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Clofazimine-Containing Regimen for the Treatment of <i>Mycobacterium abscessus</i> Lung Disease
Yang, Bumhee,Jhun, Byung Woo,Moon, Seong Mi,Lee, Hyun,Park, Hye Yun,Jeon, Kyeongman,Kim, Dae Hun,Kim, Su-Young,Shin, Sung Jae,Daley, Charles L.,Koh, Won-Jung American Society for Microbiology 2017 Antimicrobial agents and chemotherapy Vol.61 No.6
<P>Patients with lung disease caused by Mycobacterium abscessus subsp. abscessus (here M. abscessus) typically have poor treatment outcomes. Although clofazimine (CFZ) has been increasingly used in the treatment of M. abscessus lung disease in clinical practice, there are no reported data on its effectiveness for this disease. This study sought to evaluate the clinical efficacy of a CFZ-containing regimen for the treatment of M. abscessus lung disease. We performed a retrospective review of the medical records of 42 patients with M. abscessus lung disease who were treated with CFZ-containing regimens between November 2013 and January 2015. CFZ was administered in combination with other antibiotics as an initial antibiotic regimen in 15 (36%) patients (initial treatment group), and it was added to an existing antibiotic regimen for refractory M. abscessus lung disease in 27 (64%) patients (salvage treatment group). Overall, there was an 81% treatment response rate based on symptoms and a 31% response rate based on radiographic findings. Conversion to culture-negative sputum samples was achieved in 10 (24%) patients after CFZ-containing antibiotic treatment, and during treatment, there were significant decreases in the positivity of semi-quantitative sputum cultures for acid-fast bacilli in both the initial (P = 0.018) and salvage (P = 0.001) treatment groups. Our study suggests that CFZ-containing regimens may improve treatment outcomes in patients with M. abscessus lung disease and that a prospective evaluation of CFZ in M. abscessus lung disease is warranted.</P>
Impact of Bronchiectasis on Incident NTM Pulmonary Disease: A 10-year National Cohort Study
( Bumhee Yang ),( Hyun Lee ),( Sun-Hyung Kim ),( Jiin Ryu ),( Taehee Kim ),( Yong Suk Jo ),( Youlim Kim ),( Hye Yun Park ),( Young Ae Kang ),( Seung Jun Lee ),( Ji-Yong Moon ),( Seung Won Ra ),( Sang- 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0
Background Despite a well-established relationship between bronchiectasis and non-tuberculous mycobacterial pulmonary disease (NTM-PD), it is unclear whether the presence of bronchiectasis increases the risk of new NTM-PD. Methods We performed a population-based, matched cohort study of adults aged 20 years with bronchiectasis using data obtained from the Korean National Health Insurance Service National Sample Cohort database between 2003 and 2013. We evaluated the incidence rate and risk of NTM-PD in the bronchiectasis cohort versus the matched cohort. We also assessed the risk factors of incident NTM-PD in bronchiectasis patients. Results During the median follow-up duration of 6.1 years, the age- and sex-adjusted incidence of NTM-PD was 109.1/100,000 person-years in the bronchiectasis cohort and 5.6/100,000 person-years in the matched cohort (hazard ratio [HR] = 22.8, 95% confidence interval [CI] = 14.0-37.0, p <0.001). Multivariable analyses revealed that age (adjusted HR for patients aged 50-59 = 5.84, 95% CI = 2.05-16.6), female sex (adjusted HR = 1.64, 95% CI = 1.11-2.42), and previous pulmonary tuberculosis (adjusted HR = 4.89, 95% CI = 3.28-7.29) were associated with increased risk of incident NTM-PD in bronchiectasis patients. Conclusion Risk of incident NTM-PD was appr oximately 23-fold greater in patients with bronchiectasis than in those without bronchiectasis. Age (the greatest risk was among patients aged 50-59), female sex, and previous pulmonary tuberculosis were risk factors for incident NTM-PD in bronchiectasis patients.
