제5기 국민건강영양조사로 추정한 소아 천식과 사회경제적 관계에 관한 연구

이해정 ( Hae Jung Lee ),김철홍 ( Chul Hong Kim ),이주석 ( Ju Suk Lee ) 대한천식알레르기학회 2018 Allergy Asthma & Respiratory Disease Vol.6 No.2

Purpose: Asthma is one of the most common chronic conditions, and its prevalence has been increasing in recent decades. Social economic status is a well-known risk factor for asthma. This study was performed to investigate the relationship between social economic status and asthma in Korean children. Methods: Data were acquired from 4,397 children, aged under 18 years who participated in the Fifth Korea National Health and Nutrition Examination Surveys, which was conducted from 2010 to 2012. The presence of asthma was based on self-reported, physician-diagnosed asthma in the Health Interview Surveys. Results: The prevalence of pediatric asthma was 5.3%, while the prevalence of atopic dermatitis in children was 14.0%. In univariate analysis, asthmatic children tended to be male, to be older, to have asthmatic mothers, to suffer from atopic dermatitis and to live in urban areas (P<0.05). The parents’ marital status, employment status, education level, and the number of household members were not associated with pediatric asthma. In logistic regression analysis, older age, male sex, maternal asthma, pediatric atopic dermatitis, and urban residence were associated with a higher prevalence of childhood asthma (P<0.01). Conclusion: Socioeconomic status was not an important risk factor for asthma in Korean children in our study. It is conceivable that socioeconomic factor could affect the asthma prevalence in a different manner in each country. Further studies are warranted to explore mechanisms responsible for the association between socioeconomic status and asthma in children. (Allergy Asthma Respir Dis 2018;6:90-96)

기관지 천식 환자에서 천식 증상의 정도에 따른 $\beta_2$ 교감신경 수용체의 유전자 다형성

심재정,김제형,이승룡,권영환,이소라,이상엽,강세용,강용구,조재연,인광호,원남희,유세화,강경호,Shim, Jae-Jeong,Kim, Jei-Hyung,Lee, Seung-Yong,Kwan, Young-Hwan,Lee, So-Ra,Lee, Sang-Youb,Kang, Se-Yong,Kang, Yong-Koo,Cho, Jae-Youn,In, Kwang-Ho,Wo 대한결핵및호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.1

