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.

Bronchoalveolar Cellularity and Interleukin-8 Levels in Measles Bronchiolitis Obliterans

Koh, Young Yull,Jung, Da Eun,Koh, Ji Yeon,Kim, Jung Yeon,Yoo, Young,Kim, Chang Keun American College of Chest Physicians 2007 Chest Vol.131 No.5

<P>BACKGROUND: Measles virus infection may progress to a chronic obstructive process including bronchiolitis obliterans (BO). This study investigates pulmonary cellular profiles and interleukin (IL)-8 levels in patients with BO following the measles. METHODS: BAL fluid was obtained from 12 children with BO who had a history of measles pneumonia during an outbreak in 2000 and 2001. BAL cell counts and differentials were compared to control patients as well as BAL IL-8 levels, which were measured by enzyme-linked immunosorbent assay. Immunohistochemical staining of BAL cells and three open-lung biopsy specimens were also analyzed for T-cell surface markers CD3, CD4, and CD8. RESULTS: BAL cellular profiles were characterized by a significantly increased percentage of neutrophils in the measles BO group (median, 16.0%) compared to the control group (2.3%) [p < 0.01]. BAL IL-8 levels were also markedly increased in the measles BO group (mean +/- SD, 418.6 +/- 286.0 pg/mL) compared to the control group (92.8 +/- 126.7 pg/mL) [p < 0.01]. BAL IL-8 levels correlated significantly with neutrophil percentages in both the measles BO group (r = 0.86, p = 0.000) and the control group (r = 0.79, p = 0.007). The lymphocyte subsets were characterized by a significantly increased number of CD8+ cells, resulting in a decreased CD4/CD8 ratio in the BAL and the biopsy specimens. CONCLUSION: These results suggest that pulmonary neutrophils and IL-8, along with CD8+ T lymphocytes may play an important role in the pathogenesis of BO after measles virus infection.</P>

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.

최대호기속도계의 사용과 기관지유발검사

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.

기관지천식 환아에서 EPA / DCHA 의 투여가 임상경과 및 기도반응에 미치는 영향

고영율(Young Yull Koh) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1993 소아알레르기 및 호흡기학회지 Vol.3 No.1

N/A I have studied the effect of dietary fish oil supplementation (1.8gm/day of eicosapentaenoic acid and 1.2gm/day of docosahexaenoic acid) for 12 weeks on the clinical course, and the methacholine and allergen induced airway responses in 12 asthmatic children. Diurnal peak expiratory flow, symptom scores, and bronchodilator use were measured for clinical course assessment, and methacholine and allergen bronchial provocation tests were performed before and after dietary supplementation of EPA/DCHA. There was no significant change in any of clinical measurements. However, the magnitude of methacholine induced bronchoconstriction and allergen induced early or late asthmatic responses were significantly attenuated following EPA/DCHA. Although the above results indicated that fish oil supplementation has little effect on the clinical severity of asthma, they may have some therapeutic implication insofar as EPA/DCHA attenuate the airways response to various stimuli.

천식의 병태생리

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)

영유아천명후 기관지천식으로의 이행에 미치는 부모이 아토피와 기관지과민성의 영향

정진화,김유영,김윤근,이명현,민경업,지영구,조상헌,고영률 대한알레르기학회 1998 천식 및 알레르기 Vol.18 No.4

Background: Many young children suffer from wheezing illness during viral respiratory infection, and some of them experience wheezing many years later and ultimately develop bronchial asthma. It is not clear whether atopy or bronchial hyperresponsiveness in the family is a significant risk factor for asthma in this clinical setting. Objective: To examine the genetic basis for the development of asthma after early childhood wheezing. Materials and methods : A measurement of serum total IgE concentration, skin prick test to common inhalant allergens, and methacholine bronchial provocation test were performed in 29 asthmatic children and their parents, and 22 non-asthmatic children with the past history of wheezing illness during the first three years of age and their parents. A questionnaire was performed to assess the presence of asthma and allergic rhinitis in the parents. Results : Positive skin test response to common inhalant allergens was more prevalent in asthmatics than in non-asthmatics(67.8% vs. 27.2%). Serum total IgE concentration was significantly higher in asthmatics than in non-asthmatics(geometric mean: 173 vs. 83 IU/ml). Positive skin test response to comman inhalant allergens was more prevalent in parents of asthmatics than in thoae of non-asthmatics(51.7% vs. 25.0%), but serum total IgE level was not different between the two groups(geometric mean: 132 vs. 120 IU/ml). Positive rate of methacholine bronchial provocation test, geometric mean of PC20-methacholine, and BR index were not different between the parents of asthmatics and non-asthmatics (18.1% vs. 13.9%; 164 vs. 180 mg/ml; 1.154 ±0.077 vs. 1.055 ±60.068, respectively). Conclusion : It is suggested that personal atopy is important in the development of asthma after early childhood wheezing, and parental atopy rather than bronchial hyperresponsiveness is a risk factor for the development of childhood asthma in this clinical setting.