만성폐쇄성폐질환 환자에서 열량섭취와 폐기능지표와의 상관관계

윤호일 ( Ho Il Yoon ),박영미 ( Young Mi Park ),조여원 ( Ryo Won Choue ),강영애 ( Yeong Ae Kang ),권성연 ( Sung Youn Kwon ),이재호 ( Jae Ho Lee ),이춘택 ( Choon Taek Lee ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5

연구배경: 이전의 연구에서 섭취의 제한은 폐기종과 유사한 변화를 유발할 수 있음이 알려져 왔다. 그러나 이러한 현상이 만성폐쇄성폐질환 환자에서 갖는 의미는 밝혀진 적이 없다. 저자들은 만성폐쇄성폐질환 환자에서 영양섭취량과 폐기능지표와의 상관관계를 알아보고자 본 연구를 수행하였다. 방법: 분당서울대학교병원에서 2006년 3월부터 1년 동안 진료받은 만성폐쇄성폐질환 환자들을 대상으로 하였으며 폐활량검사, 확산능검사, 폐용적검사와 함께 영양섭취상태평가를 시행한 후 분석하였다. 결과: 총섭취열량과 1초간노력호기량이나 최대노력호기량(%예측치)과는 아무런 상관관계를 찾을 수 없었다. 반면 폐확산능의 지표인 DLCO (%예측치), DLCO/VA (%예측치)와는 양의 상관관계를, 총폐용량(%예측치)과는 음의 상관관계를 보임을 관찰할 수 있었다. 섭취한 열량 중 단백질섭취열량과 폐확산능 DLCO (%예측치), DLCO/VA(%예측치)은 통계적으로 의미 있는 상관관계를 보였다. 그러나 탄수화물 및 지방섭취에 의한 열량과 폐기능지표는 의미 있는 상관관계를 보이지 않았다. 결론: 만성폐쇄성폐질환 환자의 하루 섭취 열량은 그 환자의 폐확산능과는 양의 상관관계, 총폐용량과는 음의 상관관계에 있어 섭취열량과 폐기종의 관련성에 대한 추가 연구가 필요하다. Background: There are reports that food deprivation causes emphysematous changes in the lungs of rats and humans. However, the meaning of this phenomenon in patients with chronic obstructive pulmonary disease has not been evaluated. The aim of this study was to determine the correlations between the caloric intake and parameters of the lung function in patients with chronic obstructive pulmonary disease. Methods: Patients with chronic obstructive pulmonary disease who had visited the respiratory clinic from March, 2006 for one year were enrolled in this study. The patients underwent pulmonary function tests, and a dietitian evaluated their nutritional intake using a food record method. Results: There was no correlation between the total caloric intake and forced vital capacity (FVC, %predicted) or forced expiratory volume in one second (FEV1, %predicted). The total caloric intake showed a positive correlation with the diffusing capacity of carbon monoxide (DLCO %predicted, DLCO/VA %predicted), and a negative correlation with the total lung capacity (TLC, %predicted). Of the calories taken, only calories from protein intake correlated with the diffusing capacity of carbon monoxide (DLCO %predicted, DLCO/VA %predicted). Conclusion: The total caloric intake of patients with chronic obstructive pulmonary disease showed a positive correlation with the diffusing capacity of the lung, and a negative correlation with the total lung capacity. Further study on the linkage between the caloric intake and severity of emphysema is needed. (Tuberc Respir Dis 2008;65:385-389)

Prediction of Pulmonary Function in Patients with Chronic Obstructive Pulmonary Disease: Correlation with Quantitative CT Parameters

구현정,이상민,Joon Beom Seo,이상민,Namkug Kim,오상영,Jae Seung Lee, M.D,오연목 대한영상의학회 2019 Korean Journal of Radiology Vol.20 No.4

