COPD의 치료가이드

정기석 ( Ki Suck Jung ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4

COPD의 치료는 앞에서 살펴본바와 같이 약물치료와 비약물치료로 나누어 광범위하게 이루어져야 한다. 또한 이 질환에 대한 전세계적인 관심이 지속되고 있고 표준화된 치료지침이 제정되어 있으므로 이에 준한 치료가 바람직하다. COPD를 폐기능 검사를 기준으로 중한 정도에 따라 경증, 중등증, 중증 및 고도중증으로 나누고 각 단계에 따른 치료가 다르기 때문에 분류를 위한 FEV1과 FVC를 측정하는 것이 진단뿐만 아니라 치료의 첫걸음이다. 일단 치료를 시작하면 중단 없이 지속적으로 해야 하고, 재평가를 통해 환자의 삶의 질을 향상시키고, 폐기능의 저하를 최소한으로 하며, 치료에 따른 부작용을 없애는 것이 장기 치료의 목표이다. The prevalence of chronic obstructive pulmonary disease (COPD) in Korea is reported to be 17.5% in aged over 45 years. The overall approach should be individualized and dependent upon the severity of the disease and clinical status of the patient. Objectives of COPD treatment are improvement of airflow obstruction, prevention and management of co-morbidity and complication of COPD and upgrading in the quality of life. Pharmacologic therapy includes bronchodilators such as beta-2 agonists, anticholinergic and theophylline. Another key pharmacologic agent is glucocorticosteroid which reduces acute exaceerbation and inflammatory burden in COPD airways. Non-pharmacologic management is not less important. Education including smoking cessation, rehabilitation, home oxygen therapy along with appropriate vaccination. More importantly, doctor-patient-patron relationship plays a central role in long-term management of COPD. (Korean J Med 77:422-428, 2009)

흉수의 생성기전

정기석 ( Ki Suck Jung ) 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.47 No.2

만성폐쇄성폐질환 급성 악화로 입원한 환자의 세균성 원인

정기석 ( Ki Suck Jung ) 대한내과학회 2009 대한내과학회지 Vol.77 No.3

Chronic obstructive pulmonary disease (COPD) is a chronic disease that has high morbidity and mortality in Korea. Since an acute exacerbation can place a great burden not only on COPD patients but also on the community, the prevention and treatment of this condition is becoming more important. An acute exacerbation of COPD is defined as an event in the natural course of the disease, characterized by a change in the patient`s baseline dyspnea, cough, or sputum that is beyond the day-to-day variation, is acute in onset, and may warrant a change in regular medication. Among the causes of exacerbation, bacteria are the most common etiology. The data of Joo et al. in this issue best describe the relevant pathogens causing COPD exacerbation in Korea. Knowing the prevalent pathogens and their antibiogram is crucial when selecting the antibiotics to use. Their manuscript provides recent information on the bacterial etiology of COPD exacerbation. (Korean J Med 77:306-308, 2009)

유도객담의 유용성

정기석 ( Ki Suck Jung ) 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.56 No.4

