천식 치료에서 순응도

정이영 ( Yi Yeong Jeong ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.2

Adherence is defined as ‘the extent to which a patient`s behavior corresponds with recommendations from a health care provider’. In all chronic diseases, including asthma, patient nonadherence to medical recommendations is common. In asthma, low rates of adherence to preventive medication are associated with higher rates of hospitalization and death. Many patients choose not to take their medication because they perceive it to be unnecessary or because they are concerned about potential adverse effects. Approximately one third of asthma patients have strong concerns about adverse effects from inhaled corticosteroids (ICSs). Clinicians must be prepared to work in an ongoing partnership with patients to ensure that they are offered a clear rationale as to why ICS are necessary and to address their concerns about potential adverse effects. This approach, based on a detailed examination of patients` perspectives on asthma and its treatment, and an open, nonjudgmental manner on the part of the clinician, is consistent with the idea of concordance. Both the efficacy of a medication and patient adherence to the therapeutic regimen influence the effectiveness of a treatment. This article will review the underlying reasons for patient nonadherence and describe the role played by clinicians in promoting optimal medicine management. (Allergy Asthma Respir Dis 2013;1:105-110)Allergy Asthma Respir Dis 2013;1:105-110)

천식 치료에서 순응도

정이영 ( Yi Yeong Jeong ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1991 소아알레르기 및 호흡기학회지 Vol.1 No.2

Adherence is defined as ‘the extent to which a patient``s behavior corresponds with recommendations from a health care provider’. In all chronic diseases, including asthma, patient nonadherence to medical recommendations is common. In asthma, low rates of adherence to preventive medication are associated with higher rates of hospitalization and death. Many patients choose not to take their medication because they perceive it to be unnecessary or because they are concerned about potential adverse effects. Approximately one third of asthma patients have strong concerns about adverse effects from inhaled corticosteroids (ICSs). Clinicians must be prepared to work in an ongoing partnership with patients to ensure that they are offered a clear rationale as to why ICS are necessary and to address their concerns about potential adverse effects. This approach, based on a detailed examination of patients’ perspectives on asthma and its treatment, and an open, nonjudgmental manner on the part of the clinician, is consistent with the idea of concordance. Both the efficacy of a medication and patient adherence to the therapeutic regimen influence the effectiveness of a treatment. This article will review the underlying reasons for patient nonadherence and describe the role played by clinicians in promoting optimal medicine management. (Allergy Asthma Respir Dis 2013;1:105-110)

가바펜틴에 의한 스티븐스-존슨 증후군

마정은 ( Jeong Eun Ma ),김현식 ( Hyun Sik Kim ),박동준 ( Dong Jun Park ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ),정이영 ( Yi Yeong Jeong ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.4

Stevens-Johnson syndrome (SJS) is a severe, diffuse mucocutaneous eruption causing erythematous or purpuric macules, blisters, target lesions. Other manifestations include fever and mucosal lesions (stomatitis, conjunctivitis, or urethral inflammation) accompanied by at least one other visceral organ, such as hepatic, renal or gastrointestinal involvement. SJS is essentially a drug-induced disease and common causative agents include antibacterial sulfonamides, anticonvulsant agents, nonsteroidal anti-inflammatory drugs and allopurinol. Gabapentin is usually considered to be a safe agent for patients with a previous history of drug allergies and there are rare cases of SJS induced by gabapentin. We experienced a 68-year-old woman who developed whole body mucosal erosions with widespread erythematous maculopapular skin rashes after ingestion of gabapentin. After discontinuation of gabapentin and use of systemic steroids, symptoms, signs and laboratory findings gradually improved. We report a case of SJS diagnosed by characteristic clinical findings with a brief review of the literature. (Korean J Asthma Allergy Clin Immunol 2007;27:283-286)

안정된 만성 폐쇄성 폐질환환자와 급성 악화상태의 혈중 Osteopontin 농도 비교

마정은 ( Jeong Eun Ma ),이승훈 ( Seung Hun Lee ),김유은 ( Yu Eun Kim ),임수진 ( Su Jin Lim ),이승준 ( Seung Jun Lee ),정이영 ( Yi Yeong Jeong ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deog Lee ),황영실 ( Young Sil Hwang ),조유지 ( Y 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.3

