Burden and Clinical Characteristics of High Grade Tuberculosis-Destroyed Lung : A Nationwide Study

한덕재,이화영,김경주,김태훈,오연목,이진국 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Objective: Evaluate burden and socioeconomic effect in high grade tuberculosis-destroyed lung (TDL) according to treatment compliance. Method: A retrospective cohort study was done using Health Insurance Review & Assessment Service database (2011-15). Patients diagnosed as high grade TDL in 2011 were enrolled then divided into two groups (adherent vs. non-adherent) and followed for a year. Result: Among 13,346 high grade TDL patients, 3,637 and 9,709 patients were defined as adherent and non-adherent group respectively. Male was predominant (80.1% vs. 60.6%, p<0.001) and mean age was older in adherent group (65.7 vs. 64.3, p<0.001). Proportion of medical aid beneficiaries (26.6% vs. 21.3%, p<0.001) and visiting frequencies of tertiary hospital (96.9% vs. 90.1%, p<0.001) were higher in adherent group. The most common comorbidities were cardiovascular diseases in all group. Total mean cost spent on healthcare utilization was higher in adherent group (US$4,152 vs. US$3,593, p<0.001). Additionally, exacerbations were even more frequent in adherent group (adjusted IRR: 0.635 [95%CI; 0.567, 0.711], ref. adherent). However, total healthcare used days were significantly shorter in adherent group (52.7 vs. 56.7, p<0.001). Conclusion: High grade TDL possess high socioeconomic burden in Korea. Although medical cost and exacerbation incidences were higher, inhaled bronchodilators significantly reduced total healthcare used days in adherent group. Acknowledgements: This study was supported by a grant of the Ministry of Health and Welfare, Republic of Korea (Grant No. HC16C-2254-010017).

P-108 Feasibility and safety of using the nasal route for convex probe endobronchial ultrasound

한덕재,김형우,신아영,김주상,안중현,하직환 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.-

Background: Convex probe endobronchial ultrasound (EBUS) is a safe and accurate diagnostic test for mediastinal lymphadenopathy. Its feasibility through the nasal route has rarely been reported. The objective of this study was to document the feasibility and safety of EBUS using the nasal route. Methods: A retrospective analysis of consecutive subjects who underwent an EBUS procedure at the Incheon St. Mary`s hospital, Incheon, Korea was conducted. In all subjects, insertion of the EBUS bronchoscope was initially tried through the nose. The oral route was used in case of failed both nostrils insertion. Results: From March 2015 to August 2016, 120 patients underwent an EBUS. Nasal insertion of the EBUS bronchoscope was possible in 86.7 %. Major complications of nasal insertion were epistaxis and pain. Epistaxis occurred in 29 (24.2%) subjects. Most cases (99.2%) of epistaxis was mild and moderate. One delayed severe epistaxis was observed in patients with cancer-related coagulopathy. Pain developed in 24 (20%) subjects. However, only 9 (7.5%) patients needed further intervention. Conclusions: Convex probe EBUS can be performed safely via the nasal route. Coagulopathy may be a contraindication of nasal route insertion.

P-76 Prevalence of Tuberculosis-Destroyed Lung and Status of Medication Usage in Patients with Tuberculosis-Destroyed Lung

한덕재,김경주,김태훈,오연목,이진국 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Objective: To define prevalence of tuberculosis-destroyed lung (TDL) in Korea and prescribing status of respiratory medication in TDL patients. Method: We reviewed patients with TDL (ICD-10 code: B90, J984) as primary to fifth diagnosis between January 2011 and December 2015, using Korea Health Insurance Review and Assessment Service(HIRA) database. Result: A total of 645,031 patients from HIRA database were enrolled. Mean age was 59.54 ± 11.91 (mean ± standard error); age under 40, in the 40s, 50s, 60s, 70s and 80 or older were respectively 3.4% (21,657), 19.1% (123,293), 28.6% (184,343), 26.3% (169,531), 17.9% (115,683), and 4.7% (30,524); 44.2% (284,886) were male; 50.2% (323,854) were using systemic bronchodilator. Use of theophylline, inhaled corticosteroid (ICS), long-acting beta-2 agonist (LABA), long-acting muscarinic antagonist (LAMA), ICS/LABA, LABA/LAMA, short-acting beta-2 agonist (SABA), short-acting muscarinic antagonist (SAMA), SABA/SAMA, leukotriene receptor antagonist (LTRA), phosphodiesterase-4 inhibitor (PDE4i) and any of respiratory medication were respectively 35.6% (229,461), 1.4% (9,063), 7.5% (48,514), 11.7% (75,317), 0.4% (2,830), 20.1% (129,603), 11.6% (74,565), 0.1% (564), 31.3% (201,905), 0.4% (2,586) and 71.3% (460,212). Conclusion: TDL is highly prevalence disease in Korea, and approximately half of the patients with TDL using at least one type of bronchodilator and large proportion of them were form in the inhaler were noted.

