The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 419
Slide Session
OS-036 Mycobacterial Diseases
Risk Factors for Recurrence of Successfully Treated Mycobacterium Avium Complex Lung Disease
Bo Young Lee1, Sunyoung Kim2, Sang-Do Lee1, Woo Sung Kim1, Dong Soon Kim1, Tae Sun Shim1, Kyung-Wook Jo1
Asan Medical Center, Korea1, Inje University Haeundae Paik Hospital, Korea2
Background: Many patients successfully treated for Mycobacterium avium complex (MAC) lung disease experience recurrence. This study analyzed the recurrence rate and risk factors for recurrence in patients successfully treated for MAC lung disease.
Methods: The medical records of 158 patients successfully treated for MAC lung dis- ease at a tertiary referral center in South Korea between March 2000 and December 2009 were retrospectively analyzed. Recurrence was recorded, and factors associated with recurrence were analyzed.
Results: The mean age of the 158 patients was 60.7 ± 11.1 year; 75 (47.5%) were male. The etiologic agent was Mycobacterium avium in 77 patients (48.7%) and Mycobacterium intracellulare in 81 (51.3%). Forty-nine patients (31.0%) had the fi bro- cavitary form of the disease. Almost all patients had been previously treated with a macrolide-containing regimen, and 68 (43.0%) had received an aminoglycoside. Dur- ing a median follow-up of 43.8 months, 50 (31.6%) patients experienced recurrence, at a median 11.9 months after treatment completion. Recurrence rate was higher in patients aged > 65 than in those = 65 years (p = 0.028) and those with the nodular bronchiectatic form than with other forms of the disease (p = 0.002). Multivariate analysis showed that only the nodular bronchiectatic form of the disease (odds ratio = 3.22, 95% confi dence interval 1.42–7.27) was independently associated with increased risk of recurrence.
Conclusions: Recurrence after successful treatment is frequent in patients with MAC lung disease. The recurrence rate was signifi cantly higher in patients with the nodular bronchiectatic form of the disease.
OS-037 Mycobacterial Diseases
Determinants of Recurrence During Follow-Up Period Among Patients with Favorable Response after Successful Treatment of Mycobacterium Avium Complex Pulmonary Disease
Jinsoo Min1, Jisoo Park1, Yeon Joo Lee1, Se Joong Kim1, Jong Sun Park1, Young-Jae Cho1, Ho Il Yoon1, Choon-Taek Lee1, 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
Background: Long-term treatment outcome among patients with favorable response after successful treatment of Mycobacterium avium complex(MAC) pulmonary disease(PD) has not been evaluated and defi ned adequately.
Methods: A retrospective review of the medical record of 276 MAC-PD patients who were treated with combination chemotherapy from 2003 to 2012 was performed. Clinical data, microbiologic study results and chest computerized tomography(CT) fi ndings were collected on each patient. The number of involved lung segments was counted in the chest CT.
Results: One hundred twenty fi ve among 276 MAC-PD patients completed the combination chemotherapy for more than 12 months and followed up for minimal 1 year. Among these 125 patients, 97 patients(34 males, mean age 60.4) showed negative sputum microbiologic conversion and favorable response to treatment, and fi nally included in this study. Mean follow-up period of these 125 patients was 27.0 months. Seventy seven(79.4%) patients remained microbiologically disease-free status. Twenty(20.6%) patients recurred after successful treatment. Among 20 recurrence cases, 14 cases occurred within 12 months, and 6 cases occurred after 12 months of completing the treatment. Age, gender, and BMI were not associated with recurrence. Longer interval between diagnosis and treatment initiation(2.88±4.65 vs. 7.20±8.21, p=0.003) bronchiectatic form(45.5% vs. 75.0%, p=0.018), increased number of lobe involvement (3.03±1.47 vs. 3.80±1.32, p=0.035), and elevated level of serum creatinine(0.79±0.18 vs. 0.91±0.14, p=0.010) were signifi cantly associated with MAC recurrence. Sputum conversion rate within 6 months after start of treatment was higher in microbiologic disease-free than in recurrence patients(98.7% vs. 80.0%, p=0.001).
