F-106 : Free Paper Presentation ; Factors Affecting Treatment Choice in Korean COPD Patients and Acute Exacerbation: The Results from KOCOSS Cohort Study

김태형,문지용,김영삼,박용범,신경철,유광하,윤형규,이상엽,이지현,이진국,황용일,정기석,( Kocoss Cohort ) 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

Acute exacerbation is important in the clinical course of COPD because it causes significant morbidity and mortality. The strategy for preventing exacerbation includes specific treatment including long acting muscarinic agent (LAMA) or combination of inhaled corticosteroid (ICS) and long acting beta agonist (LABA). Objectives: We investigated the factors affecting initial treatment choice in COPD patients and the effect of treatment regimen on the clinical course of COPD in the KOCOSS cohort. Methods: Among the 470 COPD patients from KOCOSS cohort, we reviewed the initial treatment regimen and demographic data, baseline lung function, and quality of life (QOL) score by SGRQ. Also, frequency of acute exacerbation, lung function, sugjective symptoms and QOL at 1 year follow-up period were compared between treatment groups. Results: Presence of chronic bronchitis, history of asthma, history of previous exacerbation, baseline FEV1 or DLCO, subjective symptoms such as mMRC or CAT score, and SGRQ score influenced the treatment choice with preference for ICS+LABA or triple therapy. At 1 year follow up, the exacerbation rate was significantly higher in the triple therapy group (36.3%) compared with LAMA (22.9%), ICS+LABA (26.1%) or Other (20.0%). Although FEV1 at 1 year was not different, subjective score such as CAT or SGRQ were significantly higher in the triple therapy group. Conclusion: Several factors influenced the initial treatment. The frequency of of acute exacerbation might be influenced by previous exacerbation history, lung function or subjective dyspnea rather than treatment regimen.Acute exacerbation is important in the clinical course of COPD because it causes significant morbidity and mortality. The strategy for preventing exacerbation includes specific treatment including long acting muscarinic agent (LAMA) or combination of inhaled corticosteroid (ICS) and long acting beta agonist (LABA). Objectives: We investigated the factors affecting initial treatment choice in COPD patients and the effect of treatment regimen on the clinical course of COPD in the KOCOSS cohort. Methods: Among the 470 COPD patients from KOCOSS cohort, we reviewed the initial treatment regimen and demographic data, baseline lung function, and quality of life (QOL) score by SGRQ. Also, frequency of acute exacerbation, lung function, sugjective symptoms and QOL at 1 year follow-up period were compared between treatment groups. Results: Presence of chronic bronchitis, history of asthma, history of previous exacerbation, baseline FEV1 or DLCO, subjective symptoms such as mMRC or CAT score, and SGRQ score influenced the treatment choice with preference for ICS+LABA or triple therapy. At 1 year follow up, the exacerbation rate was significantly higher in the triple therapy group (36.3%) compared with LAMA (22.9%), ICS+LABA (26.1%) or Other (20.0%). Although FEV1 at 1 year was not different, subjective score such as CAT or SGRQ were significantly higher in the triple therapy group. Conclusion: Several factors influenced the initial treatment. The frequency of of acute exacerbation might be influenced by previous exacerbation history, lung function or subjective dyspnea rather than treatment regimen.

전국적 COPD Cohort 연구 기초 자료(KOCOSS 연구 Cohort)

유광하,정기석,김영삼,박용범,신경철,윤형규,이상엽,이진국,이진화,( Kocoss Cohort ) 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.0

배경: 국내 COPD 유병률이 40세 이상 성인의 경우 13% 이상이지만 전국적 규모의 COPD 환자에 대한 역학 자료는 거의 없는 실정이다. 이에 제주도를 포함한 전국적 규모의 COPD cohort를 구축하여 국내 COPD 환자의 phenotype을 확인하고 그 위험인자를 밝혀 임상적인 활용과 함께 기초 연구 자료로 활용한 목적으로 COPD cohort 연구를 진행하였다. 방법: 전국적으로 43개 병원 61명의 공동 연구자와 함께 COPD 환자 1,000명을 목표로 cohort를 구축하여 후향적으로 5년간 경과 관찰을 할 예정이다. 결과: 2012년 9월까지 221명의 COPD 환자가 입적되었다. 평균 나이는 68.6±8.2이며 남성이 89%를 차지하였다. 약 40%에서 비 흡연력을 가지고 있으며 평균 22년값을 흡연력이 있었다. 폐기능에 따른 중증도는 FEV1≥80% pred., 50%≤ and <80% pred., 30%≤ and <50%pred., FEV1<30%이 각 각 6.5%, 46.8%, 36.0%, 10.8%였다. 평균 CAT 점수는 16.27±8.36, 6분 보행 검사의 평균은 401.71±104.95M였다. 평균 BMI는 22.99±3.38 였으며 평균 3.7개의 호흡기 약물을 사용하였다. 결론: 본 연구는 국내 COPD 역학 연구에 중요한 기본 자료를 제공할 것으로 예상되며 표현형을 확인하고 그 위험 요소를 관리 함으로써 환자의 경과를 바꿀 수 있는 지를 확인할 수 있는 중요한 기초 자료가 될 것으로 기대한다.

