The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 421
Slide Session
OS-043 COPD
Effectiveness and Safety of Bronchoscopic Lung Volume Reduction by Endobronchial Valve in Korean Emphysema Patients
Tai Sun Park1, Jae Seung Lee1, Yeon-Mok Oh1, Sang-Do Lee1, Sei Won Lee1
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea1
Background: Although bronchoscopic lung volume reduction (BLVR) by endobronchial valve (EBV) has been demonstrated as an effective and a safe treatment of severe emphysema, there have been few cases treated with BLVR in Korea. We sought to assess the effectiveness and safety of BLVR using EBV in Korean patients with severe emphysema.
Methods: Patients with severe chronic obstructive pulmonary disease (COPD), and heterogeneous emphysema were eligible for this procedure. The most hyper-infl at- ed and the least perfused lobes were selected as target lobes. All target lobes had complete fi ssure on computed tomography. Before inserting EBV into target lobe, we checked if the target lobe had collateral ventilation with adjacent lobes. Pulmonary function test, exercise capacity, quality of life and adverse events were evaluated 24 weeks later.
Results: A total of forty-three patients were treated with EBV. Atelectasis of target lobe on a chest radiography occurred in 36 patients (83.7%). At 24 weeks, there were significant improvements in forced expiratory volume in 1 second (0.68±0.26 vs.
0.92±0.40 liters; p < 0.001), 6-min walk distance (233.5±114.8 vs. 299.6±87.5; p = 0.018), and modifi ed Medical Research Council dyspnea scale (3.67±0.64 vs. 2.61±1.16;
p = 0.001). However, COPD Assessment Test score did not improved significantly (25.51±6.31 vs. 24.91±6.40; p = 0.614). 10 patients (23.3%) underwent pneumothorax, and 1 patient (2.3%) was treated for pneumonia. Precipitating factors for pneumotho- rax included coughing, valsalva maneuver for urination or defecation, and bending.
Conclusions: BLVR with EBV showed clinical improvements with acceptable safety in Korean emphysema patients.
OS-044 COPD
Artifi cial Nanovesicles from Adipose Derived Stem Cells Is New Therapeutic Candidate to Induce Regeneration of Emphysematous Lung
You-Sun Kim1,2, Ji-Young Kim1, Ryeon Jin Cho2, Seiwon Lee3, Sang-Do Lee3, Yeon-Mok Oh2,3
Asan Institute for Life Science, Korea1, University of Ulsan College of Medicine, Korea2, Departure of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, Korea3
Background: Because it is expensive and low effect of adipose derived stem cells (ASCs) to induce regeneration of emphysematous lung in mice model, we applied new approach that artifi cial nanovesicles made by serial extrusion were injected into em- physematous mice lung.
Methods: Artificial nanovesicles were produced by the breakdown of ASCs pass- ing through a serial extrusion with fi lters (10, 5 and 1 μm). To induce emphysema, C57BL/6 mice were intratracheally injected with 0.4U of porcine pancreas elastase.
0.5 and 1.5 μg of artifi cial nanovesicles were intratacheally injected at 7 day after elastase injection and lung collected at 14 day after elastase injection. Lung regenera- tion was measured by mean linear intercept using (MLI) from lung histology stained by H&E.
Results: We observed that artifi cial nanovesicles were nanometer-sized (30 – 200 nm) on NanoSight analysis and simultaneously expressed extracellular vesicles’ and ASCs’
marker protein. 1 x 10 of ASCs produced 1.5 μg of Nanovesicles based on protein amount. Emphysematous lungs (MLI: 106 μm ± 11 μm, n=8) were slightly regenerated by systemic injected 1 x 10^5of ASCs (MLI: 87 μm ± 15 μm, n=5, p = 0.03). Regenera- tion in lung from elastase induced emphysema mice were improved in 0.5 (MLI: 82 μm
± 8 μm, n=9, p < 0.001) and 1.5 μg (MLI: 81 μm ± 13 μm, n=3, p = 0.04) of artifi cial nanovesicles injected mice compared with ASC injected mice.
