The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 413
Slide Session
OS-013 PFT
Airfl ow Obstruction Is Associated with Nontuberculous Lesions on Simple Chest X-Ray
Sunmin Kim1, Dong-Chul Lee2, Yu-Il Kim1, Hong-Jun Shin1, Chul-Kyu Park1, Bo-Ram Lee1, Hee-Jung Ban1, Yong-Soo Kwon1, In-Jae Oh1, Kyu-Sik Kim1, Young-Chul Kim1, Sung-Chul Lim1
Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Korea1, Department of Internal Medicine, Kwangju Christian Hospital, Korea2
Background: The radiologic change and airway infl ammation by tuberculosis can be associated with airfl ow obstruction. However, the association between airfl ow ob- struction and abnormalities on chest X-ray other than tuberculosis (nontuberculous lesions) is not well known.
Objective: This study was to evaluate the association between airfl ow limitation and nontuberculous lesion on plain chest X-ray (CXR) in a population based sample.
Method: The data of the 5th Korea National Health and Nutrition Examination Sur- vey (5th KNHANES); a cross-sectional survey in the general population of Korea was analyzed. CXR fi ndings were categorized into 3 groups; normal, tuberculosis (active or inactive tuberculosis), and nontuberculous lesion (lung nodule, cancer, mediastinal disease, active other lung diseases, or inactive other lung diseases). We compared the prevalence of airfl ow obstruction according to the presence of the radiologic change by the tuberculosis or nontuberculous lesion.
Results: We analyzed 10,546 subjects (age> 40 years) who took the spirometry and simple chest radiography in 5th KNHANES. Airfl ow obstruction was defi ned as FEV1/
FVC <0.7. A total of 1,214 (11.5%) subjects showed airfl ow obstruction. A total of 949 (9.0%) and 495 (4.7%) subjects showed radiologic change by tuberculosis and nontuberculous lesion, respectively. Among them, 27.1% (n= 257/949) for tuberculosis and 22.0% for nontuberculous lesion (n= 109/495) had airfl ow obstruction. For the subjects with normal chest X-ray, the prevalence of airfl ow obstruction was only 9.3%.
The adjusted odds ratio for airfl ow obstruction according to the radiologic changes, tuberculosis and nontuberculous lesion, was 3.240 (95% CI: 2.633-3.988) and 2.491 (95% CI: 1.883-3.294), respectively.
Conclusion: The abnormal X-ray change by nontuberculous lesion as well as tubercu- losis was associated with airfl ow limitation.
OS-014 PFT
Clinical Usefulness of Impulse Oscillometry in Elderly Patients with Chronic Obstructive Airway Disease
Jin-Han Park1, Sun-Young Kim1, Hang-Jea Jang1, Hyun-Kuk Kim1, Chan-Sun Park1 Inje University Haeundae Paik Hospital, Korea1
Background: The aim of this study was to evaluate whether impulse oscillometry (IOS) can represent bronchodilator response and to distinguish between subtypes of chronic obstructive airway disease (COAD), especially in elderly patients.
Methods: We enrolled 66 elderly (mean age 74±11) patients with chronic obstructive airway disease, including 33 asthma and 33 COPD respectively. Pre- and post- bron- chodilator IOS and forced spirometry was assessed. Correlation analysis was used to compare spirometry measurements and IOS parameters. In addition, we compared changes of the parameters and the measurements in COPD and asthma group.
Results: In whole group analysis, the percent changes of IOS parameters, especially respiratory resistance at 5Hz (R5) and frequency dependency of resistance (R5 to 20) after bronchodilation were strongly correlated with the percent changes of forced expiratory volume at 1 second and forced expiratory fl ow at 25-75%. (p<0.05) But, percent changes of IOS parameters failed to reveal differences between asthma and COPD group.
Conclusions: In elderly patients with CAOD, IOS may be useful for identifying bron- chodilator response. But to discriminate between COPD and asthma by IOS, we need further study. Further investigation through classifying asthma-COPD overlap syn- drome and COPD may be helpful.