Objective: We aimed to evaluate correlations between computed tomography (CT) parameters and pulmonary function test (PFT) parameters according to disease severity in patients with chronic obstructive pulmonary disease (COPD), and to determine whether CT parameters can be used to predict PFT indices. Materials and Methods: A total of 370 patients with COPD were grouped based on disease severity according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) I–IV criteria. Emphysema index (EI), air-trapping index, and airway parameters such as the square root of wall area of a hypothetical airway with an internal perimeter of 10 mm (Pi10) were measured using automatic segmentation software. Clinical characteristics including PFT results and quantitative CT parameters according to GOLD criteria were compared using ANOVA. The correlations between CT parameters and PFT indices, including the ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) and FEV1, were assessed. To evaluate whether CT parameters can be used to predict PFT indices, multiple linear regression analyses were performed for all patients, Group 1 (GOLD I and II), and Group 2 (GOLD III and IV). Results: Pulmonary function deteriorated with increase in disease severity according to the GOLD criteria (p < 0.001). Parenchymal attenuation parameters were significantly worse in patients with higher GOLD stages (P < 0.001), and Pi10 was highest for patients with GOLD III (4.41 ± 0.94 mm). Airway parameters were nonlinearly correlated with PFT results, and Pi10 demonstrated mild correlation with FEV1/FVC in patients with GOLD II and III (r = 0.16, p = 0.06 and r = 0.21, p = 0.04, respectively). Parenchymal attenuation parameters, airway parameters, EI, and Pi10 were identified as predictors of FEV1/FVC for the entire study sample and for Group 1 (R2 = 0.38 and 0.22, respectively; p < 0.001). However, only parenchymal attenuation parameter, EI, was identified as a predictor of FEV1/FVC for Group 2 (R2 = 0.37, p < 0.001). Similar results were obtained for FEV1. Conclusion: Airway and parenchymal attenuation parameters are independent predictors of pulmonary function in patients with mild COPD, whereas parenchymal attenuation parameters are dominant independent predictors of pulmonary function in patients with severe COPD.

Evaluation of Quality of Life with the Chronic Obstructive Pulmonary Disease Assessment Test in Chronic Obstructive Pulmonary Disease and the Effect of Dyspnea on Disease-Specific Quality of Life in These Patients

OguzhanOkutan,Dilaver Tas,Ersin Demirer,ZaferKartaloglu 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.5

Purpose: The chronic obstructive pulmonary disease (COPD) assessment test (CAT) was recently introduced for use in assessing disease-specific quality of life and follow-up of patients with COPD. The purpose of this study was to evaluate the effect of the dyspnea on disease-specific quality of life detected by CAT score in patients with COPD. Materials and Methods: In this study, 90 stable patients with COPD as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included. The level of dyspnea was assessed with the Medical Research Council (MRC) dyspnea scale, and disease-specific quality of life was assessed with CAT score. Results: The mean±SD age was 68.5±10.9 (range 41-97) years. A significant relationship was established between CAT score, MRC dyspnea scale score and GOLD stage in patients with COPD. There was also a positive correlation between dyspnea scale scores and GOLD stage in the patients (p<0.001), as well as positive correlation between CAT score and dyspnea scale score (p<0.001). CAT score showed a significant correlation with hospitalization and exacerbations (p<0.05). Conclusion: Dyspnea is an important symptom that may impact quality of life in patients with COPD. CAT was shown to be a simple, fast and intelligible measurement of disease-specific quality of life, and was correlated with levels of dyspnea in patients with COPD.

Chronic Obstructive Pulmonary Disease: Respiratory Review of 2014

Lee, Young-Min The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.77 No.4

Chronic obstructive pulmonary disease (COPD) is characterized by a diverse array of pulmonary and nonpulmonary manifestations, but our understanding of COPD pathogenesis and the factors that influence its heterogeneity in disease presentation is poor. Despite this heterogeneity, treatment algorithms are primarily driven by a single measurement, forced expiratory volume in 1 second ($FEV_1$) as a percentage of its predicted value ($FEV_1%$). In 2011, a major shift in Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment recommendations was proposed that stratifies patients with COPD on the basis of symptoms and exacerbation history. This article reviews the work reported in 2013 that enlightens our understanding of COPD with respect to COPD classification systems, phenotype, biomarker, exacerbation, and management for patients with COPD.

REVIEW : Chronic Obstructive Pulmonary Disease: Respiratory Review of 2014

( Young Min Lee ) 대한결핵 및 호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.77 No.4

Chronic obstructive pulmonary disease (COPD) is characterized by a diverse array of pulmonary and nonpulmonary manifestations, but our understanding of COPD pathogenesis and the factors that influence its heterogeneity in disease presentation is poor. Despite this heterogeneity, treatment algorithms are primarily driven by a single measurement, forced expiratory volume in 1 second (FEV1) as a percentage of its predicted value (FEV1%). In 2011, a major shift in Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment recommendations was proposed that stratifies patients with COPD on the basis of symptoms and exacerbation history. This article reviews the work reported in 2013 that enlightens our understanding of COPD with respect to COPD classification systems, phenotype, biomarker, exacerbation, and management for patients with COPD.