Conclusions: Recurrence of MAC after successful treatment was associated with longer in- terval between diagnosis and treatment initiation, bronchiectatic form, increased number of lobe involvement, elevated level of serum creatinine, sputum conversion rate after 6 months of treatment initiation.
OS-038 COPD
Increased Prevalence of COPD Among Korean Population: An Analysis of KNHANES II and V
Ji Young Hong1, Song Yee Kim1, Kyung Soo Chung1, Eun Young Kim1, Ji Ye Jung1, Young Ae Kang1, Moo Suk Park1, Se Kyu Kim1, Joon Chang1, Young Sam Kim1 Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseas- es, Yonsei University College of Medicine, Korea1
Background: COPD is a serious public health problem. Understanding the longitudinal trend of prevalence is important in characterizing the burden of COPD and planning health service planning.
Method: We analyzed the prevalence of airfl ow obstruction between 2001 and 2011 using data from Korean National Health and Nutritional Examination Survey (KNHANES II and V). Airway obstruction was defi ned by FEV1/FVC < 0.7. The participants aged over 40 years recording less than 0.7 of FEV1/FVC was defi ned to have COPD. To com- pare the prevalence of COPD after age and gender standardization, we used the data from the Population and Housing Census, which was conducted by Statistics Korea in 2010. Statistical analyses were performed using SAS version 9.2.
Result: Data were acquired from 5,318 subjects, who aged =40 years and underwent spirometry adequately (2001: n=2,217; 2011: n=3,101). The prevalence of COPD in- creased from 2001 to 2011 (2001: 13.0%, 2011: 13.2%). The prevalence of COPD in- creased in men, but not in women (2001: men 20.5%, women 6.5%; 2011: men 22.2%, women 6.4%). Interestingly, the prevalence of COPD decreased after age and gender standardization (2001: total 15%, men 22.3%, women 8.3%; 2011: total 12.6%, men 19.6%, women 6.4%).The proportion of ever-smokers increased from 2001 to 2011 (2001: men 79.8%, women 5.2%; 2011: men 82.9%, women 6.3%). On the contrary, the proportion of current smokers decreased from 2001 to 2011 (2001: men 54.1%, women 4.5%; 2011: men 36.7%, women 3.7%).
Conclusions: From 2001 to 2011, the prevalence of COPD in Korea has been increased, but it declined after age and gender standardization. This result suggests the burden of COPD increased mainly due to aging of population despite the progressive anti-smok- ing prevention policies.
OS-039 COPD
Association Between COPD and Educational Level in Korean Adult Population
Chanho Lee1, Young Sam Kim1
Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseas- es, Yonsei University College of Medicine, Korea1
Background: Chronic obstructive pulmonary disease(COPD) has been one of the major diseases and prevalence and mortality is still increasing worldwide.
Methods: Korean National Health and Nutrition Examination Survey(KNHANES) is a nationwide cross-sectional survey of the Korean population and 50,405 subjects per- formed health and nutritional survey during fourth and fi fth KNHANES. Among them, 25,812 subjects aged over 40 years old performed spirometry and a trained interviewer administered a questionnaire on respiratory diseases and various health-related infor- mation, including educational level, residential pattern, income, smoking, and other risk factors of COPD. The educational level was classifi ed into four groups and household income was stratifi ed into 4 quartiles. The statistical analyses were carried out using SAS 9.3 (SAS Institute Inc.). T-test, Chi-square test and logistic regression analysis were done.
Results: Data from 15,971 adults who performed spirometry adequately were used for this analysis. Of all subjects, 6,871 (43.0%) were male and 9,100 (57.0%) were female.
The mean age was 56.7 for men and 57.1 for women. Prevalence of COPD, defi ned as FEV₁/ FVC<0.7, was 13.6% (22.7% male; 6.7% female). COPD is more prevalent in older age group, male gender, heavy smoker and lower income and educational level population. Multivariate analysis showed that older age, male gender, smoking status, and lower educational level were signifi cant independent risk factors for COPD. The prevalence of smoker is higher and duration of smoking is longer in lower educational level group and total amount of smoking expressed as pack-year is bigger.
Conclusions: Low educational level may considered as an independent risk factor of COPD in Korean adult population and further study is needed.
