Relationship between duration of disease and bronchial responsiveness in 6.8 years old children with asthma

( Eunhee Shim ),( Jinho Yu ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.1

Purpose: Bronchial hyperresponsiveness is considered as a hallmark of asthma. The duration of asthma was demonstrated to be associated with bronchial responsiveness, expressed as methacholine PC20. We investigated the relationship between duration of asthma and percentage fall in forced vital capacity (FVC) at PC20 (ΔFVC), another index of bronchial responsiveness, which reflects excessive bronchoconstriction. Methods: Six- to 8-year-old children with asthma underwent methacholine inhalation test. The PC20 and ΔFVC were calculated for each individual. The subjects were classified into those with wheezing onset in the first three years of life (early-onset asthma [EA], n=63) and those with wheezing onset from three years onwards (late-onset asthma [LA], n=99). Results: From the time of wheezing onset, duration of asthma ranged from 0.2 to 8.3 years. The mean duration of asthma in patients with EA was 5.6 years (standard deviation [SD], 1.2 years), compared with 2.2 years (SD, 1.3 years) in the patients with LA. Patients with EA had a significantly lower forced expiratory volume in 1 second/FVC than did those with LA (84.6%±5.9% vs. 86.8%±5.1%, P<0.05). The ΔFVC was significantly higher in patients with EA than in those with LA (19.4%±5.1% vs. 17.0%±4.5%, P<0.01), but PC20 was not different between the two groups. In total subjects, asthma duration correlated significantly with ΔFVC (r=0.222, P<0.01), but not with PC20. Conclusion: These data suggest that prolonged asthma is associated with worsened bronchial responsiveness during childhood, and such an association may be reflected primarily by ΔFVC rather than PC20. (Allergy Asthma Respir Dis 2014;2:23-29)

기관지 천식의 기도과민 반응과 기관지폐포세척액 소견

이숙영(Suk Young Lee),송정섭(Jeong Sup Song),김영균(Young Kyoon Kim),김관형(Kwan Hyoung Kim),문화식(Hwa Sik Moon),박성학(Sung Hak Park) 대한내과학회 1995 대한내과학회지 Vol.48 No.2

Objectives: Chronic asthma has a number of characteristic feature: the increased airway responsiveness and the development of bronchial inflammation. Although mechanism of airway inflammation in bronchial asthma is not clear, activated T cell has an important role in migration and activation of inflammatory cells through secretion of lymphokine. Oxygen radicals produced by air-space cells are is increased in symptomatic asthma in relation to clinical disease activity. With this background, we examined whether lymphocyte subsets and oxygen radicals released from alveolar macrophage are increased in asthmatic subjects compared with controls, and are correlated with degree of bronchial inflammation or bronchial hyperresponsiveness in asthmatic subject. Method: 22 stable asthmatics and 8 healthy controls were participated in this study and stable asthmatics were divided into 3 group according to PC20 for methacholine: mild, moderate, and severe. We performed flow-cytomatry analysis of lymphocytes obtained from bronchoalveolar lavage (BAL) fluid and peripheral blood. The oxygen radicals released from alveolar macrophage was measured after either stimulated with phorbol myristate acetate (PMA) or non-stimulated states. Superoxide anion production were measured by spectrophotometeric assay using the principle of superoxide dismutase inhibitable cytochrome-C reduction. Total oxygen free radicals were measured by chemiluminescence using lucigenin. Results: 1) Total cell counts and composition of eosinophil significantly increased in patient with bronchial asthma compared with healthy controls (p<0.01). Of lymphocyte, composition of CD8+ cell significantly increased in patients with bronchial asthma (p<0.01). 2) There were no difference in composition of lymphocyte subset in peripheral blood between patients with bronchial asthma and controls (p>0.05). 3) The composition of CD4+ cell significantly increased in moderate and severe groups compared with mild group (p<0.05), whereas the composition of CD8+ cell were not different among 3 groups (p>0.05). 4) Superoxide anion and total oxygen radicals released from alveolar macrophage significantly increased in patients with bronchial asthma compared with controls (p<0.05). In moderate group, superoxide anion and total oxygen radicals released from alveolar macrophage was higher than controls when alveolar macrophage was stimulated with PMA (p<0.05). In severe group, they was higher than controls irrespective of PMA-stimulation (respectively, p<0.01, p<0.05). 5) There were correlation between superoxide anion released from alveolar macrophage after stimulation with PMA and composition of eosinophil in BAL fluid (p<0.05, r=0.47). Conclusion: This study incriminates a role for T cell (esp, CD4+, CD8+ cell) and reactive oxygen radicals released from alveolar macrophage in the development of bronchial asthma.

