바퀴벌레 훈연 살충제에 의한 반응성 기도 과민 증후군

박원우 ( Won Wo Park ),서승철 ( Seung Chul Seo ),이현경 ( Hyun Kyung Lee ),이성순 ( Sung Soon Lee ),이영민 ( Young Min Lee ),이혁표 ( Hyuk Pyo Lee ),김주인 ( Joo In Kim ),최수전 ( Soo Jeon Choi ),염호기 ( Ho Kee Yum ) 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.3

Reactive airway dysfunction syndrome (RADS) is a clinical entity characterized by sudden onset of obstructive airway disorder and nonspecific airway hyperresponsiveness after exposure to a toxic or irritant chemical with negative history of obstructive airway symptoms prior to exposure. After exposure to high concentrations of irritating substances, obstructive symptoms are usually persistent. Causative substances are nonspecific and various. The exact mechanism of this dysfunction remains to be elucidated. We report a case of RADS which presented with dyspnea elicited by smoking insecticide of cockroach containing dichlorvos as a main ingredient. (Korean J Asthma Allergy Clin Immunol 2006;26:246-248)

염소가스 노출에 의한 반응성 기도과민 증후군 3예

권영석 ( Young Seok Kwon ),강혜련 ( Hye Ryun Kang ),김주희 ( Joo Hee Kim ),김창환 ( Chang Hwan Kim ),박성훈 ( Sung Hoon Park ),황용일 ( Yong Il Hwang ),장승훈 ( Seung Hun Jang ),김동규 ( Dong Gyu Kim ),정기석 ( Ki Suck Jung ) 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.4

Acute inhalational exposure to chlorine gas can cause reactive airway dysfunction syndrome (RADS) but only a few data are available on its long term sequelae. We experienced three cases of RADS induced by chlorine gas. Fifteen adults were accidentally exposed to chlorine gas at a local swimming pool because of an error in exchanging disinfectant. The exposure time was within 5 minutes. Most patients experienced throat irritation and sense of breathlessness. Three of them showed wheezing and obstructive patterns in pulmonary function tests and were diagnosed as RADS. Two of them received inpatient care for respiratory difficulty. Inhaled corticosteroid and bronchodilator were discontinued within a few months with resolution of obstructive lung impairment. At the 1-year follow-up, only one patient, demonstrated a positive response to the methacholine provocation test and needed anti-asthmatic medication for frequent nocturnal wheezing. After one year medication with inhaled corticosteroid and bronchodilator, he became free of symptoms and showed negative response to the methacholine provocation test. Another patients showed a borderline airway hyperresponsiveness (PC20=25 mg/mL) and the third patient had a negative test result without any symptoms. These two patients have not experienced any respiratory symptoms since they recovered from acute symptoms of RADS. (Korean J Asthma Allergy Clin Immunol 2009;29:283-288)

반응도 기도과민(기능장애)증후군 1예

김희숙,이상준,박봉건,진성림,진재용,이혁표,김주인,최수전,염호기 인제대학교 2000 仁濟醫學 Vol.21 No.1

RADS(Reactive Airways Dysfunction Syndrome) is a clinical pathologic entity characterized by exposure to a toxic or irritant chemical, negative history of obstructive symptoms prior to exposure, persistence of obstructive symptoms after exposure, objective evidence of obstructive airway disease and/or nonspecific bronchial hyperresponsiveness, and abnormal bronchial biopsy result. We report a case of typical RADS after a single exposure to an irritant gas. He had worked as a specialist in a factory of copying-press for 30 years with no previously respiratory symptoms. Immediately after a exposure to the gas, he had eye irritation, rhinorrhea, cough and shortness of breath. He had no personal and familial history of allergy and respiratory disease. Allergoc skin prick test revealed negative response. Total IgE level by PRIST was 49 IU/ ml and eosinophil count was 235/mm3. Methacholine bronchial provocation test revealed a positive response. Bronchial biopsy showed chronic bronchitis with mild mononuclear cell infiltration and neither eosinophilic infiltration nor thickening of basement membrane.

