A Case of Bronchus-Associated Lymphoid Tissue(BALT) Lymphoma in the Lung of the Patient with Primary Sjogren's Syndrome / 결핵

A bronchus-associated lymphoid tissue(BALT) lymphoma of the lung is a rare disorder of patients with Sjogren's syndrome. A 49-year-old woman was admitted for an evaluation of exertional dyspnea and general weakness which had persisted for two years. The patient had suffered from dry mouth and dry eyes for five years. The physical examinations showed a coarse breath sound with inspiratory crackles on the whole lung field, particularly on the both basal lungs. The laboratory data disclosed high titers of anti-nuclear antibodies, and anti-SSA (Ro), and anti-SSB(La) antibodies. Chest radiographs demonstrated the presence of bilateral, diffuse, reticulonodular densities in both lungs. Thin-section CT scans showed diffusely distributed mosaic pattern of an inhomogeneous attenuation extending over the entire lung zone. The histological findings from an open-lung biopsy specimen revealed an accumulation of lymphoid cells around the bronchioles and an extension of malignant lymphoma cells from the bronchiolar epithelium toward the alveolar space. Immunohistochemically, the neoplastic cells reacted positively to the CD 20 antigen and were focally positive for the UCHL 1 antigen. The histological diagnosis was consistent with a low grade marginal zone B-cell lymphoma originating in the BALT. Here, we present a case of a histologically proven BALT lymphoma of the lung in a patient with primary Sjogren's Syndrome.

Clinical Significance of PCR-Based Rapid Detection of Mycobacterium tuberculosis DNA in Peripheral Blood / 결핵

BACKGROUND: Since the advent of AIDS, tuberculosis has become a major public health problem in the western society. Therefore, it is essential that pulmonary tuberculosis be rapidly diagnosed. Light microscopic detection of acid-fast organisms in sputum has traditionally been used for rapidly diagnosing tuberculosis. However positive smears are only observed in about one-half to three-quarters of cases. Studies using PCR for diagnosing pulmonary tuberculosis disclosed several shortcomings suggesting an inability to distinguish between active and treated or in active tuberculosis. In this study, the clinkcal significance of a PCR-bases rapid technique for detecting Mycobacterium tuberculosis DNA in peripheral blood investigated. MATERIALS AND METHODS: From July 1, 1998 through to August 30, 1999, 59 patients with presumed tuberculosis, who had no previous history of anti-tuberculosis medication use whithin one year prior to this study were recruite and followed up for more than 3 months. AFB stain and culture in the sputum and/or pleural fluids and biopsies when needed were performed. Blood samples from each of the 59 patients were obtained in order to identify Mycobacterium Tuberculosis DNA by a PCR test. RESULTS: 1) Forty five out of 59 patients had a final diagnosis of tugerculosis; Twenty eight were confirmed as having active pulmonary tuberculosis by culture or biopsy. Four were clinkcally diagnosed with pulmonary tuberculosis. The othe 13 patients were diagnosed as having tuberculous pleurisy (9) and extrapulmonary tuberculosis (4). 2) Fourteen patients showed a positive blood PCR test. The PCR assay correctly identified active tuberculosis in 13 out of 14 patients. The overall sensitivity and specificity of this blood PCR assay for diagnosing tuberculosis were 29% and 93%, respectively. The positive predictive value was 93%, the negative predictive value was 29% and diagnostic accuracy was 44%. 3) Six out of 14(43%) patients with blood PCR positive tuberculosis were immunologically compromised hosts. 4) A simple chest radiograph in blood PCR positive tuberculosis patients showed variable and inconsistent findings. CONCLUSION: A peripheral blood PCR assay for Mycobacterium tuberculosis is not recommended as screening method for diagnosing active tuberculosis. However, it was suggested that the blood PCR assay could contribute to an early diagnostic rate due to its high positive predictive value.

How Reliable is Sputum PCR Test in the Diagnosis of Pulmonary Tuberculosis When Sputum Smear is Negative? / 결핵

BACKGROUND: Recent technological developments have introduced a new method to identifying M. tuberculosis complex DNA in clinical samples directly. The direct amplification test (DAT) is approved for identifying M. tuberculosis complex in respiratory specimens that are smear-positive for acid-fast bacilli (AFB). When there is a discrepancy between the AFB smear and DAT, no information on their clinical utility is currently available. In this study, the diagnostic reliability of DAT was investigated in suspected pulmonary tuberculosis patients whose sputum AFB smear was negative. METHODS: From June 1, 1998 through May 30, 1999, 909 patients with presumed active pulmonary tuberculosis were enrolled. A sputum AFB stain, culture, DAT and /or biopsy were performed. using the criteria of clinical tuberculosis or confirmed tuberculosis, the positive predictive value of DAT in diagnosing pulmonary tuberculosis was investigated. RESULTS: The positive predictive value of DAT was 82.1% by the clinically active tuberculosis criteria. However, it decreased to 61.5% when diagnosis was restricted to only to culture positive or biopsy proven cases. The false positive rate of DAT was 18.0%. CONCLUSION: The DAT is a valuable diagnostic method in suspected patients whose sputum AFB is was negative.