Review of a Case of Chronic Obstructive Pulmonary Disease in Workers Exposed to Synthetic Fibers

Hyeon-cheol Oh,Chae-seong Lim,Jung-won Kim,Eun-seok Kim,Ji-eun Lee,Sang-cheol Kim 한국산업보건학회 2023 한국산업보건학회지 Vol.33 No.3

Objectives: Objectives of this study were: 1) to introduce industrial situation and health hazards of synthetic fiber, 2) to review a case of chronic obstructive pulmonary disease in a worker exposed to synthetic fiber reported to the Korea Occupational Disease Surveillance Center, and 3) to suggest supplementary measures for the occupational health system for workers exposed to synthetic fibers. Methods: Respiratory exposure, health hazards, and exposure standards for synthetic fiber dust in Korea and other countries were reviewed. In addition, a case of chronic obstructive pulmonary disease due to exposure to nylon dust reported to the Korea Occupational Disease Surveillance Center was reviewed and summarized. Results: The worker was a 53-year-old non-smoking male who had been involved in the nylon weaving process for 26 years. He had shortness of breath from three years ago. He was diagnosed with chronic obstructive pulmonary disease. PM1.0, PM2.5, and PM10 were measured at 26.6 μg/m3, 48.2 μg/m3, and 91.7 μg/m3, respectively. Fiber components estimated as nylon fiber were detected in the microscopic examination of a solid sample. Conclusions: For workers exposed to synthetic fiber dust, special health examinations of the respiratory system, regular work environment measurement, and work environment management through workplace health management should be performed. It is necessary to research on health effects of synthetic fibers.

만성 폐쇄성 폐질환 환자에서 병기에 따른 영양상태 평가

박영미(Park Young Mi),윤호일(Yoon Ho Il),손정민(Sohn Cheongmin),조여원(Choue Ryowon) 韓國營養學會 2008 Journal of Nutrition and Health Vol.41 No.4

The purpose of the study was to investigate nutritional status of chronic obstructive pulmonary disease (COPD) patients and to find out the differences according to the stages of disease. From March to October, 2006, 41 stable male patients of mild to severe COPD patients were recruited from Seoul National University hospital. The patients’ of body weight and fat free mass were assessed by bioelectrical impedance analysis. The nutritional status of the patients was also assessed by 3-day recall, index of nutritional quality (INQ), dietary diversity score (DDS), dietary variety score (DVS), food group index pattern and dietary quality index (DQI). The total of 41 patients were classified into three groups, stage Ⅰ, stage Ⅱ and stage Ⅲ groups according to the classification of Global Initiative for Chronic Obstructive Lung Disease (GOLD) standard. The mean age of the patients in each stage were 67.2-66.9 years showing no significant difference. The ratio of FEV₁/FVC were 57.5 ± 7.3, 46.9 ± 7.6 and 38.2 ± 6.8%, respectively showing significant differences according to the stages of disease. The fat free mass of the stage Ⅱ (48.2 ± 4.7 kg) and Ⅲ (47.3 ± 4.5 kg) was significantly lower than that of stage Ⅰ (53.1 ± 6.9 kg) patients. There were significant correlation of fat free mass with FEV₁, and BMI (body mass index) with FEV₁/FVC ratio (p < 0.05). COPD patients showed the diet-related clinical symptoms of anorexia, dyspnea, dyspepsia, and chewing difficulty. Daily intakes of calorie, K, vitamin B₂ and folate of the patients were very low (83.8 ± 20.7%, 58.9 ± 14.4%, 70.7 ± 19.6% and 74.7 ± 10.2%, respectively) however, they did not significantly different according to the stages of disease. Daily intake of calcium was significantly lower in the stage Ⅲ patients (p < 0.05). The mean scores of dietary variety score was significantly lower in the stage Ⅲ patients (p < 0.001). Dietary quality index of the patients were not different among the stages of disease and the scores indicated poor quality of diet. As a summary, we found that body fat free mass, regularity of exercise, frequency of having snacks and dietary variety score were significantly associated with the severity of chronic obstructive pulmonary disease. (Korean J Nutr 2008; 41(4): 307 ~ 316)

