학령 전기 아동의 천식 진단에서 흉부 청진과 산소 포화도를 이용한 기관지 과민성 측정의 진단적 의의

서동인,유영,김도균,유진호,강희,고영률 대한 소아알레르기 호흡기학회 2004 Allergy Asthma & Respiratory Disease Vol.14 No.2

Prenatal Maternal Distress and Allergic Diseases in Offspring: Review of Evidence and Possible Pathways

서동인,장형윤,이은,양송이,홍수종 대한천식알레르기학회 2017 Allergy, Asthma & Immunology Research Vol.9 No.3

Recent studies have suggested a close association between prenatal maternal distress and allergic diseases in the offspring. We selected relevant birth-cohort or national registry studies using a keyword search of the PubMed database and summarized current evidence on the impact of prenatal maternal distress on the development of offspring’s allergic diseases. Moreover, we postulated possible pathways linking prenatal distress and allergic diseases based on relevant human and animal studies. Both dysregulated hypothalamic-pituitary-adrenal axis and increased oxidative stress may cause structural (altered brain/lung development) and functional (skewed immune development) changes, which may predispose the fetus to developing allergic diseases during childhood. Although many facts are yet to be discovered, changes in the placental response and epigenetic modification are presumed to mediate the whole process from maternal distress to allergic diseases. Maternal prenatal distress can also interact with other physical or environmental factors, including familial or physical factors, indoor and outdoor pollutants, and early childhood psychological distress. The gut-microbiome-brain axis and the role of the microbiome as an immune modulator should be considered when investigating the stressallergy relationship and exploring potential intervention modalities. Further research is needed, and particular attention should be given to defining the most vulnerable subjects and critical time periods. To this end, studies exploring relevant biomarkers are warranted, which can enable us to explore adequate intervention strategies.

국내 경력몰입연구의 최근 동향

서동인,김태원,박선영 한국상담학회 2013 한국상담학회 학술대회 논문집 Vol.2013 No.8

알레르기비염과 천식 소아에서의 기관지확장제 반응 및 기관지과민성과의 연관성

서동인,이주경,이진희,고영률 대한 소아알레르기 호흡기학회 2010 Allergy Asthma & Respiratory Disease Vol.20 No.1

Purpose:Bronchial impairment has been observed in patients with allergic rhinitis (AR) as well as asthma. Few reports exist on bronchodilator response (BDR) and its relationship with bronchial hyperresponsiveness (BHR) in children with AR. Methods:A total of 309 children (170 asthmatic children, 80 children with AR and 59 control subjects) were included. After conducting methacholine bronchial provocation and BDR tests, we compared the mean of BDR between the 3 groups and examined the relationships between BDR, prebronchodilator forced expiratory volume in 1 second (FEV1) and provocative concentration causing 20% fall in FEV1 (PC20) in both AR and asthmatic patients. Results:Asthmatic children showed a higher mean BDR than those with AR or control subjects. There were significant relationships between BDR, PC20 and prebronchodilator FEV1 in asthmatic children. Children with AR also showed a higher BDR than control subjects. Though AR children with elevated BDR had lower prebronchodilator FEV1, they showed no significant relationship between BDR and PC20. Conclusion:Children with AR as well as asthma demonstrated an elevated BDR as compared to control subjects. Though the relationship between BDR and BHR in AR subjects was not so remarkable as in asthmatic children, the elevated BDR was associated with the decreased airway caliber in AR patients. These results may reflect the lower airway impairment in children with AR, which suggests a close link between AR and asthma. 목 적:기도폐쇄와 그 가역성은 천식의 주요 특징으로서 기관지확장제 반응 검사로 평가한다. 소아의 경우 기관지확장제 반응에 대한 적절한 양성 기준치가 제시되지 않아 임상적 활용에 많은 제약이 있고, 기관지과민성과의 상관관계는 아직 잘 알려지지 않았다. 한편 알레르기비염 환자에서도 하부기도의 기능장애가 관찰됨이 보고되고 있는데, 알레르기비염 소아의 기관지확장제 반응 및 기관지과민성과의 연관성에 대한 보고는 거의 없다. 방 법:서울대병원 소아청소년과 알레르기 클리닉에 내원한 천식 환아 170명, 알레르기비염 환아 80명, 정상 대조군 59명을 대상으로 메타콜린 기관지유발시험과 기관지확장제 반응 검사를 시행하였다. 정상대조군의 95 백분위 수를 기준으로 기관지확장제 반응 양성 기준치(Cut-off value)를 설정하고 세 군의 기관지확장제 반응의 크기를 비교하였다. 천식 환아 및 알레르기비염 환아에서 각각 기관지확장제 반응과 메타콜린 Provocative concentration causing 20% fall in FEV1 (PC20)그리고 기관지확장제 흡입 전 1초간 강제호기량 (Forced expiratory volume in 1 s, FEV1)사이의 연관성을 살펴보았다. 결 과:본 연구에 참여한 소아들의 기관지확장제 양성 기준치는 7.53% 이었다. 천식환아와 알레르기비염 환아는 정상 대조군보다 높은 기관지확장제 반응을 나타내었다. 천식환아에서 기관지확장제 반응, 메타콜린 PC20, 기관지확장제 흡입 전 FEV1사이에 상호 연관성을 보였다. 알레르기비염 환아에서는 기관지확장제 반응과 기관지확장제 흡입 전 FEV1사이에 연관성이 관찰되었으나 기관지확장제 반응과 메타콜린 PC20사이에 유의한 연관성을 찾을 수 없었다. 결 론:본 연구는 국내 소아에서 기관지확장제 반응의 양성치를 제시하고, 알레르기비염 환아에서 기관지확장제 반응의 정도 및 기관지과민성 지표와의 연관성을 천식환아의 경우와 대조하여 고찰하였다. 알레르기비염이 상부기도뿐만 아니라 하부기도에도 영향을 미친다는 사실을 기도기능의 한 지표인 기관지확장제 반응을 통해 확인할 수 있었다.

