조기 및 후기 발생 노인천식의 임상적 특성 비교

최인선(Inseon S . Choi),명보현(Bo Hyun Myung),강광원(Kwang Won Kang) 대한내과학회 2001 대한내과학회지 Vol.61 No.6

N/A Background: The asthma mortality has risen during last decades, especially in the elderly. This study was performed to investigate whether newly-developed asthma in the elderly has any difference in clinical features relating to asthma severity compared to early-onset asthma (EOA).Methods: Thirty-three asthma patients (≥60 years-old) hospitalized due to severe attack were classified to late-onset (LOA) when their asthma developed after the age of 60 and the remaining to EOA. Data obtained from their medical records were analyzed retrospectively. Results: Ten out of the 33 patients (30.3%) were LOA. Duration of asthma was significantly longer in EOA (21.6±14.8 years vs. 2.9±2.4 years, p<0.001). There were no significant differences between both groups in age, sex, atopy history (personal and familial), sinusitis, and peripheral blood eosinophils. However, EOA showed more smoking history and frequent exacerbations following URI-like symptoms (p<0.05, respectively), and higher serum total IgE level (geographic mean: 228 vs. 20 IU/mL, p<0.001). Life-threatening asthma attack was developed more frequently (89.5% vs. 40%, p<0.05), and the lung function measurements obtained just before discharge were significantly lower (FEV1/FVC: 54.8±10.1% vs. 64.6±11.7%, p<0.05) in EOA. Severity of chronic asthma was significantly more severe in EOA (moderate to severe persistent asthma: 95.6% vs. 60.0%, p<0.05). Conclusion: Many elderly asthmatics develop asthma newly in their old age. EOA is more related to atopic allergy, and seems to have more severe and long-standing asthma leading to chronic persistent airflow obstruction.(Korean J Med 61:616-622, 2001)

중증 천식발작 회복 후 임상 경과- 제3보

최인선 ( Inseon S. Choi ),은정남 ( Jeong-nam Eun ),홍지윤 ( Ji-yun Hong ),박명수 ( Myeong-soo Park ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.5

Purpose: Up to 10% of the mortality rate of asthmatics within a year from the near-fatal attacks has been reported. We previously reported that not a few patients with acute severe asthma died after discharge from the hospital. This study investigated whether our efforts to improve clinical outcomes of patients after recovery from severe asthma exacerbation did work or not. Methods: Follow-up data from asthmatic patients who had been hospitalized due to severe exacerbation between 2007 and 2014 (present) were compared with that the previous one (1998.2006) (previous). Results: Sex, age, near-fatal asthma, and mortality (9.8% vs. 9.6%) were not significantly different between the previous (n=225) and present (n=397) studies. However, rehospitalization rate was significantly lower in the present study (29.3% vs. 52.4%, P=0.000). The patients in the present study used inhaled steroid more frequently (78.5% vs. 68.0%, P=0.006), had better asthma knowledge (P=0.000), and higher proportion of regular hospital visitors to total subjects (75.6% vs. 64.9%, P=0.004) than did the previous patients. The regular hospital visitors (n=300) showed a significantly lower mortality (3.3% vs. 28.9%, P=0.000), better knowledge (P=0.000) and higher inhaled steroid use (85.8% vs. 54.1%, P=0.000) than did the other group (n=97) in the present study. Conclusion: Clinical outcomes after recovery from severe asthma exacerbation in the present study were better than the previous one. Our efforts to educate patients might contribute to these better results. (Allergy Asthma Respir Dis 2016:4:340-345)

감작된 BALB/c 생쥐에서 Schultz-Dale 반응과 Th2 면역반응에 대한 Dehydroepiandrosterone의 효과

최인선 ( Inseon S. Choi ),최용 ( Yong Cui ),고영아 ( Young Ah Koh ),조용범 ( Yong Beom Cho ),원영호 ( Young Ho Won ) 대한천식알레르기학회 2008 천식 및 알레르기 Vol.28 No.2

Background: Dehydroepiandrosterone (DHEA) increases the production of interferon (IFN)-γ, and IFN-γ suppresses the Th2 response. Objective: To investigate whether DHEA suppresses the in vitro allergen-induced response of airway muscles. Method: Female BALB/c mice were fed mouse chow containing 0, 0.001, 0.01 or 0.1% DHEA during the study period. The animals were sensitized with ovalbumin (OVA), and then the Schultz-Dale reaction to 50μg/ml OVA, serum OVA-specific IgE concentration and cytokine production by cultured splenocytes were measured. Result: OVA-sensitized mice (n=20) developed a Schultz-Dale reaction, had significantly high concentrations of IgE and IL-5 and a significantly low IFN-γ/IL-5 ratio compared to the controls (n=20). The treatment with 0.1% DHEA significantly decreased the IL-5 level (123 vs. 54 pg/ml, P<0.001) and tended to increase the IFN-γ/IL-5 ratio (2.2±0.3 vs. 3.7±0.7, P=0.09), but did not suppress the Schultz-Dale reaction and IgE levels. The contractile responses of muscles to OVA were significantly related to OVA-specific IgE levels (r=0.446, P<0.001) and the IFN-γ/IL-5 ratio (r=?0.427, P<0.001). Conclusion: DHEA did not suppress the Schultz-Dale reaction or the OVA-specific IgE production despite a significant suppression in the Th2 response in mice. (Korean J Asthma Allergy Clin Immunol 2008;28:121-127)

