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성인 천식 환자에서 흡연에 따른 폐기능 및 임상적 특성
최종기 ( Jong-Ki Choi ),강세훈 ( Se-Hun Kang ),박영훈 ( Young-Hoon Park ),배윤정 ( Yun-Jeong Bae ),김태범 ( Tae-Bum Kim ),이태훈 ( Tae-Hoon Lee ),박찬선 ( Chan-Sun Park ),문희범 ( Hee-Bom Moon ),조상헌 ( Sang-Heon Cho ),박흥우 ( H 대한천식알레르기학회 2008 천식 및 알레르기 Vol.28 No.4
Background: Cigarette smoking is common in adult asthmatic patients and the smoking rates in these patients are similar to those in the general population. However, adult asthmatics who are current smokers or ex-smokers have been excluded in many clinical studies. Objective: We investigated the impacts of smoking on pulmonary functions and clinical features of asthmatics by using a data from a recently established adult asthma cohort: COREA (Cohort for Reality and Evolution of Adult Asthma). Method: COREA is a Korean adult asthma cohort established since 2005. 1,283 asthma patients were enrolled in this COREA. The patients in this cohort were divided into 3 groups; the current smoker group, the ex-smoker group and the non-smoker group according to the status of smoking. We analyzed and compared the clinical and laboratory parameters of these 3 groups using clinical data, symptom score, pulmonary functions, and quality of life score. Result: Among 1,283 asthmatic patients, 16% were current smokers, 38% were ex-smokers, and 46% were non-smokers. The current smoker and ex-smoker groups were male dominant. Ex-smokers were older and had a longer history of asthma symptoms, mean treatment duration and smoking. Currently smoking asthmatics coughed more frequently in past 3 months. Current smokers and ex-smokers presented significantly lower FEV1, FVC, FEV1/FVC than nons-mokers (P<0.05). Elevated total serum IgE levels were observed in the current smoking and ex-smoking asthmatics groups. In an induced sputum analysis, eosinophil counts were observed to be reduce in the current smoking asthmatic group. Conclusion: The results of this study indicated that smoking has deteriorating effects on pulmonary functions and clinical respiratory symptoms in asthmatic patients. Education for quitting smoking in asthmatics should be stressed for a better control of asthma. (Korean J Asthma Allergy Clin Immunol 2008;28:263-270)
고주파열치료 중 펜타닐에 의해 발생한 아나필락시스 1예
김진용 ( Jin Yong Kim ),엄상용 ( Sang Yong Om ),윤선영 ( Sun Young Yoon ),김태범 ( Tae Bum Kim ),조유숙 ( You Sook Cho ),문희범 ( Hee Bom Moon ),권혁수 ( Hyouk Soo Kwon ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1991 소아알레르기 및 호흡기학회지 Vol.1 No.3
This case report describes a life-threatening anaphylaxis to fentanyl during radiofrequency ablation (RFA). A 50-year-old woman with hepatocellular carcinoma was admitted for RFA. She denied any history of adverse drug reactions or past adverse anesthetic reaction. Physical examination, vital signs, any laboratory findings were all within normal limits. Ten minutes after intravenous administration of 50 mcg of fentanyl before starting RFA, she developed generalized erythema and sudden onset of bronchospasm followed by respiratory arrest. Cardiopulmonary resuscitation (CPR) commenced with 100% oxygen and intravenous administration of epinephrine 1 mg. After 5 minutes of CPR, she had the return of spontaneous circulation. Chest X-ray revealed pulmonary edema which resolved over two days. She recovered completely and was discharged home. After six weeks, intradermal tests performed with fentanyl, remifentanyl, midazolam, and profopol. Among those, only fentanyl induced positive skin response. Fentanyl induced anaphylaxis was diagnosed for this case, and fentanyl was avoided in the subsequent general anesthesia for liver transplantation. This case suggested that fentanyl could induce anaphylaxis combined with uncommon comorbidities like pulmonary edema. (Allergy Asthma Respir Dis 2013;1:284-287)
증례 : 난치성 및 비순응성 천식 환자에서 뇌사에 이른 천식 발작
박소영 ( So Young Park ),윤다림 ( Da Lim Yoon ),강병주 ( Byoung Ju Kang ),김가희 ( Ga Hee Kim ),조유숙 ( You Sook Cho ),문희범 ( Hee Bom Moon ),김태범 ( Tae Bum Kim ) 대한내과학회 2012 대한내과학회지 Vol.83 No.3
Although guideline-based asthma therapy has had a positive impact on fatalities due to asthma over the last few decades, some patients refractory to or noncompliant with asthma treatment remain at risk of fatality. A 45-year-old female with refractory asthma and poor compliance and with a frequent history of hospitalization for asthma exacerbations was taken to the emergency room because of cardiorespiratory arrest. Her family reported that she had suffered from an upper respiratory infection followed by severe dyspnea for a few days. The patient developed status asthmaticus, and in spite of intensive cardiopulmonary resuscitation, she was eventually declared brain dead. The patient had not taken medication for asthma regularly for several months before the attack. Refractory and difficult-to-treat asthma should be aggressively monitored to prevent severe asthma exacerbations, which can be fatal, especially in noncompliant patients.