Relationship Between Atopy and Bronchial Hyperresponsiveness

서동인,고영률 대한천식알레르기학회 2013 Allergy, Asthma & Immunology Research Vol.5 No.4

Both atopy and bronchial hyperresponsiveness (BHR) are characteristic features of asthma. They are also found among non-asthmatic subjects, including allergic rhinitis patients and the general population. Atopy and BHR in asthma are closely related. Atopy induces airway inflammation as an IgE response to a specific allergen, which causes or amplifies BHR. Moreover, significant evidence of the close relationship between atopy and BHR has been found in non-asthmatic subjects. In this article, we discuss the relationship between atopy and BHR in the general population, asthmatic subjects, and those with allergic rhinitis. This should widen our understanding of the pathophysiology of atopy and BHR.

Assessment of Bronchodilator Responsiveness after Methacholine-Induced Bronchoconstriction

서동인,고영률 대한천식알레르기학회 2011 Allergy, Asthma & Immunology Research Vol.3 No.4

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학문분야별 평가인증제 운영에 관한 질적 사례 연구:한의학을 중심으로

서동인,신상우 대한한의학회 2019 대한한의학회지 Vol.40 No.3

Objectives: The purpose of this article is to develop steering of program accreditation system in Korean Medicine Education through meta-evaluation. For this study, the subjects of our research were categorized as the accreditation criteria and system, results and effects, tasks for improvement on Korean Medicine Education. Methods: We conducted Focus Group Interview on 102 full-time professors with experience of participating on accreditation of Korean Medicine Education from 12 college of Korean Medicine Education and we analyzed it by thematic analysis. Results: The accreditation criteria and program evaluation system of Korean Medicine were listed as ‘Confusion about the goals of program evaluation’, ‘High hurdles on accreditation’, ‘obsession to success cases’, ‘Small college complaints about applying the same criteria’, ‘Dilemma of quantitative and qualitative evaluation’. The results and effects of program evaluation in Korean Medicine Education were listed as ‘Establishment of base infrastructure for basic medical education’, ‘Benchmarking and exchanging opinions through evaluation certification’, ‘Resistance to documents and document-based evaluation’, and ‘Double-sided of evaluation certification’. As for the tasks for further improvement, the following list is suggested. ‘Actively promote evaluation certification’, ‘Simplification and standardization of forms’, ‘Requesting for activating about Evaluation committee’, ‘Need for consulting before regular evaluation’. Conclusion: It is necessary to upgrade the accreditation system and make efforts to improve the issues discovered for better Korean Medicine Education.

Early childhood wheezing: various natural courses and their relationship to later asthma

서동인,고영률 대한소아청소년과학회 2012 Clinical and Experimental Pediatrics (CEP) Vol.55 No.8

Wheezing is one of the most frequent complaints that lead to the use of medical resources in younger children. Generally, wheezing is caused by bronchiolitis and resolves spontaneously without recurrence, but sometimes, wheezing can progress into asthma. Early data on the natural history of childhood wheezing was mostly obtained from retrospective reviews of medical records or from questionnaires, which made it difficult to exclude biases. Now that many cohort studies are available, reviewing the results of birth cohort studies makes it possible to understand the natural course of early childhood wheezing and the risk factors for asthma. In this study, we have reviewed the various phenotypes of early childhood wheezing and their natural courses to help select the most appropriate management modalities for the different types of early childhood wheezing.

물고기 여자 외 1편

서동인 고요아침 2004 열린시학 Vol.9 No.4

Leukocyte Telomere Length Reflects Prenatal Stress Exposure, But Does Not Predict Atopic Dermatitis Development at 1 Year

서동인,강미진,박윤미,이준규,이소연,신윤호,김경원,안강모,원혜성,이미영,최석주,권자영,박희진,전종관,홍수종,고영율 대한천식알레르기학회 2019 Allergy, Asthma & Immunology Research Vol.11 No.3

Purpose: Prenatal maternal stress affects offspring's atopic dermatitis (AD) development, which is thought to be mediated by the oxidative stress. We aimed to evaluate the difference in leukocyte telomere length (LTL), a marker for exposure to oxidative stress, according to the prenatal stress exposure and the later AD development. Methods: From a birth cohort (the COhort for Childhood Origin of Asthma and allergic diseases) that had displayed a good epidemiologic association between the exposure to prenatal stress and AD development in the offspring, we selected 68 pairs of samples from 4 subject groups based on the level of prenatal maternal stress and later AD development. The LTL was measured from both cord blood and 1-year peripheral blood, and their LTLs were compared between subject groups. Finally, the proportion of AD development was examined in the subject groups that are reclassified based on subjects' exposure to prenatal stress and there LTL. Results: Cord-blood LTL was shorter in prenatally stressed infants than in unstressed ones (P = 0.026), which difference was still significant when subjects became 1 year old (P = 0.008). LTL of cord blood, as well as one of the 1-year peripheral blood, was not different according to later AD development at 1 year (P = 0.915 and 0.174, respectively). Shorter LTL made no increase in the proportion of later AD development in either prenatally high-stressed or low-stressed groups (P = 1.000 and 0.473, respectively). Conclusions: Cord-blood LTL may reflect subjects' exposure to maternal prenatal stress. However, the LTL shortening is not a risk factor of increasing AD development until the age of 1, and a longer investigation may be necessary for validation. Currently, the results doubt the role of LTL shortening as a marker for risk assessment tool for the prenatal stress associated with AD development in the offspring.