442 32nd World Congress of Internal Medicine (October 24-28, 2014)
The Korean Academy of Tuberculosis and Respiratory Diseases
PS 1542 COPD
Clinical Implication of Viral Pathogens in Acute
Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and COPD with Pneumonia
Hocheol KIM1, Sangho CHOI2, Jinwon HUH1, Chaeman LIM1, Sangbum HONG1, Younsuck KOH1
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea1, Department of Infectious diseases, Asan Medical Center, University of Ulsan College of Medicine, Korea2
Background: Respiratory viruses are well-known causes of acute exacerbation of COPD (AE-COPD). Several investigations showed that respiratory viruses are also important path- ogens for concomitant pneumonia in COPD (CP-COPD). However, types of respiratory vi- ruses and clinical characteristics between two groups have not been adequately compared.
Methods: The clinical and microbiological data of 477 COPD patients admitted with AE- COPD (n=241) or CP-COPD (n=236) who underwent multiplex respiratory virus reverse transcription polymerase chain reaction (RT-PCR) test were retrospectively reviewed in a tertiary care hospital between January 2010 to December 2012. Demographic charac- teristics, types of identifi ed viruses, and clinical features and outcomes were compared between two groups.
Results: Baseline mean FEV1 was higher in CP-COPD group than in AE-COPD group (AE- COPD, 47.6% vs. CP-COPD, 53.1%, P = 0.01), chronic oxygen therapy (AE-COPD, 13.3% vs.
CP-COPD, 7.2%, P = 0.02) and systemic steroid (AE-COPD, 12.9% vs. CP-COPD, 5.1%, P <
0.01) had been used more commonly in AE-COPD group. Respiratory viruses were identifi ed in 41.9% (101/241) of AE-COPD group and 33.5% (79/236), respectively (P = 0.06). Among AE-COPD group, infl uenza virus was the most commonly encountered pathogen (33.7%), followed by rhinovirus (24.8%), parainfl uenza virus (22.7%), and human coronavirus (14.9%).
In contrast, human coronavirus (24.1%) was the commonest virus in CP-COPD group, followed by rhinovirus (22.8%), parainfl uenza virus (21.5%), and infl uenza virus (19.0%).
Of patients who had viral infection, bacterial co-infection was common both in AE-COPD (41.6%, 42/101) and CP-COPD group (50.6%, 40/79) (P = 0.23). In-hospital mortality of AE-COPD and CP-COPD were 1.2% (3/241) and 12.3% (29/236), respectively (P < 0.01).
Conclusions: Respiratory viral infection was common in both AE-COPD and CP-COPD.
However, types of respiratory viruses involved and clinical outcome were different between two groups.
PS 1543 COPD
Clinical Features and Prognostic Factors of the Patients Who Hospitalized Due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Myoung Kyu Lee1, Sang-Ha Kim1, Suk Joong Yong1, Kye Chul Shin1, Ye-Ryung Jung1, Jae Ho Seong1, Yeun Seoung Choi1, Jiwon Choi1, Won-Yeon Lee1
Department of Internal Medicine, Wonju Severance Christian Hospital, Korea1
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important causes of hospital admission and mortality. We investigated the clinical features of hospitalized patients with severe AECOPD and evaluated prognostic fac- tors associated the readmission or mortality due to re-exacerbation of COPD within 6 months.
Methods: The prospective study was enrolled 314 patients who hospitalized with severe AECOPD. And we collected demographic, clinical and laboratory fi ndings at ad- mission. Lung function was evaluated using the COPD assessment test (CAT) question- naire, the modifi ed Medical Research Council (mMRC) dyspnea scale, and spirometry in the stable state.
Results: The mean age was 72.2 ± 9.4 years (76.4% of male), and the rate of read- mission within 6 months was 45.2% and mortality rate was 16.6%. When multivariate analysis was performed by using the signifi cant variables, age (P < 0.001), CAT score (P
< 0.001), old pulmonary tuberculosis (P = 0.003), initial PaO2 (P = 0.026), hemoglobin (P = 0.009), albumin (P = 0.005) and CRP at discharge (P < 0.001) were signifi cantly associated with mortality. And also CAT score (P < 0.001), diabetes mellitus (P = 0.030) and CRP at discharge (P = 0.004) were signifi cantly associated with readmission. In receiver operating characteristic curves, CRP at discharge than CAT score showed a good accuracy to predict the mortality. But CAT score showed good accuracy to pre- dict readmission due to severe AECOPD.
