천식의 병태생리

고영률(Young Yull Koh) 대한소아알레르기호흡기학회 2000 소아알레르기 및 호흡기학회지 Vol.10 No.4

N/A

식도 기관루의 수술 후에 발생한 반복성 폐렴 1 례

고영률(Young Yull Koh),강혜경(Hye Kyoung Kang) 대한소아알레르기호흡기학회 1993 소아알레르기 및 호흡기학회지 Vol.3 No.1

After successful repairs of tracheoesophageal fistula (TEF), the high incidence of esophageal dysmotility, gastroesophageal reflux and abnormalitis in lung functions with respiratory symptoms have been documented. Most commonly, respiratory symptoms after repair of TEF have been attributed to aspiration resulting from GER. Occasionally other factors, such as tracheomalacia, esophageal dysmotility, anastomotic stricture, and recurrent TEF, are often responsible for respiratory symptoms. We experienced a 6-year-old girl who suffered from recurrent pneumonia and stridor for 5 years after the repair of esophageal atresia with TEF. She took barium esophagogram two times, the first study revealed no remarkable reflux, but her esophageal motility was markedly decreased. The second study showed poor peristalsis and major degree gastroesophageal reflux. An intense antireflux treatment abolished the respiratory attacks. Therefore, gastroesophageal reflux should be considered as a possible cause or contributing factor in any child with recurrent respiratory symptoms, with or without repair of TEF.

최대호기속도계의 사용과 기관지유발검사

고영률(Young Yull Koh) 대한소아알레르기호흡기학회 2000 소아알레르기 및 호흡기학회지 Vol.10 No.4

N/A

청소년기 장기간 천식 관해

고영률 ( Young Yull Koh ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.1

Asthma is a heterogeneous disorder with a variable course, characterized by episodes of cough, wheezing and shortness of breath, reversible airflow limitation, and bronchial hyperresponsiveness (BHR). It begins early in life in many subjects, and it is well recognized that over 50% of asthmatic children go into long-term clinical remission, defined as the complete absence of asthmatic symptoms and no asthma medication for at least 24 months, during adolescence. Several studies have shown spirometric abnormalities and BHR during clinical remission. It is unknown whether these functional abnormalities, which are supposed to be indicative of asthma severity with respect to symptomatic asthma, reflect persistent airway inflammation or merely indicate residual airway damage or are related to another mechanism such as a familial predisposition. It is likely that the nature of BHR in asthma remission is not same as that in symptomatic asthma. We have shown that the former condition is associated with lower levels of blood eosinophils and eosinophilic cationic protein, a lower degree of bronchial responsiveness to exercise, and a more common formation of plateau on the dose-response curve to high-dose inhaled methacholine (i.e., limited maximal airway narrowing), compared to the latter condition. It is still controversial whether BHR in adolescents with asthma remission is reduced by inhaled corticosteroids. Better understanding of the mechanisms that lead to asthma remission, especially that seen during adolescence, is likely to lead to significant advances in our understanding of asthma pathogenesis, and should provide insights into how remission might be induced with therapy. We still have minimal understanding of the mechanism underlying BHR in adolescents with asthma remission. Elucidation of this mechanism would be an important step towards new perspectives that see remission as the next therapeutic frontier in asthma. (Allergy Asthma Respir Dis 1(1):11-19, 2013)Allergy Asthma Respir Dis 1(1):11-19, 2013)

급성 천식 발작시 혈청 호산구 양이온 단백 ( ECP ) 치와 기관지 확장제에 대한 반응도의 상관 관계

고영률(Young Yull Koh),이명현(Myung Hyun Lee),이준호(Joon Ho Lee),박찬후(Chan Hoo Park),선용한(Yong Han Sun) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1996 소아알레르기 및 호흡기학회지 Vol.6 No.2

