본문 바로가기
KERD
논문KCI 등재

중증난치성 천식의 정의

Definition of Severe Refractory Asthma

조유숙
대한내과학회 (The Korean Association Of Internal Medicine)|2012.10|대한내과학회지 (The Korean Journal of Medicine)|제83권 제4호|pp. 417-423|DOI http://dx.doi.org/10.3904/kjm.2012.83.4.417

2

조회

0

다운로드

0

인용

0

참고문헌

키워드

정의분류ClassificationPhenotype다양성HeterogeneitySevere asthmaDefinitions중증 천식임상형
주제분류내과학

초록

중증 천식의 정의와 정확한 분류는 아직 완전히 정립되지 않았으며, 현재도 진행 중인 연구 과제라 할 수 있다. 또한, 치료에 대한 반응성이라는 측면에서 천식을 구분할 때는 중증 천식이 나머지 천식 환자군과 구분되는 하나의 임상형이기는 하나, 중증 천식 또한 매우 다양한 임상양상을 보이고 있어 ‘중증 천식’의 정의 확립과 더불어 각각의 임상형에 대한 명확한 분류와 정의가 절대적으로 필요하다. 현 시점에서 또 한 가지 생각해야 할 것은 현재 제시되고 있는 각 임상형이 장기적인 임상경과를 볼 때 안정적으로 유지되는 하나의 확립된 임상형이 될 수 있는지에 대한 문제이다. 특히 중증 천식을 정의하는 데 있어, 아직 밝혀지지 않은 어떤 기전에 의해 일시적으로 내인성의 중증 천식의 양상을 보이는 경우를 실제로 완전히 배제하기는 어렵기 때문이다. 결론적으로, 중증 천식 정의를 확립하기 위해서는 천식의 다양성을 이해하는 과정이 선행되어야 함이 특히 강조되어야 할 것이며, 이를 바탕으로 다양한 임상연구의 수행, 각 임상형을 구분해 내고 경과를 예측할 수 있는 특이적인 바이오마커의 발굴, 병인 기전연구 등의 기초연구를 진행해 가는 것이 중증 천식을 극복할 수 있는 최선의 전략이 될 것이다.

Abstract

Severe refractory asthma is a group of asthmatic patients showing heterogeneous phenotypes with frequent exacerbations and progressive airway remodeling despite high levels of therapy. Studies of severe asthma is difficult not only because of diverse pathogenesis, difficulty in translating pre-clinical human and animal models to clinical trials, and absence of biomarkers that predict therapeutic efficacy but because of lack of consensus on precise definition and diagnostic criteria of severe asthma. Furthermore, the burden of severe asthma is considerably high, therefore, there has been an urgent need for researching strategies to overcome severe asthma. In conclusion, precise characterization, exact definition, and appropriate classification of severe asthma would be critical to improve management of this challenging disease and these efforts could help to develop novel therapeutic strategies. (Korean J Med 2012;83:417-423)

참고문헌 (59)