Background: Osteopontin (Opn) is recognized as an important adhesive bone matrix protein and a key cytokine involved in immune cell recruitment and tissue repair and remolding. However, serum levels of osteopontin have not been evaluated in patients with chronic obstructive pulmonary disease (COPD). Thus, the aim of this study was to evaluate and compare the serum levels of osteopontin in patients experiencing COPD exacerbations and in patients with stable COPD. Methods: Serum samples were obtained from 22 healthy control subjects, 18 stable COPD patients, and 15 COPD with exacerbation patients. Serum concentrations of osteopontin were measured by the ELISA method. Results: Serum levels of osteopontin were higher in patients with acute exacerbation than with stable COPD and in healthy control subjects (62.4±51.9 ng/mL, 36.9±11.1 ng/mL, 30±11 ng/mL, test for trend p=0.003). In the patients with COPD exacerbation, the osteopontin levels when the patient was discharged from the hospital tended to decrease compared to those at admission (45±52.1 ng/mL, 62.4±51.9 ng/mL, p=0.160). Osteopontin levels significantly increased according to patient factors, including never-smoker, ex-smoker and current smoker (23±5.7 ng/mL, 35.5±17.6 ng/mL, 58.6±47.8 ng/mL, test for trend p=0.006). Also, osteopontin levels showed a significantly negative correlation with forced expiratory volume in one second (FEV1%) predicted in healthy controls and stable COPD patients (r=?0.389; p=0.013). C-reactive protein (CRP) was positively correlated with osteopontin levels in patients with COPD exacerbation (r=0.775; p=0.002). Conclusion: The serum levels of osteopontin increased in patients with COPD exacerbation and tended to decrease after clinical improvement. These results suggest the possible role of osteopontin as a biomarker of acute exacerbation of COPD.

우중엽증후군의 원인 -최근 수년간 지역 3차 병원의 경험-

김현옥 ( Hyun Ok Kim ),마정은 ( Jeong Eun Ma ),이승준 ( Seung Jun Lee ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),전경녀 ( Kyoung Nyeo Jeon ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.3

배경: 우중엽증후군은 반복적이고 만성적인 우중엽의 허탈을 나타내는 질환으로 그 원인은 매우 다양하다. 최근 국내에서 우중엽증후군의 원인에 대한 발표는 부족한 실정이어서 저자들은 최근 수년간 지역 3차 병원에서 경험한 우중엽증후군의 원인과 임상적 특징을 알아보고자 하였다. 방법: 2003년 1월부터 2006년 7월까지 경상대학교 병원에 내원하여 흉부 단순촬영 또는 전산화 단층촬영에서 우중엽증후군이 의심되어 기관지내시경 검사를 시행한 88명의 환자(남:여=22:64, 평균연령: 67.2±10.3)를 대상으로 그 원인과 임상적 특징을 후향적으로 조사하였다. 결과: 1) 여자가 64예(72.7%)로 남자보다 많았고 연령별 빈도에서 65세 이상의 고령환자가 58예로 65.9%를 차지하였다. 2) 임상 증상은 기침이 30예(34.1%)로 가장 흔하게 나타났고, 호흡곤란 21예(23.9%), 객담 15예(17.0%), 객혈 11예(12.5%), 흉부통증과 전신 쇠약감이 각각 5예(5.7%)에서 나타났으며, 증상이 없이 우연히 발견된 경우가 8예(9.1%)였다. 3) 흉부 방사선 촬영에서는 무기폐 49예(55.7%), 폐경화 43예(48.9%), 종괴 4예(4.5%) 소견을 보였다. 4) 기관지내시경 검사 소견에서 충혈을 동반한 점막 부종 38예(43.2%), 탄분증을 동반한 점막 부종 16예(18.2%), 점액 매복(mucus impaction) 13예(14.8%), 섬유성 협착 10예(11.4%), 종괴 8예(9.1%), 삼출성 조직 괴사 4예(4.5%), 외인성 압박에 의한 협착 2예(2.3%), 정상 12예(13.6%)로 나타났다. 5) 원인 질환은 결핵이 23예(26.1%, 기관지 결핵 22예, 폐결핵 1예)로 가장 많았고, 염증성 변화에 의한 양성 협착 22예(25%), 탄분섬유화증 13예(14.8%), 폐렴 11예(12.5%), 폐암 10예(11.4%), 점액 매복 3예(3.4%), 기관지 확장증 2예(2.3%), 특별한 이상이 발견되지 않은 경우가 7예(8.0%)이었다. 결론: 본 연구에서 우중엽증후군은 65세 이상의 환자에서 흔하게 관찰되었으며, 원인은 대부분 양성 질환이었고, 그 중 기관지 결핵이 가장 흔한 원인이었다. Background: Right middle lobe syndrome (RMLS) is defined as transient or chronic and recurrent atelectasis of the right middle lobe. Although numerous conditions are associated with RMLS, there are very few recent reports in Korea. This study evaluated the causes of RMLS in a local tertiary hospitalover a period of 42 months. Method: Eighty-eight patients (M:F=64:22, mean age: 67.2±10.3 years), who had consistent chest radiography findings and underwent bronchoscopy in Gyeongsang University Hospital from January 2003 to July 2006, were enrolled in this study. The clinical characteristics and causes of RMLS in these patients were retrospectively reviewed. Results: The most common symptoms fo RMLS were cough, dyspnea and sputum. Tuberculosis was the most common cause (endobronchial tuberculosis in 22 and pulmonary tuberculosis in 1) The other causes were bronchial stenosis by benign fibrotic changes in 22 cases (25%), anthracofibrosis in 13 cases (14.8%), pneumonia in 11 cases (12.5%), lung cancer in 10 cases (11.4%), mucus impaction in 3 cases (3.4%), bronchiectasis in 2 cases (2.3%) and no demonstrable causes in 7 cases (8%). The bronchoscopy findings were mucosal edema with hyperemic changes in 38 cases (43.2%), mucosal edema with anthracotic pigmentation in 16 cases (18.2%), mucus impaction in 13 cases (14.8%), fibrotic stenosis in 13 cases (14.8%), a mass like lesion in 8 cases (9.1%), exudative necrotic material in 4 cases (4.5%), narrowing as a result of extrinsic compression in 2 cases (2.3%) and no demonstrable abnormalities in 12 cases (13.6%). Conclusion: Right middle lobe syndrome was observed more frequently in patients over the age of 65. The causes were mainly benign diseases with endobronchial tuberculosis being the most common. (Tuberc Respir Dis 2007; 62: 192-196)

