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 Allergy Asthma & Respiratory Disease 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.

소아 및 성인 천식 유병률 파악을 위한 델파이법을 활용한 표준조사서 개발

안재우,이경석,김진택,양현종,조유숙,장광천,송우정,권혁수,윤종서,한만용 대한 소아알레르기 호흡기학회 2018 Allergy Asthma & Respiratory Disease Vol.6 No.1

Purpose: Recently, the prevalence and disease burden of asthma have increased. Thus, the need for early diagnosis and appropriate management of asthma is emerging. However, it is difficult to identify the diagnosis, symptoms and the prevalence of asthma due to lack of reliable investigating items. The purpose of this study was to develop a standardized survey format in order to assess the prevalence of asthma in Koreans. Methods: We investigated surveys and related information that are utilized to assess asthma diagnosis and prevalence by systematic review. After that, Delphi survey was conducted on 44 Korean allergists in order to develop a standardized survey in Korea. The process consisted of 3 serial rounds across 3 age groups. Each subsequent round narrowed investigating items for the decision of standard set about asthma prevalence, current asthma, and asthma aggravation. Results: Lifetime asthma was defined as “ever doctor-diagnosed asthma” in all age groups. Current asthma was defined as “treatment for asthma during the past 12 months” in all age groups, and “doctor-diagnosed asthma during the past 12 months” was added on the ≥5-year-old and adult groups. “Wheezing ever” was defined as “wheezing at any time in the past,” and current wheeze was defined as “wheezing in the last 12 months.” Asthma aggravation was defined as “visits at the emergency department or admission due to asthma attack within the last 12 months” in all age groups. Conclusion: We established applicable nationwide definitions of “lifetime asthma,” “current asthma,” and “asthma aggravation” in Koreans by the Delphi survey.

Global Disease Burden and Attributable Risk Factor Analysis of Asthma in 204 Countries and Territories From 1990 to 2019

Liu Hailing,Zhang Jing,Liu Li,Lian Guoli,Shi Ruiming,Xu Man,Yang Juan,Liu Xiaohong 대한천식알레르기학회 2023 Allergy, Asthma & Immunology Research Vol.15 No.4

Purpose: Asthma is a common chronic inflammatory respiratory tract disease with high morbidity and mortality. The global trends in asthma burden remain poorly understood, and asthma incidence has increased during the worldwide coronavirus disease 2019 (COVID-19) pandemic. This study aimed to provide a comprehensive view of the global distribution of asthma burden and its attributable risk factors from 1990 to 2019. Methods: Based on the Global Burden of Disease Study 2019 Database, asthma incidence, deaths, disability-adjusted life years (DALYs), the corresponding age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), age-standardized DALY rate, and estimated annual percentage change were analyzed according to age, sex, sociodemographic index (SDI) quintiles, and locations. Risk factors contributing to asthma deaths and DALYs were also investigated. Results: Globally, the asthma incidence increased by 15%, but deaths and DALYs decreased. The corresponding ASIR, ASDR, and age-standardized DALY rate also decreased. The high SDI region had the highest ASIR, and the low SDI region had the highest ASDR. The ASDR and age-standardized DALY rate were negatively correlated with the SDI. The low-middle SDI region, particularly South Asia, showed the highest asthma-related deaths and DALYs. The incidence peak was under 9 years old, and more than 70% of all deaths occurred in the population over 60 years old. Smoking, occupational asthmagens, and a high body mass index were the main risk factors for asthma-related mortality and DALYs, and their distributions varied between sexes. Conclusions: Globally, the asthma incidence has increased since 1990. The greatest asthma burden is borne by the low-middle SDI region. The 2 groups that need special attention are those under 9 years old and those over 60 years old. Targeted strategies are needed to reduce the asthma burden based on geographic and sex-age characteristics. Our findings also provide a platform for further investigation into the asthma burden in the era of COVID-19.

Effect of Asthma and Asthma Medication on the Prognosis of Patients with COVID-19

( Yong Jun Choi ),( Ju-young Park ),( Hye Sun Lee ),( Jin Suh ),( Jeung Yoon Song ),( Min Kwang Byun ),( Jae Hwa Cho ),( Hyung Jung Kim ),( Jae-hyun Lee ),( Jung-won Park ),( Hye Jung Park ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Purpose Coronavirus disease (COVID-19) has rapidly spread worldwide. However, the effects of asthma, asthma medication, and asthma severity on the clinical outcomes of COVID-19 have not yet been established. Methods The study included 7,590 de-identified patients, who were confirmed to have COVID-19 using the severe acute respiratory syndrome-coronavirus-2 RNA-polymerase chain reaction tests conducted up to 15th May 2020; and we used the linked-medical claims data provided by the Health Insurance Review and Assessment Service. Asthma and asthma severity (step suggested by GINA) was defined using the diagnostic code and history of asthma medication usage. Results Among 7,590 COVID-19 patients, 218 (2.9%) had underlying asthma. The total medical cost associated with COVID-19 patients with underlying asthma was significantly higher than that of other patients. Mortality rate for COVID-19 patients with underlying asthma (7.8%) was significantly higher than that of other patients (2.8%; P<0.001). However, asthma was not an independent risk factor for the clinical outcomes of COVID-19 after adjustment. Asthma medication use and asthma severity also did not affect the clinical outcomes of COVID-19. However, use of oral short-acting β2-agonists (SABA) was an independent factor to increase the total medical cost burden. Patients with step 5 asthma showed significant prolonged admission duration than those with step 1 asthma in both univariate and multivariate analysis. Conclusions Asthma led to poor outcomes of COVID-19; however, underlying asthma, use of asthma medication, and asthma severity were not independent factors for poor clinical outcomes of COVID-19, generally.

