Sang-Do Lee

Ulsan University Hospital, Urusan, Ulsan, South Korea

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Publications (61)115.73 Total impact

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    ABSTRACT: Although many patients with severe emphysema have benefited from bronchoscopic lung volume reduction (BLVR) worldwide, experience of BLVR in Asian emphysema patients is scarce. Between July 2012 and March 2013, seven patients with advanced heterogeneous emphysema underwent BLVR in the Asan Medical Center. They had severe dyspnea and poor lung function (Modified Medical Research Council dyspnea scale 3-4; median forced expiratory volume in 1 sec [FEV1], 0.59 L [19.0 % predicted]; median 6-min walk distance [6MWD], 195 m). Endobronchial valves were inserted into the target lobe which was most hyperinflated and least perfused, and had no collateral ventilation with other lobes. Six patients showed clinical improvement after 1 month. Of them, 2 patients improved to dyspnea scale 1 and 4 patients did to scale 2 (P = 0.026). The median FEV1 increased from 0.59 to 0.89 L (51%; P = 0.028) and the median 6MWD increased from 195 to 252 m (29.2%; P = 0.028). Two patients developed a pneumothorax (one requiring drainage) and one patient experienced slight hemoptysis; however, there were no other serious adverse events. BLVR is effective in Asian advanced emphysema patients, with noted clinical improvements in lung function and exercise capacity.
    Journal of Korean medical science. 10/2014; 29(10):1404-10.
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    ABSTRACT: One objective was to evaluate the air trapping index (ATI), measured by inspiration/expiration CT, in COPD patients and nonsmokers. Another objective was to assess the association between the pulmonary function test (PFT) and CT parameters such as ATI or other indices, separately in the whole lung, in emphysema, and in hyperinflated and normal lung areas.
    European radiology. 09/2014;
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    ABSTRACT: We compared the survival of patients with idiopathic pulmonary arterial hypertension (IPAH), receiving conventional and targeted therapies.
    Heart & lung : the journal of critical care. 08/2014;
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    ABSTRACT: We aimed to investigate the treatment outcomes of patients with refractory Mycobacterium avium complex (MAC) lung disease treated with regimens containing drugs with unclear efficacy. Of all patients diagnosed with MAC lung disease between April 2004 and September 2012 at a tertiary referral center in South Korea, the outcomes of 51 patients treated with regimens containing drugs with unclear efficacy (clofazimine, moxifloxacin, rifabutin, and linezolid) because of treatment failure after receiving standard treatment were retrospectively analyzed. The mean age (standard deviation) of the 51 patients was 59.0 (10.3) years and 29 (56.9%) were male. The etiologic agent was M. avium in 17 patients (33.3%) and Mycobacterium intracellulare in 34 patients (66.7%); 42 patients (82.4%) had the fibrocavitary form of the disease. Of the 51 patients, 26, 28, 35, and 7 received clofazimine-, moxifloxacin-, rifabutin-, and linezolid-containing regimens (numbers are not mutually exclusive), with median drug administration durations of 147, 128, 209, and 88 days, respectively. Overall, 8 patients (15.7%) had a favorable response. Treatment outcomes did not differ by drug regimen or even by the combination of more than 2 drugs. The treatment outcomes of patients with refractory MAC lung disease were unsatisfactory with regimens containing possibly effective drugs such as clofazimine, moxifloxacin, rifabutin and linezolid.
    Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy. 06/2014;
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    ABSTRACT: Abstract Despite extensive effort, only a few chronic obstructive pulmonary disease (COPD)-associated genes have been suggested, indicating that there must be additional risk-associated loci. Here we aimed to identify additional COPD-associated SNPs and to explore the potential relationship between COPD subgroups and the SNPs in the Korean population. We performed a genome-wide association study (GWAS) with 990 Korean individuals; 102 COPD cases and 544 controls for GWAS using Affymetrix SNP array 5.0, and 173 COPD cases and 171 controls for replication. After validating the candidate single nucleotide polymorphisms (SNP), we performed subgroup analysis by disease phenotype. Through GWAS, we identified a novel SNP in the phosphodiesterase-4D (PDE4D) gene [rs16878037 (C>T), p = 1.66 × 10(-6)] that was significantly associated with COPD. This signal in PDE4D was successfully replicated in the independent set (p = 0.041). When we combined the discovery and replication data, the association signal became more significant (p = 5.69 × 10(-7)). In the COPD subgroup analysis, the T allele of rs16878037 was significantly more frequent in COPD patients without severe diffusion capacity impairment (mild mixed and obstruction-dominant group) than in patients with severe impairment (severe mixed and emphysema-dominant groups). This result supports that PDE4D polymorphisms might be involved in the susceptibility to COPD especially in non-emphysematous individuals and that they could also affect the responsiveness of the PDE4 inhibitor treatment.
    COPD. 06/2014;
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    ABSTRACT: We evaluated the predictive value of the COPD assessment test (CAT™) for exacerbation in the following six months or time to first exacerbation among COPD patients with previous exacerbations. COPD outpatients with a history of exacerbation from 19 hospitals completed the CAT questionnaire and spirometry over six months. Exacerbation events were prospectively collected using a structured questionnaire. The baseline CAT score categorised into four groups (0–9, 10–19, 20–29, and 30–40) showed strong prediction for time to first exacerbation and modest prediction for any exacerbation or moderate-severe exacerbation (AUC 0.83, 0.64, and 0.63 respectively). In multivariate analyses, the categorised CAT score independently predicted all three outcomes (p=0.001 or p<0.001). Compared with the lowest CAT score category, the higher categories were associated with significantly shorter time to first exacerbation and higher exacerbation risks. The corresponding adjusted median time was >24, 14, 9, and 5 weeks and the adjusted RR was 1.00, 1.30, 1.37, and 1.50 in the category of 0-9, 10-19, 20-29, and 30-40 respectively. Exacerbation history (≥2 vs. 1 event in the past year) was related to time to first exacerbation (adjusted HR 1.35; p=0.023) and any exacerbation during the study period (adjusted RR 1.15; p=0.016). The results of this study support the use of the CAT as a simple tool to assist in the identification of patients at increased risk of exacerbations. This could facilitate timely and cost-effective implementation of preventive interventions, and improve health resource allocation.
    Respiratory Medicine 02/2014; 108. · 2.59 Impact Factor
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    ABSTRACT: Background We aimed to identify the 1-year relapse rate and risk factors for patients with pulmonary tuberculosis (TB) treated with a 6-month daily regimen. Methods A total of 317 patients with pan-susceptible pulmonary TB who completed a 6-month daily course of treatment [2HRZ(E)/4HR(E)] were retrospectively analyzed. Results The mean age was 50.0±16.8 years and men were predominant (61.2%). All of 137 adults tested for HIV were negative. Six (1.9%) cases relapsed within one year. Relapse rate was higher in patients with a positive culture after 2 months of treatment (10.0%, p = 0.049) and in patients with both a positive culture after 2 months of treatment and cavitation on initial chest radiograph (18.2%, p = 0.015), whereas relapse rate in patients with cavitation alone was comparable to that of the total population (2.7%). Among various risk factors known to increase risk of relapse, the combined variable of cavitation and positive culture at 2 months (OR=15.56, 95% CI 2.56-98.71, p = 0.003) was only associated with increased relapse rate in a multivariate analysis. Conclusions Even with a 6-month daily treatment regimen throughout the intensive and continuation phases, the relapse rate was unacceptably high in patients with both a positive culture at 2 months of treatment and cavitation on baseline chest radiography. Intensification of treatment, such as an extension of treatment duration, should be considered in this category of patients.