기관지내 아스페르길루스종으로 오인된 폐암

함현석 ( Hyun Seok Ham ),이승준 ( Seung Jun Lee ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),전경녀 ( Kyoung Nyeo Jeon ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.2

A 70-year-old man was referred to the department of pulmonology due to blood tinged sputum and an abnormal chest X-ray. The chest X-ray and CT scans revealed a lobulated contour mass-like lesion in the left upper lung field. The bronchoscopic examination showed a whitish and polypoid mass occluding the left upper lobe bronchus. A biopsy specimen from the lesion revealed many aspergillus hyphae. Intravenous and oral itraconozole were administered over a 4 weeks period. Several months later, the size of the mass on chest X-ray increased and a percutaneous lung biopsy revealed a sarcomatoid carcinoma. We reported a case of lung cancer that was obscured by an endobronchial aspergilloma with a review of the relevant literature. (Tuberc Respir Dis 2006; 61: 157-161)

Enflurane에 의한 약물 과민 반응

김경묵 ( Kyung Mook Kim ),김성환 ( Sung Hwan Kim ),권혁수 ( Hyouk Soo Kwon ),정이영 ( Yi Yeong Jeong ),권용은 ( Yong Eun Kwon ),박흥우 ( Heung Woo Park ),김상헌 ( Sang Heon Kim ),김태범 ( Tae Bum Kim ),박혜경 ( Hye Kyung Park ) 대한천식알레르기학회 2004 천식 및 알레르기 Vol.24 No.4

당뇨 환자에서 진단된 대량 객혈을 보인 폐 모균증

조유지 ( Yu Ji Cho ),강명희 ( Myoung Hee Kang ),김현식 ( Hyeon Sik Kim ),정이영 ( Yi Yeong Jeong ),장인석 ( In Seok Jang ),김호철 ( Ho Cheol Kim ),황영실 ( Young Sil Hwang ),이종덕 ( Jong Deog Lee ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.6

Pulmonary mucormycosis is an uncommon, serious opportunistic infection caused by fungi belonging to the order Mucorales and it occurs exclusively in debilitated or immuno-compromised hosts. It is known that the fungi can invade the blood vessels and cause serious ischemic necrosis and bleeding5. We experienced a fatal case of pulmonary mucormycosis in a diabetic 75-year-old man who developed a progressive necrotizing lesion despite administering proper and prompt medical and surgical treatment. We report here on this case along with a review of the relevant medical literature.