The Prevalence and Risk Factors of Renal Insufficiency among Korean HIV-Infected Patients: The Korea HIV/AIDS Cohort Study

김은진,안진영,김윤정,위성헌,박대원,송준영,최희정,장현하,최보율,최윤수,최주연,한명국,강춘,김준명,최준용,The Korea HIV/AIDS Cohort Study 대한감염학회 2017 Infection and Chemotherapy Vol.49 No.3

Background: Renal disease is one of the leading causes of morbidity and mortality among people infected with human immunodeficiency virus (HIV). However, there are very few published studies about renal insufficiency in HIV-infected persons in Asia, especially in South Korea. Materials and Methods: A cross-sectional study was performed to investigate the prevalence and risk factors of renal insufficiency, defined as <60 mL/min/1.73 m2, in subjects in the Korea HIV/AIDS Cohort Study enrolled from 19 institutions between December 2006 and July 2013. Data at entry into the cohort were analyzed. Results: Of 454 enrolled subjects, 24 (5.3%) showed renal insufficiency at entry into the cohort. The mean age of patients in the renal insufficiency group was 5.28 years and the majority were male subjects (91.7%). All the patients were receiving antiretroviral agents, mostly protease inhibitor-based regimens (76.4%), for an average of 19 months. In univariate analysis, older age (P = 0.002), diabetes mellitus (DM) (P = 0.0002), unknown route of transmission (P = 0.007), and taking indinavir (P = 0.0022) were associated with renal insufficiency. In multivariable analysis, older age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.03– 1.12, P = 0.002], DM [OR 3.03, 95% CI 1.17–7.82, P = 0.022], unknown route of transmission [OR 6.15, 95% CI 1.77–21.33, P = 0.004], and taking indinavir [OR 3.07, 95% CI 1.17–8.05, P = 0.023] were independent risk factors of renal insufficiency.

Risk Factors for Acute Exacerbations in Elderly Asthma: What Makes Asthma in Older Adults Distinctive?

Kyoung-Hee Sohn,Woo-Jung Song,Jong-Sook Park,박흥우,Tae Bum Kim,Choon-Sik Park,조상헌,Elderly Asthma Cohort in Korea Group 대한천식알레르기학회 2020 Allergy, Asthma & Immunology Research Vol.12 No.3

Purpose: Asthma in the elderly (EA; ≥ 65 years of age) is increasing, adding a heavy socioeconomic burden to the healthcare system. However, little is known about risk factors associated with acute exacerbations in EA patients. The objective of this study was to investigate risk factors for acute exacerbation in EA compared to non-elderly asthma (NEA). Methods: We combined data from 3 adult asthma cohorts under a unified protocol and database. Asthmatic patients with regular follow-up during a 1-year period were selected from the cohorts to identify the risk factors predicting acute exacerbations in EA compared to NEA. Results: We selected a total of 1,086 patients from the merged cohort. During the observation period, 503 and 583 patients were assigned to the EA and NEA groups, respectively. The exacerbation rate was 31.0% in the EA and 33.2% in the NEA group. Multivariate logistic regression analysis revealed fixed airway obstruction, chronic rhinosinusitis (CRS), and male sex as independent risk factors for exacerbation in the EA group. In the NEA group, exacerbation increased along with an increase in eosinophil count. Bayesian analysis of the interactions among clinical factors revealed that forced expiratory volume in 1 second/forced vital capacity was directly related to exacerbation in the EA group, and eosinophil count was related to exacerbation in the NEA group. Conclusions: We suggest that fixed airway obstruction and CRS as the important clinical factors predicting acute exacerbations in EA, whereas in NEA, eosinophil count was the strong predictor of exacerbation.

