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.

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

연구배경 : COPD환자에서 질환의 중증도, 치료 반응정도, 급성악화등을 평가하는데 $FEV_1$과 PEFR이 중요한 측정지표로 사용되고 있다. 하지만 COPD환자에서 PEFR과 $FEV_1$의 일치성에 대해서는 잘 알려져 있지 않아 PEFR 측정이 중증도 분류 검사로 사용이 가능한지는 모르는 상태이다. 방 법 : 2003년 9월부터 2004년 8월까지 건국대학교 병원호흡기 내과 외래에서 진료받은 COPD환자 125명을 대상으로 $FEV_1$과 PEFR을 측정하여 그 결과를 통계, 분석하였다. 결 과 : $FEV_1$ 예측치의 평균은 $56.98{\pm}18.21$이었고 PEFR 예측치의 평균은 $70{\pm}27.60$로 PEFR 예측치가 $FEV_1$ 예측치보다 13%정도 높게 측정 되었다. 두 검사 사이에는 유의한 상관관계가 있었다. COPD환자들의 나이와 PEFR 과는 유의한 상관관계가 없었다. 주관적 증상인 호흡 곤란과 PEFR 과는 유의한 상관관계가 있었다. 결 론 : COPD 환자들에서 PEFR 을 이용한 중증도 분류시 $FEV_1$에 비해 경한 쪽으로 분류되는 성향이 있으므로 증상이 심한 경우 중증도 분류 해석에 주의를 요해야 하겠다. COPD 환자들에서 중증도 분류가 확정된 경우 추적 관찰은 PEFR 값으로 $FEV_1$을 대체하는 것이 가능할 것으로 생각된다. 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 $FEV_1$.

체중 잔차를 이용한 12세 아동의 정상 폐기능 예측식

강종원,성주헌,조수헌,주영수,Kang, Jong-Won,Sung, Joo-Hon,Cho, Soo-Hun,Ju, Yeong-Su 대한예방의학회 1999 Journal of Preventive Medicine and Public Health Vol.32 No.1

Objectives. Changes in lung function are frequently used as biological markers to assess the health effects of criteria air pollutants. We tried to formulate the prediction models of pulmonary functions based on height, weight, age and gender, especially for children aged 12 years who are commonly selected for the study of health effects of the air pollution. Methods. The target pulmonary function parameters were forced vital capacity(FVC) and forced expiratory volume in one second(FEV1). Two hundreds and fifity-eight male and 301 female 12-year old children were included in the analysis after excluding unsatisfactory tests to the criteria recommended by American Thoracic Sosiety and excluding more or less than 20% predicted value by previous prediction equations. The weight prediction equation using height as a independent variable was calculated, and then the difference of observed weight and predicted weight (i.e. residual) was used as the independent variable of pulmonary function prediction equations with height. Results. The prediction equations of FVC and FEV1 for male are FVC(ml) = $50.84{\times}height(cm)+7.06{\times}weight$ residual 4838.86, FEV1(ml) = $43.57{\times}height(cm)+3.16{\times}weight$ residual - 4156.66, respectively. The prediction equations of FVC and FEV1 for female are FVC(ml) = $42.57{\times}height(cm)+12.50{\times}weight$ residual - 3862.39, FEV1(ml) = $36.29{\times}height(cm)+7.74{\times}weight$ residual - 3200.94, respectively. 환경오염과 관련된 건강효과 연구에서 흡연, 직업 등 교란변수의 영향을 효과적으로 배제할 수 있으면서 폐기능검사가 제대로 시행될 수 있는 연구대상으로 선호되고 있는 특정 연령층인 12세 학동의 보다 정확한 FVC와 FEV1 예측식을 만 들고자 전국 11개 중학교의 학생들(남자 256명, 여자 301명)을 대상으로 측정된 신장, 체중, 그리고 폐기능검사 값으로 신장-체중의 회귀식을 유도하였고, 이를 통해 12세 인구의 신장별 표준체중을 산출하였다. 이 표준체중과 실측체중의 차이인 잔차를 독립변수로 하여 폐기능 예측 식을 남녀별로 만들었는데, 남자의 경우는, FVC(ml) = 50.84 $\times$ 신장(cm) + 7.06 $\times$ 체중 잔차 - 4838.86, FEV1(m1) = 43.57 $\times$ 신장(cm) + 3.16 $\times$ 체증 잔차 4156.66 이었다. 여자에서는 FVC(ml) = 42.57 $\times$ 신장(cm) + 12.50 $\times$ 체중 잔차 - 3862.39, 그리고 FEV1(ml) = 36.29 $\times$ 신장(cm) + 7.74 $\times$ 체중 잔차 - 3200.94 이었다. 이렇게 얻어진 예측값들의 설명력(R2)은 남자에서 FVC, FEV1가 각각 0.708, 0.670이었고, 여자에서는 FVC, FEV1가 각각 0.580, 0.513이었다.