노인 호흡기질환의 효과적 관리 : 노인 폐렴

정기석 ( Ki Suck Jung ) 대한내과학회 2008 대한내과학회지 Vol.75 No.2

지역사회폐렴은 노인에서 더 흔하고 사망률도 높으며 심각한 경제적 비용을 초래한다. 노인 폐렴은 젊은 성인과는 자연경과나 임상경과가 달라 치료에 있어서 다르게 접근할 필요가 있다. 많은 경우 임상증상이 특이적이지 않아 진단이 쉽지 않고, 치료 또한 지연되기 쉽다. 따라서 기저질환을 포함한 임상증상의 악화를 보이는 경우에는 폐렴의 가능성을 항상 생각해야 한다. 외래와 입원치료의 결정은 CURB-65나 PSI를 참고로 여러가지 요인들을 고려하여야 한다. 경험적 항생제를 선택할 때는 먼저 지역사회폐렴인지 HCAP인지를 구분하고, 환자의 동반질환이나 건강상태를 종합적으로 고려하여 적절하고 항생제를 빠른 시간 내에 투여하여야 좋은 치료결과를 얻게 된다. 폐렴을 예방하기 위해서는 흡인의 기회를 줄이고, 금연 및 예방접종을 권한다. Community-acquired pneumonia (CAP) is one of major medical illness and leading causes of death in the elderly patients. They account for the majority of CAP-related hospital admission, and suffer from more severe degree of illness that often requires broad-spectrum antibiotics and intensive care unit (ICU) admission. Recently, the incidence and mortality of CAP is rising. Therefore, the economic and clinical burden is expected to increase consistently at present time and also in the future. Although Streptococcus pneumoniae is still the most common pathogen identified, pneumonia in elderly patients is different from that in younger patients, with regard to the etiology, clinical course, and treatment response. The most striking characteristic of pneumonia in older patients is its clinical presentation: classic symptoms are often absent. Therefore, appropriate diagnosis and treatment can be delayed. When approaching the treatment for pneumonia in older patients, patients with healthcare-associated pneumonia (HCAP) should be distinguished from those with CAP. Patients with HCAP are at high risk for multidrug-resistant (MDR) pathogens and tend to have much more severe illness due to multiple co-morbidities and decreased functional status, which are associated with poor outcome. Prevention should also be implemented, focusing on smoking cessation, aspiration prevention, and influenza and pneumococcal vaccination. (Korean J Med 75:129-140, 2008)

Respiratory Inductive Plethysmography 를 이용한 운동부하 검사

권오정(O Jung Kwon),정기석(Ki Suck Jung),심영수(Young Soo Shim),한용철(Yong Chol Han) 대한내과학회 1986 대한내과학회지 Vol.31 No.1

N/A The study was undertaken to evaluate the significance of coordination between the movement of chest wall and abdomen during exercise in patients with chronic obstructive pulmonary disease and far advanced pulmonary tuberculosis. Resting pulmonary function tests including maximal expiratory flow-volume curve, single breath nitrogen washout test, diffusing capacity using carbon monoxide, arterial blood gas analysis and exercise tolerance test with respiratory inductive plethysmography were performend in 15 patients with chronic obstructive pulmonary disease and 15 patients with far advanced pulmonary tuberculosis. The results are summarized as follows: 1) Breathing patterns were divided into 3 groups. Group 1 showed synchronized pattern between rib cage and abdomen. Group 2 showed a synchronized pattern during inspiration but had a prolonged outward motion of abdomen duing expiration. Group 3 had complete paradoxical pattern which showed asynchrony between rib cage and the abdomen during whole respiration. 2) There were 20 patients in Group 1, 6 patients in Group 2, and 4 patients in Group 3. 3) The resting pulmonary function was significantly poor in group 2 and 3 compared with Group 1. 4) Exercise test data showed that exercise tolerance was diminished in Group 2 and 3 than Group 1. 5) There was no significant difference between Group 2 and Group 3 in resting pulmonary function and exercise tolerance test data. 6) Paradoxical pattern was observed less frequently in far advanced pulmonary tuberculosis group than in chronic obstructive pulmonary disease group even though both groups have similar values of FEV1.0.

지역사회획득 폐렴의 치료지침 권고안

송재훈 ( Jae Hoon Song ),정기석 ( Ki Suck Jung ),강문원 ( Moon Won Kang ),김도진 ( Do Jin Kim ),배현주 ( Hyun Joo Pai ),서지영 ( Gee Young Suh ),심태선 ( Tae Sun Shim ),안중현 ( Joong Hyun Ahn ),안철민 ( Chul Min Ahn ),우준희 ( Ju 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.4

The successful treatment of community-acquired pneumonia requires appropriate, empirical antimicrobial therapy. The etiology and antimicrobial susceptibility of major pneumonia pathogens can differ by country. Therefore, the ideal treatment guidelines for community-acquired pneumonia should be based on the studies performed in each country. We developed a treatment guideline for community-acquired pneumonia for immunocompetent adults in Korea. This guideline was developed by the joint committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory diseases.