Review of Cohort Studies for Mood Disorders

Hong Jin Jeon,Ji Hyun Baek,Yong Min Ahn,김세주,Tae Hyun Ha,Bo-Seok Cha,Eun Soo Moon,강희주,Vin Ryu,조철현,Jung-Yoon Heo,Ki-Won Kim,Heon-Jeong Lee,Mood Disorders Cohort Research Consortium 대한신경정신의학회 2016 PSYCHIATRY INVESTIGATION Vol.13 No.3

This paper aimed to review currently available cohort studies of subjects with mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD). Using the PubMed and KoreaMed databases, we reviewed eight major cohort studies. Most studies recruited participants with MDD and BD separately, so direct comparison of factors associated with diagnostic changes was difficult. Regular and frequent follow-up evaluations utilizing objective mood ratings and standardized evaluation methods in a naturalistic fashion are necessary to determine detailed clinical courses of mood disorders. Further, biological samples should also be collected to incorporate clinical findings in the development of new diagnostic and therapeutic approaches. An innovative cohort study that can serve as a platform for translational research for treatment and prevention of mood disorders is critical in determining clinical, psychosocial, neurobiological and genetic factors associated with long-term courses and consequences of mood disorders in Korean patients.

Causes of HIV Drug Non-Adherence in Korea: Korea HIV/AIDS Cohort Study, 2006-2015

김민정,이상아,장현하,김민자,우준희,김상일,강춘,기미경,최주연,최윤수,최보율,김준명,최준용,김효열,송준영,김신우,Korea HIV/AIDS Cohort Study 대한감염학회 2017 Infection and Chemotherapy Vol.49 No.3

We aimed to determine the initial adherence of HIV cohort patients to ART (antiretroviral therapy), and reasons for non-adherence. Patients who received ART at the time of enrollment in the Korea HIV/AIDS Cohort were included in this study. Treatment adherence was determined at the baseline interview by self-reported questionnaire. Eight-hundred thirty two HIV-infected patients received ART. Of these, 253 (30.4%) patients skipped ART more than once a month. The most common reason of skipping medication was “simply forgot” (60.4%).

Trend of CD4+ Cell Counts at Diagnosis and Initiation of Highly Active Antiretroviral Therapy (HAART): Korea HIV/AIDS Cohort Study, 1992-2015

김민정,장현하,김상일,김윤정,박대원,강춘,기미경,최주연,김수민,최보율,김우주,김준명,최준용,최영화,이진수,김신우,Korea HIV/AIDS Cohort Study 대한감염학회 2017 Infection and Chemotherapy Vol.49 No.2

Background: CD4+ cell counts reflect immunologic status of human immunodeficiency virus (HIV) patients. Recommended CD4+ cell counts for the initiation of highly active antiretroviral therapy (HAART) has increased over the past several years in various HIV treatment guidelines. We investigated the trend of CD4+ cell counts at diagnosis and treatment start using data from the Korea HIV/acquired immune deficiency syndrome (AIDS) Cohort Study. Materials and Methods: The Korea HIV/AIDS Cohort Study started in 2006 and enrolled HIV patients from 21 tertiary and secondary hospitals in South Korea. The data for CD4+ cell counts at diagnosis and HAART initiation from these HIV patients were analyzed by three-year time intervals and presented by number of CD4+ cells (≤100, 101-200, 201-350, 351-500 and >500 cells/mm3). The HIV-RNA titer at diagnosis and HAART initiation were presented by 3-year intervals by groups ≤50,000, 50,001-100,000, 100,001- 200,000, 200,001-1,000,000, and >1,000,000 copies/mL. Results: Median values of CD4+ cell count and HIV-RNA titer at initial HIV diagnosis were 247 cells/mm3 and 394,955 copies/mL, respectively. At time of initiating HAART, median values of CD4+ cell count and HIV-RNA were 181 cells/mm3 and 83,500 copies/ mL, respectively. Patients with low CD4+ cell count (CD4+ cell count ≤200 cells/mm3) at diagnosis (31-51%) and initiation of HAART accounted for the largest proportion (30-65%) over the three-year time intervals. This proportion increased until 2010-2012. Conclusion: CD4+ cell count at initiation of HAART was found to be very low, and the increase in late initiation of HAART in recent years is of concern. We think that this increase is primarily due to an increasing proportion of late presenters. We recommend early detection of HIV patients and earlier start of HAART in order to treat and prevent spread of HIV infection.

Gender Differences in Paediatric Patients of the Swiss Inflammatory Bowel Disease Cohort Study

Denise Herzog,Patrick Buehr,Rebekka Koller,Vanessa Rueger,Klaas Heyland,Andreas Nydegger,Johannes Spalinger,Susanne Schibli,Christian P. Braegger,The Swiss IBD Cohort Study Group 대한소아소화기영양학회 2014 Pediatric gastroenterology, hepatology & nutrition Vol.17 No.3

