약물요법을 받고 있는 성인 천식환자에서 폐기능의 종적 변화
Longitudinal Changes in Lung Functions in Adult Asthmatics Treated with Medications
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Lung functions in asthmatics may depend on various factors: reversible airway obstruction, irreversible airway obstruction associated with airway remodeling, more rapid decline in lung functions than non-asthmatics, and medication effect on decline in lung functions. This study aimed to investigate longitudinal changes in lung functions in adult asthmatics. Methods: Fifty-one adult asthmatics were included in the study. Their medical records were retrospectively reviewed. Lung functions were obtained at baseline, and visits 1, 2, 3 and 4, with intervals of 10∼15 months. Asthmatics were classified into those with forced expiratory volume in 1 second (FEV_1)≥80% predicted (normal lung function) and those with FEV_1＜80% (decreased lung function) in reference to baseline lung functions. Results: Annual decline rates of FEV_1 were −12.4±10.1 mL/yr in all asthmatics, −25.9±12.6 mL/yr in asthmatics with normal lung functions, and 14.7±13.8 mL/yr in asthmatics with decreased lung functions. FEV1 did not significantly change at visits 1, 2, 3 and 4 compared to the baseline value in all asthmatics and asthmatics with normal or decreased lung functions. FEV_1 values at visits 1, 2, 3, and 4 decreased only in 8.3%∼18.2% of asthmatics with normal lung functions and normalized only in 16.7%∼30% of asthmatics with decreased lung functions. Conclusion: In adult asthmatics treated with medications, irreversible airway obstruction may not occur in those with normal lung functions, while reduced functions may not normalize in those with decreased lung functions, in whom airway remodeling may have occurred early in the disease state.
Abstract
Background: Lung functions in asthmatics may depend on various factors: reversible airway obstruction, irreversible airway obstruction associated with airway remodeling, more rapid decline in lung functions than non-asthmatics, and medication effect on decline in lung functions. This study aimed to investigate longitudinal changes in lung functions in adult asthmatics. Methods: Fifty-one adult asthmatics were included in the study. Their medical records were retrospectively reviewed. Lung functions were obtained at baseline, and visits 1, 2, 3 and 4, with intervals of 10∼15 months. Asthmatics were classified into those with forced expiratory volume in 1 second (FEV_1)≥80% predicted (normal lung function) and those with FEV_1＜80% (decreased lung function) in reference to baseline lung functions. Results: Annual decline rates of FEV_1 were −12.4±10.1 mL/yr in all asthmatics, −25.9±12.6 mL/yr in asthmatics with normal lung functions, and 14.7±13.8 mL/yr in asthmatics with decreased lung functions. FEV1 did not significantly change at visits 1, 2, 3 and 4 compared to the baseline value in all asthmatics and asthmatics with normal or decreased lung functions. FEV_1 values at visits 1, 2, 3, and 4 decreased only in 8.3%∼18.2% of asthmatics with normal lung functions and normalized only in 16.7%∼30% of asthmatics with decreased lung functions. Conclusion: In adult asthmatics treated with medications, irreversible airway obstruction may not occur in those with normal lung functions, while reduced functions may not normalize in those with decreased lung functions, in whom airway remodeling may have occurred early in the disease state.
