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.

한국인 비흡연 COPD 환자의 임상 특성

윤형규,이진국,이재희,최혜숙,이재천,박소영,김태형,이진화,박용범,김영삼,이상학,이상엽,신경철,유광하,정기석,( Kocoss Cohort ) 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

연구배경: COPD는 대개 흡연에 의해 발생하지만 20-30%의 COPD환자는 흡연과 무관하게 발생하는 것으로 알려져 있다. 하지만 거의 모든 COPD 연구가 흡연에 의한 COPD를 대상으로 하고 있어 비흡연자의 COPD에 대해서는 거의 연구되어 있지 않고 있다. 방법: KOCOSS연구에 등록된 COPD 환자 224명을 대상으로 흡연력을 포함한 병력, 삶의 질 평가, 폐기능 등 COPD와 관련된 임상 자료를 수집 분석하였다. 결과: 총 229명의 COPD 환자 중 49명(21.9%)이 비흡연자였다. 비흡연 COPD 환자에서 여성의 비율이 유의하게 높았으나(P<0.001) 나이는 양군간 차이가 없었다. CAT score와 SGRQ scores는 흡연 COPD 환자에서 높은 경향을 보였으나 유의하지는 않았지만 흉부 답답함과 운동시 호흡곤란 항목의 점수는 흡연 COPD 환자에서 유의하게 높았다(P<0.05). 6분 도보 검사는 양군간 차이가 없었으며 폐기능 검사에서 DLco/VA가 흡연 COPD환자에서 유의하게 낮았으며(P<0.001) 폐용적은 흡연 COPD 환자에서 유의하게 증가되어 있었다(P<0.05). 결론: 비흡연 COPD 환자는 전체 COPD 환자의 20%이상을 차지하고 있었으며 여성에서 많았다. COPD로 인한 전체적 영향은 흡연 COPD와 차이가 없었지만 흉부 증상과 운동시 호흡곤란은 흡연 COPD에서 더 심하게 나타났다. 이것은 비흡연 COPD 환자가 폐기종의 영향이 적기 때문인 것으로 보인다.

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.

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.