서 론: $\beta_2$ 교감신경 수용체 유전자에는 여러 종류의 다형성(polymorphism)가 존재하며, 천식 환자에서 $\beta_2$ 교감신경 수용체의 대표적인 변이는 $\beta_2$ 교감신경 수용체의 아미노산이 대치된 부분으로 Arg16-Gly, Gln27-Glu, Val34-Met 및 Thr164-Ile 등인 것으로 알려져 있다. 지속적인 $\beta_2$ 교감신경 유도체의 자극에 대하여 세포표면으로 부터 세포내의 전달과정이 둔화되어 점차 세포전달이 없어질 수도 있는 desensitization 또는 수용체와 수가 감소하는 downregulation이 존재하는 것으로 알려져 있다. 천식환자에서 $\beta_2$ 교감신경 수용체의 desensitization 또는 downregulation 뿐만 아니라 천식 표현형과 $\beta_2$ 교감신경 수용체 유전자 다형성의 상관 관계에 대한 연구가 이루어지고 있으나 논란이 많다. 이에 본 연구는 기관지 천식환자에서 $\beta_2$ 교감신경 수용체의 가장 흔한 16, 27, 34 및 164 의 아미노산에 해당하는 유전자의 다형성을 MASA (Mutated Allele Specific Amplification)법으로 시행하여 각각의 다형성의 발생 빈도와 천식의 심한 정도와 연관이 있는 가를 확인하였다. 대상 및 방법: 대상 환자는 천식 환자 103명이었으며, 이중 남자는 54명, 여자는 49명으로 평균 연령은 46.6세 (19~80세)였고 이환 기간은 4.7년이었다. 대상 환자는 경미하고 간헐적 증상을 보인 30명, 지속적인 경미한 천식 환자는 32명으로 경미한 천식은 모두 62명이었으며, 중등증의 천식 증상은 17명 및 중종의 천식증상을 보인 환자는 24명이었다. 이중 1년 중에 6개월 이상 전신적 스테로이드를 투여하는 환자는 39명이었으며, 투약 중에도 야간 발작이나 야간 기침이 발생되었던 환자는 44명이었다. 대상 환자로부터 10cc의 전혈구를 체취 하여 분리된 림파구에서 분리된 DNA를 이용하여 MASA 방법으로 $\beta_2$ 교감신경 수용체 16번, 27번, 34번 및 164번째 아미노산의 다형성을 검색하였고, 천식의 심한 정도 따른 $\beta_2$ 교감신경 수용체 유전자의 다형성의 분포와 야간 천식의 발작이나 증상의 유무에 따른 $\beta_2$ 교감신경 수용체 유전자의 다형성의 분포를 확인하였다. 결 과: 16 번째 Arginine이 Glycine으로 변이는 heterozygous 변이가 67명, homozygous 변이가 13명으로 heterozygous 변이가 65.1%로 가장 많았다. 27번째 Glutamine이 Glutamate로 변이는 heterozygous만 11명으로 10.7%였으며, 34번째 Valine이 Methionine으로 변이를 일으키는 100번째 핵산의 경우도 heterozygous만 6명으로 5.8%였다. 27 번째와 34번째 아미노산의 변이를 일으키는 homozygous 변이와 164번째 아미노산의 변이는 대상 환자 중에는 없었다. 천식 증상의 심한 정도를 경종 및 중등증, 중중으로 2 구분하여 $\beta_2$ 교감신경 수용체 다형성의 발생빈도를 관찰한 결과 중증의 천식환자에서 16번째 아미노산의 변이의 빈도는 많았으나 (p=0.015), 27번, 34번 및 164번째의 아미노산의 변이는 천식 증상의 정도와는 연관성이 없었다. 야간 천식 증상의 유무에 따른 $\beta_2$ 교감신경 수용체 다형성은 16, 27, 34 및 164번째 아미노산의 핵산의 변이와 연관성이 없었다. 결 론: 이상의 결과로 기관지 천식 환자에서 $\beta_2$ 교감신경 수용체 다형성은 Arg 16, Gln 27 및 Val 34의 변이가 존재하고, Arg 16이 가장 많았으며, Thr 164는 없었다. 기관지 천식 환자에서 증상이 심한 중증 천식은 $\beta_2$ 교감 신경 수용체의 다형성중 Arg 16의 변이는 중증 천 Background: Genetic and environmental factors are known to affect the incidence and severity of asthma. Stimulation of $\beta_2$-Adrenergic Receptor ($\beta_2$AR) results in smooth muscle relaxation, leading to decrease in resistance of airflow. The gene encoding the $\beta_2$AR has recently been seguenced. The $\beta_2$AR genotype at the polymorphic loci of codons 16, 27, 34, and 164 was known to cause changes in the amino acids. The relationships between the structure of the $\beta_2$AR and its functions are being elucidated. Purpose : The gene encoding the $\beta_2$AR was carried out to assess the frequency of polymorphisms in bronchial asthma, to determine wheather these polymorphisms have any relation to the severity, or nocturnal symptoms in bronchial asthma. Methods: The subjects studied were 103 patients with bronchial asthma, which consisted of 30 mild episodic, 32 mild persistent, 17 moderate, and 24 severe asthma patients. The polymorphisms of the $\beta_2$AR gene were detected by mutated allele specific amplification (MASA) method at the codons 16,27,34, and 164. Results: The most frequent polymorphism was arginine 16 to glycine. The other two polymorphisms, valine 34 to methionine and glutamine 27 to glutamic acid occured in 11 and 6 patients respectively. The polymorphism of threonine 164 to isoleucine was not found in our enrolled patients. The homozygous polymorphism of $\beta_2$AR gene was found in only arginine 16 to glycine (12.6%). The heterozygous polymorphisms of $\beta_2$AR gene were in arginine 16 to glycine, valine 34 to methionine, and glutamine 27 to glutamic acid, as 65.1 %,10.7%, and 5.8% respectively in asthma patients. The presence of agrginine 16 to glycine heterozygous or/and homozygous polymorphism was associated in severe asthma (p=0.015), but there was no association between the other three polymorphisms and the severity of asthma. The frequency of the $\beta_2$AR gene polymorphisms was no relation in nocturnal asthma as compared with non-nocturnal asthma. Conclusion: The arginine 16 to glycine polymorphism of the $\beta_2$AR gene is the most frequently found in asthma patients and association with severe asthma. But there was no association between the polymorphism of the $\beta_2$AR gene and nocturnal asthma.