70세 이상의 고령에서 발생한 기관지 결핵의 임상적 특징

김휘종 ( Hwi Jong Kim ),김현식 ( Hyeon Sik Kim ),마정은 ( Jeong Eun Ma ),이승준 ( Seung Jun Lee ),함현석 ( Hyoun Seok Ham ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),전경녀 ( Kyoung Nyeo Jeon ),김호철 ( Ho Cheol Kim ),이종덕 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.5

연구배경: 폐결핵의 발생은 연령이 증가함에 따라 그 빈도가 증가하는 것으로 알려져 있어 기관지 결핵의 발생률도 고령에서 증가할 것으로 생각된다. 본 연구는 70세 이상의 고령에서 발생한 기관지 결핵의 임상적 특징을 알아보고자 하였다. 방 법: 2003년 3월부터 2006년 6월까지 경상대학교병원에서 기관지 결핵으로 진단 받은 74명의 환자(남:여=12:62, 평균나이: 64.6±16.2세)를 대상으로 70세 이상 환자군과 70세 미만 환자군으로 나누어 임상적 특징을 후향적으로 조사하였다. 결 과: 1) 70세 이상의 환자는 41명(55%), 70세 미만의 환자는 33명(45%)이었다. 2) 양군 모두에서 가장 흔한 증상은 기침이었으며, 호흡곤란의 빈도는 70세 이상 환자군이 70세 미만 환자군보다 높았다(31.7% vs. 12.1%). 3) 기관지내시경 소견상 70세 이상의 환자군이 70세 미만의 환자군보다 건락성 괴사형의 비율은 낮았고(39% vs. 66.7%), 부종 충혈형은 상대적으로 높았다(53.7% vs. 27.2%)(p<0.05). 4) 병변의 위치는 기관 또는 주 기관지를 침범하는 경우가 70세 이상의 환자군이 70세 미만의 환자군보다 유의하게 많았다(9.7% vs. 30.3%). 5) 객담 및 기관지 세척액의 항산균 도말 양성률과 배양 양성률은 유의한 차이가 없었다. 결 론: 70세 이상의 고령에서도 기관지 결핵은 흔히 관찰할 수 있으며, 70세 미만의 기관지 결핵 환자와는 다른 몇 가지 임상양상을 보였다. Background: The possibility of developing pulmonary tuberculosis usually increases with increasing age. Therefore, the incidence of endobronchial tuberculosis in older people may increase. We evaluated the clinical characteristics in patients with endobronchial tuberculosis above the age of 70 years. Methods: We enrolled 74 patients (12 males and 62 females; mean age 64.6±16.2 years) that were diagnosed with endobronchial tuberculosis from March 2003 to July 2006 at Gyeongsang University Hospital. We retrospectively evaluated the clinical characteristics of endobronchial tuberculosis for patients 70 years or older (older group) and for patients below the age of 70 years (younger group). Results: The number of patients in the older group was 41 (55%). Cough was the most common symptom in the two groups of patients and dyspnea on exertion was more common in the older group of patients than in the younger group of patients (31.7% vs. 12.1%). The actively caesating type of disease was more common in the younger group of patients than in the older group of patients (66.7% vs. 39%). The edematous type of disease was more common in the older group of patients than in the younger group of patients (53.7% vs. 27.2%) (p<0.05). Tracheal and main bronchial involvement of lesions were more common for the younger group of patients than for the older group of patients (30.3% vs. 9.7%) (p<0.05). Conclusion: Endobronchial tuberculosis was commonly observed in patients older than 70 years and this group of patients had some clinical characteristics that were different from the younger group of patients. (Tuberc Respir Dis 2007;63:412-416)

기계 환기가 요구된 중증 지역사회 획득 폐렴에서 저용량 하이드로코르티손 주입의 효과

김호철 ( Ho Cheol Kim ),이승준 ( Seung Jun Lee ),함현석 ( Hyoun Seok Ham ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.4