    Respiratory medicine 01/2014; · 2.33 Impact Factor
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    ABSTRACT: We aimed to investigate the treatment outcomes of patients with refractory Mycobacterium avium complex (MAC) lung disease treated with regimens containing drugs with unclear efficacy. Of all patients diagnosed with MAC lung disease between April 2004 and September 2012 at a tertiary referral center in South Korea, the outcomes of 51 patients treated with regimens containing drugs with unclear efficacy (clofazimine, moxifloxacin, rifabutin, and linezolid) because of treatment failure after receiving standard treatment were retrospectively analyzed. The mean age (standard deviation) of the 51 patients was 59.0 (10.3) years and 29 (56.9%) were male. The etiologic agent was M. avium in 17 patients (33.3%) and Mycobacterium intracellulare in 34 patients (66.7%); 42 patients (82.4%) had the fibrocavitary form of the disease. Of the 51 patients, 26, 28, 35, and 7 received clofazimine-, moxifloxacin-, rifabutin-, and linezolid-containing regimens (numbers are not mutually exclusive), with median drug administration durations of 147, 128, 209, and 88 days, respectively. Overall, 8 patients (15.7%) had a favorable response. Treatment outcomes did not differ by drug regimen or even by the combination of more than 2 drugs. The treatment outcomes of patients with refractory MAC lung disease were unsatisfactory with regimens containing possibly effective drugs such as clofazimine, moxifloxacin, rifabutin and linezolid.
    Journal of Infection and Chemotherapy. 01/2014;
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    ABSTRACT: The traditional oxygen delivery methods for oxygen therapy are continuous flow oxygen (CFO) and demand oxygen delivery (DOD); however, wastage of oxygen is considerable in CFO, while DOD is uncomfortable for patients. Synchronized DOD (SDOD), which was designed to overcome the drawbacks of both CFO and DOD, supplies oxygen according to the patient's breathing pattern and the desired oxygen-saving. This study was conducted to examine the overall performance of SDOD in terms of oxygen saturation (SpO2), patients' comfort, and oxygen saving ratio (SR). Study subjects were patients who required oxygen for chronic obstructive pulmonary disease (COPD) or pneumonia. Patients received oxygen through nasal prongs by CFO and SDOD for 30 minutes each. SpO2 was measured every 10 minutes by pulse oximetry, and subjects recorded their level of comfort after 30 minutes. The flow rate of discharged oxygen was recorded to calculate SR. Ten patients (median age, 68 years; range, 56-86 years) were enrolled. The SpO2 of patients during SDOD (97±2%) was similar to that during CFO (96±3%) with no statistically significant difference (p=0.53). Patients reported SDOD to be more comfortable than CFO. Comfort score of subjects treated with SDOD was 7.05±2.07 (0: very uncomfortable, 10: very comfortable); this was significantly higher (p=0.02) than the comfort score (5.20±1.83) of subjects treated with CFO. The inputted SRs set by clinicians were very similar to calculated SRs. SDOD appears to be more suitable for oxygen therapy than CFO when considering SpO2, patients' comfort, and SR.
    Respiratory care. 12/2013;
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    ABSTRACT: Background: Published data concerning the utility of computed tomography (CT)-based lung volumes are limited to correlation with lung function. Objectives: The aim of this study was to evaluate the clinical utility of the CT expiratory-to-inspiratory lung volume ratio (CT Vratio) by assessing the relationship with clinically relevant outcomes. Methods: A total of 75 stable chronic obstructive pulmonary disease (COPD) patients having pulmonary function testing and volumetric CT at full inspiration and expiration were retrospectively evaluated. Inspiratory and expiratory CT lung volumes were measured using in-house software. Correlation of the CT Vratio with patient-centered outcomes, including the modified Medical Research Council (MMRC) dyspnea score, the 6-min walk distance (6MWD), the St. George's Respiratory Questionnaire (SGRQ) score, and multidimensional COPD severity indices, such as the BMI, airflow obstruction, dyspnea, and exercise capacity index (BODE) and age, dyspnea, and airflow obstruction (ADO), were analyzed. Results: The CT Vratio correlated significantly with BMI (r = -0.528, p < 0.001). The CT Vratio was also significantly associated with MMRC dyspnea (r = 0.387, p = 0.001), 6MWD (r = -0.459, p < 0.001), and SGRQ (r = 0.369, p = 0.001) scores. Finally, the CT Vratio had significant correlations with the BODE and ADO multidimensional COPD severity indices (r = 0.605, p < 0.001; r = 0.411, p < 0.001). Conclusion: The CT Vratio had significant correlations with patient-centered outcomes and multidimensional COPD severity indices. © 2013 S. Karger AG, Basel.