The Etiological Role of Legionella Pneumophila in Patients with Community-Acquired Pneumonia in Korea / 결핵

BACKGROUND: Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluated the etiological imprtance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. METHOD: The CAP patient over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age 63.8±15.3) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. RESULT: The average Fine's PORT score was 99.7(±44.9). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pneumophila serogroup 1 were not detected. CONCLUSION: Legionella pneumophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.

Four cases of kerosene pneumonitis / 대한내과학회지

Kerosene is one of the petroleum distillates with low viscosity and high volatility. Kerosene is widely used in Korean home in heating and cooking. Kerosene ingestion or aspiration is one of the most common poisonings in young children but extremely rare in adults because kerosene is not taken with the intention of committing suicide. We report four adult cases of aspiration pneumonitis by accidental aspiration of kerosene with similar clinical presentation.

Specific IgG1 and IgG4 antibodies to citrus red mite in citrus farmers: a study of their relationship to respiratory symptoms

Citrus red mite (CRM) is known as the most common sensitizing allergen in subjects with asthma and rhinitis working on citrus farms. The aim of this study is to evaluate the role of specific IgG1 (slgG1) and specific IgG4 (slgG4) to CRM in citrus farmers. Questionnaire survey and skin prick test including CRM antigen was done by 136 workers. Specific IgE (slgE), slgG1 and slgG4 to CRM were detected by enzyme-linked immunosorbent assay (ELISA). CRM-sensitive-asthma was diagnosed upon presence of asthmatic symptoms by questionnaire, airway hyperresponsiveness to methacholine and slgE to CRM. CRM-sensitive rhinitis was diagnosed upon presence of rhinitis symptoms and slgE to CRM. Eleven (8.1+ACU-) had CRM-sensitive asthma and 25 (18.4+ACU-) had CRM-sensitive rhinitis. Significant association was noted between presence of asthmatic symptoms and slgE or slgG4 (p+ADw-0.05, respectively), while no significant association was noted in slgG1 (p+AD4-0.05). Significant association was noted in the prevalence between slgG4 and slgE (p+ADw-0.05), while no significant association was noted between slgG1 and slgG4 or slgE (p+ADw-0.05, respectively). There was a significant correlation between slgE and slgG4 level (r+AD0-0.39, p+ADw-0.05). These findings suggest that the presence of slgG1 to CRM is response to CRM exposure, and further studies will be needed to evaluate the role of slgG4.Citrus red mite (CRM) is known as the most common sensitizing allergen in subjects with asthma and rhinitis working on citrus farms. The aim of this study is to evaluate the role of specific IgG1 (slgG1) and specific IgG4 (slgG4) to CRM in citrus farmers. Questionnaire survey and skin prick test including CRM antigen was done by 136 workers. Specific IgE (slgE), slgG1 and slgG4 to CRM were detected by enzyme-linked immunosorbent assay (ELISA). CRM-sensitive-asthma was diagnosed upon presence of asthmatic symptoms by questionnaire, airway hyperresponsiveness to methacholine and slgE to CRM. CRM-sensitive rhinitis was diagnosed upon presence of rhinitis symptoms and slgE to CRM. Eleven (8.1+ACU-) had CRM-sensitive asthma and 25 (18.4+ACU-) had CRM-sensitive rhinitis. Significant association was noted between presence of asthmatic symptoms and slgE or slgG4 (p+ADw-0.05, respectively), while no significant association was noted in slgG1 (p+AD4-0.05). Significant association was noted in the prevalence between slgG4 and slgE (p+ADw-0.05), while no significant association was noted between slgG1 and slgG4 or slgE (p+ADw-0.05, respectively). There was a significant correlation between slgE and slgG4 level (r+AD0-0.39, p+ADw-0.05). These findings suggest that the presence of slgG1 to CRM is response to CRM exposure, and further studies will be needed to evaluate the role of slgG4.