천식에서 과잉 기도수축 지표로서의 기도 허탈성

최인선 ( Inseon S. Choi ),임호 ( Ho Lim ),박선영 ( Seon Yeong Park ),고영일 ( Youngil I. Koh ),정세웅 ( Se Woong Chung ) 대한천식알레르기학회 2003 천식 및 알레르기 Vol.23 No.2

Background:It has been suggested that excessive airway narrowing in asthma may be de-tected by a decrease in forced vital capacity (FVC). A volume difference between slow vital capacity (SVC) and FVC may be used as a surrogate index of airway collapse. Ob

천식에서 외부 저항 부하와 기관지수축 유발에 의한 호흡곤란 인지능 측정 비교 연구

최인선 ( Inseon S. Choi ),정성훈 ( Seong Hoon Cheong ),정대호 ( Dae Ho Cheong ),이우진 ( Woo Jin Lee ),한의령 ( Eui Ryoung Han ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.2

Background: Since blunted perception of dyspnea may predispose to fatal asthma attacks, dyspnea perception should be measured in severe asthma. Few studies have compared the testing methods. Objective: To investigate whether the degree of dyspnea perception depends on the testing method in asthma. Method: The Borg scale-based dyspnea perception scores during breathing through an inspiratory muscle trainer, and during bronchoprovocation tests using histamine or methacholine were measured in asthma patients and normal volunteers. The relationships between Borg scores and atopy markers were determined. Result: The △Borg scores induced by the external resistive loads were significantly lower in subjects with moderateto-severe airway hyperresponsiveness (AHR) to histamine than in those with negative AHR (P=0.021). Among the patients with AHR to both histamine and methacholine (n=19), the △Borg scores/△lung function ratio induced by histamine was significantly higher than that by methacholine (15.6±2.3 vs. 9.5±2.1, P<0.05). The load-induced △Borg scores were significantly related to serum total IgE levels (r=0.541, P<0.05). Conclusion: Dyspnea perception depends on AHR severity. Histamine induces more severe dyspnea than methacholine, and allergy may affect dyspnea perception. Dyspnea perception vary according to the testing methods. (Korean J Asthma Allergy Clin Immunol 2007;27:111-117)

천식 의심환자에서 기도과민성과 관련된 공기 매개성 알레르겐

한의령 ( Eui Ryoung Han ),최인선 ( Inseon S. Choi ),이석 ( Seok Lee ),조영욱 ( Yeong Wook Cho ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.2

Background: House dust mites and cats are major allergens causing asthma, and grass pollens are more closely related to allergic rhinitis. Objective: To investigate which aeroallergens are related to airway hyperresponsiveness (AHR), a characteristic feature of asthma, in Korean patients. Method: Medical records of suspected asthmatics, who performed both skin prick tests using common aeroallergens and the methacholine bronchoprovocation test between 2001 and 2007, were reviewed. A positive response to an allergen was defined as allergen/histamine wheal ratio of ≥1. A positive and a ≥moderate AHR were defined as 20% fall in FEV1 to ≤25 and ≤2 mg/mL of methacholine, respectively. The relative risks (adjusted odds ratio) for AHR compared to non-atopy were determined by a multivariate logistic regression analysis. Result: House dust mites were the most prevalent allergens in both asthma (n=238) and non-asthma (n=149) patients. The AHR severity was significantly related to the sensitization rates to house dust mites in asthmatics. The relative risks for ≥moderate AHR of subjects sensitized to Dermato-phagoides farinae and hazel were 1.21 (P<0.01) and 0.72 (P<0.05), respectively. Conclusion: Sensitization to a house dust mite, D. farinae, might be a significant risk factor for AHR, but hazel sensitization was protective and might be related to allergic rhinitis. (Korean J Asthma Allergy Clin Immunol 2007;27:105-110)

천식 환자에서 흡입용 스테로이드 장기 사용의 시상하부-뇌하수체-부신축 억제 효과

심다운 ( Da Woon Sim ),최인선 ( Inseon S Choi ),김승훈 ( Seung Hun Kim ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.4