내독소에 의한 혈관 내피세포 손상에서 혈관 내피세포로부터 유리된 산소기의 역할에 관한 연구

최형석 ( Hyung Seok Choi ),정기호 ( Ki Ho Jeong ),유철규 ( Chul Gyu Yoo ),김영환 ( Young Whan Kim ),한성구 ( Sung Koo Han ),심영수 ( Young Soo Shim ),김건열 ( Keun Youl Kim ),한용철 ( Yong Chol Han ),정기석 ( Ki Suck Jung ) 대한결핵 및 호흡기학회 1994 Tuberculosis and Respiratory Diseases Vol.41 No.4

원발성 쇼그렌 증후군(Primary Sj$\ddot{o}$gren's Syndrome) 환자에서 발생한 Bronchus-Associated Lymphoid Tissue(BALT) 림프종 1례

강민종,이재명,이승준,손지웅,김동규,이명구,현인규,정기석,Kang, Min-Jong,Lee, Jae-Myung,Lee, Seung-Joon,Son, Jee-Woong,Kim, Dong-Gyu,Lee, Myung-Goo,Hyun, In-Gyu,Jung, Ki-Suck 대한결핵및호흡기학회 2002 Tuberculosis and Respiratory Diseases Vol.52 No.2

원발성 쇼그렌 증후군 (Primary Sj$\ddot{o}$gren's syndrome) 환자에서 폐에 발생하는 Bronchus-associated lymphoid tissue(BALT) 림프종은 드문 질환이다. 본 환자는 49세 여자 환자로 5년 전부터 안구 건조증 및 구강 건조증이 점차 진행하였으나 그냥 지내던 중 2년 전부터 운동시 호흡곤란 및 전신 무력감이 계속 진행하여 본원에 입원하였다. 흉부청진상 호흡음이 거칠게 들렸으며 양측 폐야 전체에 걸쳐 흡기시 악 설음이 관찰되었다. 형광항핵항체시험 (FANA)이 양성으로 "speckled pattern"을 보였으며 anti-SSA(Ro) Ab 및 anti-SSB(La) Ab는 강양성 소견을 보였다. 단순 흉부 방사선 사진 상 양측 폐에서 미만성의 망상 결절성 음영 증가가 관찰되었으며 고해상도 흉부 컴퓨터 단층촬영상에서 양측 폐에 걸쳐 미만성 분포를 보이는 모자이크 양상의 비균질성 감쇠 (mosaic pattern of inhomogeneous attenuation) 소견이 관찰되었다. 경기관지 폐 조직 생검상 림프구의 침윤이 관찰되었고 개흉 폐 생검술을 이용하여 얻은 폐조직의 병리 소견에서 'low grade marginal zone B cell lymphoma of BALT(bronchus associated lymphoid tissue) type'에 합당한 소견을 얻어 원발성 쇼그렌 증후군 (Primary Sj$\ddot{o}$gren's syndrome) 환자에서 폐에 발생한 Bronchus-associated lymphaid tissue(BALT) 림프종으로 확진되었다. A bronchus-associated lymphoid tissue(BALT) lymphoma of the lung is a rare disorder of patients with Sj$\ddot{o}$gren's syndrome. A 49-year-old woman was admitted for an evaluation of exertional dyspnea and general weakness which had persisted for two years. The patient had suffered from dry mouth and dry eyes for five years. The physical examinations showed a coarse breath sound with inspiratory crackles on the whole lung field, particularly on the both basal lungs. The laboratory data disclosed high titers of anti-nuclear antibodies, and anti-SSA (Ro), and anti-SSB (La) antibodies. Chest radiographs demonstrated the presence of bilateral, diffuse, reticulonodular densities in both lungs. Thin-section CT scans showed diffusely distributed mosaic pattern of an inhomogeneous attenuation extending over the entire lung zone. The histological findings from an open-lung biopsy specimen revealed an accumulation of lymphoid cells around the bronchioles and an extension of malignant lymphoma cells from the bronchiolar epithelium toward the alveolar space. Immunohistochemically, the neoplastic cells reacted positively to the CD 20 antigen and were focally positive for the UCHL 1 antigen. The histological diagnosis was consistent with a low grade marginal zone B-cell lymphoma originating in the BALT. Here, we present a case of a histologically proven BALT lymphoma of the lung in a patient with primary Sj$\ddot{o}$gren's Syndrome.

메탈 프탈로시아닌의 마이크로파 합성

서차수(Cha Soo Suh),박성수(Seong Soo Park),정기석(Ki Suck Jung),이종영(Jong Young Lee),박진환(Jin Hwan Park),이근대(Gun Dae Lee) 한국공업화학회 2001 공업화학 Vol.12 No.7

N/A N/A