참고문헌 (32)
- Expert panel report 3: guidelines for the diagnosis and management of asthma, "National Heart, Lung and Blood Institute", National Institutes of Health, ~ (2007)
- Bateman ED, "GOAL Investigators Group. Can guideline- defined asthma control be achieved? The Gaining Optimal Asthma ControL study", Am J Respir Crit Care Med, 170, pp.836~844 (2004)
- O'Byrne PM, "Pharmacological management of mild or moderate persistent asthma", Lancet, 368, pp.794~803 (2006)
- Holgate ST, "The mechanisms, diagnosis, and management of severe asthma in adults", Lancet, 368, pp.780~793 (2006)
- Busse WW, "Asthma", N Engl J Med, 344, pp.350~362 (2001)
- Jeffery PK, "Remodeling and inflammation of bronchi in asthma and chronic obstructive pulmonary disease", Proc Am Thorac Soc, 1, pp.176~183 (2004)
- Tang ML, "Airway remodelling in asthma: current understanding and implications for future therapies", Pharmacol Ther, 112, pp.474~488 (2006)
- Payne DN, "Early thickening of the reticular basement membrane in children with difficult asthma", Am J Respir Crit Care Med, 167, pp.78~82 (2003)
- James AL, "Decline in lung function in the Busselton Health Study: the effects of asthma and cigarette smoking", Am J Respir Crit Care Med, 171, pp.109~114 (2005)
- Lange P, "A 15-year follow-up study of ventilatory function in adults with asthma", N Engl J Med, 339, pp.1194~1200 (1998)
- ten Brinke A, "Risk factors associated with irreversible airflow limitation in asthma", Curr Opin Allergy Clin Immunol, 8, pp.63~69 (2008)
- Dijkstra A, "Lung function decline in asthma: association with inhaled corticosteroids, smoking and sex", Thorax, 61, pp.105~110 (2006)
- Lange P, "Inhaled corticosteroids and decline of lung function in community residents with asthma", Thorax, 61, pp.100~104 (2006)
- de Marco R, "ECRHS Therapy Group. Inhaled steroids are associated with reduced lung function decline in subjects with asthma with elevated total IgE", J Allergy Clin Immunol, 119, pp.611~617 (2007)
- Busse WW, "START Investigators Group. The Inhaled Steroid Treatment As Regular Therapy in Early Asthma (START) study 5-year follow- up: effectiveness of early intervention with budesonide in mild persistent asthma", J Allergy Clin Immunol, 121, pp.1167~1174 (2008)
- The Childhood Asthma Management Program Research Group, "Long-term effects of budesonide or nedocromil in children with asthma", N Engl J Med, 343, pp.1054~1063 (2000)
- Guilbert TW, "Long-term inhaled corticosteroids in preschool children at high risk for asthma", N Engl J Med, 354, pp.1985~1997 (2006)
- O'Byrne PM, "START Investigators Group. Effects of early intervention with inhaled budesonide on lung function in newly diagnosed asthma", Chest, 129, pp.1478~1485 (2006)
- Phelan PD, "The Melbourne Asthma Study: 1964-1999", J Allergy Clin Immunol, 109, pp.189~194 (2002)
- Vonk JM, "Risk factors associated with the presence of irreversible airflow limitation and reduced transfer coefficient in patients with asthma after 26 years of follow up", Thorax, 58, pp.322~327 (2003)
- ten Brinke A, "Factors associated with persistent airflow limitation in severe asthma", Am J Respir Crit Care Med, 164, pp.744~748 (2001)
- Miller MR, "ATS", ERS Task Force. Standardisation of spirometry, 2005, pp.26, 319~338
- Expert panel report 2: guidelines for the diagnosis and management of asthma, "National Heart, Lung and Blood Institute", National Institutes of Health, ~ (1997)
- Panettieri RA Jr, "Natural history of asthma: persistence versus progression-does the beginning predict the end?", J Allergy Clin Immunol, 121, pp.607~613 (2008)
- Hoshino M, "Inhaled corticosteroid reduced lamina reticularis of the basement membrane by modulation of insulin-like growth factor (IGF)-I expression in bronchial asthma", Clin Exp Allergy, 28, pp.568~577 (1998)
- Henderson WR Jr, "A role for cysteinyl leukotrienes in airway remodeling in a mouse asthma model", Am J Respir Crit Care Med, 165, pp.108~116 (2002)
- Jeffery PK, "Effects of treatment on airway inflammation and thickening of basement membrane reticular collagen in asthma. A quantitative light and electron microscopic study", Am Rev Respir Dis, 145, pp.890~899 (1992)
- Ward C, "Airway wall remodelling: the influence of corticosteroids", Curr Opin Allergy Clin Immunol, 5, pp.43~48 (2005)
- Jenkins HA, "A comparison of the clinical characteristics of children and adults with severe asthma", Chest, 124, pp.1318~1324 (2003)
- Burrows B, "Findings before diagnoses of asthma among the elderly in a longitudinal study of a general population sample", J Allergy Clin Immunol, 88, pp.870~877 (1991)
- Gelb AF, "Unsuspected loss of lung elastic recoil in chronic persistent asthma", Chest, 121, pp.715~721 (2002)
- Ulrik CS, "Outcome of asthma: longitudinal changes in lung function", Eur Respir J, 13, pp.904~918 (1999)