Conclusions: CRP at discharge as well as CAT score was signifi cantly associated with both mortality and readmission due to AECOPD.
PS 1544 COPD
Effectiveness of Bronchoscopic Lung Volume Reduction Using Unilateral Endobronchial Valve : A Systematic Review and Meta-Analysis
Miyoung Choi1, Worl Suk Lee1, Min Lee1, Kyeongman Jeon2, Seungsoo Sheen3, Sanghoon Jheon4, Young Sam Kim5
National Evidence-Based Healthcare Collaborating Agency, Korea1, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea2, Department of Pulmonary and Critical Care Medicine Ajou University School of Med- icine, Korea3, Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Korea4, Department of Internal Medicine. Severance Hospital, Yonsei University College of Medicine, Korea5
Background: Bronchoscopic lung volume reduction (BLVR) can be suggested as an alternative for surgical lung volume reduction surgery for severe emphysema patients. This article intends to evaluate the safety and effectiveness of BLVR using one-way endobronchial valve by systematic review.
Methods: A systematic search of electronic databases including MEDLINE, EM- BASE, and Cochrane Library, as well as eight domestic databases up to Decem- ber 2013 was performed. Two reviewers independently screened all references according to selection criteria. The Scottish Intercollegiate Guidelines Network (SIGN) criterion was used to assess quality of literature. Data from randomized controlled trials (RCTs) were combined and meta-analysis was performed.
Results: This review included 15 studies. The forced expiratory volume in one second (FEV1) improved in the intervention group compared to the control group (MD=6.71, 95% CI: 3.31 to 10.11). Six minute walking distance (MD=15.66, 95% CI : 1.69 to 29.64) and cycle workload (MD= 4.43, 95% CI: 1.80- to7.07) also improved. In addition, the St. George’s Respiratory Questionnaire (SGRQ) score decreased (MD -4.29, 95% CI: -6.87 to -1.71) in the intervention group.
In a subgroup analysis of patients with complete fi ssure, the FEV1 change from baseline was higher in the BLVR group than the control group for both 6 month (MD=14.75, p <.001) and 12 months (MD=17.43, p <.001) whereas patients with
WCIM 2014 SEOUL KOREA 443
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
incomplete fi ssure the FEV1 and 6MWD showed no change. One year follow-up randomized controlled trials reported deaths although the cause of death was not related to BLVR. Respiratory failure and pneumothorax incidence rate was relatively higher in the BLVR group but the difference was not signifi cant. Con- clusions: Bronchoscopic lung volume reduction may be an effective and safe procedure for the treatment of severe COPD patients with emphysema based on existing studies.
PS 1545 COPD
Three-Month Treatment Response and Exacerbation in Chronic Obstructive Pulmonary Disease
Jung Su Lee1, Chin Kook Rhee2, Kwang Ha Yoo3, Ji-Hyun Lee4, Ho Il Yoon5, Tae-Hyung Kim6, Woo Jin Kim7, Jin Hwa Lee8, Seong Yong Lim9, Tai Sun Park1, Jae Seung Lee1, Sei Won Lee1, Sang-Do Lee1, Yeon-Mok Oh1
Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstruc- tive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Korea1, Department of Internal Medicine, Seoul St. Mary’ Hospital, Catholic University of Korea, Korea2, Department of Internal Medicine, Konkuk University School of Medicine, Korea3, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Korea4, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea5, Division of Pulmon- ology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Korea6, Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, School of Medicine, Kangwon National University, Korea7, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Korea8, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea9
Background: To investigate relationships between acute exacerbation and FEV1im- provement after treatment with combined long-acting beta-agonist(LABA) and inhaled corticosteroid (ICS) in patients with chronic obstructive pulmonary disease (COPD).
Methods: A total of 137 COPD patients were classifi ed as responders or nonrespond- ers according to FEV1 improvement after 3 months of LABA/ICS treatment. Exacerba- tion occurrence in these two subgroups was compared over a period of 1 year.
Results: Seventy-seven of the 137 COPD patients (56.2%)were classifi ed as respond- ers and 60 (43.8%) as nonresponders. Acute exacerbations occurred in 23 patients (29.9%) in the responder group and in 28 patients (46.7%) in the nonresponder group (P = 0.044). FEV1 improvement after LABA/ICS treatment was a signifi cant prognostic factor for fewer acute exacerbations in a multivariate Cox proportional hazard model adjusted for age, sex, FEV1, smoking history, 6min walk distance, body mass index, exacerbation history in the previous year, and dyspnea scale.