Factors Associated with Bronchiectasis in Korea: A National Database Study
( Bumhee Yang ),( Hyun Lee ),( Hyo Jun Jang ),( Sung Jun Chung ),( Seung-jin Yoo ),( Taehee Kim ),( Sun-hyung Kim ),( Yoon Mi Shin ),( Hyung Koo Kang ),( Jung Soo Kim ),( Hayoung Choi ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-
Background In recent studies, many important clinical features of bronchiectasis have been reported. However, the factors were evaluated using a specific disease cohort. Thus, clinical factors associated with bronchiectasis have not been well assessed in comparison to the general population. Methods A cross-sectional study using data from the Korea National Health and Nutrition Examination Survey 2007-2009 was performed. Results The prevalence of bronchiectasis was 0.4%. Compared with subjects without bronchiectasis, subjects with bronchiectasis were older (55.1 years vs. 44.4 years, p < 0.001) and had lower body mass index (BMI, 23.2 kg/m2 vs. 24.2 kg/m2, p < 0.001). The proportions of low family income (70.5 vs. 40.2%, p < 0.001) and low educational level (85.3 vs. 70.6%, p = 0.041) were higher in subjects with bronchiectasis than in subjects without bronchiectasis. Regarding comorbidities, subjects with bronchiectasis were more likely to have asthma (17.8% vs. 2.9%, p < 0.001) and previous history of pulmonary tuberculosis (TB) (43.5% vs. 5.0%, p < 0.001) compared with subjects without bronchiectasis. In addition, subjects with bronchiectasis had more respiratory symptoms and poorer quality of life measured using the EuroQoL five dimensions questionnaire (EQ-5D) index (0.87 vs. 0.93, p < 0.001) than subjects without bronchiectasis. In multivariable logistic regression analysis, low family income (adjusted odds ratio, OR = 3.83, 95% confidence interval, CI: 1.46-10.03), asthma (adjusted OR = 3.73, 95% CI: 1.29-10.79), pulmonary TB (adjusted OR = 7.88, 95% CI: 2.65-23.39), and the presence of airflow limitation (adjusted OR = 2.98, 95% CI: 1.01-8.98) were independently associated with bronchiectasis. Conclusion Subjects with bronchiectasis suffered from more respiratory symptoms with limited physical activity and poorer quality of life than the general population. Factors independently associated with bronchiectasis were lower family income and comorbid pulmonary conditions, such as previous pulmonary TB, asthma, and airflow limitation.
( Bumhee Yang ),( Sun-hyung Kim ),( Sun Hye Shin ),( Hayoung Choi ),( Ji-yong Moon ),( Hye Yun Park ),( Hyun Lee ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-
Tuberculosis (TB) survivors experience post-TB lung damage and ventilatory function disorders. However, the proportions of obstructive and restrictive ventilatory disorders as well as normal ventilation among post-TB subjects are unknown. In addition, the impacts of ventilatory disorder and its severity on respiratory symptoms, physical activity limitations, and the quality of life in post-TB subjects remain unclear. Subjects who participated in the Korean National Health and Nutritional Examination Survey 2007-2016 were enrolled in this study. We evaluated the impact of each ventilatory disorder and its severity on respiratory symptoms, physical activity limitations, and quality of life (measured by the EuroQoL five dimensions questionnaire [EQ-5D] index values) in post-TB subjects. Among 1,466 post-TB subjects, 29% and 16% had obstructive ventilatory disorders and restrictive ventilatory disorders, respectively. Mild and moderate obstructive ventilatory disorders were not associated with respiratory symptoms, physical activity limitation, or EQ-5D index value compared with normal ventilation; however, severe obstructive ventilatory disorders were associated with more respiratory symptoms (adjusted odds ratio [aOR] = 5.82, 95% confidence interval [CI] = 2.80-12.10), more physical activity limitation (aOR = 92.20, 95% CI = 16.33-520.62), and decreased EQ-5D index (adjusted coefficient = -0.055, 95% CI = -0.096 - -0.013) compared with normal ventilation. Mild restrictive ventilatory disorders were associated with more respiratory symptoms (aOR = 1.95, 95% CI = 1.07-3.56) compared with normal ventilation, while moderate (aOR = 9.17, 95% CI = 1.02-82.22) and severe restrictive symptoms (aOR = 9.17, 95% CI = 1.02-82.22) were associated with physical activity limitation compared with normal ventilation. Among post-TB subjects, 29% and 16% developed obstructive and restrictive ventilatory disorders, respectively. Severe obstructive ventilatory disorder was associated with more respiratory symptoms, more physical activity limitation, and poorer quality of life, while severe restrictive ventilatory disorder was associated with more physical activity limitations.