Conclusions: Artifi cial nanovesicles from ASCs were more effective even with less amount of cells compared with ASCs only. Therefore, artifi cial nanovesicles may be new therapeutic candidate to regenerate emphysematous lung.
OS-045 COPD
The Economical Effect of Inhaler in Patients with Early Chronic Obstructive Pulmonary Disease
Jinkyeong Park1, Chin Kook Rhee4, Yong Bum Park3, Ki-Suck Jung3, Kwang Ha Yoo2 Wonkwang University Sanbon Hospital, Korea1, Konkuk University College of Medicine, Korea2, Hallym University Medical Center, Hallym University College of Medicine, Korea3, St. Mary’s Hospital, The Cath- olic University of Korea College of Medicine, Korea4
Background: Patients with chronic obstructive pulmonary disease (COPD) remain un- diagnosed and potentially unknown until the more advanced stages of the disease. The rate of FEV1 decline was greater in patients with less severe disease than those with more severe disease. We aim to investigate the cost-effectiveness of inhaled treat- ment in early COPD.
Methods: We reviewed the database of Korean adults recording less than 0.7 of FEV1/
FVC from the Korean National Health and Nutritional Examination Survey (KNHANES) and Korean National Health Insurance (NHI) from 2007 to 2009. The early COPD was determined with more than 50% of FEV1.
Results: 0f 1,919 patients who identifi ed with early COPD in KNANES, 120 patients were confi rmed that they visited hospital within the next year after diagnosis in NHI database. 58 (48%) patients were on inhaler for COPD. The others took oral medica- tions. In patients using inhaler regularly, medical costs of outpatient clinic were signif- icantly higher(P=0.012). However, totally medical costs including admission and emer- gency room were not different whether using inhaler or not. Multiple linear regression adjusting with age, sex, using inhaler, FEV1, income showed that smoking status was signifi cant factors affecting the number of medical utilizations(ß=4.26, P=0.008) and cost(ß=658352, P=0.022).
Conclusions: In early COPD patient, using inhaler did not cost more than taking the other type. The uncontrolled aggravating factors such as smoking increased directly medical costs in early COPD.
OS-046 COPD
The Economic Burden for Last 2 Years in Mild COPD Patients with or Without 2 Years Follow-Up After Diagnosis
Young Seok Lee1, Chin Kook Rhee2, Jin Hwa Lee3, Yong Bum Park4, Deog Kyeom Kim5, Yong Il Hwang4, Woo Jin Kim6, Yoonki Hong6, Ji Ye Jung7, Jinkyeong Park8, Hye Yun Park9, Kyung Hoon Min10, Ji-Yong Moon11, Kwang Ha Yoo12
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Korea1, Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic Univer- sity of Korea, Korea2, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Korea3, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Korea4, Division of Pulmonology, Department of Internal Medicine, Seoul National University Boramae Hospital, Korea5, Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, Korea6, Department of Internal Medicine and Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Korea7, Department of Pulmonary and Critical Care Medicine Wonkwang University, Sanbon Hospital, Korea8, Department of Internal Medicine, Samsung Medical Center, Univer- sity of Sungkyunkwan College of Medicine, Korea9, Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Korea University, Korea10, Department of Internal Medicine, Hanyang University College of Medicine, Korea11, Department of Internal Medicine, Konkuk University School of Medicine, Korea12
Background: Chronic obstructive pulmonary disease (COPD) is associated with sig- nifi cant economic burden, especially uncontrolled COPD. In addition, little report is available medical utilization and cost in patients with mild COPD. The aim of this study is to investigate the economic burden for last 2 years in mild COPD patients with or without 2 years follow-up after diagnosis.
Methods: Using the Korean National Health Insurance (NHI) database, mild COPD pa- tients were identifi ed. Medical utilization and costs were analyzed during last 2 years in patients with or without 2 years follow-up after diagnosis.
Results: Of a total of 1204 patients with mild COPD, 146 (12.1%) had follow-up dur- ing fi rst 2 years after diagnosis. We analyzed medical utilization and cost for last 3