    Respiration 12/2013; · 2.92 Impact Factor
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    ABSTRACT: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.
    Tuberculosis and Respiratory Diseases 12/2013; 75(6):238-43.
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    ABSTRACT: COPD Diagnosis & Evaluation PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PMPURPOSE: The aim of this study was to evaluate the relationship between volumetric CT metrics and lung volume compartments measured by body plethysmography in patients with chronic obstructive pulmonary disease (COPD).METHODS: Data on a total of 156 patients with stable COPD from the Korean Obstructive Lung disease (KOLD) cohort were retrospectively analyzed. Volumetric CT was performed to quantify emphysema extent, air trapping, and large airway thickness. Lung volumes, including total lung capacity (TLC), vital capacity (VC), inspiratory capacity (IC), functional residual capacity (FRC) and residual volume (RV), were measured by body plethysmography. We examined the relationship between volumetric CT metrics and lung volume compartments.RESULTS: Of the 156 included patients, 150 (96%) were male, the mean age was 66.2 (SD: 7.5) years, mean smoking history was 45.7 (25.1) pack-years, and mean post-bronchodilator FEV1 was 52.8 (15.7) % of predicted value. The full inspiratory lung volume (Vinsp) and full expiratory lung volume (Vexp) measured by volumetric CT were highly correlated with the TLC and FRC (R=0.769, p<0.001, R=0.800, p<0.001). However, the mean Vinsp and Vexp were significantly lower than the mean TLC and FRC (6.04 vs 6.59, p<0.001, and 4.20 vs 4.54, p<0.001). Simple correlation analysis showed that CT emphysema extent was significantly correlated with TLC (% predicted) (R=0.454, p<0.01), FRC (% predicted) (R=0.500, p<0.001), RV (% predicted) (R=0.412, p<0.001), and IC/TLC (%) (R=-0.445, p<0.001). CT air-trapping index was also significantly correlated with TLC (% predicted) (R=0.492 p<0.01), FRC (% predicted) (R=0.555, p<0.001), RV (% predicted) (R=0.473, p<0.001), and IC/TLC (%) (R=-0.571, p<0.001). However, airway wall thickness was only correlated with IC/TLC (%) (R=-0.212, p=0.008). Multiple linear regression analysis showed that CT emphysema index, air-trapping index and airway wall thickness had independent association with IC/TLC (%).CONCLUSIONS: This study shows that volumetric CT metrics correlate relatively well with lung volume compartments measured by body plethysmography.CLINICAL IMPLICATIONS: Volumetric CT metrics is useful for assessing the lung volume compartments in patients with COPD.DISCLOSURE: The following authors have nothing to disclose: JaeSeung Lee, Sei Won Lee, Jin Won Huh, Yeon-Mok Oh, Sang-Do LeeNo Product/Research Disclosure Information.
    Chest 10/2013; 144(4_MeetingAbstracts):690A. · 7.13 Impact Factor
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    ABSTRACT: Although the efficacy of inhaled long-acting bronchodilators has been well documented in randomised controlled studies, whether similar effects are obtained in real-life clinical practice is not clear. In this study, we analysed the effect of inhaled long-acting bronchodilators in newly-diagnosed COPD patients. The Korean Health Insurance Review and Assessment Service databases were used. Participants ≥40-years-old who had not been diagnosed with COPD between 2007 and 2008 but were diagnosed and prescribed COPD medication in 2009 were designated as newly-diagnosed COPD patients. Patients were divided into three groups based on the use of bronchodilators, an inhaled long-acting bronchodilator (LA-B), an inhaled short-acting bronchodilator (SA-B) and an oral medication (OM) group. A total of 77,480 newly-diagnosed COPD patients with a mean age of 68.5 years, among which 43,530 (56.2%) were men, were included in the study. ER visits and hospitalisation were associated with SA-B group, male gender, older age, Medicaid coverage, tertiary healthcare centre visits and higher comorbidities. Multivariate analysis showed that the SA-B group was associated with more ER visits, recurrent ER visits, hospitalisation and recurrent hospitalisation (adjusted ORs [95% confidence intervals] = 4.32 [3.93-4.75], 6.19 [5.24-7.30], 5.04 [2.95-3.39], and 8.49 [7.67-9.39], respectively) compared with the LA-B group. Medical utilisation cost was also higher in the SA-B group. Inhaled long-acting bronchodilator use was associated with lower rates of hospitalisation, fewer ER visits and lower medical costs in newly-diagnosed COPD patients in real-life clinical practice.
