Airway Measurement for Airway Remodeling Defined by Post-Bronchodilator FEV1/FVC in Asthma: Investigation Using Inspiration-Expiration Computed Tomography

채은진,김태범,조유숙,박찬선,서준범,김남국,문희범 대한천식알레르기학회 2011 Allergy, Asthma & Immunology Research Vol.3 No.2

Purpose: Airway remodeling may be responsible for irreversible airway obstruction in asthma, and a low post-bronchodilator FEV1/FVC ratio can be used as a noninvasive marker of airway remodeling. We investigated correlations between airway wall indices on computed tomography (CT) and various clinical indices, including post-bronchodilator FEV1/FVC ratio, in patients with asthma. Methods: Volumetric CT was performed on 22 stable asthma patients who were taking inhaled corticosteroids. Airway dimensions were measured at four segmental bronchi using in-house software based on the full-width/half-maximum method. Parameters included luminal area, wall thickness (WT), wall thickness percentage (WT%), wall area percentage (WA%), bronchial-to-arterial diameter (BA) ratio on inspiration CT, airway collapsibility (AC), and air trapping index (ATI). Correlations were analyzed between CT parameters and clinical indices, including %FEV1, FEV1/FVC, FEF25–75%, and post-bronchodilator FEV1/FVC ratio. Results: Post-bronchodilator FEV1/FVC showed significant correlations with WT%, WT, BA ratio, AC, and ATI (r=–0.503, –0.576, 0.454, 0.475, and –0.610, respectively). WT showed negative correlations with FEV1/FVC and FEF25–75% (r=–0.431 and –0.581), and WT% was negatively correlated with %FEV1, FEV1/FVC, and FEF25–75% (r=–0.434, –0.431, and –0.540, respectively). WA% showed correlations with FEF25–75% and body mass index (r=–0.459 and 0.453). The BA ratio was positively correlated with %FEV1 (r=0.459) and FEF25–75% (r=0.479). AC showed strong positive correlation with FEV1/FVC (r=0.592), and ATI showed negative correlations with FEV1/FVC (r=–0.534) and FEF25–75% (r=–0.591). Conclusions: WT%, WT, BA ratio, and AC on inspiration and expiration CT are good indices for measuring airway remodeling defined by post-bronchodilator FEV1/FVC in stable asthma patients treated with inhaled corticosteroids.

1 year RV/TLC change as a predictor of long term decline of FEV1

김인애,박용범,이진국,황용일,유광하 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Backgrounds: The impact of the 1 year-change of Residual volume/Total Lung Capacity (RV/TLC) in patients with COPD has not been studied in a long term prospective cohort. We explored the effect of 1 year-change of RV/TLC to identify predictors in FEV1 decline for 3 years in COPD patients treated by respiratory physicians. Methods: The study population included 240 patients from a multi-center observational COPD, who followed up for more than 3 years in KOCOSS cohort. With the 1 years change of RV/TLC, patients were classified into the aggravation group (△3% increased), the stable group (-3% ≤△RV/TLC≤3% ), and the improved group (△RV/TLC<-3%). We compared the FEV1 decline in each group to identify correlation between RV/TLC with FEV1 decline by mixed regression model. Results: The patients of the aggravation group were older, had lower lung function and showed significantly less bronchodilator response. The amount of three year FEV1 decline was -130 ml in the aggravation group (n=64) and it was -20 ml in the stable group (n=89), while it increased by 123 ml in the improved group (n=87)(p<0.001). The annual change in FEV1 was 67.8ml/year in the improving group, 30.4ml/year in the stable group and -36ml/year in the aggravation group. The multivariate logistic regression analysis showed that lower FEV1 and less positive bronchodilator response were significantly associated with RV/TLC aggravation. Conclusion: 1 year change in RV/TLC is a predictor of long term FEV1 decline in the COPD patients treated by bronchodilator inhaler therapy.

