460 32nd World Congress of Internal Medicine (October 24-28, 2014)
The Korean Academy of Tuberculosis and Respiratory Diseases
PS 1607 COPD
The Impact of COPD on Survival of Patients with Small Cell Lung Cancer
Sunmi Ju1, Tae Won Lee1, Wan Chul Kim1, Seung Hun Lee1, Yu Ji Cho1, Yi Yeong Jeong1, Ho Cheol Kim1, Jong Deog Lee1, Young Sil Hwang1, Seung Jun Lee1
Division Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Korea1
Background: There is a growing interest in the association between chronic obstruc- tive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC). However, to the best of our knowledge, there are no previous studies to investigate the impact of COPD on the patients with small cell lung cancer (SCLC). The aim of this study is to compare the mortality and clinical characteristics of patient with SCLC according to the presence of COPD.
Methods: We reviewed medical records of 110 patients with SCLC who had started chemotherapy at Gyeongsang National University Hospital from July 2006 to Oc- tober 2013. The clinical characteristics between COPD and non-COPD groups were compared, and the impact of coexisting COPD on survival of patients with SCLC was assessed.
Results: Of all 110 patients with SCLC, COPD was present in 57 patients (51.8%). There were no differences in age, sex, body mass index, smoking status, Eastern Cooperative Oncology Group Performance Status (ECOG PS), stage of SCLC, and comorbidities be- tween COPD and non-COPD groups. More patients with COPD had a higher modifi ed Medical Research Council scale, but other symptoms at presentation were compara- ble. The mean overall survival time of patients with COPD was shorter (14.7 ± 12.8 months) than that of patients without COPD (17.7 ± 16.6 months), which was not statistically signifi cant (log-rank test, p=0.289). After multivariate analysis, ECOG PS = 2 and extensive stage of SCLC were independent risk factors for shorter survival, but coexisting COPD was not predictor of survival.
Conclusions: COPD present over half of the patients with SCLC. But coexisting COPD doesn’t infl uence on the mortality of the patients with SCLC in this study.
PS 1608 Mycobacterial Diseases Changes of Lung Function According to the Anatomical Involvement Before and After Pulmonary Tuberculosis
Yousang Ko1, Ho Young Lee1, Young Seok Lee1, Junwhi Song2, Goohyeon Hong3, Mi- Yeong Kim1, Hyun-Kyung Lee1, Young-min Lee1, Seok Jin Choi4
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Korea1, Division of Pulmonary Medicine, Gumi CHA Hos- pital, CHA University School of Medicine, Korea2, Devision of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Dankook University Hospital, Korea3, Department of Radiology, Inje University College of Medicine, Korea4
Background: Almost previous studies have evaluated the pulmonary impairment in pulmonary function test (PFT) during and after pulmonary tuberculosis (TB). The aim of this study was to evaluate the change of lung function by means of quantifying the lung function in the same individuals both before and after the occurrence pulmonary TB, as well as the different change of lung function according to disease extents based on number of lobes involved on chest computed tomography.
Methods: The changes of lung function and predictors from patients with pulmonary TB according to disease extents were evaluated. Localized and advance pulmonary TB was defi ned as one or less and two or more involvement of lobe by TB, respectively.
Results: In total, 41 patients were included. The patients were predominantly male (70%) and old (median age, 63.5 years, IQR, 56.5–69.8 years). The advanced TB group had a median decline in FEV1 of 0.3L (0.2-0.6) and the localized TB group had a medi- an decline of 0.1L (0.0-0.2) (△FEV1, % predicted, 14.5% (7.3-25.1) vs. 5.6% (2.8-9.7)).
For FVC, the median decline in the advanced TB group was 0.45L (0.2-0.5) compared with 0.2L (0.0-0.3) in the localized TB group (△FVC, % predicted, 11.5% (8.9-25.6) vs.
4.1% (1.4-8.9). In multivariate analysis, remarkable lung function decline of FEV1 and FVC was independently associated with advanced TB.
Conclusions: The localized pulmonary TB does not lead to significant pulmonary impairment. However, further lung function decline occurred in cases of advanced pulmonary TB. In addition, advanced pulmonary TB was independently associated with remarkable lung function decline in FEV1 and FVC after pulmonary TB.