  1. Bateman ED, "Global strategy for asthma management and prevention: GINA executive summary", Eur Respir J, 31, pp.143~178 (2008)
  2. Panickar JR, "Trends in deaths from respiratory illness in children in England and Wales from 1968 to 2000", Thorax, 60, pp.1035~1038 (2005)
  3. Bellia V, "Asthma in the elderly: mortality rate and associated risk factors for mortality", Chest, 132, pp.1175~1182 (2007)
  4. Boulet LP, "A guide to the translation of the Global Initiative for Asthma (GINA) strategy into improved care", Eur Respir J, 39, pp.1220~1229 (2012)
  5. Ducharme FM, "Long-acting beta2-agonists versus anti-leukotrienes as add-on therapy to inhaled corticosteroids for chronic asthma", Cochrane Database Syst Rev, pp.CD003137~ (2006)
  6. Ducharme FM, "Addition of long-acting beta2-agonists to inhaled steroids versus higher dose inhaled steroids in adults and children with persistent asthma", Cochrane Database Syst Rev, pp.CD005533~ (2010)
  7. Sullivan SD, "TENOR Study Group. Extent, patterns, and burden of uncontrolled disease in severe or difficult-to-treat asthma", Allergy, 62, pp.126~133 (2007)
  8. Antonicelli L, "Asthma severity and medical resource utilisation", Eur Respir J, 23, pp.723~729 (2004)
  9. Wenzel S., "Severe asthma: from characteristics to phenotypes to endotypes", Clin Exp Allergy, 42, pp.650~658 (2012)
  10. Wardlaw AJ, "Special issue on severe asthma", Clin Exp Allergy, 42, pp.611~ (2012)
  11. Durham A, "Steroid resistance in severe asthma: current mechanisms and future treatment", Curr Pharm Des, 17, pp.674~684 (2011)
  12. Blakey JD, "What is severe asthma?", Clin Exp Allergy, 42, pp.617~624 (2012)
  13. Hashimoto S, "Current treatment of severe asthma", Clin Exp Allergy, 42, pp.693~705 (2012)
  14. O'Byrne PM, "Severe asthma: future treatments", Clin Exp Allergy, 42, pp.706~711 (2012)
  15. Robinson CB, "Drug development for severe asthma: what are the metrics?", Pharmacol Ther, 135, pp.176~181 (2012)
  16. Barnes PJ., "Severe asthma: advances in current management and future therapy", J Allergy Clin Immunol, 129, pp.49~59 (2012)
  17. Thomson NC, "Emerging therapies for severe asthma", BMC Med, 9, pp.102~ (2011)
  18. Oliveinstein R, "Challeges in the management of severe asthma: role of current and future therapies", Curr Pharm Des, 17, pp.703~711 (2011)
  19. Jarjour NN, "Severe asthma: lessons learned from the National Heart, Lung, and Blood Institute Severe Asthma Research Program", Am J Respir Crit Care Med, 185, pp.356~362 (2012)
  20. Kupczyk M, "US and European severe asthma cohorts: what can they teach us about severe asthma?", J Intern Med, 272, pp.121~132 (2012)
  21. Gibeon D, "The investigation of severe asthma to define phenotypes", Clin Exp Allergy, 42, pp.678~692 (2012)
  22. Fitzpatrick AM, "Severe asthma in childhood: recent advances in phenotyping and pathogenesis", Curr Opin Allergy Clin Immunol, 12, pp.193~201 (2012)
  23. Wenzel SE., "Asthma phenotypes: the evolution from clinical to molecular approaches", Nat Med, 18, pp.716~725 (2012)
  24. Carlstrom L, "Severe asthma: what makes it so hard to manage?", Curr Allergy Asthma Rep, 9, pp.393~400 (2009)
  25. Soler-Cataluña JJ, "Consensus Document on the Overlap Phenotype COPD-Asthma in COPD", Arch Bronconeumol, 48, pp.331~337 (2012)
  26. Miravitlles M, "Difficulties in differential diagnosis of COPD and asthma in primary care", Br J Gen Pract, 62, pp.68~75 (2012)
  27. Kenn K, "Vocal cord dysfunction: what do we know?", Eur Respir J, 37, pp.194~200 (2011)
  28. Williams DJ, "Endobronchial tuberculosis presenting as asthma", Chest, 93, pp.836~838 (1988)
  29. Saliba J, "Asthma: the great imitator in foreign body aspiration?", J Otolaryngol Head Neck Surg, 41, pp.200~206 (2012)
  30. Bae YJ, "Severe asthma patients in Korea overestimate their adherence to inhaled corticosteroids", J Asthma, 46, pp.591~595 (2009)
  31. Gamble J, "The prevalence of nonadherence in difficult asthma", Am J Respir Crit Care Med, 180, pp.817~822 (2009)
  32. Kandane-Rathnayake RK, "Adherence to asthma management guidelines by middleaged adults with current asthma", Thorax, 64, pp.1025~1231 (2009)
  33. Melani AS, "Inhaler mishandling is very common in patients with chronic airflow obstruction and long-term home nebuliser use", Respir Med, 106, pp.668~676 (2012)
  34. Kennedy JL, "The role of allergy in severe asthma", Clin Exp Allergy, 42, pp.659~669 (2012)
  35. D'Amato G, "Urban air pollution and climate change as environmental risk factors of respiratory allergy: an update", J Investig Allergol Clin Immunol, 20, pp.95~102 (2010)
  36. Silverman RA, "Age-related association of fine particles and ozone with severe acute asthma in New York City", J Allergy Clin Immunol, 125, pp.367~373 (2010)
  37. Meghji Z, "Allergen inhalation challenge in smoking compared with non-smoking asthmatic subjects", Clin Exp Allergy, 41, pp.1084~1090 (2011)
  38. Vignoud L, "Smoking and asthma: disentangling their mutual influences using a longitudinal approach", Respir Med, 105, pp.1805~1814 (2011)
  39. Lee T, "Smoking, longer disease duration and absence of rhinosinusitis are related to fixed airway obstruction in Koreans with severe asthma: findings from the COREA study", Respir Res, 12, pp.1~ (2011)
  40. Boulet LP, "Influence of comorbid conditions on asthma", Eur Respir J, 33, pp.897~906 (2009)
  41. Bachert C, "Rhinosinusitis and asthma: a link for asthma severity", Curr Allergy Asthma Rep, 10, pp.194~201 (2010)
  42. Lin DC, "Association between severity of asthma and degree of chronic rhinosinusitis", Am J Rhinol Allergy, 25, pp.205~208 (2011)
  43. 김시환, "Predictors of bronchial hyperresponsiveness in chronic rhinosinusitis with nasal polyp", ALLERGY, 64, pp.118~122, BLACKWELL PUBLISHING
  44. Pawankar R, "Rhinosinusitis in children and asthma severity", Curr Opin Allergy Clin Immunol, 9, pp.151~153 (2009)
  45. Mastronarde JG, "Efficacy of esomeprazole for treatment of poorly controlled asthma", N Engl J Med, 360, pp.1487~1499 (2009)
  46. Bor S, "Prevalence of gastroesophageal reflux disease in patients with asthma and chronic obstructive pulmonary disease", J Gastroenterol Hepatol, 25, pp.309~313 (2010)
  47. Tsai MC, "Increased risk of concurrent asthma among patients with gastroesophageal reflux disease: a nationwide population-based study", Eur J Gastroenterol Hepatol, 22, pp.1169~1173 (2010)
  48. Lugogo NL, "Does obesity produce a distinct asthma phenotype?", J Appl Physiol, 108, pp.729~734 (2010)
  49. Hardin M, "The clinical features of the overlap between COPD and asthma", Respir Res, 12, pp.127~ (2011)
  50. Bush A, "WHO universal definition of severe asthma", Curr Opin Allergy Clin Immunol, 11, pp.115~121 (2011)
  51. Bel EH, "Diagnosis and definition of severe refractory asthma: an international consensus statement from the Innovative Medicine Initiative (IMI)", Thorax, 66, pp.910~917 (2011)
  52. Adcock IM, "Steroid resistance in asthma: a major problem requiring novel solutions or a non-issue?", Curr Opin Pharmacol, 4, pp.257~262 (2004)
  53. "The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma: European Network for Understanding Mechanisms of Severe Asthma", Eur Respir J, 22, pp.470~477 (2003)
  54. Dolan CM, "Design and baseline characteristics of the epidemiology and natural history of asthma: Outcomes and Treatment Regimens (TENOR) study: a large cohort of patients with severe or difficultto- treat asthma", Ann Allergy Asthma Immunol, 92, pp.32~39 (2004)
  55. Chung KF., "Inflammatory biomarkers in severe asthma", Curr Opin Pulm Med, 18, pp.35~41 (2012)
  56. Bossley CJ, "Pediatric severe asthma is characterized by eosinophilia and remodeling without T(H)2 cytokines", J Allergy Clin Immunol, 129, pp.974~982 (2012)
  57. Brightling CE, "Lung damage and airway remodelling in severe asthma", Clin Exp Allergy, 42, pp.638~649 (2012)
  58. Nakagome K, , Int Arch Allergy Immunol, 158(Suppl 1), pp.96~102 (2012)
  59. Poon AH, "Pathogenesis of severe asthma", Clin Exp Allergy, 42, pp.625~637 (2012)