The Impact of Asthma Control on Salivary Cortisol Level in Adult Asthmatics

신유섭,Jing Nan Liu,김주희,남영희,최길순,박해심 대한천식알레르기학회 2014 Allergy, Asthma & Immunology Research Vol.6 No.5

Asthma is a chronic disease causing psychological stress which leads to the activation of hypothalamus-pituitary-adrenal axis. The purpose of thisstudy is to compare morning salivary cortisol levels in persistent asthma patients according to their disease severities and control status. Total 206adult asthma patients were recruited from four university hospitals. Spirometry, questionnaire of Asthma Quality of Life (AQOL) and Asthma ControlTest (ACT) were completed, and saliva samples were collected prospectively to measure morning cortisol level. The mean patient age was 56.5±15.3 years with mean asthma duration of 9.1±11.1 years. Sixty five patents (31.6%) were classified as mild persistent asthma, and 141 patients(68.4%) were classified as moderate persistent asthma according to the Expert Panel Report 3. The mean predicted FEV1 was 88.8%±18.4%, andthe methacholine PC20 was 9.6±8.5 mg/mL in all study population. The mean ACT score for all patients was 19.9±3.6, and there were 71 (34.5%)patients in poorly controlled and 135 (65.5%) in well controlled asthma. The poorly controlled asthma patients were characterized by significantlylower FEV1 (84.6%±17.6% vs 91.1%±18.5%, P=0.018), lower AQOL scores (46.0±13.9 vs 73.8±26.3, P<0.001), and lower salivary cortisol levels(0.14±0.08 vs 0.18±0.11 μg/dL, P=0.04) compared to well controlled asthma. The ACT score was significantly related to salivary cortisol levels(P=0.034) after adjusting for age. There was no significant difference in salivary cortisol levels (0.17±0.12 vs 0.16±0.08, P=0.725) when analyzedaccording to the dose of used corticosteroid and lung function. Asthma control status affects morning salivary cortisol level. Measuring themorning salivary cortisol level might be a simple and new way to assess asthma control status.

Heterogeneity of Childhood Asthma in Korea: Cluster Analysis of the Korean Childhood Asthma Study Cohort

윤지선,엄은진,김진택,임대현,김우경,송대진,유영,서동인,백혜성,신미용,권지원,장광천,양현종,이은,김환수,서주희,우성일,김형영,신윤호,이주석,정성수,한민규,유진호 대한천식알레르기학회 2021 Allergy, Asthma & Immunology Research Vol.13 No.1

Purpose: Asthma is a heterogeneous airway disease occurring in children, and it has various clinical phenotypes. A clear differentiation of the clinical phenotypes can provide better asthma management and prediction of asthma prognosis. Little is currently known about asthma phenotypes in Korean children. This study was designed to identify asthma phenotypes in school-aged Korean children. Methods: This study enrolled 674 children with physician-diagnosed asthma from the Korean childhood Asthma Study (KAS) cohort. The physicians verified the relevant histories of asthma and comorbid diseases, as well as airway lability and hyper-responsiveness from the results of pulmonary function tests and bronchial provocation tests. Questionnaires regarding the participants' baseline characteristics, their environment and self-rating of asthma control were collected at the time of enrollment. Laboratory tests were performed to assess allergy and airway inflammation. Children with asthma were classified by hierarchical cluster analysis. Results: Of the 674 patients enrolled from the KAS cohort, 447 were included in the cluster analysis. Cluster analysis of these 447 children revealed 4 asthma phenotypes: cluster 1 (n = 216, 48.3%) which was characterized by male-dominant atopic asthma; cluster 2 (n = 79, 17.7%) which was characterized by early-onset atopic asthma with atopic dermatitis; cluster 3 (n = 47, 10.5%) which was characterized by puberty-onset, female-dominant atopic asthma with the low lung function; and cluster 4 (n = 105, 23.5%) which was characterized by early-onset, non-atopic dominant asthma. Conclusions: The asthma phenotypes among Korean children can be classified into 4 distinct clusters. Long-term follow-up with these phenotypes will be needed to define their prognosis and response to treatment.