Specific IgG1 and IgG4 antibodies to citrus red mite in citrus farmers: a study of their relationship to respiratory symptoms

Citrus red mite (CRM) is known as the most common sensitizing allergen in subjects with asthma and rhinitis working on citrus farms. The aim of this study is to evaluate the role of specific IgG1 (slgG1) and specific IgG4 (slgG4) to CRM in citrus farmers. Questionnaire survey and skin prick test including CRM antigen was done by 136 workers. Specific IgE (slgE), slgG1 and slgG4 to CRM were detected by enzyme-linked immunosorbent assay (ELISA). CRM-sensitive-asthma was diagnosed upon presence of asthmatic symptoms by questionnaire, airway hyperresponsiveness to methacholine and slgE to CRM. CRM-sensitive rhinitis was diagnosed upon presence of rhinitis symptoms and slgE to CRM. Eleven (8.1+ACU-) had CRM-sensitive asthma and 25 (18.4+ACU-) had CRM-sensitive rhinitis. Significant association was noted between presence of asthmatic symptoms and slgE or slgG4 (p+ADw-0.05, respectively), while no significant association was noted in slgG1 (p+AD4-0.05). Significant association was noted in the prevalence between slgG4 and slgE (p+ADw-0.05), while no significant association was noted between slgG1 and slgG4 or slgE (p+ADw-0.05, respectively). There was a significant correlation between slgE and slgG4 level (r+AD0-0.39, p+ADw-0.05). These findings suggest that the presence of slgG1 to CRM is response to CRM exposure, and further studies will be needed to evaluate the role of slgG4.Citrus red mite (CRM) is known as the most common sensitizing allergen in subjects with asthma and rhinitis working on citrus farms. The aim of this study is to evaluate the role of specific IgG1 (slgG1) and specific IgG4 (slgG4) to CRM in citrus farmers. Questionnaire survey and skin prick test including CRM antigen was done by 136 workers. Specific IgE (slgE), slgG1 and slgG4 to CRM were detected by enzyme-linked immunosorbent assay (ELISA). CRM-sensitive-asthma was diagnosed upon presence of asthmatic symptoms by questionnaire, airway hyperresponsiveness to methacholine and slgE to CRM. CRM-sensitive rhinitis was diagnosed upon presence of rhinitis symptoms and slgE to CRM. Eleven (8.1+ACU-) had CRM-sensitive asthma and 25 (18.4+ACU-) had CRM-sensitive rhinitis. Significant association was noted between presence of asthmatic symptoms and slgE or slgG4 (p+ADw-0.05, respectively), while no significant association was noted in slgG1 (p+AD4-0.05). Significant association was noted in the prevalence between slgG4 and slgE (p+ADw-0.05), while no significant association was noted between slgG1 and slgG4 or slgE (p+ADw-0.05, respectively). There was a significant correlation between slgE and slgG4 level (r+AD0-0.39, p+ADw-0.05). These findings suggest that the presence of slgG1 to CRM is response to CRM exposure, and further studies will be needed to evaluate the role of slgG4.

Efficacy of Combination Chemotherapy with Vinorelbine, Ifosfamide, and Cisplatin in Patients with Advanced Non-Small Cell Lung Cancer / 대한암학회지

PURPOSE: To evaluate the efficacy and toxicity of combination chemotherapy with vinorelbine, ifosfamide, and cisplatin in patients with advanced non-small cell lung cancer. MATERIALS AND METHODS: Patients with unresectable, pathologically proven non-small cell lung cancer who had no prior chemotherapy were eligible. Patients received vinorelbine (25 mg/m2, iv., D1 & 8), ifosfamide (1.5 g/m2, iv., D1-3 with mesna), and cisplatin (60 mg/m2, iv., D1). The treatment was repeated every 3 weeks. RESULTS: Between degrees Ctober, 1997 and June, 1999, 26 patients were enrolled. Median age was 61. 1 patient had stage IIIA, 13 had stage IIIB, and 12 had stage IV. Patients with adendegrees Carcinoma were 15, squamous cell carcinoma were 11. Of 22 evaluable patients, objective responses were observed in 9 patients (response rate: 40.9%, CR: 1 (4.5%), PR 8 (36.4%)). Median duration of response was 48 weeks. Median overall survival was 52 weeks. Grade 3-4 leukopenia was observed in 10.2% of the 88 courses. There was 1 death related to febrile neutropenia. Non- hematologic toxicities were mild. CONCLUSION: We concluded that combination chemotherapy with vinorelbine, ifosfamide, and cisplatin was effective and tolerable in patients with advanced non-small cell lung cancer, and phase III randomized trial is needed to compare this regimen to other cisplatin-based regimens.