관련 논문AI추천

중증난치성 천식의 치료남영희, 이수걸대한내과학회 · 대한내과학회지2012 · 제83권 제4호중증 천식의 임상적, 병태생리적 특징김상헌대한내과학회 · 대한내과학회지2012 · 제83권 제4호중증천식의 진단김주희대한내과학회 · 대한내과학회지2018 · 제93권 제2호새로운 천식 표현형의 등장권지원, 홍수종대한 소아알레르기 호흡기학회 · Allergy Asthma & Respiratory Disease2012 · 제22권 제2호천식진단과 조절수준평가에서 호기산화질소검사의 유용성김주희대한천식알레르기학회 · 천식 및 알레르기2012 · 제32권 제2호중증 천식과 기침송우정, 이영재, 이화영대한내과학회 · 대한내과학회지2023 · 제98권 제6호

이 간행물의 다른 논문 (9건)

중증 천식의 임상적, 병태생리적 특징김상헌pp. 424-429중증난치성 천식의 치료이수걸, 남영희pp. 438-443Sarcopenia의 최신지견: 근감소증홍상모, 최웅환pp. 444-454임상에서 사용하는 사구체여과율의 평가 공식이창화pp. 455-457COPD 환자에서 우울증 선별검사정기석, 이상도, 김현정, 오연목, 원왕연, 조준성, 황용일pp. 468-475
원문 보기