건강한 성인 남녀에서 폐기능과 고감도 C-반응성단백질 관련성

공은희 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.2

Background: The aim of this study was to evaluate the association of high sensitive C-reactive protein(hs-CRP) with pulmonary function as forced expiratory volume in 1 second(FEV1) within the normal range of predicted FEV1(%). Methods: The data was analyzed in healthy adult, who had visited a health promotion center at a university hospital from January, 2007 to July, 2009. Elevated hs-CRP(≥2.2 mg/L) level in relation to the values of predicted FEV1(%) as pulmonary function was studied by multiple logistic regression analysis. Results: In this cross-sectional study, there was an inverse association between hs-CRP levels and quartiles of predicted FEV1(%) in healthy adults.(P for trend=0.02 in men, P for trend<0.001 in women) The odds ratios of having elevated hs-CRP(≥2.2 mg/L) across predicted FEV1(%) quartiles, with the highest quartile(Q1) as the basal group, was 3.8(95% CI, 1.1∼3.1) in men, 4.3(95% CI, 1.1∼15.1) in women after adjusting for the confounding variables. Conclusion: The decline of predicted FEV1(%) within the normal range was inversely associated with low grade inflammation as measured by hs-CRP in healthy adults. This result showed that systemic inflammation may be linked to early impaired pulmonary function in healthy adults.

천식 환아에서 메타콜린 기관지유발시험 중 천명의 발생과 천식 발작 중증도의 관계

남궁욱 ( Koong Wook Nam ),김동현 ( Dong Hyun Kim ),정우식 ( Woo Sik Jung ),곽종훈 ( Jong Hoon Kwak ),임대현 ( Dae Hyun Lim ),김정희 ( Jeong Hee Kim ),손병관 ( Byong Kwan Son ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 Allergy Asthma & Respiratory Disease Vol.19 No.1

목적: 2005년 세계 천식 관리 지침(Global Initiative for Asthma, GINA guideline 2005) 에서는 천명의 높이와 크기를 이용하여 천식의 중증도를 평가할 것을 제안하였다. 그러나 천명과 직접적인 폐기능 감소 간의 관련성에 대한 객관적인 연구는 부족한 실정이다. 본 연구에서는 천명시의 FEV1감소율 실측치를 국내 소아 환자들을 대상으로 측정하여 중등도 이상의 천식 발작으로 조기 분류하여 적극적인 치료 계획을 수립하기 위한 토대를 제공하고자 하였다. 방법: 2005년 5월부터 2006년 6월까지 천식이 의심되는 증상으로 인하대병원 소아청소년과 외래에 방문한 3세부터 18세까지의 환아 370명 중 메타콜린을 사용한 기관지유발시험에서 FEV1값이 기저치(baseline value)의 20%가 감소되었을 때의 메타콜린 농도(PC20)가 16 mg/mL 이하로 나타난 환아 228명을 대상으로 하였고, 이들에 대하여 전향적으로 문진, 신체검사, 폐기능 검사, 피부 단자검사, 말초혈액 호산구, 혈청 총 IgE, 비즙도 말 호산구 백분율 검사를 시행하였다. 결과: 총 228명의 환아들 중 127명(55.7%)이 검사 도중 천명이 나타났다. 이들 중 FEV1감소율이 20% 이상인 경우는 82명(64.6%)이었다. FEV1감소율이 20% 미만인 경우는 45명(35.4%, 228명 중 19.7%) 이었다. FEV1값이 20% 이상으로 떨어져 검사가 중지될 때까지도 천명음이 들리지 않은 환아는 101명(44.3%)이었다. 