Purpose: Long-term treatment with inhaled steroids (ICS), especially fluticasone that developed lately, may suppress the hypothalamic-pituitary-adrenal (HPA) axis. This study investigated the relationship between ICS use and HPA axis suppression in asthmatics under ICS treatment for average 4.5 years. Methods: The medical records of 129 adult asthmatics who received ICS treatment for 6 months or more and underwent a corticotropin stimulation test from January 2005 to August 2013 were retrospectively reviewed. Results: The patients received ICS only (n=87) were found to have an abnormal response to the corticotropin test in as high as 32.2%, and those received ICS in combination with oral steroids (n=42) had a significantly higher prevalence of the response (71.4%, P<0.001). Abnormal responses to corticotropin occurred depending on ICS daily doses (low, n=8, 12.5%; medium, n=19, 36.8%; high, n=102, 49.0%; X2=4.384, P=0.036). Among the subjects received ICS only, nasal steroid doses (P=0.016) but not ICS doses (P=0.159) were significantly higher in those with abnormal responses than the others. Among all the subjects, oral steroid use (odds ratio [OR], 4.27; 95% confidence interval [CI], 2.35-11.80; P<0.001) and nasal steroid dose (OR, 1.02; 95% CI, 1.00-1.04; P=0.015) were significant risk factors for HPA axis suppression. Conclusion: One-third of asthmatics under long-term treatment with ICS showed a suppression of the HPA axis in a dose-dependent manner. Oral or nasal steroid use may be a risk factor for the suppression. However, since our results may have been overestimated due to subject selection bias, further prospective case-control studies are warranted.

실험 생쥐에서 BCG 백신과 DHEA 복합 투여의 천식 발생 예방효과

최용 ( Yong Cui ),최인선 ( Inseon S. Choi ),고영아 ( Young Ah Koh ) 대한천식알레르기학회 2005 천식 및 알레르기 Vol.25 No.4

Background: Both Bacille Calmette-Guerin (BCG) vaccine and dehydroepiandrosterone (DHEA) have a suppressive effect on asthma. Objective: To evaluate the effect of BCG and DHEA combination against the development of asthma. Method: Female BALB/c mice were sensitized and provoked with ovalbumin (OVA). One week before sensitization, BCG (1×105 CFUs) was administered intraperitoneally and the animals were fed with a diet incorporated with 0.01% (w/w) of DHEA for 4 weeks. Methacholine brochoprovocation tests and bronchoalveolar lavages (BAL) were carried out. Result: As compared with control, the combined BCG and DHEA treatment significantly suppressed both maximal airway resistance expressed as enhanced pause (P<0.01) and airway hypersensitivity (35.0 vs. 10.2 mg/mL, P<0.05) to methacholine, and BAL fluid eosinophilia (1.4±0.3 vs.10.7±1.4%, P<0.001); however, the combination was not superior to each treatment. The level of IFN-γ in splenocyte supernatant was significantly higher in the combined group than that in control group (295.1 vs. 218.8 pg/mL, P<0.05). Conclusion: A combined BCG and DHEA treatment suppresses the development of airway hyperresponsiveness and eosinophilic inflammation along with increased Th1 response in OVA-induced asthma mice. However, there is no beneficial effect of the combination above each. (Korean J Asthma Allergy Clin Immunol 2005;25:291-298)

천식 환자에서 흡입용 스테로이드 장기 사용의 시상하부-뇌하수체-부신축 억제 효과

심다운 ( Da Woon Sim ),최인선 ( Inseon S Choi ),김승훈 ( Seung Hun Kim ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.1

천식발작 환자에서 말초혈액 내 호산구와 호중구 증가의 임상적 의의

이우진 ( Woo Jin Lee ),최인선 ( Inseon S. Choi ),정종원 ( Jong Won Jeong ),이세련 ( Se Ryeon Lee ) 대한천식알레르기학회 2008 천식 및 알레르기 Vol.28 No.3

Background: Neutrophilic airway inflammation has been reported in severe intractable asthma. Therefore, direct assessment of airway inflammation may be useful. However, but it is not easy especially in patients with acute asthma. Objective: To investigate whether the clinical characteristics of patients with acute asthma differ according to the cellular profiles of their blood samples which are easily obtainable. Method: The medical records of 410 adult patients with acute asthma, who were hospitalized between 2002 and 2007, were reviewed. Blood eosinophilia and neutrophilia were defined as the cell counts of ≥450/μL and ≥7,500/μL, respectively. Result: The patients with eosinophilia were relatively young, and they had high serum levels of total IgE and posttreatment lung function. The patients with neutrophilia showed a significantly lower posttreatment lung function and a higher prevalence of emphysema than those with eosinophilia. The levels of PaCO2 were significantly related to the eosinophil counts, while the levels of PaO2 and C-reactive protein (CRP) were related to the neutrophil counts(all P<0.01). Conclusion: Eosinophilic or neutrophilic response in peripheral blood which occur in acute asthma patients may depend on upon the attack severity and clinical characteristics of subjects such as allergy or irreversible airflow obstruction. (Korean J Asthma Allergy Clin Immunol 2008;28:184-191)