합성수지 반제품 생산 공장에서 발생한 반응성 기도과민 증후군

박소영,이종성,김부욱,이정오,박규철,최병순 大韓産業醫學會 2008 대한직업환경의학회지 Vol.20 No.4

배경 직업성 천식 감시체계의 활성으로 국내 직업성 천식의 보고가 증가하였음에도 불구하고 전체 직업성 천식의 약 5-18%를 차지한다고 알려진 반응성 기도과민증후군의 보고는 많지 않다 이에 저자들은 합성수지 반제품을 생산하는 사업장에서 발생한 반응성 기도과민 증후군 사례를 발견하였기에 이를 보고하는 바이다 증례 평소 건강하던 61세 남자 환자는 40세 때인 1987년부터 약 20년 간 합성수지 반제품을 생산하는 사업장에서 배합작업을 하였다 2007년 8월 PVC(polyvinyl chloride) DEHP (d₁-(2-ethylhexyl)phthalate) dibutyl tin maleate epoxidized soybean oil 등의 원료를 혼합하는 기계의 가열로 작업장내 연기가 자욱하게 된 사고가 발생한 직후 환자는 기침 콧물 호흡곤란 천명 등의 증상을 보였다 폐기능 검사에서는 FEV₁ 1.63 L(50%) FVC 3.81 L(82%) FEV₁/FVC 43% 소견을 보였으며 기관지 확장제 투여 후 FEV₁은 1.80 L로 투여 전에 비해 170 ml 10.4% 증가하였다 흡입용 스테로이드 및 기관지 확장제를 포함한 치료 시행 7개월 후에는 FEV₁ 3.21 L(99.3%) FVC 6.56 L(143.5%)로 회복되었으며 메타콜린 기관지 유발검사에서는 음성이었다 결론 혼합기 가열로 인해 발생한 원료물질 자체 또는 이들의 열분해산물에 고농도로 노출되면서 RADS가 발생한 것으로 판단된다. Background Reactive airways dysfunction syndrome (RADS). which represents between 5% and 18% of new-onset, work-related asthma remains underreported in spite of increasing reports of occupational asthma cases through occupational asthma surveillance in Korea We report a 61-year-old male who developed RADS after exposure to a high level of toxic gases from a workplace accident. Case The patient who had worked for 21 years at a PVC manufacture factory and had retained good health until Aug 22, 2007, when he was exposed to PVC (Polyvinyl chloride) DEHP (D₁ (2-Ethylhexyl) Phthalate) dibutyl tin maleate and epoxidized soybean oil gases from a heated mixer. Within several minutes of exposure, he developed coughing rhinorrhea dyspnea and wheezing. Pulmonary function tests (PFTs) showed an FVC of 3.81 L(82% of predicted) FEV₁ of 1.63 L/s (50% of predicted) FEV₁/FVC% of 43 % and FEV₁ of 1.80 L/s that increased by 170 ml and 10.4% in response to bronchodilator. After 7 months of treatment with inhaled steroids and bronchodilators, repeat PFTs showed an FVC of 6.56L(143.5% of predicted) FEV₁ of 3.21 L(99.3% of predicted) and FEV₁/FVC% of 48.9%. A methacholine challenge test was negative at a concentration of 25 ㎎/ml. Conclusion RADS occurred due to exposure to raw material vapors or their thermal decomposition products.

Acute health effects of accidental chlorine gas exposure

Joo-An Kim,Seong-Yong Yoon,Seong-Yong Cho,Jin-Hyun Yu,Hwa-Sung Kim,Gune-Il Lim,Jin-Seok Kim 대한직업환경의학회 2014 대한직업환경의학회지 Vol.26 No.-

Objectives: This study was conducted to report the course of an accidental release of chlorine gas that occurred in a factory in Gumi-si, South Korea, on March 5, 2013. We describe the analysis results of 2 patients hospitalized because of chlorine-induced acute health problems, as well as the clinical features of 209 non-hospitalized patients. Methods: We analyzed the medical records of the 2 hospitalized patients admitted to the hospital, as well as the medical records and self-report questionnaires of 209 non-hospitalized patients completed during outpatient treatment. Results: Immediately after the exposure, the 2 hospitalized patients developed acute asthma-like symptoms such as cough and dyspnea, and showed restrictive and combined pattern ventilatory defects on the pulmonary function test. The case 1 showed asthma-like symptoms over six months and diurnal variability in peak expiratory flow rate was 56.7%. In case 2, his FEV1 after treatment (93%) increased by 25% compared to initial FEV1 (68%). Both cases were diagnosed as chlorine-induced reactive airways dysfunction syndrome (RADS) on the basis of these clinical features. The most frequent chief complaints of the 209 non-hospitalized patients were headache (22.7%), followed by eye irritation (18.2%), nausea (11.2%), and sore throat (10.8%), with asymptomatic patients accounting for 36.5%. The multiple-response analysis of individual symptom revealed headache (42.4%) to be the most frequent symptom, followed by eye irritation (30.5%), sore throat (30.0%), cough (29.6%), nausea (27.6%), and dizziness (27.3%). Conclusions: The 2 patients hospitalized after exposure to chlorine gas at the leakage site showed a clinical course corresponding to RADS. All of the 209 non-hospitalized patients only complained of symptoms of the upper airways and mucous membrane irritation.