    Respiratory medicine 08/2013; · 2.33 Impact Factor
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    ABSTRACT: We aimed to investigate the results of anti-tumor necrosis factor (TNF) therapy in patients with a previous history of tuberculosis (TB). A total of 101 patients with a previous history of TB receiving TNF antagonists between December 2004 and September 2012 at the Asan Medical Center in South Korea were retrospectively analyzed. The mean age of the 101 subjects was 40.4 ± 16.0 years and 51 patients (50.5%) were male. The underlying immune-mediated inflammatory diseases (IMIDs) were Crohn's disease in 55 (54.5%), rheumatoid arthritis in 27 (26.7%), and ankylosing spondylitis in 13 (12.9%) patients. Chest radiography findings were suggestive of previous TB lesions in 33 (32.7%) patients. The rates of positivity in the tuberculin skin test and interferon-gamma release assay were 21.8% (22/101) and 44.6% (45/101), respectively. Latent TB infection (LTBI) treatment was initiated in 11 subjects (10.9%) based on previous inappropriate anti-TB treatments (n = 10) or recent TB contact history (n = 1), irrespective of the LTBI test results. The median follow-up duration after the initiation of TNF antagonist therapy was 31.5 months. Active TB developed, six years after the initiation of TNF antagonist, in one patient (1.0%) who had not received LTBI treatment. The incidence rate of TB was calculated at 336 per 100,000 person-year (PY). Patients with IMIDs who have a previous history of TB can be treated with TNF antagonists with an acceptable incidence of TB, if LTBI treatment is performed based on clinical judgments including the adequacy of previous anti-TB treatment and recent contact history.
    Respiratory medicine 08/2013; · 2.33 Impact Factor
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    ABSTRACT: Some patients with chronic obstructive pulmonary disease (COPD) have pulmonary hypertension (PH) that adversely affects survival. We performed a systematic review and meta-analysis to assess whether PH-specific therapies have an effect for stable COPD. Data sources were Medline, EMBASE, Cochrane Central Register of Controlled Trials, Korea med and references from relevant publications. Randomized prospective trials that compared PH specific therapy in COPD for more than 6 weeks with placebo were included. The outcomes were the exercise capacity and adverse events. Four randomized controlled trials involving 109 subjects were included in the analysis. Two trials involved bosentan, one sildenafil and one beraprost. The studies varied in duration of treatment from 3 to 18 months. In a pooled analysis of four trials, exercise-capacity was not significantly improved with PH-specific treatment for COPD (risk ratio, -5.1; 95% CI, -13.0 to 2.8). COPD with overt PH significantly improved the exercise capacity (mean difference, 111.6; 95% CI, 63.3 to 159.9) but COPD with PH unknown did not (mean difference, 26.6; 95% CI, -24.3 to 77.5). There was no significant difference in hypoxemia (mean difference, 2.6; 95% CI, -3.7 to 8.8). PH specific treatments have a significant effect in improving exercise capacity in COPD with overt PH.