OS-015 PFT
Forced Expiratory Flow Between 25% and 75% of Vital Capacity Has a Value of Predicting the Airway Responsiveness to Mannitol
Ji-Yong Moon1, Sung Jun Jung1, Gun Woo Koo1, Ji Young Yhi1, Dong Won Park1, Hyun Jung Kwak1, Sang-Heon Kim1, Tae Hyung Kim1, Jang Won Sohn1, Dong Ho Shin1, Sung Soo Park1, Ho Joo Yoon1
Department of Internal Medicine, Hanyang University College of Medicine, Korea1
Background: Bronchial hyperresponsiveness is a pathophysiologic feature of asthma and can be evaluated by means of bronchial challenge. Mannitol is a pharmacologic agonist of an indirect bronchial provocation test. It has been suggested that small air- way obstruction is an early marker of bronchial impairment. The correlation between small airway dysfunction and responsiveness to mannitol has not been studied.
Objective: To determine whether forced expiratory fl ow between 25% and 75% of vital capacity (FEF25-75%) as a surrogate measure of small airways function is asso- ciated with airway responsiveness to mannitol.
Methods: We compared the baseline FEF25-75% (presented as percent of predicted) with the other spirometric parameters including forced expiratory volume in 1 second (FEV1) percent predicted, forced vital capacity (FVC) percent predicted and ratio of FEV1 to FVC (FEV1/FVC), in regard to predicting the result of the subsequent mannitol bronchial provocation test in 428 consecutive patients. Statistical analyses were car- ried out using the area under the receiver operating characteristic curve (AUC) with comparisons using the DeLong method.
Results: The rate of bronchial hyperresponsiveness to mannitol (defi ned by a PD15 of
< 635 mg) was 20.3 percent. AUC analysis showed that FEF25-75% had signifi cantly higher AUC value (0.772; 95% confi dence interval [CI], 0.729-0.811) than FEV1 % pre- dicted (0.666; 95% CI, 0.619-0.710; P < 0.0001) and FEV1/FVC (0.741; 95% CI, 0.697- 0.782; P = 0.0469). Similar results were obtained after excluding subjects with low FEV1 % predicted (< 80) or low FEV1/FVC (< 70).
Conclusions: FEF25-75% showed signifi cantly better association with responsiveness to mannitol compared to the other spirometric indices even in the patients with a nor- mal spirometry, suggesting that small airway dysfunction could be a sign of bronchial hyperresponsiveness.
OS-016 Mycobacterial Diseases
Tuberculosis Associated with Gastrectomy in Gastric Cancer
Ah Young Shin1, Ju Sang Kim1, Hye Sun Kang1, Joong Hyun Ahn1 The Catholic University of Korea, Incheon St. Mary`s Hospital, Korea1
Background: Gastrectomy for malignancy are known risk factors for tuberculosis.
However, the incidence of tuberculosis among patients who have undergone gastrec- tomy in Korea is not well studied. Therefore, we describe patients with tuberculosis who have undergone gastrecomy, their prevalence, and clinical features, outcomes or problems.
Methods: In a retrospective cohort study from 1997 to 2014, data for 1649 patients diagnosed with gastric cancer at our hospital were compared with data from general population, to identify confi rmed cases of tuberculosis.
Results: Patients with gastrectomy for gastric cancer at our hospital from January 1997 to May 2014 were studied. A total of 1649 patients were admitted with gastric cancer. The prevalence of tuberculosis among patients with gastrectomized patients was 2.4%. The mean interval of gastrectomy - tuberculosis diagnosis was 72months except concurrent tuberculosis and gastric cancer diagnosed patients. (n=4) Preoper- ative patients’ mean body mass indexs (BMIs) were 21.6kg/m2. When patients were diagnosed tuberculosis, the patients’ mean body mass indexs (BMIs) were 19.1kg/
m2. But these BMIs were below 18kg/m2 in 8 of the 16 patients. Patients with active TB lost a median of 6.1kg of body weight as compared with preoperative status. The patients’ blood type ratio, A:B:O:AB is 37.5% :12.5% :37.5% :12.5%. The recurrence rate among patients with previous anti-TB treatment was 12.5% (2/16) after gastrec- tomy. When divided according to tuberculosis-infected area, pulmonary tuberculosis was 66.7% (12/18), TB pleurisy was 27.8% (5/18), extrapulmonary tuberculosis was 5.5% (1/18). In pulmonary tuberculosis patients, cavitary form was 31.3% (5/16). The mortality of patients was 18.8% (3/16), these patients was died because of acute res- piratory failure due to tuberculosis infection.
Conclusions: An increased risk of tuberculosis incidence after gastrectomy was ob- served in patients with previous anti-TB treatment, low body weight, old age.