소아천식에 대한 임상적 고찰

김윤희,Kim, Yun-Hee 대한한방소아과학회 2002 대한한방소아과학회지 Vol.16 No.1

Objective : This study was to investigate more effective oriental medical treatment for Pediatric Bronchial Asthma Method : Aroma therapy and Herbal medicine was given to 28 pediatric bronchial asthma patients(19 males and 9 females) for about 5months from the First, August 1999 The Fifth, January 2002. Results: 1. Demographic factor : The sample consisted of 28 persons among whom 19 were male, 9 were female. The age ranges from 1 year old to 6 year old. Less than 2 year old were 4 and 2-6 year old were 20. 2.Residence : Apartment and villar dwellers were 19(67.9%), Residential street divellers were 9(32.1%). 3.Age distribution at on set : 6(21.4%) fell ill befor 1 year old and 22(78.6%) fell ill after 1 year old 4. The period of illness : 9(32.2%) suffered during 1-3 year and 6(21.4%) suffered during 6 mouth-1year and 6(21.4%) suffered during more than 3 year. 5. Frequency of the symptoms : The symptoms appeared 2-3 times a year in the case of 16(57.2%), one time a year in the case of 1, 4 times a year in the case of 6(21.4%). 6. Concomitance symptoms : All experienced coughing sign, wheezing, 23(82.1%) experienced epistaxis, nose dripping, 13(46.4%) got fever, anorexia. 7. Past history of illness : 16(57.1%) got brochiolitis, brochitis, 12(42.9%) suffered pneumonia, 9(32.1%) had allergic rhinitis. 2 had allergic rhinitis, sinusitis, atopic dermatitis, bronchial asthma, 3 got atopic dermatitis, bronchial asthma and 7 had allergic rhinitis, sinusitis, bronchial asthma, 8. Family disease : In the case of family disease, 21(75%) had allergic dermatitis, 9(42.9%) had bronchial asthma, 8(38.1%) had allergic dermatitis. 9. The symptoms became very severe in the change of season in the case of 13(46.4%) and in the case of 11(39.3%), the change of season made no difference 10. Associated caused of induction symtoms : 28(100%) got sick by common cold, infectional disease, 8(28.6%) got sick by cold food, cold air 11.The kind of therapy : 15(53.6%) got oriental therapy after occidental therapy, 11(39.3%) took only oriental therapy. 12. Improvement degree of each symptoms : In the case of cough and wheeze that are the main symptoms of bronchial asthma, 78.6% and 64.3% of the patients replied < improvement > and in the case of dyspnea, tachypnea 41.7% of the patients replied <improvement>. In other symptoms, all replied <improvement> 13. Degree of satisfaction : 19(67.9%) replied <satisfaction>, 2(7.1%) replied <very satisfaction>. Conclusion : Herbal medicine and aroma therapy proved to be a very effective oriental medical treatment for pediatric bronchial asthma.

기관지천식 환자의 혈중 eosinophil cationic protein 치와 기관지과민성과의 관계

유지훈,최재선,안창혁,이병훈,나문준,김재열,박인원,최병휘,허성호 ( Ji Hoon Yoo,Jae Sun Choi,Chang Hyuk Ahn,Byung Hoon Lee,Moon Jun Na,Jae Yul Kim,In Won Park,Byung Whui Choi,Sung Ho Hue ) 대한천식알레르기학회 1998 천식 및 알레르기 Vol.18 No.3

Background: Serum eosinophil cationic protein(ECP) level has been proposed as a indirect marker of eosinophilic inflammation of the airway in bronchial asthma. Objective'. To evaluate serum ECP against indirect clinical markers of disease, we compared bronchial obstruction, bronchial hyperresponsiveness and peripheral blood eosinophil counts, total IgE with serum ECP levels in patients with bronchial asthma and normal controls. Method: Fourty-two patients with bronchial asthma and twenty-six normal controls were enrolled. Measurement were made by spirometry, inhalation challenge with methacholine, peripheral blood eosinophil counts, total IgE and FEIA(fluoroenzymatic immunoassay) of serum ECP Result. Serum ECP levels were significantly higher in asthmatic patients than normal controls(p<0.0,5). Serum ECP levels were correlated with peripheral blood eosinophil counts(p<0.01, r=0.544) and bronchial hyperresponsiveness(PC,)(p<0.01, r=-0.456) in patients with bronchial asthma. Serum ECP levels were correlated with degree of bronchial obstruction(FEV, % to predicted value, FEV1/FVC%) in total subjects, but not in asthmatic patients. Conchcsion.' Serum ECP level may be used as indicator of disease activity in bronchial asthma and be helpful in differentiation between normal person and asthmatic patients on simple serological method. Further studies on the changes of serum ECP levels according to disease course and therapeutic responses are needed.