목적 : 기관지 천식에서 혈청 ECP치는 기도염증상태를 반영하는 것으로 알려져 있다. 급성 천식 발작에서 일차적으로 사용되는 기관지확장제에 대한 반응은 개인에 따라 차이가 많은데, 이는 이론적으로 기도폐쇄(airway obstruction)가 기관지근육수축 혹은 기도염증의 두가지 요소중 주로 어떤 요소에 의해 이루어지는가에 따른 것이라 생각된다. 본 연구의 목적은 급성 발작시에 기관지확장제에 대한 반응이 기도염증상태의 정도에 따라 결정될 것이라는 가설을 검정하고자 하는 데 있다. 방법 : 48명의 급성 천식 발작 상태의 환아에서 폐기능(FEV_1)과 혈청 ECP치를 측정하고, 기관지확장제에 의찬 페기능의 변화를 평가하였으며, 임상적 완해시에 또한 폐기능과 혈청 ECP치를 측정하였다. 결과 : 전체 환아에서 급성 발작시에 혈청 ECP치는 임상적 완해시의 혈청 ECP치보다 의미있게 증가되어 있었고, 급성 발작시의 혈청 ECP치는 급성 발작의 심한 정도와 상관관계를 나타내었다. 급성 발작시의 혈청 ECP치는 기관지확장제후 FEV_1이 75%예상치 이하인 군(n=18)에서 기관지화장제후 FEV_1이 75%예상치 이상인 군(n=30)에 비하여 의미있게 상승되어 있었으며 전체 환아에서 급성 발작시 혈청 ECP치는 기관지확장제에 대한 반응(기관지확장제 흡입 전후의 FEV_1차이)과 역상관관계를 나타내었다. 결론 : 급성 천식발작시 혈청 ECP치는 기관지확장제 치료에 대한 반웅이 낮을수록, 높은 수치를 나타내었다. 이와 같은 소견은 기도염증상태가 현저하면 기관지확장제에 대한 반응이 저하됨을 암시하며, 이는 급성발작시 기관지확장제에 대한 반응은 기관지근육수축 혹은 기도염증의 상대적인 중요성에 의해 결정된다는 이론을 뒷받침하는 것이다. Serum levels of eosinophil cationic protein(ECP) are an indirect measure of airway inflammation in asthma. It is proposed that the extent to which bronchoco-nstriction or airway inflammation contributes to airflow obstruction of acute asthma may determine the responsiveness to bronchodilator therapy. To test the hypothesis that the subjects with acute attack(AA) who respond poorly to inhaled bronchodilator may have more marked airway inflammation, compared tothose who respond well to identical therapy. Forty-eight asthmatic children who visited ER due to AA were studied. Serum levels of ECP were measured at the times of AA and clinical remission(CR). At AA, FEV_1s were assessed before and after the administration of aerosolized salbutamol. The mean serum level of ECP at AA (41.1±12.8 ㎍/L) was significantly (p<0.01) higher than that at CR (30.0±8.5 ㎍/L) in the study population. The AA level was even higher in group A(n=18: post-bronchodilator FEV_1(75%predicted) than in group B(n=30: post-bronchodilator FEV_1≥75 %predicted), whereas the two groups were similar for the CR level. The AA level correlated positively with the severity of exacerbation (r=0.47, p<0.01) and negatively with the bronchodilator responses (r=-0.56, p<0.01). This negative correlation was valid among the subjects with the similar degree of exacerbation. In the higher ECP level at AA was associated not only with the more severe exacerbation but also with the less degree of bronchodilator responsiveness. This suggests that the degree of airway inflammation may be one determinant of the degree of responsiveness to the initial bronchodilator therapy at AA.

기관지 확장증 환아들의 기관지 과민성에 대한 Roxithromycin 의 효과에 관한 연구

고영률(Young Yull Koh),이명현(Myung Hyun Lee),윤경애(Kyung Ae Yoon),성기웅(Gi Woong Seoung) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1996 소아알레르기 및 호흡기학회지 Vol.6 No.1

N/A Nonspecific bronchial hyperresponsiveness(BHR) is frequently associated with bronchiectasis and may have a role in its pathogenesis. Roxithromycin is a new semisynthetic macrolide antibiotic that also has antiinflammatory activities. This study was designed to see whether roxithromycin could favorably alter bronchial responsiveness in patients with bronehiectasis. Twenty-six children with bronchiectasis were treated for eight weeks with roxithromycin, 4ml/Kg twice a day, orally. To estimate bronchial responsiveness, high-dose methacholine challenge tests were performed before and after treatment. On the dose-response curve to methacholine, PC20 and maximal response, two indices of bronchial responsiveness, were measured. In the methacholine test before roxithromycin treatment, twelve subjects were found to have BHR, defined as a PC20 < 25mg/ml. This group with (+) BHR had significantly higher maximal response than the 14 patients in the (-) BHR group. Changes in FEV1 were not observed during the course of roxithromycin treatment. After eight weeks' treatment the geometric mean of PC20 increased significantly and the mean of maximal response decreased significantly and the mean of maximal response decreased significantly among patients in both groups, as compared with initial values. The magnitude of change in both parameters was statistically significant only in (+) BHR group. Our results indicated that roxithromycin may decrease BHR in the patients with bronchiectasis. This finding suggests that roxithromycin might be a good agent in the long-term management of bronchiectasis, especially when accompanied by BHR.