정영진 ( Yeong Jin Jeong ),강병주 ( Byeong Zu Ghanh ),이지완 ( Ji Wan Lee ),박진오 ( Jin Oh Park ),김태범 ( Tae Bum Kim ),조유숙 ( You Sook Cho ),문희범 ( Hee Bom Moon ),권혁수 ( Hyouk Soo Kwon ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.1
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome-also known as drug-induced hypersensitivity syndrome-is an uncommon disease entity that manifests as fever, skin rash, blood cell abnormalities, lymphadenopathy, and often coagulopathy. Tigecycline is an antibiotic that is selectively used to treat complicated intra-abdominal and soft-tissue infections. Recently, a few cases of tigecycline-induced coagulopathy have been reported. Herein, we report a case of tigecycline-induced coagulopathy in a patient with DRESS syndrome. Both prothrombin time and activated partial thromboplastin time were abruptly exceeded beyond 180 seconds on day 6 of tigecycline treatment and normalized after discontinuation of tigecycline. (Allergy Asthma Respir Dis 2016;4:74-78)
증례 : 알레르기 ; 천식과 혼돈되어 진단이 지연된 기관지 내 이물 1예
선병주 ( Byung Joo Sun ),최지영 ( Ji Young Choi ),배윤정 ( Yun Jeong Bae ),박찬선 ( Chan Sun Park ),김태범 ( Tae Bum Kim ),조유숙 ( You Sook Cho ),문희범 ( Hee Bom Moon ) 대한내과학회 2009 대한내과학회지 Vol.76 No.2
기관지 내 이물 흡인은 장기간 지속되는 기침, 가래, 발열 등의 비특이적 증상만을 보일 수 있고, 특히 환자가 인지하지 못하는 경우, 반복적인 폐렴, 육아종 형성 및 기관지 변형 등의 합병증으로 이어질 수 있다. 따라서 임상가는 기관지 내 이물 흡인의 임상적 특징을 이해하고, 치료에 잘 반응하지 않는 만성 기침이나, 천식, 재발성 폐렴환자에서 기관지 이물 흡인을 감별진단의 범주에 포함시키고 흉부 전산화 단층 촬영 및 기관지 내시경 등을 조기에 고려하는 것이 바람직하겠다. 저자들은 폐렴이 반복되고, 만성적인 기침의 원인이 치료에 잘 반응하지 않는 천식 때문으로 판단했었던 환자에서 기관지 내시경 검사를 통해 기도 이물을 진단하고 제거한 증례를 경험하여 이를 보고하는 바이다. Tracheobronchial foreign bodies can remain undetected for months, or even years, and often present as chronic respiratory symptoms, such as an intractable cough. We report the case of a 51-year-old woman with a cough for over 3 years and hemoptysis for 2 weeks. She had been treated for asthma for the previous 3 years because of her cough, wheeze, and positive bronchodilator response. Her symptoms waxed and waned. Her chest X-ray showed a new mass-like opacity and ill-defined infiltration in the right lower lobe. Computed tomography showed a 2.5-cm mass-like lesion in the right infrahilar area. At fiberoptic bronchoscopic, a solid foreign body was found in the right lower lobe bronchus and was identified as a fish bone. Tracheobronchial foreign body aspiration should always be considered in the differential diagnoses of radiographic lesions or chronic respiratory symptoms that cannot be easily explained. (Korean J Med 76:244-247 2009)
김진용 ( Jin Yong Kim ),엄상용 ( Sang Yong Om ),윤선영 ( Sun Young Yoon ),김태범 ( Tae Bum Kim ),조유숙 ( You Sook Cho ),문희범 ( Hee Bom Moon ),권혁수 ( Hyouk Soo Kwon ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.3
This case report describes a life-threatening anaphylaxis to fentanyl during radiofrequency ablation (RFA). A 50-year-old woman with hepatocellular carcinoma was admitted for RFA. She denied any history of adverse drug reactions or past adverse anesthetic reaction. Physical examination, vital signs, any laboratory findings were all within normal limits. Ten minutes after intravenous administration of 50 mcg of fentanyl before starting RFA, she developed generalized erythema and sudden onset of bronchospasm followed by respiratory arrest. Cardiopulmonary resuscitation (CPR) commenced with 100% oxygen and intravenous administration of epinephrine 1 mg. After 5 minutes of CPR, she had the return of spontaneous circulation. Chest