Occupational asthma and rhinitis caused by curry powder / 천식및알레르기

Curry powder is widely used in various dishes. It is a mixture of 20-50 kinds of natural spices made from the leaves and seeds of plants. Although there have been some reports of allergy caused by inhalation of spices in western countries, while there are no reports of occupational allergy caused by spices in our country. We report a patient with rhinitis and asthma induced by exposure to spice dusts in a curry industry. A 32-year-old man developed rhinorrhea, sneezing and coughing three years prior to visiting our hospital. Since 10 years ago, he has been involved in grinding and mixing spices in a curry industry. Total peripheral eosinophil count was 400/mm3 and serum total IgE level was 163 IU/ml. Allergy skin-prick test showed positive responses to mugwort (3+), D. farinae (3+) and celery (3+), while serum specific IgE detected by RIA (DPC, LA, CA) showed all negative results. Skin-prick test to four kinds of spice extractscelery seed, fennel, cumin and coriander-showed strong positive responses. Bronchoprovocation test with celery seed extract (1:10 v/v) showed an early asthmatic response. Specific IgE and IgG4 antibodies to celery seed and the other three spices were detectable by ELISA. IgE-ELISA inhibition test using each spice antigen showed significant inhibitions. In conclusion, IgE-mediated mechanism may be involved in the pathogenesis of curry powder-induced bronchoconstriction in an exposed worker. Further studies will be needed to investigate the role of specific IgG4 in pathogenesis of bronchoconstriction in curry powder-induced asthma.

The Influence of Aging on Pulmonary Function Tests in Elderly Korean Population / 결핵

BACKGROUND: Many studies have shown that pulmonary function differs widely among race, age and geographical residency. By virtue of the improvement of nutrition and environment, the elderly population in Korea is markedly increasing and so are the ages of patients complaining respiratory symptoms. However, we do not have our own data on the pulmonary functional reserve of elderly persons in Korea. We evaluate the deterioration of pulmonary functional reserve and standardize the predictive values of pulmonary function in the elderly population. METHOD: Pulmonary function tests were conducted in 100 men and 100 women over the age of 65. We analyzed changes of FVC and FEV1 according to age and height by linear regression. We compared our new multiple linear regression equation with other equations currently used in Korea. RESULTS: In men, the mean age was 71.5±5.2(mean±SD) years and the mean height was 163.6±6.2cm. The mean FVC was 3.42±0.49ℓ and the mean FEV1, 2.72±0.40ℓ. In women, the mean age was 72.0±5.1 years and the mean height was 149.1±5.9cm. The mean FVC was 2.22±0.42ℓ and the mean FEV1, 1.83±0.34ℓ. Multiple linear regression equation using age and height as an independent factors was as follows : FVC(ℓ)=1.857-0.0356×age(year)+0.02157×height(cm) (p<0.01, R2=0.279), FEV1(ℓ)=1.340-0.02698×age(year)+0.02021×height(cm) (p<0.01, R20.255) in men, FVC(ℓ)=-0.09765-0.03332×age(year)+0.03164×height(cm) (p<0.01, R2=0.435), FEV1(ℓ)=-0.169-0.02469×age(year)+0.02539×height(cm) (p<0.01, R2=0.41) in women. CONCLUSION: We established prediction regressions for pulmonary functional tests in the elderly Korean population. We also confirmed that currently adopted equations do not exactly anticipate the expected pulmonary functional reserve in the aged person over 65 years old. We suggest that our new equations from this study should be applied to interpret the pulmonary function tests in the elderly population in Korea.

Comparison of basophil histamine releasability between atopic and nonatopic thmatics

To compare the mediator releasability between atopic and nonatopic asthmatics, we measured basophil histamine releasability (BaHR) using a calcium-ionophore A23187 and anti-IgE in 137 subjects who were treated at Seoul National University Hospital. Subjects were categorized into atopic (group AA, n=77) or nonatopic asthmatics (group NA, n=32), or normal controls (group NC, n=28). Serum total IgE levels were determined and correlation with BaHR was assessed. Anti-IgE-induced maximal BaHR in groups AA, NA, and NC was 41.0+/-3.2, 23.1+/-4.5, and 16.8+/-3.8, respectively (mean+/-SE, %). Anti-IgE-induced BaHR in group AA was significantly higher than that in groups NA and NC (p<0.05). Calcium ionophore A23187-induced maximal BaHR was 43.1+/-2.8, 40.8+/-4.4, and 50.5+/-5.2, respectively (mean+/-SE, %), and there was no significant difference among the groups. Serum total IgE level correlated significantly with anti-IgE-induced maximal BaHR (r=0.281, p<0.01) but not with that induced by calcium ionophore A23187. In conclusion, IgE receptor-related BaHR is higher in atopic asthmatics than in nonatopic asthmatics, and this increased BaHR in atopics is significantly associated with increased serum total IgE level.