PS 1609 Mycobacterial Diseases Non-Tuberculosis Mycobacteria Related Liquefactive Necrosis of Progressive Massive Fibrosis in a Coal Briquettes Manufacture Factory Worker
J un-Pyo Myong1, Younmo Cho1, Jong In Lee1, Hyoung-Ryoul Kim1, Jung-wan Koo1 Department of Occupational and Environmental Medicine, Seoul St. Mary`s Hospital, The Catholic Uni- versity of Korea, Korea1
Background: Pneumoconiosis is common among those who exposured to massive coal dust. The patient with pneumoconiosis are apt to co-morbid with non-tuberculo- sis mycobacteria infection. We can fi nd prominent process of liquefactive necrosis of progressive massive fi brosis (PMF) from a coal briquettes manufacture factory worker.
Methods: 73 years old male worked for a coal briquettes manufacture factory for 20 years, and retired. A ILO classifi cation of his chest X ray graph was (2/3, p/q, 6 lung zone, em, tbi, id B). He has complaint melanoptysis since several months. The serial computed tomograph and sputum analysis were followed.
Results: With increased black colored sputum, an air-fl uid level was formed at the PMF at right upper lung fi eld from Apr 05 2013. Black colored secretion was drained from whole the bronchus under bronchocsopy at Apr 02 2013. M. Intracellulare was identified at sputum & BAL fluid AFB. Finally, a cavitary lesion remained. Another air-fl uid level was shown at the small sized PMF at left middle lung fi eld from Jul 31 2013. We can show those serial radiological and biological fi ndings and while follow up of patients with complicated pneumoconiosis.
Conclusions: Aspergilluma is apt to be followed by a cavitary lung lesion. Therefore, those patients with PMF necrosis might have more poor prognosis due to a massive hemoptysis by angiogenesis of lung vasculatures. To prevent fatal events, further eval- uation should be followed NTM related liquefactive necrosis of PMF.
PS 1610 Mycobacterial Diseases Serum Concentrations of Second-Line Anti-
Tuberculosis Drugs in Multidrug-Resistant Tuberculosis
Jong Sun Park1, Yeon Joo Lee1, Se Joong Kim1, Young Jae Cho1, Ho-Il Yoon1, Choon- Taek Lee1, Jae Yong Chung2, Junghan Song3, Jae-Ho Lee1
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National Uni- versity College of Medicine, Seoul National University Bundang Hospital, Korea1, Department of Clinical Pharmacology and Therapeutics, Seoul National University Bundang Hospital, Korea2, Department of Laboratory Medicine, Seoul National University Bundang Hospital, Korea3
Background: Therapeutic drug monitoring of second-line anti-tuberculosis drugs may be useful in the treatment of multidrug-resistant tuberculosis (MDR TB). However, little is known about the pharmacokinetics of second-line anti-tuberculosis drugs.
Methods: We evaluated pharmacokinetics and serum concentrations of second-line anti-tuberculosis drugs in 14 patients with MDR pulmonary TB between February 2013 and March 2014. Blood samples were collected 0.5, 1, 2, 4, 6 and 12h after simultaneous cycloserine (CS), p-aminosalicylic acid (PAS), prothionamide (PTH) inges- tion. Serum concentration was measured by ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). The Maximum serum concentrations (Cmax), time to achieve maximum serum concentrations (Tmax), half-life (T1/2) and the areas under the serum concentration-time curve (AUC) were determined.
Results: The Cmax were 21.9 ± 14.2, 45.2 ± 21.0, 3.1 ± 1.9 mg/L in CS, PAS and PTH, respectively. Tmax were 2 h in all of the three drugs. The AUC were 198.3 ± 114.6 in CS, 160.7 ± 93.1 in PAS, 9.8 ± 12.4 mg*h/L in PTH. In 9 patients (64%), Cmax of CS was below the reference range. The Cmax of PAS and PTH was below the reference range in 2 and 4 patients, respectively. Post 2h serum concentrations of CS, PAS and PTH showed good correlation with Cmax and AUC of them.
Conclusions: Serum concentrations of CS, PAS and PTH varied considerably in Korean MDR TB patients. The peak serum concentration of CS was low in 60% of the pa- tients. Therapeutic drug monitoring may be needed to identify patients with subther- apeutic second-line anti-tuberculosis serum concentrations.
