current smokers (32.9%) were more prevalent in the ACO group compared with the pure COPD group (90.5% and 25.3%, respectively; P=0.015 and P=0.026, respectively). Patients with ACO had a better quality of life (St. George’s Respiratory Questionnaire for COPD score=31.0±18.0 [mean±standard deviation]) than those with pure COPD (35.3±19.1) (P=0.002). Although the prevalence of acute exacerbation was not different between the 2 groups, patients with severe exacerbation required hospital admission significantly more frequently in the pure COPD group than in the ACO group. Patients with ACO showed a higher likelihood of FEV1 recovery than those with pure COPD (P<0.001). Conclusions: We suggest that ACO is characterized by less severe symptoms, and therefore it might lead to rare severe exacerbation and the possibility of lung function recovery.

Significant Predictors of Medically Diagnosed Chronic Obstructive Pulmonary Disease in Patients with Preserved Ratio Impaired Spirometry : A 3-year Cohort Study

박혜정,변민광,이진국,김경주,김형중,유광하 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Purpose: We investigated the incidence and significant predictive factors of chronic obstructive pulmonary disease (COPD) in preserved ratio impaired spirometry (PRISm) patients. Methods: From 11,922 subjects registered in the Korea National Health and Nutrition Examination Survey, never or light smokers, young subjects, and those already medically diagnosed with COPD (defined by ICD-10 code and prescribed medication) were excluded. The 2,666 remaining subjects were categorized into PRISm (normal forced expiratory volume in the first second [FEV1]/force vital capacity [FVC] [≥ 0.7] and low FEV1 (<80%); n=313); normal (n=1,666); and unrevealed COPD groups (FEV1/FVC ratio <0.7; n=687). These groups were compared using matched Health Insurance Review and Assessment Service data over a 3-year follow-up. Results: COPD incidence in PRISm patients (17/1,000 person-year [PY]) was higher than that in normal subjects (4.3/1,000 PY; P<0.001), but lower than that in unrevealed COPD patients (45/1,000 PY; P<0.001). PRISm patients visited hospitals, took COPD medication, and incurred hospitalization costs more frequently than normal subjects, but less frequently than unrevealed COPD patients. In the overall sample, age, FVC, FEV1, dyspnea, and wheezing were significant predictors of COPD, but in PRISm patients, only age (OR, 1.14; P=0.002) and wheezing (OR, 4.56; P=0.04) were significant predictors. Conclusion: PRISm patients are likely to develop COPD, and should be monitored carefully, especially older patients and those with wheezing, regardless of lung function.

기관지동맥 색전술 후 객혈의 재발에 관한 연구

정우영,변민광,한창훈,강신명,박무석,김영삼,김세규,이도연,김성규,장준 대한내과학회 2005 대한내과학회 추계학술대회 Vol.2005 No.1

Clinical Outcomes of Tigecycline in the Treatment of Multidrug-Resistant Acinetobacter baumannii Infection

신정아,변민광,장윤수,김형중,김세규,장준,안철민 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.5

Purpose: Acinetobacter baumannii (A. baumannii) has emerged as a major cause of nosocomial pneumonia and sepsis in seriously ill patients. Multidrug-resistant A. baumannii (MDRAB) is increasing in frequency, and the management of it’s infections is consequently difficult. Therefore, tigecycline is considered to be the drug of choice for MDRAB treatment. The aim of our study was to evaluate the microbiological eradication and clinical effectiveness of tigecycline against MDRAB in seriously ill patients, including patients with ventilator-associated pneumonia (VAP). Materials and Methods: We conducted a retrospective study including patients with A. baumannii infections who were treated with tigecycline between April 1, 2009 and March 31, 2010. We treated 27 patients with tigecycline for MDRAB infections. Results: The mean age of patients was 66.2 years, and 20 (74.1%) patients were male. The median length of stay at hospital was 74.6 days. MDRAB was eradicated from the site of infection in 23 cases (85.2%), however,only 17 cases (63.0%) showed positive clinical responses. Overall, an in-hospital mortality rate of 51.9% was observed, and 4 cases of death were attributable to sepsis. The combination therapy showed better clinical and microbial success rates than the monotherapy without significant difference. Conclusion: We observed the relatively low clinical success rate although the microbial eradication rate was high, probably due to superinfections in VAP and bacteremia. We suggest that clinicians should limit tigecycline monotherapy for MDRAB infection in critically ill patients, until large controlled clinical trials should be conducted.