    Journal of Korean medical science 08/2013; 28(8):1200-6. · 0.84 Impact Factor
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    ABSTRACT: This study was conducted to investigate the association between the chronic obstructive pulmonary disease (COPD) assessment test (CAT) and depression in COPD patients. The Korean versions of the CAT and patient health questionnaire-9 (PHQ-9) were used to assess COPD symptoms and depressive disorder, respectively. In total, 803 patients with COPD were enrolled from 32 hospitals and the prevalence of depression was 23.8%. The CAT score correlated well with the PHQ-9 score (r=0.631; P<0.001) and was significantly associated with the presence of depression (β±standard error, 0.452±0.020; P<0.001). There was a tendency toward increasing severity of depression in patients with higher CAT scores. By assessment groups based on the 2011 Global Initiative for Chronic Obstructive Lung Disease guidelines, the prevalence of depression was affected more by current symptoms than by airway limitation. The area under the receiver operating characteristic curve for the CAT was 0.849 for predicting depression, and CAT scores ≥21 had the highest accuracy rate (80.6%). Among the eight CAT items, energy score showed the best correlation and highest power of discrimination. CAT scores are significantly associated with the presence of depression and have good performance for predicting depression in COPD patients.
    Journal of Korean medical science 07/2013; 28(7):1048-54. · 0.84 Impact Factor
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    ABSTRACT: BACKGROUND: The progression of lung hyperinflation in patients with chronic obstructive pulmonary disease (COPD) has not been studied in a long-term prospective cohort. We explored the longitudinal changes in lung volume compartments with the aim of identifying predictors of a rapid decline of the inspiratory capacity to total lung capacity ratio (IC/TLC). METHODS: The study population comprised 324 patients with COPD who were recruited prospectively. Annual rates of changes in pulmonary function, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV), vital capacity (VC), IC, and IC/TLC, were estimated using the random coefficient models. RESULTS: The mean annual rates of changes in pre- and post-bronchodilator FEV1 were -23.0 mL/year (p < 0.001) and -26.5 mL/year (p = 0.004). The mean annual rates of changes in VC, IC, TLC, and IC/TLC were -33.7 mL/year (p = 0.007), -53.9 mL/year (p < 0.001), -43.7 mL/year (p = 0.012), and -0.65 %/year (p = 0.001), respectively. RV, FRC, and RV/TLC did not change significantly during the study period. Multivariate logistic regression analysis showed that a high modified Medical Research Council (MMRC) dyspnea scale score, a high Charlson comorbidity index value, and low post-bronchodilator FEV1 were associated with rapid decline in IC/TLC. CONCLUSION: MMRC dyspnea scale, post-bronchodilator FEV1, and the Charlson comorbidity index at baseline were independent predictors of a rapid decline in IC/TLC.
    Beiträge zur Klinik der Tuberkulose 05/2013; · 2.06 Impact Factor
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    ABSTRACT: Abstract Background: Despite the high worldwide prevalence of asthma and headache, little is known about the association between these conditions. The objective of our study was to evaluate the association between asthma and daily headache in a representative sample of the general population of South Korea. Methods: We retrospectively analyzed 7,984 individuals included in the Second Korean National Health and Nutrition Examination Survey (KNHANES II), a prospectively administered survey performed in 2001 by a government organization within the Ministry of Health and Welfare. After adjustment of risk factors for daily headache, multivariate logistic regression analysis was performed to evaluate the association between asthma and daily headache. Results: Of 7,984 individuals, 69 (0.9%) had daily headache and 429 (5.4%) had asthma symptoms. Daily headache was significantly more prevalent in subjects with asthma symptoms (14/429, 3.3%) than in those without (55/7555, 0.7%; P<0.001). Of the 4,833 nonsmokers, 46 (1.0%) had daily headache and 287 (5.9%) had asthma symptoms, with daily headache being significantly more prevalent in subjects with asthma symptoms (11/231, 4.8%) than in those without (35/4602, 0.8%; P<0.001). Multivariate logistic regression showed that the odds ratios for daily headache were 2.3 (95% CI: 1.21-4.33, P=0.01) in all individuals with asthma symptoms and 3.4 (95% CI: 1.65-7.12, P=0.001) in nonsmokers with asthma symptoms. Conclusion: Individuals with asthma symptoms are at higher risk of daily headache than those without the symptoms, suggesting a link between these conditions.