천명음이 들린 환아 127명의 메타콜린 PC20 기하평균(1SD의 범위)은 2.29 mg/mL (0.86-6.13)이었고, 천명음이 들리지 않은 환아 101명의 메타콜린 PC20 기하평균(1SD의 범위)은 4.11 mg/mL (1.82-9.24)로 천명음이 들린 환아들의 메타콜린 PC20 평균값이 유의하게 낮았다. 대상군 가운데 피부단자검사를 시행한 180명 중에서 아토피 양성그룹은 143명(79.4%)으로 이들의 메타콜린 PC20 기하평균(1SD의 범위)은 2.57 mg/mL (0.97-6.81)로 나타난 반면 아토피 음성그룹은 37명(20.6%)으로 이들의 메타콜린 PC20 기하평균(1SD의 범위)은 3.69 mg/mL (1.57-8.66)로 측정되어 양성그룹이 낮았다.(P<0.05) 결론: 우리는 이 연구에서 천명이 들리는 소아의 경우 대부분에서 FEV1 감소가 20% 이상임을 보였다. 따라서, 천명이 청진되는 소아 천식 환자들은 중등도 이상의 천식 발작으로 생각할 수 있으며, 이에 준하는 치료 계획을 수립하여야 할 것으로 사료된다. Purpose: Global Initiatives for Asthma (GINA guideline) 2005 suggests that the pitch and intensity of wheezing as the determinating factor for the severity of asthma exacerbation. However, there have not yet been sufficient data to support the correlation between wheezing and the severity of asthma exacerbation. This study was aimed to estimate the relationship between wheezing threshold and the level of forced expiratory volume in 1 second (FEV1). Methods: Among 370 pediatric patients who visited Inha University Hospital between May 2005 and June 2006, who underwent the methacholine bronchial challenge tests in order to diagnose asthma, 228 patients with PC20 less than 16 mg/mL were examined. Medical history, physical examination, skin prick test, eosinophil count and total IgE level in peripheral blood, and nasal smear for eosinophil count were performed. Results: Among the 228 patients 127 (55.7%) showed wheezing during the methacholine challenge test. Among the patient with wheezing 82 patients (36%) showed more than 20% fall of FEV1, and the other, 45 patients (19.7%), showed less than 20% FEV1%fall. One hundred one patients (43.3%) did not show any wheezing until the %fall of FEV1 was below 20%. The geometric mean (range of 1SD) [2.29 (0.86-6.13) mg/mL] of methacholine PC20 of the 127 patients with wheezing was significantly lower than that [4.11 (1.82-9.24) mg/mL] of the 101 patients without wheezing (P<0.001). The geometric mean (range of 1SD) of methacholine PC20 in the 143 patients with positive skin prick test results was 2.57 (0.97-6.81) mg/mL, which was significantly lower than that of the 37 patients with negative results [3.69 (1.57-8.66) mg/mL] (P<0.001). Conclusion: We could learn that most wheezing patients showed more than 20% fall of FEV1. Therefore, it is suggested that the asthmatic children with wheezing were regarded and treated as moderate or more severe state. [Pediatr Allergy Respir Dis(Korea) 2009;19:28-37]