중증 천식 환자 스테로이드 사용과 감량에 대한 전문가 의견서

김주희,강노을,강성윤,심다운,박소영,박종숙,이 현,진현정,송우정,김소리,김상헌 대한 소아알레르기 호흡기학회 2025 Allergy Asthma & Respiratory Disease Vol.13 No.1

Systemic corticosteroids play an essential role in the management of asthma. During acute exacerbation, the short-term use of systemic corticosteroids is recommended. For patients with uncontrolled asthma and severe asthma, long-term and low-dose oral corticosteroids (OCS) have frequently been advocated. However, both short-term and long-term use of systemic corticosteroids carry the risk of adverse events (AEs), including various morbidities and even mortality. Despite recent progress in adult severe asthma management and the availability of new treatment options, the current domestic guidelines for asthma do not provide specific recommendations for oral corticosteroid tapering in patients with severe asthma. Therefore, the task force team of the severe asthma working group in the Korean Academy of Allergy, Asthma, and Clinical Immunology has proposed a tapering protocol for systemic corticosteroid use in severe asthma. This includes practical recommendations for monitoring OCS-related AE, particularly for adrenal insufficiency and osteoporosis, which suggests corticosteroid-sparing strategies that include alternative therapies, modifying treatable traits, timely specialist assessment, and shared decision-making with patients. However, further real-world research and collaboration with doctors from primary and academic institutes, patients, and policymakers are necessary to establish an OCS stewardship approach. This should include realistic OCS-tapering strategies for patients with severe asthma using regular OCS, education, and campaigns for patients, the public, and healthcare providers about the burden of severe asthma, as well as improving timely access to specialized severe asthma services for optimal management. .

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

( Mary Claire Rolfes ),( Young Jun Juhn ),( Chung-il Wi ),( Youn Ho Sheen ) 대한결핵 및 호흡기학회 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.

지역사회 인구 집단에서 천식 발병 연령 및 성인 천식과의 연관성

원하경,강예원,안진,이지향,강민규,김태범,송우정 대한 소아알레르기 호흡기학회 2025 Allergy Asthma & Respiratory Disease Vol.13 No.1

. Purpose: The classification of asthma phenotypes frequently depends on the age of onset. However, the rationale for specific age cutoffs remains unclear. This study aimed to explore the distribution of asthma onset age, to define subgroups based on onset age, and to examine their characteristics within a broad Korean population. Methods: An analysis of cross-sectional data involving 56,632 participants from the Korean National Health and Nutrition Examination Survey (2010–2016) was conducted. Data on asthma history, including diagnosis, self-reported age of asthma onset, and current disease status, were collected using structured questionnaires. Results: The distribution of asthma onset age showed a distinct peak in early childhood, with a decline between the ages 15 and 20. Based on this distribution, asthma was categorized into childhood-onset (≤18 years) and adult-onset (>18 years) for further analysis. Multivariate analyses indicated that adult-onset asthma was associated with older age, female sex, obesity, and a history of smoking, whereas childhood-onset asthma was linked to younger age, male sex, allergic rhinitis, and atopic dermatitis. Among the adult-onset group, current asthma had a later onset age, increased history of smoking history, and atopic dermatitis compared to past asthma. Conclusion: This analysis of nationwide general population data suggests that an age threshold around 18 years may be relevant for defining adult-onset asthma.

Application of impulse oscillometry to adult asthma with preserved lung function

( Sung-ryeol Kim ),( Kyungchul Kim ),( Jinyeong Moon ),( Sang Chul Lee ),( Kyung Hee Park ),( Jae-hyun Lee ),( Jung-won Park ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Purpose: Spirometry has limitations in evaluating asthma with preserved lung function. Whereas, impulse oscillmetry (IOS) can detect not only airway resistance, but also reactance. Therefore, it is pressumed that IOS can help diagnosis of adult asthma with preserved lung function. However, the application of IOS to these patients have not been adequately investigated. Method:One thousand two hundred fifty-five patients with suspected asthma, who visited the Allergy and Asthma Clinic of Severance Hospital from 2015 to 2018, were enrolled. Patients performed pulmonary function test (PFT) and IOS. Among them, 117 patients were excluded due to parenchymal lung disease or chronic obstructive lung disease (COPD), or asthma- COPD overlap. Five hundred thirty-eight patients with asthma were excluded due to decreased lung function (predicted forced expiratory volume in 1 second < 80%). Six hundred asthma patients with preserved lung function were compared with 195 non-asthma patients. Then, among 600 asthma patients, asthma control status of 277 patients, who performed second PFT, were also analyzed. Result: Most IOS parameters were significantly higher in asthma patients than in non-asthma patients. Among the IOS parameters, Area of Reactance (AX) was the most appropriate parameter for predicting asthma (the area under a receiver operating characteristic curve (AUC) = 0.757). Optimal cut-off value for AX to diagnose asthma was 0.605. Its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 52.4%, 91.6%, 91.4%, and 52.9%, respectively. Change rate of AX between 1st and 2nd IOS showed highest AUC (0.678) for predicting the stable asthma status. Conclusion: IOS is a useful utility for diagnosis and management of adult asthma with preserved lung function.