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 소아알레르기 및 호흡기학회지 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]

천식 환아에서 메타콜린 기관지유발시험 중 천명의 발생과 천식 발작 중증도의 관계

남궁욱,김동현,곽종훈,김정희,손병관,정우식,임대현 대한 소아알레르기 호흡기학회 2009 Allergy Asthma & Respiratory Disease Vol.19 No.1

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. 목 적 : 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. 방 법 : 2005년 5월부터 2006년 6월까지 천식이 의심되는 증상으로 인하대병원 소아과 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, 피부단자검사, 말초혈액 호산구, 혈청 총 IgE, 비즙도말 호산구 백분율 검사를 시행하였다. 결 과 : 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) 결 론 : 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.

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.

만성폐쇄성폐질환자에서 질병 중증도 및 삶의 질을 비롯한 사회적 요인과 호흡곤란과의 관계

김은진 ( Eun Jin Kim ),박재형 ( Jae Hyung Park ),윤석진 ( Suk Jin Yoon ),이승준 ( Seung Jun Lee ),차승익 ( Seung Ick Cha ),박재용 ( Jae Yong Park ),정태훈 ( Tae Hoon Jung ),김창호 ( Chang Ho Kim ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.4

연구배경: 만성폐쇄성폐질환은 질병의 중증도를 추정 정상치에 대한 FEV1의 백분율을 기준으로 분류해 왔다. 그러나, 같은 폐기능 검사소견을 보이는 환자들 사이에서도 환자가 느끼는 주관적 호흡곤란에는 차이가 있다. 본 연구에서는 호흡곤란이 FEV1를 비롯하여, 건강관련 삶의 질, 주변으로부터 받는 도움의 정도, 직업 등에 영향을 받는지에 대해 알아보고자 하였다. 방법: 2002년 6월부터 2004년 5월까지 경북대학교병원 호흡기 내과에서 만성폐쇄성폐질환으로 추적관찰 중이며, 임상적으로 안정되어 있고 비가역적인 폐쇄성 폐기능 장애를 가진 환자 36명을 대상으로 하였다. 만성 폐쇄성 폐질환의 병기는, GOLD 병기를 따랐으며, 호흡곤란 척도는 MRC 호흡곤란 척도를 사용하였다. 건강 관련 삶의 질은 한국어 St. Goerge`s respiratory questionnaire(SGRQ)를 사용하였다. 결과: 환자들의 평균 FEV1은 추정 정상치의 32.0%였다. GOLD 병기와 호흡곤란 정도사이에 유의한 상관관계는 없었다(p=0.114). 호흡곤란이 심할수록 SGRQ 값의 증상(symptom)(p=0.041), 활동력 (activity)(p=0.004), 영향력(impact)(p=0.001), 총점(total)(p<0.001) 수치 모두에서 의미있게 높은 수치를 보였다. 호흡곤란 정도와 직업간에 의미있는 상관관계는 없었으며(p=0.259), 호흡곤란이 심할수록 환자가 주변으로부터 받는 도움 정도는 적다고 느끼는 상관관계가 뚜렷하였다(p=0.011). 결론: 만성폐쇄성폐질환자의 진료에서 환자가 느끼는 주관적인 호흡곤란은 FEV1에 따른 병기 외에도 건강관련 삶의 질 및 주변의 지지 정도와 더 연관성을 가질 수 있다는 점이 고려되어야 할 것으로 사료된다. Background: Chronic obstructive pulmonary disease(COPD) is categorized by the percentage of the predicted FEV1(Forced expiratory volume in 1 second) result which is highly correlated with disease severity(morbidity and mortality). In COPD patients, dyspnea seems to be different from disease severity. We investigated whether dyspnea is correlated with disease severity, as measured by FEV1, quality of life(QoL), occupation, and supporting level of family members and neighbors. Method: Thirty-six clinically stable patients with chronically irreversible airflow limitation were enrolled. We used the Medical Research Council(MRC) dyspnea scale to assess the level of dyspnea and the Korean St. Goerge`s respiratory questionnaire(SGRQ) as measure the QoL. Result: The mean percentage of the predicted FEV1 was 32.0%. Dyspnea was not correlated with GOLD stage using FEV1(p=0.114). With deteriorating level of dyspnea the scores of symptoms(p=0.041), activity(p=0.004), impact(p=0.001), and total SGRQ score(p<0.001) were significantly increased. Dyspnea was not correlated with the level of occupation(p=0.259). The supporting level of family members and neighbors was significantly negatively correlated with dyspnea scale(p=0.011). Conclusion: In the management of COPD patients, we have to remember that the level of subjective dyspnea is correlated with QoL(symptom, activity and impact on society) and social supporting level as well as GOLD stage(FEV1). (Tuberc Respir Dis 2006; 60: 397-403)

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.