천식 소아에서 혈청 vascular endothelial growth factor, transforming growth factor-beta1과 YKL-40 증가의 임상적 의의

장윤영 ( Yoon Young Jang ),이현석 ( Hyun Seok Lee ),정지은 ( Ji Eun Jeong ),이은주 ( Eun Joo Lee ),홍석진 ( Suk Jin Hong ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),김우택 ( Wootaek Kim ),정혜리 ( Hai Lee Chung ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.6

Purpose: Vascular endothelial growth factor (VEGF), transforming growth factor beta1 (TGF-β1), and platelet derived growth factor (PDGF) are known to be involved in the pathogenesis of inflammation and remodeling in asthmatic airways. YKL-40, a chitinase-like protein, and clusterin have been reported to be biomarkers for severe asthma. We examined the serum levels of growth factors, YKL-40, and clusterin in children with acute asthma or stable asthma, and investigated their correlation with clinical findings and lung function parameters. Methods: Forty-one children (≥6 years of age) with asthma were enrolled, and 2 groups were defined: 23 patients admitted with acute asthma (acute asthma group) and 18 patients with stable asthma (stable asthma group). The serum levels of VEGF, TGF-β1, PDGF-BB, YKL-40, and clusterin were measured using enzyme-linked immunosorbent assay and assessed in relation to clinical manifestations and spirometric parameters. Fifteen age-matched controls were also studied. Results: The serum levels of VEGF, TGF-β1, and YKL-40 were significantly elevated in children with acute asthma compared to controls. The serum levels of VEGF and YKL-40 were higher in the stable asthma group than in controls. The serum levels of VEGF, TGF-β1, and YKL-40 were not different between the acute asthma and stable asthma groups. The serum VEGF levels in the acute asthma group correlated significantly with asthma severity. The serum TGF-β1 levels in stable asthma group showed a significant inverse correlation with (FEV1) forced expiratory volume in one second and FEF25% 75% (forced expiratory flow between 25 and 75 percent of expired vital capacity). Serum YKL-40 had no significant relationship with clinical manifestations and spirometric parameters. Conclusion: Our study suggests that increased serum levels of VEGF and YKL-40 might affect asthmatic airways not only during acute exacerbation but also in stable state and that serum TGF-β1 might be a biomarker for airway obstruction in children with asthma. (Allergy Asthma Respir Dis 2015;3:417-424)

Copy Number Variation Burden on Asthma Subgenome in Normal Cohorts Identifies Susceptibility Markers

Sangeetha Vishweswaraiah,Avinash M Veerappa,Padukudru A Mahesh,Sareh R Jahromi,Nallur B. Ramachandra 대한천식알레르기학회 2015 Allergy, Asthma & Immunology Research Vol.7 No.3