조기발병형 파킨슨병환자와 정상인의 호흡 및 발성 특성 비교

전은애(Eun Ae Chun),손영호(Young Ho Shon),백승재(Seung Jae Baek),이필휴(Phil Hyu Lee),남정모(Chung Mo Nam),이지은(Ji Eun Lee),최예린(Yaelin Choi) 한국언어청각임상학회 2010 Communication Sciences and Disorders Vol.15 No.4

배경 및 목적: 파킨슨병은 호흡과 발성에 영향을 준다. 49세 이전에 발병하는 조기발병형 파킨슨병(young-onset parkinson’s disease: YOPD, 이하 YOPD)도 호흡과 발성에 문제가 있는지 보기 위해 정상군과 비교하여 살펴보고자 하였다. 또한 파킨슨병 환자의 음성에 관한 연구는 있었지만 YOPD 환자의 음성특성에 대한 호흡과 발성 기능에 대해서 연구된 선행연구는 찾아보기 어렵다. 방법: YOPD 환자군 6명과 빈도대응 시킨 정상군 6명을 대상으로 호흡기능 평가를 위하여 MicroQuarkⓇ를 이용하여 노력성 폐활량(forced vital capacity: FVC, 이하 FVC), 1초간 노력성 호기량(forced expiratory volume at one second: FEV1, 이하 FEV1)과 1초간 노력성 호기량의 노력성 폐활량에 대한 비(이하 FEV1/FVC)를, 음향학적인 평가를 위하여 Multi-Dimentional Voice Program(이하 MDVP)를 이용하여 주기간 주파수 변동률 (이하 jitter)과 주기간 진폭 변동률(이하 shimmer)을, 공기역학적인 평가를 위하여 Phonatory Aerodynamic System(이하 PAS)를 이용하여 평균호기류율(mean airflow rate: MFR, 이하 MFR)과 성문하압(subglottal pressure: Psub, 이하 Psub)을, MDVP를 이용하여 최대발성지속시간(maximum phonation time: MPT, 이하 MPT)을 측정하고 분석하였다. 이비인후과 전문의사가 후두 스트로보스코피(stroboscopy)를 통해 후두의 병리 유무를 평가하였다. 두 집단의 호흡기능, 발성기능의 차이는 맨-휘트니 U검정(Mann-Whitney U-test)을 실시했다. 결과: MPT는 YOPD 환자군에 비하여 정상군이 통계적으로 유의하게 길었고, jitter와 shimmer는 정상군에 비하여 YOPD 환자군이 통계적으로 유의하게 컸다. 그러나 두 군간의 FVC, FEV1, FEV1/FVC, MFR, Psub은 통계적으로 유의한 차이가 없었다. 논의 및 결론: 두 집단 간의 호흡기능에서 차이가 없고 YOPD의 MPT, jitter, shimmer가 정상범주를 벗어나 차이가 있다. 이들 변수들이 YOPD의 음성적 진단, 치료계획과 예후를 판단하는데 도움이 될 것이다. 따라서 본 연구는 ‘연령’이라는 혼란변수를 배제하고 파킨슨병의 음성 특성을 규명 하는데 의의가 있다고 할 수 있다. Background & Objectives: Parkinson’s disease affects respiration as well as phonation. Young-onset Parkinson’s disease (YOPD) can occur even before the age of 49 years. The present study selected YOPD patients in such a manner as to exclude the confounding variable of ‘age’ and thus examine the vocal characteristics of Parkinson’s disease solely. We aimed to compare the respiration function and phonation characteristics of these YOPD patients with a normal group. Methods: The present study’s subjects included a YOPD group comprised of 6 patients whose chronological ages were between 38 and 49 years and onset ages were prior to 49 years, and a normal group comprised of 6 subjects selected by frequency-matching. For testing respiration function, FVC, FEV1 and FEV1/FVC were measured using Cosmed’s MicroQuarkⓇ as a basic test for the ventilation function of the lung. For vocal sampling, the Multi-Dimensional Voice Program (MDVP) and the Advanced Model 5105 of KayPENTAX’s Computerized Speech Lab (CSL) Model 4400 were used to analyze maximum phonation time (MPT), jitter, and shimmer. Additionally, KayPENTAX’s Phonatory Aerodynamic System (PAS) 4500 was utilized to analyze mean air flow rate (MFR) and subglottal pressure (Psub). Otolaryngologists and neurologists participated in the research cooperatively, and the otolaryngologists assessed the presence of laryngeal disease directly through larynx stroboscopy in the all subject. Mann-Whitney’s U test was used to analyze the difference between the 2 groups’ respiration and phonation function. Results: The MPT was longer in the normal group than YOPD patient group, and both jitter and shimmer were larger in the YOPD patient group than the normal group; both of these differences were statistically significant. However, there was no statistically significant difference in FVC, FEV1, FEV1/FVC, MFR, and Psub. Discussion & Conclusion: The 2 groups’ respiration function did not differ, and YOPD patients’ MPT, jitter, and shimmer differed beyond the normal range. Thus, these variables will help in YOPD patients’ phonation diagnosis and therapeutic plans or prognosis. Although there have been studies on the phonation of Parkinson’s disease patients, limited advanced research can be found on the respiration and phonation function of YOPD patients’ vocal characteristics. The results of this study are meaningful and provide a better understanding of Parkinson’s disease because the subjects were selected such that confounding by age was avoided.

신장과 노력성 호기곡선 지표간의 상관성

진복희 ( Bok Hee Jin ),박선영 ( Sun Young Park ),박혜림 ( Hyea Lim Park ) 대한임상검사과학회 2004 대한임상검사과학회지(KJCLS) Vol.36 No.2