X-ray revealed pulmonary edema which resolved over two days. She recovered completely and was discharged home. After six weeks, intradermal tests performed with fentanyl, remifentanyl, midazolam, and profopol. Among those, only fentanyl induced positive skin response. Fentanyl induced anaphylaxis was diagnosed for this case, and fentanyl was avoided in the subsequent general anesthesia for liver transplantation. This case suggested that fentanyl could induce anaphylaxis combined with uncommon comorbidities like pulmonary edema. (Allergy Asthma Respir Dis 2013;1:284-287)
심장의 벽운동 이상과 심낭삼출로 발현된 과호산구 증가 증후군 1예
이현기 ( Hyun Kee Lee ),이상진 ( Sang Jin Lee ),배윤정 ( Yun Jeong Bae ),박찬선 ( Chan Sun Park ),김태범 ( Tae Bum Kim ),조유숙 ( You Sook Cho ),문희범 ( Hee Bom Moon ) 대한내과학회 2008 대한내과학회지 Vol.75 No.4
저자들은 심내막의 섬유성 비후나 심장내 혈전과 같은 전형적인 심장 침범과는 다른 다발성 국소벽 운동이상과 심막 삼출이 발생한 특발성 과호산구 증가 증후군 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Idiopathic hypereosinophilic syndrome is characterized by unexplained blood eosinophilia > 1500/mm3 for more than 6 months and eosinophilic infiltration of several organs. A major source of the morbidity and mortality of this syndrome is the associated cardiac involvement. The typical cardiac involvement includes endocardial fibrosis and mural thrombus. We report a case of idiopathic hypereosinophilic syndrome manifested as multiple regional wall motion abnormalities and moderate pericardial effusion on transthoracic echocardiography that was successfully treated by pericardiostomy and steroid therapy. (Korean J Med 75:484-487, 2008)
최근 10년간 천식환자에서 흡입 스테로이드제 처방 빈도와 중증 악화 빈도의추세 분석
노창석 ( Chang Suk Noh ),이재승 ( Jae Seung Lee ),송진우 ( Jin Woo Song ),김태범 ( Tae Bum Kim ),김남국 ( Nam Kug Kim ),조유숙 ( You Sook Cho ),이상도 ( Sang Do Lee ),문희범 ( Hee Bom Moon ),오연목 ( Yeon Mok Oh ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.5
Background: Inhaled corticosteroids (CSs) are the most essential medication for asthma control. Many reports suggest that the usage of ICSs improves not only the control of asthma symptoms but also prevents exacerbation. We investigated whether increases in ICS prescriptions are associated with decreases in asthma exacerbation in the clinical practice setting. Methods: We retrospectively analyzed the database of adult asthma patients who had visited a tertiary referral hospital, the Asan Medical Center between January 2000 and December 2009. The number of emergency department (ED) visits, admissions, intensive care unit (ICU) care, deaths, and ICS prescriptions were analyzed to evaluate the time trend of asthma exacerbation as a function of the ICS prescription rate during the ten years. Results: The numbers of ED visits, admissions, and episodes of ICU care decreased during the ten years (p<0.001, p=0.033, p=0.001, respectively) while the number of ICS prescriptions increased (p<0.001). We found a correlation between the number of ICS prescriptions and the number of ED visits, admissions, or ICU care. For these outcomes, the correlation coefficients were r=-0.952, p<0.001; r=-0.673, p=0.033; r=-0.948, p<0.001, respectively. Conclusion: The number of ICS prescriptions increased during the past ten years while the number of asthma exacerbations decreased. Our results also showed a negative correlation between the ICS prescription rate and asthma exacerbation in the clinical practice setting. In other words, an increase in ICS prescription may be a major cause of a decrease in asthma exacerbations.