기관지천식이 없는 일반인에서 메타콜린에 대한 기관지반응의 양상

김윤근,손지웅,이상록,김우경,조상헌,이명현,고영률,민경업,김유영 ( Yoon Keun Kim,Jee Wong Son,Sang Rok Lee,Woo Kyung Kim,Sang Heon Cho,Myung Hyeon Lee,Young Yull Koh,Kyung Up Min,You Young Kim ) 대한천식알레르기학회 1998 천식 및 알레르기 Vol.18 No.3

Backgrognd: Bronchial hbyperresponsiveness (BHR) is a key feature of asthma, and may precede the development of asthma. Genetically determined and acquired factors may contribute to development of BHR. Objective .' To evaluate expression of bronchial responsiveness to methacholine according to age, sex, smoking habit, and atopy in general population without bronchial asthma, a cross sectional study was performed. Method: A total of 1,190 general population who composed of 408 subjects with age less than 19 years (young age group), 621 subjects with age from 20 to 40 years (middle age group), and 161 subjects with age more than 41 years (old age group) were enrolled. Evaluations were made by a questionnaire, serum IgE level and skin prick test to common inhalant allergens, and methacholine bronchial provocation test (MBPT). Bronchial responsiveness were evaluated by positive rate of MBPT (PC,p-methacholine 4 25mg/ml), and slope of dose- response curve (slope, %fall of FEV, / log[last concentration of methacholine, mg/ml]). Result: Positive rate of MBPT was 11.0%, and slope (mean+SE) was 10.6+0.2 %/mg/ml. Postive rate of MBPT was more prevalent in the young age group than in middle and old age groups (19.6% vs. 6.6% vs. 6.2%, p<0.05), and slope was higher in young age group than in other groups (14.4+0.4 vs. 8.6+0.3 vs. 8.9+0.5 %/mg/ml, p<0.05). No significant differences in positive rate of MBPT and slope were noted according to sex in young and old age groups. However, in the middle age group, slope was higher in females than in males (9.5+0.4 vs. 7.9+ 0.3 %/mg/ml, p<0.05). No significant differences of slope was observed according to smoking habit in males of middle age group, but in males of old age group, the slope was higher in subjects with smoking habit than those without it (9.6+0.8 vs. 6.5+0.9 %/mg/ml, p<0.05). Sig- nificant relationship was observed between geometric value of serum IgE level and slope(r=0. 152, p=0.009). The postive rate of MBPT and slope were significantly higher in subjects with positive skin rea,ctivity to common inhalant allergens than those without it (14.3% vs. 8.6%, p ( 0.05; 11.8+0.4 vs. 9.8+0.3 %/mg/ml, p<0.05). The difference of bronchial responsiveness according to skin reactivity was observed in young and middle age groups, but not in old age group. Conclusion : Bronchial responsiveness to methacholine is significantly higher in children than in adults, in middle-aged females than in middle-aged males. Atopy and smoking may have a dif ferent role to determine the bronchial responsiveness depending upon age and sex.

Mycoplasma pneumoniae 폐렴 후 HRCT상 Bronchiolitis Obliterans 소견과 기관지 과민성의 연관성

유영 ( Young Yoo ),서동인 ( Dong In Suh ),김도균 ( Do Kyun Kim ),유진호 ( Jin Ho Yu ),고영률 ( Young Yull Koh ),김창근 ( Chang Keun Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2004 소아알레르기 및 호흡기학회지 Vol.14 No.4

장기간 천식 관해 청소년에서 지속되는 기관지 과민성과 β₂-아드레날린 수용체 유전자 다형과의 연관성 분석

강희,고영률,Kang, Hee,Koh, Young Yull 대한소아청소년과학회 2007 Clinical and Experimental Pediatrics (CEP) Vol.50 No.6