배경 : 중증 지역사회 획득 폐렴은 항생제의 발달과 보조요법의 발전에도 불구하고 사망률이 높은 질환으로 호흡부전으로 진행되어 기계환기가 필요한 경우 사망률은 더욱 증가하게 된다. 최근 중증 지역사회 획득 폐렴에서 저용량 하이드로코르티손 주입이 사망률을 감소시킨다고 보고되었다. 본 연구는 기계환기가 요구된 중증 지역사회 획득 폐렴 환자에서 하이드로코르티손 정주의 효과를 알아보기 위하여 시행하였다. 방법 : 2005년 2월부터 7월까지 중증 지역사회 획득 폐렴으로 기계환기를 유지한 13명의 환자(남:여=10:3, 평균 연령: 68.6±14.1)를 대상으로 하이드로코르티손을 240mg을 부하로 정주하고 시간당 10mg을 지속적으로 7일간 주입하였다. 대조군은 연구 기간 이전 중증 지역사회 획득 폐렴으로 기계환기를 유지하고 스테로이드 치료를 하지 않았던 13명의 환자를 대상으로 하였다. 하이드로코르티손 주입 전과 주입 8일째 두 군 간의 임상적, 생리적 지표의 차이와 최종결과를 비교하였다. 결과 : 1) 하이드로코르티손 주입 전 주입군과 대조군의 나이, 성별, 내원 당시의 SAPS II, SOFA 점수, 체온, 백혈구 수, PaO2/FiO2(P/F) 비, P/F 200이 하인 환자수, 흉부방사선 사진 점수, 폐손상 점수, 카테콜라민 의존성 패혈성 쇽의 빈도 등은 유의한 차이가 없었다. 2) 하이드로코르티손 주입 8일 후 대조군에 비해 주입군이 P/F비가 100이상 호전된 환자의 비율과 흉부 방사선 점수가 호전된 환자의 비율이 유의하게 높았다(61.5% vs. 15.4% p=0.016, 76.9%vs. 23.1% p<0.05). 이외 다른 임상적 및 생리적 지표들은 주입군과 대조군 사이에 유의한 차이는 없었다. 3) 두 군 간에 기계환기 유지기간, 중환자실 재원기간, 병원내 재원기간, 재원 10일째와 30일째의 사망률은 유의한 차이가 없었다. 결론 : 기계환기가 요구되는 중증 지역사회 획득 폐렴에서 하이드로코르티손 정주는 산소화와 흉부 방사선 점수의 빠른 호전을 보이지만 최종 치료 성적에 대해서는 많은 환자를 대상으로 한 전향적 무작위 대조 연구가 필요할 것으로 사료된다. Background : Severe community-acquired pneumonia (CAP) can develop into respiratory failure that requires mechanical ventilation (MV), which is associated with a higher rate of mortality. It was recently reported that a hydrocortisone infusion in severe CAP patients was associated with a significant reduction in the length of the hospital stay and mortality. This study evaluated efficacy of a hydrocortisone infusion for patients with severe CAP requiring MV. Methods : From February 2005 to July 2005, 13 patients (M:F=10:3, mean age: 68.6±14.1 years), who were diagnosed with severe CAP and required MV, were enrolled in this study. Hydrocortisone was administered as an intravenous 200mg loading bolus, which was followed by an infusion at a rate of 10mg/hour for 7 days. The control group was comprised of patients with severe CAP requiring MV but in whom corticosteroid was not used before study period. The clinical and physiologic parameters on or by day 8 and the outcome in the hydrocortisone infusion group were compared with those in the control group. Results : 1) There was no significant difference in age, gender ratio, SAPS II, SOFA score, temperature, leukocyte count, PaO2/FiO2 (P/F) ratio, the number of patients with P/F ratio < 200, chest radiograph score, lung injury score and catecholamine-dependent septic shock between the hydrocortisone infusion group and control group at day 1. 2) At day 8, the proportion of patients with an improvement in the P/F ratio ≥ 100 and the chest radiograph score was significantly higher in the hydrocortisone infusion group than in the control group (61.5% vs. 15.4%, 76.9% vs. 23.1%, p<0.05). However, there was no significant difference in the other clinical and physiologic parameters. 3). There was no significant difference in the duration of the MV, ICU stay, hospital stay and 10th and 30th day mortality between the two groups. Conclusion : Hydrocortisone infusion for patients with severe CAP requiring invasive mechanical ventilation may be effective in improving the level of oxygenation and the chest radiograph score. (Tuberc Respir Dis 2006; 60: 419-425)