Height has become one of the most important factors to determine the pulmonary function test index, and there is a high correlation between them, so that they have been utilized for evaluating pulmonary function test predictive value or nomogram. Therefore, we have tried to find out that difference and if there is any correlation and linear relationship between height and forced expiratory flow curve. There were a total of 163 subjects, male 93 and female 70. This study was done at the Department of Pulmonary Function Test of Jeon-Ju Presbyterian Hospital and we measured the index at the forced expiratory flow curve of FVC, FEV1.0, FEV1.0/FVC, FEF25-75%, and FEF200-1200㎖. When we subjected the group of height more than 160cm, there were gradual increments at FVC(p<0.001), FEV1.0(p<0.001), FEF25-75%(p<0.05) and FEF200-1200㎖(p<0.001), but no changes at FEV1.0/FVC in terms of forced expiratory flow curve index. We have analyzed the relationship between height and forced expiratory flow curve, there was a close relationship at FVC(r=0.670, p<0.01), FEV1.0(r=0.491, p<0.01), FEF25-75% (r=0.175, p<0.05) and FEF200-1200㎖(r=0.370, p<0.01) but there was reciprocal relationship at FEV1.0/FVC(r=-0.215, p<0.01). We have tried simple regression analysis to see if height affects forced expiratory flow curve index as a sector, and the result was FVC(ℓ)= 0.0642×height(㎝)-7.2978(p<0.01, R2=0.449), FEV1.0(ℓ)=0.0407×height(㎝)-4.2774 (p<0.01, R2=0.2411), FEV1.0/FVC(%) = -0.2892×height (㎝)+121.44(p<0.01, R2=0.0464), FEF25-75%(ℓ/sec)=0.0176×height(㎝)-0.7876(p<0.05, R2=0.0237), FEF200-1200 ㎖(ℓ/sec)=0.0967 ×height(㎝)-11.037(p<0.01, R2=0.1214) this was approved statistically. According to this study, if height is taller than average, forced expiratory flow curve index were increased, there was a close relationship between height and forced expiratory flow curve, and there was a linear relationship as sector between height and forced expiratory flow curve index. Therefore, researches that study other factors such as sex, age, weight, body surface area, and obesity indexes other than height should be done to see if there are any further relationships.

스쿼트 운동, 브레이싱 운동, 그리고 유산소 운동이 폐기능에 미치는 영향 비교

김현수,이건철,김충유 대한통합의학회 2022 대한통합의학회지 Vol.10 No.2

Purpose : The purpose of this study is to investigate the effect of squat, bracing and aerobic exercise on lung function, which is known to be effective for strength training, on lung function. Methods : The study was conducted with 33 students from Busan K university. Eleven students were assigned to squats, bracing, and aerobic exercise, six weeks three times a week. In order to measure lung activity, pony Fx manufactured the change amount of FVC ( forced vital capacity), FEV1 (Forced expiratory volume at one second), and FEV1/FVC % (forced vital capacity/forced expiratory volume at one second) was analyzed after inputting the information of experimental group A and B controls. As a method of measurement, the difference between the three groups was analyzed using repeated ANOVA. Results : 1. as a result of analyzing the effects of squat, bracing, and aerobic exercise for 6 weeks, all values of FVC, FEV1, FEV1/FVC % were increased from 0 weeks to 6 weeks except FEV1/FVC %. There was no significant difference in FVC from week 3 to week 6. 2. In the squat, bracing, and aerobic exercise, the changes in spirometry showed that the FVC, FEV1, and FEV1/FVC % values in bracing exercise were significantly increased with time than before exercise. 3. As a result of analyzing the changes in the spirometry of squat, bracing, and aerobic exercise, the FVC, FEV1, FEV1/FVC % values in the squat exercise showed statistically significant difference according to the period, but the lowest increase among the three groups. Conclusion : In conclusion, aerobic, bracing and squat exercises all had a significant impact on improving lung function. Therefore, even without aerobic exercise, squat or bracing exercise alone can be expected to improve lung function.