목 적 : 본 연구에서는 현증 천식 환자의 BHR에는 기도 염증이 중요한 요인으로 작용하기 때문에 ${\beta}_2$-아드레날린 수용체 유전자와의 연관성이 나타나지 않지만, 청소년기 천식 관해 상태에서 지속되는 BHR에는 상대적으로 유전적인 영향이 강하기 때문에 ${\beta}_2$-아드레날린 수용체 유전자와의 연관성이 나타날 것이라는 가설을 세우고, 이를 검증해 보고자 하였다. 방 법 : 장기간 천식 관해 상태(최근 2년간 천식 증상이 없고 치료가 필요 없었던 경우)에서 BHR이 지속되는 청소년 202명(천식 관해군), 현증 천식 청소년 182명(현증 천식군), 정상군 200명을 대상으로, 메타콜린 기관지 유발검사와 피부단자시험을 시행하였으며 혈청 총 IgE를 측정하였다. ${\beta}_2$-아드레날린 수용체 유전자의 일배체형 분석을 위해 아미노산 16번과 27번을 포함하고 있는 ${\beta}_2$-아드레날린 수용체 유전자 부위를 polymerase chain reaction(PCR)으로 증폭한 뒤, 16번 유전형은 allele specific PCR, 27번 유전형은 PCR-restriction fragment length polymorphism (RFLP) 방법으로 분석하였다. 결 과 : Gly 동형접합자(homozygote)의 빈도는 정상군에서 14.5%, 현증 천식군에서 18.1%, 천식 관해군에서 24.2%로 증가하는 경향이 관찰되었으며(P=0.01), 현증 천식군과 정상군 사이에서는 차이가 없었지만 천식 관해군과 정상군 사이에서는 유의한 차이가 관찰되었다(P=0.01). Gly16-Gln27 일배체형 빈도는 정상군에서 36.5%, 현증 천식군에서 40.4%, 천식 관해군에서 44.6%로 증가하는 경향이 관찰되었으며(P=0.02), 현증 천식군과 정상군 사이에서는 차이가 없었지만 천식 관해군과 정상군 사이에서는 유의한 차이가 관찰되었다(P=0.02). 천식 관해군에서 Gly16-Gln27 일배체형의 수가 증가함에 따라 $PC_{20}$ 기하 평균값이 유의한 차이를 보임으로써(P=0.02) Gly16-Gln27 일배체형과 $PC_{20}$ 사이의 연관성이 관찰되었으나 현증 천식군에서는 이러한 연관성이 관찰되지 않았다. 결 론 : ${\beta}_2$-아드레날린 수용체 유전자가 BHR을 유발하는 유전자적 배경을 가지면서 천식 질병을 조절하는 역할을 하고 있음을 시사한다. Purpose : We hypothesized that the persisting bronchial hyperresponsiveness (BHR) of adolescents with asthma remission may be controlled mainly by genetic factors, and the BHR of symptomatic asthma by airway inflammation. ${\beta}_2$-adrenoceptor gene is considered to be a candidate gene in the development of BHR. Thus, ${\beta}_2$-adrenoceptor gene polymorphism may be associated with the BHR of adolescents with asthma remission, but not with the BHR of symptomatic asthma. To evaluate this hypothesis, ${\beta}_2$-adrenoceptor gene polymorphism at 2 sites (Arg16-Gly, Gln27-Glu) were examined. Methods : Two hundred two adolescents with BHR ($PC_{20}<18\;mg/mL$) and long term remission (neither asthma-related symptoms nor medication during the previous 2 years) of their asthma (remission group), 182 adolescents with symptomatic asthma (symptomatic group), and 200 healthy adolescents (control group) were studied. Asthma phenotypes were determined using methacholine bronchial provocation test and skin prick test. Genotypes of ${\beta}_2$-adrenoceptor polymorphism were evaluated by PCR-based methods. Results : Gly/Gly allele and Gly16-Gln27 haplotype were more prevalent in the remission group than in the control group (P=0.01, P=0.02), although there was no difference between the symptomatic group and the control group. In the remission group, there was significant difference in geometric mean of $PC_{20}$ among the 3 groups subdivided by the number of Gly16-Gln27 haplotype, showing that the Gly16-Gln27 haplotype was positively associated with BHR. However, no association was found between Gly16-Gln27 haplotype and BHR in the symptomatic group. Conclusion : This study demonstrates that ${\beta}_2$-adrenoceptor polymorphism at amino acid 16 and 27 was associated with BHR persisting in adolescents with asthma remission.

소아의 기관지 과민성과 아토피 상태에 따른 형제에서의 빈도

유영 ( Young Yoo ),유진호 ( Jin Ho Yu ),김도균 ( Do Kyun Kim ),강희 ( Hee Kang ),고영률 ( Young Yull Koh ) 대한천식알레르기학회 2005 천식 및 알레르기 Vol.25 No.1