개인 연구자와 중소규모 연구팀을 위한 DIY cohort tool

한덕재 대한응급의학회 2022 대한응급의학회 학술대회초록집 Vol.2022 No.2

Feasibility and safety of nasal route for linear endobronchial ultrasound: a single center experiences

반우호,한덕재,김형우,신아영,김주상,안중현,하직환 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Purpose: Linear endobronchial ultrasound (EBUS) has proved to be a safe and accurate method for diagnosing mediastinal lymphadenopathy. Recently, a few studies establishing the feasibility through the nasal route insertion have been conducted in Canada, however there has been lack of reports in Asian population. This study aimed to investigate the feasibility and safety of linear EBUS using the nasal route in Korean population. Methods: A retrospective analysis was conducted in our institution. Patients with mediastinal lymphadenopathy who underwent EBUS were included. In all subjects, insertion of EBUS was initially tried through the nasal route. The oral route was used in case of failed to approach through both nostrils. Clinical parameters, characteristics of the procedure, diagnostic accuracy were compared between the nasal and oral route insertion. Results: Among 175 patients, nasal insertion of the EBUS was succeeded in 87.4% of patients. Twenty-two patients underwent the EBUS through oral route. There was no significant difference in nodal stations among two groups. Procedural time and dose of analgesics were similar. However, doses of sedative drug were significantly lower in the nasal group. Complications associated with the route of insertion were similar. Severe epistaxis requiring bleeding control occurred in only one case in the nasal group. Diagnostic yield were not significantly different between two groups. Conclusion: Nasal insertion of EBUS was relatively safe and feasible in Korean population compared with oral route insertion.

F-76 Comparison of Incidence of Adverse Effect and Discontinuation Rate of Roflumilast Between 250 Microgram and 500 Microgram

주현수,한덕재,이재하,이진국 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Background: Roflumilast is the only approved oral phosphodiesterase-4 inhibitor to treat severe chronic obstructive pulmonary disease (COPD) patients with chronic bronchitis and a history of frequent exacerbations. We aimed to examine incidence of adverse effect of roflumilast in real world. Moreover, we aimed to compare the incidence of adverse effect and discontinuation Method: We identified all outpatients diagnosed with COPD at Seoul St. Mary’s Hospital between May 2011 and September 2016. We retrospectively reviewed the medical records during the study period. Roflumilast was prescribed to patients not only in 500 μg dose but also in 250 μg. Results: A total 287 patients were prescribed the roflumilast in our hospital from May 2011 to September 2016. Among them, 178 patients were treated with roflumilast 500μg and 91 patients were treated with 250μg during the period. Incidence of adverse effect was 38.2% in 500μg treatment group and 25.3% in 250μg treatment group (p=0.034). Discontinuation rate of roflumilast was 41.6%(n=74) in 500μg treatment group and 23.1%(21) in 250μg treatment group (p=0.003). When adjusted with age, sex, smoking status, and lung function, 500μg was significantly associated with discontinuation of roflumilast (OR: 2.87, P < 0.001) Conclusion: Treatment of 250μg roflumilast is lower incidence of adverse events and discontinuation rates than treatment of 500μg roflumilast. However, further studies regarding optimal dose of roflumilast are required

Incidence of Adverse Effects and Discontinuation Rate between Patients Receiving 250 Micrograms and 500 Micrograms of Roflumilast: A Comparative Study

주현수,한덕재,이재하,이진국 대한결핵및호흡기학회 2018 Tuberculosis and Respiratory Diseases Vol.81 No.4