호산구증다증이 동반된 맥관부종 환자에서 혈전성 미세혈관병증이 병발한
최준석 ( Jun Seok Choi ),나수영 ( Soo Young Na ),박경선 ( Kyung Sun Park ),배윤정 ( Yoon Jung Bae ),김태범 ( Tae Bum Kim ),문희범 ( Hee Bom Moon ),조유숙 ( You Sook Cho ) 대한천식알레르기학회 2010 천식 및 알레르기 Vol.30 No.1
Episodic angioedema with eosinophilia (EAE) is characterized by recurrent angioedema, fever, weight gain and eosinophilia in peripheral blood. It has been considered as a distinct clinical entity which is different from the idiopathic hypereosinophilic syndrome. In general, EAE has been known to show a good prognosis and have no internal organ involvement. A couple of recent reports show that EAE could be accompanied by serious complications such as thrombotic microangiopathy (TMA). Here, we report a complicated case of EAE which is believed to be associated with TMA for the first time in Korea. A 38-year-old Korean man initially presented with angioedema, fever, eosinophilia and weight gain which were compatible with EAE. After administration of high-dose glucocorticoids, angioedema and eosinophilia improved; however, severe hemolytic anemia caused by TMA developed suddenly on the 12th day after the medication. Therapeutic plasmapheresis was performed which led to the improvement of all his clinical manifestations. He completely recovered from EAE and hemolytic anemia associated with TMA. The patient has been periodically follow up at our outpatient clinic. (Korean J Asthma Allergy Clin Immunol 2010
척-스트라우스증후군(eosinophilic granulomatosis with polyangiitis) 환자에서 성공적으로 수행한 심장이식 1예
박소영 ( So Young Park ),김태은 ( Tae Eun Kim ),김효정 ( Hyo Jung Kim ),신보미 ( Bo Mi Shin ),권혁수 ( Hyouk Soo Kwon ),문희범 ( Hee Bom Moon ),조유숙 ( You Sook Cho ),김태범 ( Tae Bum Kim ),박소영 ( So Young Park ) 대한천식알레르기학회(구 대한알레르기학회) 2015 Allergy Asthma & Respiratory Disease Vol.3 No.2
Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is a rare systemic necrotizing vasculi¬tis affecting small- to medium-sized vessels. EGPA is associated with severe asthma and eosinophilia. The most frequently involved organs are skin and peripheral nerves; however, EGPA may involve other organs, such as the gastrointestinal tract, kidney, and heart. Antineutrophil cytoplasm antibodies (ANCAs)-related abnormal immune reactions are known to be associated with EGPA, but only 30%-40% of patients have a positive marker of ANCA. ANCA-negative patients are at higher risk of cardiac involvement than ANCA-positive patients. Cardiac involvement is one of the leading causes of mortality and could be resistant to conventional treatment. Early treatment with steroid plus cyclophosphamide is important because it could give chances of restoration of cardiac function. For patients undergoing heart transplantation, we should consider the severity of cardiac disease and the presence of systemic dis¬eases, including vasculitis. Here, we report a case of a 25-year-old EGPA patient with cardiac involvement who eventually received heart transplantation for progressive heart failure, although treated with systemic corticosteroid with cyclophosphamide. EGPA pa¬tients undergoing heart transplantion are rarely reported worldwide, and this is the first case report in Korea.(Allergy Asthma Respir Dis 2015;3:159-163)