동적 코어 운동과 정적 코어 운동이 COVID-19 병력이 있는 남성 대학생의 폐 기능과 가슴 우리 가동성에 미치는 영향

김성호 대한치료과학회 2024 대한치료과학회지 Vol.16 No.1

Objective: The purpose of this study was to compare the effects of applying static core exercise(SCG) and dynamic core exercise(DCG) on lung function(FEV1, FEV6, FEV1/FEV6 ratio) and thoracic mobility in men in their 20s with a history of COVID-19. Method: SCG(n=10) and DCG(n=10) groups were received intervention 3 times per week for 4 weeks. A FEV1, FEV6, FEV1/FEV6 ratio, thoracic mobility were measured before and after interventions for each group. A paired t test was used to compare variables before and after intervention between groups, and the independent t test was used to compare variables before and after intervention between groups, and the significance level was p<.05. Results: There was a significant difference in the static core exercise group only in the thoracic mobility after the intervention(p<.05), The dynamic core exercise group had significant differences in FEV1, FEV6, and thoracic mobility after intervention(p<.05). There were no significant difference in FEV1, FEV6, FEV1/FEV6 ratio, thoracic mobility between the two groups before and after intervention. Conclusion: These results suggest that the dynamic core exercise is an effective intervention in increasing lung function and thoracic mobility in COVID-19 patients.

만성 폐쇄성 폐질환 환자의 중증도 분류시 FEV₁과 PEFR의 연관성

신상열,윤재호,김순종,유광하,Shin, Sang Youl,Ho, Yoon Jae,Kim, Sun Jong,Yoo, Kwang Ha 대한결핵및호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.58 No.5

Background : Measurement of the $FEV_1$ and PEFR in COPD patients is a significant indicator of the disease severity, the response to treatment and the acute exacerbation. However, it is not known if PEFR can be used to determine the severity of COPD because the agreement between PEFR and $FEV_1$ in COPD patients is not well known. Methods : From September, 2003 to August, 2004, 125 out patients with COPD who were treated at the pulmonary clinic in KonKuk University Hospital were enrolled in this study. The $FEV_1$ and PEFR of each patient were measured and all the data was analyzed using SPSS. Results : The average predicted $FEV_1$ % and PEFR % was $56.98{\pm}18.21%$ and $70{\pm}27.60%$, respectively. There was linear correlation between the predicted $FEV_1$ % and predicted PEFR %. There was no correlation between age of the COPD patients and the predicted PEFR %. There was correlation between dyspnea, which is a subjective symptom of the patients, and the predicted PEFR %. Conclusion : In COPD patients, the classification of the severity by PEFR tends to underestimate the state of the disease compared with the classification of the severity by the $FEV_1$. Therefore, the classification of the severity by PEFR should be interpreted carefully in patients with severe symptoms. Once the classification of the severity has made, the follow-up examination may use the PEFR instead of the $FEV_1$.

The Study on Respiratory Function, Spirometric Lung Pattern and Fatigue of Elderly in a Facility

Hee Joon Shin,Ji Sung Kim,Joong San Wang,Yoo Rim Choi,Hong Rae Kim,Si Eun Park,Ho Jung An,Kyung Ok Min 국제물리치료학회 2013 Journal of International Academy of Physical Ther Vol.4 No.1

The purpose of this study was to investigate spirometric lung pattern, respiratory function and degree of fatigue by lung function tests and fatigue tests of 39 elderly people in a care facility aged 65 and over. The respiratory function tests were used to the Spirovit SP-1 and fatigue tests were used modified Piper fatigue scale(mPFS). Regarding the respiratory function, the FVC was 1.41±0.36ℓ, the FVC % predicted was 69.10±14.98%, the FEV1 was 1.02±0.31ℓ, the FEV1 % predicted was 63.27±16.05%, the FEV1/FVC was 72.77±13.40%, and the fatigue score was 5.83±1.09. As for the spirometric lung pattern, 19 patients had a restrictive pattern(48.7%), followed by 11 with a mixed pattern(28.2%), 5 with an obstructive pattern( 12.8%), and 4 with a normal pattern(10.3%). Regarding the respiratory function and fatigue by spirometric lung pattern, the FVC and the FVC % predicted of patients with a normal pattern or an obstructive pattern were greater than other groups at a statistically significant level. As for the FEV1, that of patients with a normal pattern was significantly higher than others, and for the FEV1 % predicted, that of patients with a normal pattern or a restrictive pattern was significantly higher(p<.001). Fatigue score by patients with a normal pattern was significantly less than patients of other patterns(p<.001). Therefore, pulmonary physical therapy is considered necessary to improve respiratory function and fatigue degradation of elderly in a facility.