Background: Roflumilast is the only approved oral phosphodiesterase-4 inhibitor for the treatment of severe chronic obstructive pulmonary disease (COPD) in patients with chronic bronchitis and a history of frequent exacerbations. The purpose of this study was to examine the incidence of adverse effects associated with roflumilast treatment in a real-world setting. Further, we compared the incidence of adverse effects and the discontinuation rate among patients receiving different doses. Methods: We identified all outpatients diagnosed with COPD at Seoul St. Mary’s Hospital between May 2011 and September 2016 and retrospectively reviewed their medical records. Roflumilast was prescribed to patients in doses of 500 mg and 250 mg. Results: A total of 269 COPD patients were prescribed roflumilast in our hospital during the study period. Among them, 178 patients were treated with 500 mg and 91 patients were treated with 250 mg. The incidence of adverse effects was 38.2% in the 500 mg group and 25.3% in the 250 mg group (p=0.034). The discontinuation rate of roflumilast was 41.6% (n=74) in the 500 mg group and 23.1% (n=21) in the 250 mg group (p=0.003). When adjusted by age, sex, smoking status, and lung function, 500 mg dose was significantly associated with the discontinuation of roflumilast (odds ratio, 2.87; p<0.001). Conclusion: There was a lower incidence of adverse effects and discontinuation among patients treated with 250 mg compared with 500 mg dose. Further studies regarding the optimal dose of roflumilast are required.

Validation of Machine Learning Models to Predict Adverse Outcomes in Patients with COVID-19: A Prospective Pilot Study

김형준,허준녕,한덕재,오홍상 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.5

Purpose: We previously developed learning models for predicting the need for intensive care and oxygen among patients withcoronavirus disease (COVID-19). Here, we aimed to prospectively validate the accuracy of these models. Materials and Methods: Probabilities of the need for intensive care [intensive care unit (ICU) score] and oxygen (oxygen score)were calculated from information provided by hospitalized COVID-19 patients (n=44) via a web-based application. The performanceof baseline scores to predict 30-day outcomes was assessed. Results: Among 44 patients, 5 and 15 patients needed intensive care and oxygen, respectively. The area under the curve of ICUscore and oxygen score to predict 30-day outcomes were 0.774 [95% confidence interval (CI): 0.614–0.934] and 0.728 (95% CI:0.559–0.898), respectively. The ICU scores of patients needing intensive care increased daily by 0.71 points (95% CI: 0.20–1.22) afterhospitalization and by 0.85 points (95% CI: 0.36–1.35) after symptom onset, which were significantly different from those in individualsnot needing intensive care (p=0.002 and <0.001, respectively). Trends in daily oxygen scores overall were not markedlydifferent; however, when the scores were evaluated within <7 days after symptom onset, the patients needing oxygen showed ahigher daily increase in oxygen scores [1.81 (95% CI: 0.48–3.14) vs. -0.28 (95% CI: 1.00–0.43), p=0.007]. Conclusion: Our machine learning models showed good performance for predicting the outcomes of COVID-19 patients andcould thus be useful for patient triage and monitoring.

18F-fluoro-2-deoxy-D-glucose positron emission tomography findings of neurolymphomatosis

정윤화,우인숙,한덕재,한치화 대한혈액학회 2014 Blood Research Vol.49 No.2

중증 역류성식도염의 임상경과: 내시경 추적 관찰

공봉한,김동률,허룡,이응구,김주희,한덕재,이원직,오정환 대한상부위장관ㆍ헬리코박터학회 2015 Korean Journal of Helicobacter Upper Gastrointesti Vol.15 No.4

Background/Aims: The natural history of severe erosive reflux disease in Korea remains uncertain. We aimed to evaluate endoscopic follow-up results in subjects with severe reflux esophagitis under routine clinical care. Materials and Methods: A total 61,891 subjects underwent an upper endoscopic examination in the health check-up program from January 2007 to December 2013. We reviewed medical charts of patients who had been diagnosed with severe reflux esophagitis. The severity of reflux esophagitis was determined by the Los Angeles (LA) classification system. Patients underwent at least one follow up endoscopy after diagnosis of severe reflux esophagitis. We classified the patients into two groups; regressed in severity and remained unchanged, according to follow up endoscopic status. Results: Based on endoscopic findings, 5,938 subjects (9.6%) were found to have reflux esopohagitis: 121 subjects (0.2%) in LA-C; 39 subjects (0.06%) in LA-D. Among 31 patients who had endoscopic follow-up, 23 patients (74.2%) showed regression from LA C/D to LA A/B or minimal change disease or normal. The mean follow up duration was 42.2 months in regression group and 53.2 months in no change group. All patients had been treated with proton pump inhibitors (PPIs) on a regular or on-demand basis. Age, sex, smoking, alcohol, exercise, hypertension, diabetes mellitus, dyslipidemia, sliding hiatal hernia, body mass index, waist circumference and duration of PPIs therapy did not significantly influence regression of severe reflux esophagitis. Conclusions: The majority of severe reflux esophagitis patients under routine clinical care showed improvement on endoscopic follow-up.