Purpose: Asthma is a complex disease caused by interplay of genes and environment on the genome of an individual. Copy number variations (CNVs) are more common compared to the other variations that disrupt genome organization. The effect of CNVs on asthma subgenome has been less studied compared to studies on the other variations. We report the assessments of CNV burden in asthma genes of normal cohorts carried out in different geographical areas of the world and discuss the relevance of the observation with respect to asthma pathogenesis. Methods: CNV analysis was performed using Affymerix high-resolution arrays, and various bioinformatics tools were used to understand the influence of genes on asthma pathogenesis. Results: This study identified 61 genes associated with asthma and provided various mechanisms and pathways underlying asthma pathogenesis. CCL3L1, ADAM8, and MUC5B were the most prevalent asthma genes. Among them, CCL3L1 was found across all 12 populations in varying copy number states. This study also identified the inheritance of asthma-CNVs from parents to offspring creating the latent period for manifestation of asthma. Conclusions: This study revealed CNV burden with varying copy number states and identified susceptibility towards the disease manifestation. It can be hypothesized that primary CNVs may not be the initiating event in the pathogenesis of asthma and additional preceding mutations or CNVs may be required. The initiator or primary CNVs sensitize normal cohorts leading to an increased probability of accumulating mutations or exposure to allergic stimulating agents that can augment the development of asthma.

Effect of pregnancy in asthma on health care use and perinatal outcomes

Kim, S.,Kim, J.,Park, S.Y.,Um, H.Y.,Kim, K.,Kim, Y.,Park, Y.,Baek, S.,Yoon, S.Y.,Kwon, H.S.,Cho, Y.S.,Moon, H.B.,Kim, T.B. Mosby 2015 The journal of allergy and clinical immunology Vol.136 No.5

Background: It is generally known that pregnancy in asthmatic patients increases the risk of asthma exacerbations and poor perinatal outcomes. However, the effect of pregnancy in asthmatic patients on health care use is not known well. In addition, its effect on perinatal outcomes is still controversial because of study limitations caused by ethical issues. National Health Insurance claim data are an ideal resource for studying real-world health care use patterns of asthma. Objective: We sought to evaluate the effect of pregnancy on asthma in terms of asthma-related health care use and prescription patterns in concert with the effect of asthma exacerbations on adverse pregnancy outcomes. Methods: Among all asthmatic patients in the Korean National Health Insurance claim database from January 2009 to December 2013, pregnant women who delivered in 2011 with pre-existing asthma were enrolled. Analyses included asthma-related health care use and prescription patterns compared between pregnant asthmatic women and nonpregnant female asthmatic control subjects, as well as within the pregnant subjects from before pregnancy throughout postpartum periods. In addition, the association between asthma exacerbation during pregnancy and adverse pregnancy outcomes was assessed. Results: A total of 3,357 pregnant asthmatic patients were compared with 50,355 nonpregnant asthmatic patients, and 10,311 pregnant patients were included to determine the effect of asthma exacerbations on adverse pregnancy outcome in the study. Pregnant asthmatic patients underwent more asthma-related hospitalizations (1.3% vs 0.8%, P = .005) but had significantly fewer outpatient visits and prescriptions for most asthma medications than nonpregnant asthmatic patients. The proportion of patients ever hospitalized gradually increased throughout pregnancy (first trimester, 0.2%; second trimester, 0.5%; and third trimester, 0.7%; P = .018). The prevalence of asthma exacerbation during pregnancy was 5.3%, and the patients who had acute exacerbation during pregnancy had significantly higher asthma-related health care use in terms of hospitalization, intensive care unit admission, and emergency department and outpatient visits within 1 year before delivery than those who had not. However, asthma exacerbation during pregnancy was not significantly related to adverse perinatal outcomes, except for cesarean section (27.1% vs 18.9%, P < .001). All exacerbations were managed with systemic corticosteroids, and the patients who ever experienced acute exacerbations maintained asthma medications, including inhaled corticosteroid-based inhalers, throughout the pregnancy period. Conclusion: Pregnancy profoundly affects asthma-related health care use but to a different degree depending on whether the patient experienced an exacerbation. Asthma exacerbation during pregnancy is not associated with adverse pregnancy outcomes while managed appropriately with systemic corticosteroids. However, further studies are needed to clarify the effect of asthma control on perinatal outcome and delivery method.