    Journal of Asthma 05/2013; · 1.85 Impact Factor
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    ABSTRACT: Despite documented efficacy and recommendations, pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) has been underutilized. Home-based PR was proposed as an alternative, but there were limited data. The adequate exercise intensity was also a crucial issue. The aim of this study was to investigate the effects of home-based PR with a metronome-guided walking pace on functional exercise capacity and health-related quality of life (HRQOL) in COPD. The subjects participated in a 12-week home-based PR program. Exercise intensity was initially determined by cardiopulmonary exercise test, and was readjusted (the interval of metronome beeps was reset) according to submaximal endurance test. Six-minute walk test, pulmonary function test, cardiopulmonary exercise test, and St. George's Respiratory Questionnaire (SGRQ) were done before and after the 12-week program, and at 6 months after completion of rehabilitation. Thirty-three patients participated in the program. Six-minute walking distance was significantly increased (48.8 m; P = 0.017) and the SGRQ score was also improved (-15; P < 0.001) over the six-month follow-up period after rehabilitation. There were no significant differences in pulmonary function and peak exercise parameters. We developed an effective home-based PR program with a metronome-guided walking pace for COPD patients. This rehabilitation program may improve functional exercise capacity and HRQOL.
    Journal of Korean medical science 05/2013; 28(5):738-43. · 0.84 Impact Factor
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    ABSTRACT: BACKGROUND AND OBJECTIVE: CD8(+) cell infiltration and apoptosis of airway epithelial cells is increased in COPD. CD8(+) T cells induce apoptosis by releasing granzymes, which can also cause extracellular matrix degradation and remodeling. Granzyme B levels and T cells expressing granzyme B are increased in BAL fluid of COPD patients, which suggests that granzyme B may contribute to the pathogenesis of COPD. This study provides quantitation of granzyme B positive cells in relation to CD8(+) cells in the small airway walls of emphysema. METHODS: Antibodies against CD8 and granzyme B were used to identify CD8(+) and granzyme B(+) cells. Volume fraction (Vv) of CD8(+) and granzyme B(+) cells were quantitated by the point counting method in the small airways of 13 nonsmoker control subjects and 46 emphysema patients (14 panlobular (PLE) and 32 centrilobular (CLE) emphysema lungs). Immunohistochemical detection of macrophage scavenger receptor was also performed in randomly selected cases. RESULTS: The volume fraction of CD8(+) and granzyme B(+) cells in CLE were greater than those in control and PLE (both p<0.001) subjects. The volume fraction of granzyme B(+) cells was greater than that of CD8(+) cells (p=0.006) and not all CD8(+) cells were positive for granzyme B in CLE subjects. Monocytes expressing both granzyme B and macrophage scavenger receptor and granulocytes expressing granzyme B were identified. CONCLUSIONS: Up-regulation of granzyme B in CD8(+) and non-CD8(+) cells is an early phenomenon of small airway wall remodeling in centrilobular emphysema and suggests its possible role in the pathogenesis of COPD.
    Respirology 02/2013; · 2.78 Impact Factor

Publication Stats

461 Citations
115.73 Total Impact Points

Institutions

  • 2006–2014
    • Ulsan University Hospital
      Urusan, Ulsan, South Korea
    • Wonkwang University
      • College of Medicine
      Iksan, North Jeolla, South Korea
  • 2005–2014
    • Asan Medical Center
      • Department of Pulmonary and Critical Care Medicine
      Sŏul, Seoul, South Korea
  • 2013
    • Inje University Paik Hospital
      • Department of Internal Medicine
      Goyang, Gyeonggi, South Korea
  • 2006–2013
    • University of Ulsan
      • • Asan Medical Center
      • • College of Medicine
      Urusan, Ulsan, South Korea
  • 2011–2012
    • Sungkyunkwan University
      • Department of Molecular and Cell Biology
      Sŏul, Seoul, South Korea
    • Seoul National University Bundang Hospital
      Sŏul, Seoul, South Korea
  • 2005–2012
    • CHA University
      • College of Medicine
      Seoul, Seoul, South Korea
  • 2007
    • Chosun University
      • Department of Medicine
      Goyang, Gyeonggi, South Korea