Conclusions: Three-month treatment response to LABA/ICS might be a prognostic factor for the occurrence of acute exacerbation in COPD patients.
PS 1546 COPD
The Relationship Between Chronic Obstructive Pulmonary Disease and Comorbidities: A Cross-
Sectional Study Using Data from KNHANES 2010-2012
Chang-Hoon Lee1, Yongsuk Jo1, Sun Mi Choi1, Jinwoo Lee1, Young Sik Park1, Sang- Min Lee1, Jae-Joon Yim1, Chul-Gyu Yoo1, Young Whan Kim1, Sung Koo Han1 Seoul National University Hospital, Korea1
Background: Multiple comorbidities related to chronic obstructive pulmonary disease (COPD) make it a diffi cult disease to treat. The relationship between these comorbidi- ties and COPD has not been fully investigated. We aimed to determine whether COPD was independently associated with various comorbidities.
Methods: This was a cross-sectional study, which used data from the Korean National Health and Nutrition Examination Survey (KNHANES) V conducted between 2010 and 2012. Survey design analysis was employed to determine the association between COPD and 15 comorbidities. A COPD patient was defined as a smoker with forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) <0.7 and comor- bidities were defi ned based on objective laboratory fi ndings and questionnaires.
Results: Of a total of 9488 patient who underwent spirometry, 744 (7.84%) COPD cases and 3313 non-COPD controls were included in the analyses. Although the prev- alence rates of the majority of the comorbidities were high among the COPD patients, only hypertension (adjusted odds ratio [aOR], 1.63; 95% CI, 1.13–2.33 in Stage 1 COPD group; aOR, 1.92; 95% CI, 1.36–2.72 in Stage 2–4 COPD group) and a history of pul- monary tuberculosis (aOR, 3.38; 95% CI, 1.90–5.99 in Stage 2-4 COPD group) were independently associated with COPD after adjustment for age, smoking status, and confounders.
Conclusions: Only hypertension and a history of pulmonary tuberculosis were inde- pendently associated with COPD after adjustment for confounders among 15 comor- bidities. The results suggest that majority of COPD patients might have similar risk factors with its comorbidities, including age and smoking status.
PS 1547 COPD
High Prevalence of Obstructive Airway Disease Among a Local Resident Based on Public Health Survey
Yeong Hun Choe1, Min Suk Kim2, Mi Hee Kang1, Yu Jeong Oh1, Yoon Chae Lee1, Seung Yong Park1, So Ri Kim1, Seoung Ju Park1, Heung Bum Lee1, Yong Chul Lee1 Department of Internal Medicine, Chonbuk National University Medical School, Korea1, Public Health Care Team of Respiratory Center, Chonbuk National University Hospital, Korea2
Background: It is known that the prevalence and social burden related to chronic ob- structive pulmonary disease is increasing. Previous survey published at 2008 demon- strated that 13.4% of subjects aged over 40 years had airfl ow obstruction (FEV1/FVC
<0.7) in Korean population. However, current status of prevalence and characteristics of elderly who have obstruction airway disease (OAD) is not well investigated yet.
Methods: A total of 2566 adults (1109 of male and 1457 of female; mean age 73.4±6.4) were included from public health survey during 3 years. Pulmonary function was measured by portable fl ow-volume device. A standard questionnaire (CAT score), smoking status, respiratory symptoms such as cough, sputum, dyspnea, and comorbid illness were collected.
Results: The prevalence of person with OAD which was defi ned as FEV1/FVC <0.7 was 18.5% (Male 29.2%, Female 10.4%). Mean FEV1 change was -33mL per year in both men and women. There was signifi cant correlation between age and prevalence of OAD. Former or current smoking was signifi cantly more common in group of OAD.
Among persons with OAD, 56.2% have FEV1 below 80% of predicted. The proportion of person according to GOLD stage A-D was 50.6%, 37.9%, 4.6%, and 6.9% respec- tively. Comparing GOLD stage A with B, persons with GOLD stage B were tent to have low BMI and comorbid illness such as hypertension and diabetes. In multivariate analysis, factors associated with higher CAT score in OAD were advanced COPD stage, history of smoking, and female gender.
Conclusions: Our data indicate that the prevalence of COPD in elderly is still high and large number of person is undiagnosed and untreated.