소아 천식의 근황과 치료 경향에 관한 조사

차재국(Jae Kook Cha),윤혜선(Hae Sun Yoon),이혜란(Hae Ran Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1998 소아알레르기 및 호흡기학회지 Vol.8 No.2

목 적 : 지난 20년간 우리 나라에서도 소아천식이 증가해왔으며, 천식의 병태 생리가 밝혀지면서 치료방법에도 않은 변화가 왔고, 지난 1994년 소아천식의 치료지침이 발표된 바 있다. 따라서 실제 일상에서 시행되고 있는 천식 치료의 실태를 알아보고자 본 조사를 실시하였다. 방 법 : 소아과 전문의를 대상으로 소아천식의 실태와 진료에 관한 24개 문항의 설문지를 통해 조사하였다. 결 과: 1) 소아천식 환자의 연령적 분포는 3-5세 이하가 전 소아천식 환아 중 72-90%를 차지하였으며, 천식의 중증도에 관한 조사에서 경중 천식이 71-80%로 대부분이었다. 2) Cough variant asthma의 분포는 전 소아천식 아동 중 약 10%로 나타났으며, 운동 유발성 천식도 응답자의 1/3에서 전 천식소아 환아 중 10%이내라고 하였다. 3) 처음 천식 환자 진료시에 환자나 보호자에게 설명하는데 소요되는 시간은 5-9분간이 대부분이었고, 증상 일기를 쓰게 하는 경우와 최대호기유속(PEFR)을 측정하도록 하는 경우가 각각 약 20-10% 이내로 소수였다. 4) 급성 천식 치료에 있어 흡입제 또는 네뷰라이저로 치료하는 경우보다 아직도 경구용을 사용한다는 경우가 73%로 많았으며, 특히 개인의원에서 경구용을 선호하고 있었다. 5) 만성 천식 치료에 있어 대학병원에서는 항염증제의 네뷰라이저 혹은 흡입제 치료가 일차 선택 약제로 사용되는 분포가 높았으나, 개인 의원에서는 60-70%에서 경구용 베타2 자극제의 사용이 흔하였다. 예방적 치료로는 케토티펜(ketotifen)이 가장 널리 (91.5%) 사용되고 있었다. 6) 면역 치료는 전체 소아 천식 환아 중 약 10% 이내에서 흔히 실시되고 있었다. 결 론 : 소아천식은 5세 이하가 대부분이었으며 경증 천식이 않았다. 천식 치료는 소아 천식치료지침이 실제 임상에서 잘 적용되고 있지 못했으며 따라서 더욱 많은 교육과 이에 대한 홍보가 요구된다. Purpose : During the past two decades in Korea, the prevalence rate of childhood asthma has been increased, and also there has been a significant evolution in the management of asthma. In 1994, a guideline for the diagnosis and treatment of asthma was established. This study was designed to investigate a real picture of clinical practice in the management of childhood asthma. Methods : This survey was conducted with data on 24 items of questionnaires from pediatricians working in private clinics, general hospitals, and university hospitals. We investigated the age distributions, severity of asthma, educational levels, management of asthma, and current trends of medication. Results : 1) In age distribution, childhood asthma was most prevalent in 3-5 years old age group(30-40%), followed by 2 years old age group, and was least prevalent in 10-15 years old age group. 2) The number of patients with cough variant asthma was about 10% of all childhood asthma. 3) A period of 5-10 minutes was the most common period consumed for the explanation of child asthma during each medical practice. Cases recording symptom diary and cases monitoring PEFR(using peak flow meter) were less than 10% each. 4) With regard to the use of β2 agonist in the treatment of acute asthmatic attack, rate of using oral drugs and nebulizer or inhalers of β2 agonist are similar in the university hospitals, but the rate of using oral drugs was over 80% in private clinics. 5) With regard to the use of anti-inflammatory drugs in the management of chronic asthma, nebulizer or inhaler therapy was the first-line choice in the university hospitals(rate over 60-90%), oral drugs were main therapy in private clinics. The administration of anti-allergic medication as a preventive measures was recommended in about 40-50%, and ketotifen was used most frequently. 6) Immunotherapy was being performed in about 10% of childhood asthma patients. Conclusion : Childhood asthma was most prevalent in the age group under 5 years and severity was mostly mild. For the management of childhood asthma, the education and control for asthma are still insufficient and previously published guidelines have been inappropriately used in practical field.