청소년기 장기간 천식 관해

고영률 ( Young Yull Koh ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.1

Asthma is a heterogeneous disorder with a variable course, characterized by episodes of cough, wheezing and shortness of breath, reversible airflow limitation, and bronchial hyperresponsiveness (BHR). It begins early in life in many subjects, and it is well recognized that over 50% of asthmatic children go into long-term clinical remission, defined as the complete absence of asthmatic symptoms and no asthma medication for at least 24 months, during adolescence. Several studies have shown spirometric abnormalities and BHR during clinical remission. It is unknown whether these functional abnormalities, which are supposed to be indicative of asthma severity with respect to symptomatic asthma, reflect persistent airway inflammation or merely indicate residual airway damage or are related to another mechanism such as a familial predisposition. It is likely that the nature of BHR in asthma remission is not same as that in symptomatic asthma. We have shown that the former condition is associated with lower levels of blood eosinophils and eosinophilic cationic protein, a lower degree of bronchial responsiveness to exercise, and a more common formation of plateau on the dose-response curve to high-dose inhaled methacholine (i.e., limited maximal airway narrowing), compared to the latter condition. It is still controversial whether BHR in adolescents with asthma remission is reduced by inhaled corticosteroids. Better understanding of the mechanisms that lead to asthma remission, especially that seen during adolescence, is likely to lead to significant advances in our understanding of asthma pathogenesis, and should provide insights into how remission might be induced with therapy. We still have minimal understanding of the mechanism underlying BHR in adolescents with asthma remission. Elucidation of this mechanism would be an important step towards new perspectives that see remission as the next therapeutic frontier in asthma. (Allergy Asthma Respir Dis 1(1):11-19, 2013)Allergy Asthma Respir Dis 1(1):11-19, 2013)

Relationship between duration of disease and bronchial responsiveness in 6–8 years old children with asthma

심은희,유진호 대한 소아알레르기 호흡기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.1

Purpose: Bronchial hyperresponsiveness is considered as a hallmark of asthma. The duration of asthma was demonstrated to be associated with bronchial responsiveness, expressed as methacholine PC20. We investigated the relationship between duration of asthma and percentage fall in forced vital capacity (FVC) at PC20 (ΔFVC), another index of bronchial responsiveness, which reflects excessive bronchoconstriction. Methods: Six- to 8-year-old children with asthma underwent methacholine inhalation test. The PC20 and ΔFVC were calculated for each individual. The subjects were classified into those with wheezing onset in the first three years of life (early-onset asthma [EA], n=63) and those with wheezing onset from three years onwards (late-onset asthma [LA], n=99). Results: From the time of wheezing onset, duration of asthma ranged from 0.2 to 8.3 years. The mean duration of asthma in patients with EA was 5.6 years (standard deviation [SD], 1.2 years), compared with 2.2 years (SD, 1.3 years) in the patients with LA. Patients with EA had a significantly lower forced expiratory volume in 1 second/FVC than did those with LA (84.6%±5.9% vs. 86.8%±5.1%, P<0.05). The ΔFVC was significantly higher in patients with EA than in those with LA (19.4%±5.1% vs. 17.0%±4.5%, P<0.01), but PC20 was not different between the two groups. In total subjects, asthma duration correlated significantly with ΔFVC (r=0.222, P<0.01), but not with PC20. Conclusion: These data suggest that prolonged asthma is associated with worsened bronchial responsiveness during childhood, and such an association may be reflected primarily by ΔFVC rather than PC20

기관지 천식 환자에서 혈청 IL - 6 , ICAM - 1 , RANTES 농도 측정의 임상적 의의

최재선(Jae Sun Choi),이병훈(Byung Hoon Lee),안창혁(Chang Hyuk Ahn),유지훈(Ji Hoon Yoo),나문준(Moon Jun Na),김재열(Jae Yeol Kim),박인원(In Won Park),최병휘(Byung Whui Choi),허성호(Sung Ho Hue) 대한내과학회 1998 대한내과학회지 Vol.55 No.5