자기결정성 이론 기반 만성폐쇄성폐질환 환자를 위한 동기면담 호흡재활 프로그램의 개발 및 평가

장준희,민혜숙 한국간호과학회 2023 Journal of Korean Academy of Nursing Vol.53 No.2

Purpose: This study aimed to develop a motivational interviewing pulmonary rehabilitation program based on self-determination theory to maintain pulmonary rehabilitation-related health behaviors in patients with chronic obstructive pulmonary disease. The program was developed by reviewing the literature on pulmonary rehabilitation guidelines, drawing on the self-determinism theory to establish its contents, recruiting experts to test its validity, and conducting a preliminary survey. Methods: A quasi-experimental design was used to confirm the effect of the program. The participants were outpatients diagnosed with chronic obstructive pulmonary disease at three general hospitals in Busan. There were 33 subjects: 15 in the experimental group and 18 in the control group. The experimental group performed a motivational interviewing pulmonary rehabilitation program which comprised 11 sessions delivered over 10 weeks. The outcomes were measured using basic psychological needs, dyspnea, 6-minute walking distance, and functional status. Intervention effects were analyzed using repeated- measures ANOVA. Results: The analysis revealed significant differences between the experimental and control groups in competence among the subdomains of basic psychological needs, dyspnea during exercise, and functional status. Conclusion: The developed program affects physical conditions and can be applied as an effective clinical nursing intervention to continuously improve the pulmonary rehabilitation behavior of patients with chronic obstructive pulmonary disease.

만성폐쇄성 폐질환 환자에서 적혈구 항산화효소의 변화

국기용,이만재,조희충,임영국,박일,김원식,이승일,이병래 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Toxic oxygen free radicals have been implicated as important pathologic mediators in many clinical disordesrs. Enhandng the intracellular content of antioxidant enzymes can provide means of limiting biological damage caused by oxygen free radicals. Many investigations have examined the potential of various oxyradical scavengers to modulate oxyradical injury. The oxygen free radicals play a role in the pathogenesis of chronic obstructive pulmonary disease. To investigate the pulmonary oxyradical injury and the protective role of antioxidant enzymes, author measured the amount of thiobarbituric acid reactants, the activiteies of antioxidant enzymes (superoxide dismutase, glutathione peroxidase, and catalase) and the sulfhydryl groups in serum and red blood cells from the chronic obstructive pulmonary disease groups and the normal controls. The thiobarbituric acid reactant in chronic obstructive pulmonary disease groups was increased than the controls in both serum and red blood cells, and the superoxide dismutase activity in red blood cells was no statistically difference in both groups. But, the glutathione peroxidase and catalase activities were lowered in chronic obstructive pulmonary disease groups than the controls. The sulfhydryl groups in serum and red blood cells were no statistically difference in both groups. These results suggest that the increased thiobarbituric acid reactant in chronic obstructive pulmonary disease groups mean oxygen radical toxicity, and the decreased glutathione peroxidase and catalase activities may play a role in cellular injury.

Implications of Managing Chronic Obstructive Pulmonary Disease in Cardiovascular Diseases

( Kartik Deshmukh ),( Arjun Khanna ) 대한결핵 및 호흡기학회 2021 Tuberculosis and Respiratory Diseases Vol.84 No.1

Globally, cardiovascular diseases and chronic obstructive pulmonary disease (COPD) are the leading causes of the non-communicable disease burden. Overlapping symptoms such as breathing difficulty and fatigue, with a lack of awareness about COPD among physicians, are key reasons for under-diagnosis and resulting sub-optimal care relative to COPD. Much has been published in the past on the pathogenesis and implications of cardiovascular comorbidities in COPD. However, a comprehensive review of the prevalence and impact of COPD management in commonly encountered cardiac diseases is lacking. The purpose of this study was to summarize the current knowledge regarding the prevalence of COPD in heart failure, ischemic heart disease, and atrial fibrillation. We also discuss the real-life clinical presentation and practical implications of managing COPD in cardiac diseases. We searched PubMed, Scopus, EMBASE, and Google Scholar for studies published 1981-May 2020 reporting the prevalence of COPD in the three specified cardiac diseases. COPD has high prevalence in heart failure, atrial fibrillation, and ischemic heart disease. Despite this, COPD remains under-diagnosed and under-managed in the majority of patients with cardiac diseases. The clinical implications of the diagnosis of COPD in cardiac disease includes the recognition of hyperinflation (a treatable trait), implementation of acute exacerbations of COPD (AECOPD) prevention strategies, and reducing the risk of overuse of diuretics. The pharmacological agents for the management of COPD have shown a beneficial effect on cardiac functions and mortality. The appropriate management of COPD improves the cardiovascular outcomes by reducing hyperinflation and preventing AECOPD, thus reducing the risk of mortality, improving exercise tolerance, and quality of life.