소아천식에서 천식 조절 상태 평가 도구의 유용성

김환수 ( Hwan Soo Kim ),김윤희 ( Yoon Hee Kim ),이희선 ( Hee Seon Lee ),한윤기 ( Yoon Ki Han ),박영아 ( Young Ah Park ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu Earn Kim ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.4

Purpose: The goal of asthma control is to maintain well-controlled state. In this study, we investigated whether childhood asthma control test (C-ACT) may reflect lung function and whether fractional exhaled nitric oxide (FeNO) can be used to improve the accuracy of C-ACT in reflecting the asthma control level. Methods: We reviewed the medical records of 155 patients with asthma underwent lung function tests and C-ACT upon visiting our outpatient clinic. We compared lung function test results according to the C-ACT score stratified by atopy and also examined FeNO according to C-ACT and the Global Initiative for Asthma (GINA) guidelines. The diagnostic accuracy of well-controlled asthma by C-ACT, FeNO, and C-ACT+FeNO was examined. We also calculated the cutoff value of FeNO and C-ACT for well-controlled asthma. Results: Peak expiratory flow (PEF) showed a significant correlation with the C-ACT score. Stratified by atopy, PEF, and forced expiration in one second (FEV1) showed significant correlations with the C-ACT score in the atopic asthma group. There was no difference in FeNO between subjects with C-ACT≥20 and <20, but FeNO was significantly higher in the uncontrolled asthma according to the GINA guidelines. The diagnostic accuracy of well-controlled asthma was higher when FeNO was combined with the C-ACT score than C-ACT or FeNO. Our study showed that the cutoff values of C-ACT and FeNO 19 and 18.3 ppb (parts per billion), respectively, for well-controlled asthma. Conclusion: C-ACT showed a significant correlation with PEF, and atopic asthma group showed significant correlations with PEF and FEV1. A combination of C-ACT with FeNO might reflect asthma control status more accurately. (Allergy Asthma Respir Dis 2015;3:261-266)

성인 천식과 우울증과의 관계에 관한 연구

김여진 ( Yeo Jin Kim ),김정은 ( Jeoung Eun Kim ),이주석 ( Ju Suk Lee ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.3

Purpose: Asthma is one of the most common allergic diseases in which depression is an important comorbidity. However, little is known about the prevalence of depression in Korean adult asthmatics. This study was performed to evaluate the association between asthma and depression and to investigate the clinical characteristics of Korean adult asthmatics with depression. Methods: Data were acquired from 18,066 men and women, aged older than 19 years who participated in the Fifth Korea National Health and Nutrition Examination Surveys, which was conducted from 2010 to 2012. The presence of asthma was based on self-reported physician diagnosis of asthma in the Health Interview Surveys. Results: The prevalence of asthma was 3.2%, and that of depression was 4.2%. In univariate analysis, adults with asthma were old age, marital status, unemployment, low education, low monthly family income, low number of household members, obesity (P<0.05) were significantly associated with asthma, but sex, residence area, and smoking status were not associated with asthma. The prevalence of hypertension and depression were higher in asthmatics (P<0.05), while diabetes mellitus was not associated with asthma. After adjustment for age, marital status, number of household members, monthly family income, body mass index, hypertension, unemployment, low educated status, and depression were associated with the higher prevalence of asthma (P<0.01). Depression was associated with female sex, unemployment, while it was not associated with lung function in asthmatics. Conclusion: The results of this study show that depression may be an important risk factor for asthma in Korean adults. Further studies are needed to explore mechanisms responsible for the association between depression and asthma.(Allergy Asthma Respir Dis 2015;3:173-179)