Bronchial asthma is a chronic airway inflammation disorder involving lymphocyte activation and various cytokines secretion by lymphocyte. The inflammatory response results from a complex network of interactions between inflammatory cells (mast cells, eosinophils, macrophages) and resident cells belonging to the lung structure itself like EC, fibroblasts, or bronchial epithelial cells. IL-6 which is known to up-regulate the endothelial cell expression of adhesion molecules participating in the development of the inflammatory reaction in bronchial asthma is produced by alveolar macrophage. ICAM-1 is produced by bronchial epithelial cell and expression by endothelial cell, which is known to enhance of the influx of various cells, RANTES which is known to a potent chemoattractant for eosinophils, lymphocytes, and monocytes, a member of the CC chemokine family, is expressed by bronchial epithelial cell. To evaluate whether markers of lymphocyte activation are useful markers of disease activity in bronchial asthma, we measured slL-6, sICAM- 1, sRANTES in 42 patients with mild to moderate bronchial asthma and in 26 normal controls and con the result with other disease activity markers in asthma(pulmonary function, blood eosinophil counts). The mean level of sIL-6 was higher than that of normal control and correlated significantly with sICAM-1, FEV1% to predicted value. The mean level of sICAM-1 was higher than that of normal control and correlated significantly with FEV1%, FEV1% to predicted value. The mean level of sRANTES showed the tendency to be higher than that of normal control, but not significant statistically, and did not correlated with sIL-6, sICAM-1, FEV1%, FEV1% to predicted value, blood eosinophil counts. It appeared that sIL-6 and sICAM-1 could be a disease marker in bronchial asthma. But, clinical application of the measurement of these markers needs to be studied further.

학령 전기 환아에서 아토피성 천식과 비아토피성 천식의 메타콜린과 아데노신 기관지 유발검사의 비교

이진희,이주경,서동인,고영률 대한 소아알레르기 호흡기학회 2009 Allergy Asthma & Respiratory Disease Vol.19 No.4

Purpose : It is well known that atopy is a major determinant of bronchial hyperresponsiveness (BHR) in both asymptomatic and asthmatic children. However, the relationship between atopy and BHR has not been well studied in preschool children with asthma. The aim of this study was to evaluate and compare BHR to direct and indirect stimuli between young children with atopic asthma and those with nonatopic asthma. Methods : Methacholine and adenosine 5'-monophosphate (AMP) bronchial challenges were performed on 177 preschool children with asthma (145 atopics and 32 nonatopics) using a modified auscultation method. The endpoint was defined as the appearance of wheezing and/or oxygen desaturation. Results : While the geometric mean of methacholine endpoint concentration was not significantly different between atopics and nonatopics that of the AMP endpoint concentration was significantly lower in atopics than in nonatopics (25.5 vs. 59.4 mg/mL; P=0.032). A positive response to methacholine (an end-point concentration ≤8 mg/mL) was observed in 96.5% (140/145) of patients with atopic asthma and in 84.3% (27/32) with non-atopic asthma. The frequency of a positive response to AMP (an endpoint concentration ≤200 mg/mL) was 86.8% (126/145) in patients with atopic asthma and 75% (24/32) in these with non-atopic asthma. Conclusion : Atopics more frequently displayed BHR to AMP and had a higher responsiveness to AMP than nonatopics. These results suggest that atopic and non-atopic asthma in preschool children may be related to the distinctive pathophysiologic pathways. 목 적 : 간접적 기관지 수축제인 아데노신 기관지 과민성은 직접적 기관지 수축제인 메타콜린 기관지 과민성에 비해 아토피 상태를 좀 더 잘 반영하는 것으로 알려져 있으나, 이러한 비교가 학령 전기 소아에서는 아직 국내에 보고된 바 없다. 본 연구는 학령전기 소아를 대상으로 아토피성 천식과 비아토피성 천식에서 메타콜린에 대한 반응과 아데노신에 대한 반응의 차이가 있는지 알아보고자 하였다. 방 법 : 천식으로 진단받은 4-6세의 소아 177명을 대상으로 하였고 이 중에 아토피성 천식군이 145명, 비아토피성 천식군이 32명이었다. 메타콜린과 아데노신 흡입 검사를 시행하였고 기관지 유발검사에 대한 반응은 청진상 천명과 산소포화도의 저하를 기준으로 메타콜린 종점 농도(endpoint concentration)와 아데노신 종점 농도로 나타내었다. 기관지 과민성의 판정 기준은 각각 메타콜린 종점 농도가 8 mg/mL미만인 경우와 아데노신 종점농도가 200 mg/mL미만인 경우로 하였다. 결 과 : 아토피성 천식군에서 각각 96.5% (140명)와 86.8% (126명)가 메타콜린 기관지 유발검사와 아데노신 기관지 유발검사에 양성을 보였고, 비아토피성 천식군에서는 각각 84.3% (27명)와 75% (24명)가 메타콜린 기관지 유발검사와 아데노신 기관지 유발검사에 양성을 나타내었다. 메타콜린 종점 농도의 기하평균은 군간에 유의한 차이가 없었으나, 아데노신 종점 농도의 기하평균은 아토피성 천식군에서 25.5 mg/mL, 비아토피성 천식군에서 59.4 mg/mL으로 아토피성 천식군에서 유의하게 낮은 값을 보였다.(P=0.010) 결 론 : 학령 전기의 아토피성 천식 환아와 비아토피성 천식 환아에서 메타콜린 기관지 과민성은 유의한 차이가 나타나지 않았으나, 아데노신 기관지 과민성은 아토피성 천식 환아에서 의미있게 증가되었다. 학령 전기 천식 환아에서 아토피성 천식과 비아토피성 천식간에 발병기전의 차이를 아데노신 기관지 유발검사가 보다 민감하게 반영함을 시사한다.