The disease burden of bronchiectasis in Korea: a national database study
( Bumhee Yang ),( Hayoung Choi ),( Jun Hyeok Lim ),( Hye Yun Park ),( Danbee Kang ),( Juhee Cho ),( Sei Won Lee ),( Yeon-mok Oh ),( Ji-yong Moon ),( Sang-heon Kim ),( Tae Hyung Kim ),( Jang Won Sohn ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Background: The prevalence and disease burden of bronchiectasis in comparison to those of chronic obstructive pulmonary disease (COPD) have not been well elucidated using a nationally representative database. Methods: We compared respiratory symptoms, physical activity, quality of life, and socioeconomic status in subjects with bronchiectasis versus those with COPD or control subjects participating in the Korea National Health and Nutrition Examination Survey 2007-2009. Participants were classified as physician- diagnosed bronchiectasis, COPD, and control (those without COPD or bronchiectasis). Results: The prevalence of bronchiectasis in subjects aged 40 years or older was 0.8%. Compared to COPD subjects, bronchiectasis subjects were more likely to be younger (median 59.0 years, p=0.001), female (47.6%, p=0.049), and never-smoker (50.1%, p=0.049) and have had history of pulmonary tuberculosis (40.5%, p < 0.001) and osteoporosis (19.1%, p < 0.001). However, as in COPD subjects, bronchiectasis subjects had low family income (p < 0.001) and the proportion of subjects working as manager/professional/ office workers (6.4%, p < 0.001) was smaller than that of control subjects. After adjusting for covariables, compared to control, bronchiectasis subjects but not COPD subjects were more likely to have respiratory symptoms (adjusted odds ratio [OR] = 7.96, 95% confidence interval [CI]: 2.10-30.12), limitation in physical activity (adjusted OR=9.43, 95% CI=1.06-83.79), and low family income (adjusted OR=3.61, 95% CI: 1.75-7.47). Conclusion: The prevalence of bronchiectasis in Korea was 0.8%. Respiratory symptoms, limitation in physical activity, and low family income were significantly associated with bronchiectasis.
( Bumhee Yang ),( Hayoung Choi ),( Bumsu Shin ),( Sung Jun Chung ),( Hyun Lee ),( Hye Yun Park ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
The impact of bronchiectasis on the occurrence of postoperative pulmonary complications (PPC) after extra-pulmonary surgery in patients with airflow limitation is not well elucidated. So, the aim of the present study was to investigate the impact of bronchiectasis on PPC following extra-pulmonary surgery in patients with airflow limitation. A retrospective analysis of 437 patients with airflow limitations, including 62 patients with bronchiectasis, was conducted. The overall rate of PPC was significantly higher in patients with bronchiectasis than in those without bronchiectasis (40.3% vs. 21.6%, p=0.001). The occurrence of pleural effusion (29.0% vs. 15.5%, p=0.009), atelectasis (19.4% vs. 9.9%, p=0.028), and acute exacerbation (8.1% vs. 1.3%, p=0.007) was significantly higher in patients with bronchiectasis than in those without bronchiectasis, while there were no significant differences in the occurrence of pneumonia and respiratory failure between the two groups. The analysis revealed that bronchiectasis was associated with increased PPC (adjusted odds ratio [OR]=2.73, 95% CI, 1.47-5.06, p=0.001), which was especially significant in patients who did not use bronchodilators (adjusted OR=3.24, 95% CI, 1.57-6.68, p=0.002). Our study indicates that bronchiectasis is associated with an increased risk of PPC following extra-pulmonary surgery in patients with airflow limitation, and bronchodilators may prevent PPC in these patients.
Lim, Bumhee,Park, Seunggun,Park, Jae Hyun,Gam, Jongsik,Kim, Sanghee,Yang, Jung Woon,Lee, Jeeyeon The Royal Society of Chemistry 2018 Organic & Biomolecular Chemistry Vol.16 No.12
<P>A mild metal-free approach to 1,3,4-oxadiazol-2(3<I>H</I>)-ones <I>via</I> 1,3,4-oxadiazin-5(6<I>H</I>)-ones is described. This novel transformation, promoted by the electron-withdrawing <I>p</I>-substituents on the phenyl group at the α-carbonyl position, features a tandem reaction consisting of oxidative hydroxylation and C-C bond cleavage using molecular oxygen. The method utilizes K2CO3 in CH3CN without any oxidants, transition metals, or additives, enabling the tunable synthesis of 1,3,4-oxadiazin-5(6<I>H</I>)-ones, 1,3,4-oxadiazol-2(3<I>H</I>)-ones, and α-ketoamides under mild aerobic conditions.</P>