Asthma and the Risk of Rheumatoid Arthritis: An Insight into the Heterogeneity and Phenotypes of Asthma

Rolfes, Mary Claire,Juhn, Young Jun,Wi, Chung-Il,Sheen, Youn Ho The Korean Academy of Tuberculosis and Respiratory 2017 Tuberculosis and Respiratory Diseases Vol.80 No.2

Asthma is traditionally regarded as a chronic airway disease, and recent literature proves its heterogeneity, based on distinctive clusters or phenotypes of asthma. In defining such asthma clusters, the nature of comorbidity among patients with asthma is poorly understood, by assuming no causal relationship between asthma and other comorbid conditions, including both communicable and noncommunicable diseases. However, emerging evidence suggests that the status of asthma significantly affects the increased susceptibility of the patient to both communicable and noncommunicable diseases. Specifically, the impact of asthma on susceptibility to noncommunicable diseases such as chronic systemic inflammatory diseases (e.g., rheumatoid arthritis), may provide an important insight into asthma as a disease with systemic inflammatory features, a conceptual understanding between asthma and asthma-related comorbidity, and the potential implications on the therapeutic and preventive interventions for patients with asthma. This review discusses the currently under-recognized clinical and immunological phenotypes of asthma; specifically, a higher risk of developing a systemic inflammatory disease such as rheumatoid arthritis and their implications, on the conceptual understanding and management of asthma. Our discussion is divided into three parts: literature summary on the relationship between asthma and the risk of rheumatoid arthritis; potential mechanisms underlying the association; and implications on asthma management and research.

천식 환자에서 우울과 천식의 중증도 및 조절과의 관련성

김원진 ( Won Jin Kim ),배현숙 ( Hyun Sook Bae ),최보경 ( Bo Kyung Choi ),황종민 ( Jong Min Hwang ),신경화 ( Kyung Hwa Shin ),김미현 ( Mi Hyun Kim ),이광하 ( Kwang Ha Lee ),김기욱 ( Ki Uk Kim ),전두수 ( Doo Soo Jeon ),박혜경 ( Hye 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.4

Background: Psychological factors are increasingly recognized for their influence on the course of asthma, on a worldwide basis. The aim of this study was to assess the presence of depression, anxiety, and asthma-related quality of life in patients with asthma and to evaluate their impact on severity and control of asthma. Methods: We assessed the severity of asthma by comparing patients` current medications to GINA guideline. The patients were classified into the controlled group (asthma patients with controlled disease) or into the uncontrolled group (asthma patients with uncontrolled disease), which included partly controlled and uncontrolled patients, again based on GINA guideline 2004. Patient-reported depressive symptoms, anxiety, and asthma-related quality of life were evaluated using the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), and Korean asthma quality of life (KAQLQ). Results: One hundred and twenty patients were enrolled (mean age, 55±1 years; 65% women). Among the 120 patients, 14 (12%) patients were classified as having mild asthma, 88 (73%) as having moderate asthma, and 18 (15%) as having severe asthma. Eighty-one (67%) of the 120 patients were controlled. The asthma-related quality of life showed the difference according to severity of asthma (p=0.002). The prevalence of depression was lower (10% vs 26%, p=0.024) and the asthma-related quality of life was higher (59.951 (29∼75) vs 35.103 (18∼72), p≤0.001) in the controlled group. Higher trait anxiety score and lower asthma-related quality of life were associated with depression (p<0.001, p=0.002, respectively). Conclusion: Psychological factors, such as anxiety and depression, are strongly associated with asthma control. Therefore, screening and management of depression is needed in patients with asthma.