Comparison of bronchial responsiveness assessing dose-response slope between cough-variant asthma and classic asthma in young children

( Jung Won Yoon ),( Hye Young Hur ),( Hye Mi Jee ),( Ji Hyeon Baek ),( Hyeong Yoon Kim ),( Youn Ho Shin ),( Man Yong Han ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.4

Purpose: Little data is currently available on the use of the impulse oscillometry system (IOS) parameter in analyzing the lung func-tion of young children with cough-variant asthma (CVA) and classic asthma. The aims of this study were to evaluate the bronchial responsiveness between patients with CVA and those with classic asthma using dose-response slope and various cutoff values. Methods: A methacholine challenge test and a pulmonary function test were performed in 43 children with classic asthma and 26 children with CVA using IOS, and the respiratory resistance (Rrs) and reactance (Xrs) were obtained. The bronchial responsiveness were assessed by provocative concentration causing an 80% fall from baseline in reactance at 5 Hz (PC80_Xrs5) and a 40% increase in resistance at 5 Hz (PC40_Rrs5) and calculating from the degree of dose-response slope (DRS) for airway resistance and reactance.Results: There was no significant difference in base lung function between the two groups. However, the mean DRS_Xrs5 and the number who showed more than an 80% fall in reactance were significantly higher in classic asthma group than those in CVA group (P=0.040 and P=0.040, respectively).Conclusion: The use of DRS in oscillatory reactance at 5 Hz is useful for the differential diagnosis of classic asthma and CVA based on bronchial hyperresponsiveness.

ORIGINAL ARTICLE : Comparison of bronchial responsiveness assessing dose-response slope between cough-variant asthma and classic asthma in young children

( Jung Won Yoon ),( Hye Young Hur ),( Hye Mi Jee ),( Ji Hyeon Baek ),( Hyeong Yoon Kim ),( Youn Ho Shin ),( Man Yong Han ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1991 소아알레르기 및 호흡기학회지 Vol.1 No.4

Purpose: Little data is currently available on the use of the impulse oscillometry system (IOS) parameter in analyzing the lung func-tion of young children with cough-variant asthma (CVA) and classic asthma. The aims of this study were to evaluate the bronchial responsiveness between patients with CVA and those with classic asthma using dose-response slope and various cutoff values. Methods: A methacholine challenge test and a pulmonary function test were performed in 43 children with classic asthma and 26 children with CVA using IOS, and the respiratory resistance (Rrs) and reactance (Xrs) were obtained. The bronchial responsiveness were assessed by provocative concentration causing an 80% fall from baseline in reactance at 5 Hz (PC80_Xrs5) and a 40% increase in resistance at 5 Hz (PC40_Rrs5) and calculating from the degree of dose-response slope (DRS) for airway resistance and reactance. Results: There was no significant difference in base lung function between the two groups. However, the mean DRS_Xrs5 and the number who showed more than an 80% fall in reactance were significantly higher in classic asthma group than those in CVA group (P=0.040 and P=0.040, respectively).Conclusion: The use of DRS in oscillatory reactance at 5 Hz is useful for the differential diagnosis of classic asthma and CVA based on bronchial hyperresponsiveness. (Allergy Asthma Respir Dis 2013;1:309-313)