Purpose: Gender differences in paediatric patients with inflammatory bowel disease (IBD) are frequently reported as a secondary outcome and the results are divergent. To assess gender differences by analysing data collected within the Swiss IBD cohort study database since 2008, related to children with IBD, using the Montreal classification for a systematic approach. Methods: Data on gender, age, anthropometrics, disease location at diagnosis, disease behaviour, and therapy of 196 patients, 105 with Crohn’s disease (CD) and 91 with ulcerative or indeterminate colitis (UC/IC) were retrieved and analysed. Results: The crude gender ratio (male : female) of patients with CD diagnosed at <10 years of age was 2.57, the adjusted ratio was 2.42, and in patients with UC/IC it was 0.68 and 0.64 respectively. The non-adjusted gender ratio of patients diagnosed at ≥10 years was 1.58 for CD and 0.88 for UC/IC. Boys with UC/IC diagnosed <10 years of age had a longer diagnostic delay, and in girls diagnosed with UC/IC >10 years a more important use of azathioprine was observed. No other gender difference was found after analysis of age, disease location and behaviour at diagnosis, duration of disease, familial occurrence of IBD, prevalence of extra-intestinal manifestations, complications, and requirement for surgery. Conclusion: CD in children <10 years affects predominantly boys with a sex ratio of 2.57; the impact of sex-hormones on the development of CD in pre-pubertal male patients should be investigated.

When is LABA/LAMA Better than LAMA in GOLD Group B or D Patients for Reducing Acute Exacerbations of COPD?

신홍준,김유일,김유림,이창열,라승원,문지용,정기석,유광하,신경철,임성철,KOCOSS Cohort Study Group 전남대학교 의과학연구소 2023 전남의대학술지 Vol.59 No.3

Long-acting b2-agonist (LABA)/long-acting muscarinic-antagonist (LAMA) dual therapy has been found to be more effective than LAMA monotherapy in the treatment of chronic obstructive pulmonary disease (COPD). However, among patients with group B or D COPD, the characteristics of patients for whom LABA/LAMA dual therapy is superior to LAMA monotherapy in minimizing acute exacerbations remain unknown. With data from a prospective COPD cohort, subgroup analyses were conducted to determine whether LABA/LAMA dual therapy was superior to LAMA monotherapy in reducing the rate of acute exacerbations in group B and D COPD patients. Group B and D COPD patients taking LAMA or LABA/LAMA were enrolled according to the 2022 Global initiative for Chronic Obstructive Pulmonary Disease guidelines. A total of 737 patients were included in this study: 600 with group B COPD and 137 with group D COPD. Compared with patients taking LAMA monotherapy, those taking LABA/ LAMA had a significantly lower incidence of acute exacerbations over 1 year. In the subgroup of patients ≥70 years old, there was a significantly lower risk of severe COPD exacerbations among group B patients taking LABA/LAMA than among those taking LAMA monotherapy (odds ratio [OR], 0.258; 95% confidence interval [CI], 0.095–0.703). In contrast, in the subgroup of group D patients with COPD Assessment Test scores ≥25, compared with LAMA monotherapy, LABA/LAMA treatment was associated with lower risk of severe COPD exacerbations (OR, 0.115; 95% CI, 0.018-0.749). The combination of LABA and LAMA was found to be superior to LAMA monotherapy, especially for treating older adults with group B COPD, as well as for group D patients with severe symptoms.

Clinical Characteristics of Chronic Bronchitis and Emphysema in Korean COPD Patients

이진국,조재화,김태형,이상학,이진화,김영삼,정지예,박용범,윤형규,이상엽,민경훈,유광하,정기석,( Kocoss Cohort ) 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Background: Traditionally, COPD can be classified as chronic bronchitis or emphysema. However, some patients showed both features of chronic bronchitis and emphysema. Moreover, there are patients who can be classified neither chronic bronchitis or emphysema. Purpose: To examine clinical characteristics of patients with COPD. Methods: Patients were recruited from 49 centres in Korea, as part of the COPD cohort (KOCOSS) study. Results: Total 223 patients with COPD were eligible for analysis. Age was 68.0±7.6 (Mean±SD) and 88.3% were male. FVC, FEV1, and FEV1/FVC were 3.08±0.84 L (83.24±19.00%), 1.42±0.56 L (51.98±17.12%), and 45.88±11.52%. Mean CAT score was 16.27±8.36. Patients were classified as chronic bronchitis (C) or emphysema (E). We analyzed characteristics of patients according to four groups - C(+)E(+), C(+)E(-), C(-)E(+), and C(-),E(-). The percentage of patients were 21.5%, 33.1%, 24.0%, and 21.5 %, respectively. Mean CAT score were 18.35, 11.72, 19.42, and 19.94 (P<0.01). Mean FEV1/FVC were 39.84%, 48.25%, 42.12%, and 50.01% (P<0.01). Conclusion: Clinical characteristics were significantly different according chronic bronchitis and emphysema.