Association of HLA-DRB1 genotype with sensitivity to house dust mite / 천식및알레르기

BACKGROUND: It is known that HLA molecule can restrict specific IgE responses, but few studies have documented the association between HLA and sensitization to house dust mite(HDM). OBJECTIVE: To evaluate whether a specific HLA type can be a risk or protective factor for the development of HDM sensitivity. METHOD: Total 146 subjects were genotyped for HLA-DRB1 using PCR-SSP technique and HDM sensitivity, determined by skin prick test using two mite allergens, D. pteronyssinus (Dp) and D. farinae (Df). Subjects were grouped according to Dp or Df sensitivity and linkage analysis between HDM sensitivity and HLA-DRB1 genotype was performed. RESULTS: The data revealed higher allele frequencies of DRB1*07 in Dp or Df sensitive groups compared to insensitive groups (11.6% vs. 2.6% in Dp, 11.5% vs. 3.3% in Df group, p<0.05), but the other allele frequencies showed no difference. CONCLUSION: There was a significant association between HLA-DRB1*07 genotype and HDM sensitization. These results indicate that antigen presentation by HLA class II molecule restricts the development of specific IgE response to HDM.

Prognostic factors in patients with reactive dye or isocyanate-induced occupational asthma after avoidance of causative agents / 천식및알레르기

BACKGROUND: Although occupational asthma is defined as a reversible airway obstruction causally related to exposure in the working environment, many occupational asthmatics complain of asthmatic symptoms despite avoidance of the causative agent. Subjects and methods. Twenty-nine patients with occupational asthma who had been confirmed by specific bronchial challenge with reactive dye or isocyanates and had avoided the causative agent for at least 6 months were included in this study. A questionnaire about asthmatic symptoms and medication requirements, a lung functiontest, and a methacholine bronchial provocation test were performed. RESULTS: Asthmatic symptoms at follow-up were remitted in seven (41.2%) isocyanate-induced asthmatics, but none with reactive dye-induced asthma were remitted. At follow-up, the symptom-medication score and FEV1 were significantly improved in isocyanate-induced asthmatics than in those with reactive dye-induced asthma, but the geometric mean of PC20-methacholine was not different between the two groups. Among 17 isocyanate-induced asthmatics, a duration from symptom onset to avoidance was significantly shorter in the remission group than in the nonremission group, although the symptom-medication scores, FEV1 (% predictive value) and logPC20-methacholine at an initial diagnosis, and follow-up period defined as duration from avoidance to follow-up, showed no difference between the two groups. CONCLUSION: The outcome of occupational asthma may be determined by the causative agents and the duration from onset of asthmatic symptoms to avoidance.

Urinary N-methylhistamine and sulfidopeptide leukotriene in exercise-induced asthma / 천식및알레르기

BACKGROUND: Exercise can aggravate asthmatic symptoms in many patients with bronchial asthma. It is caused by that inhaled air bypasses nasal cavity and goes directly to the lower airways through open mouth dring exercise. Although the pathogenetic mechanisms of exercise-induced asthma(EIA) have not been clarified yet, there is evidence that chemical mediators, released from the inflammatory cells triggered by airway cooling or drying, might be responsible for induction of bronchoconstriction. However, it has been controversial which chemical mediators or cells are involved in such process. Objectiye . The aim of this study was to evaluate the role of activated mast cells in the pathogenesis of EIA and find out whether or not sulfidopeptide leukotrienes (LTC4/d4/E4) are involved in the exercise-induced bronchoconstriction. MATERIAL AND METHOD: Eleven asthmatics with documented exercise-induced bronchoconstriction and 10 control subjects were studied. Before and 6 hours after free running for 6 minutes, forced expiratory volume in 1 second (FEV,) and the concentrations of N- methylhistamine, LTE4, and creatinine in unine collected for 6 hours after exercise were determined. RESULT: Urinary concentrations of N-methylhistamine(mean+SE, ng/mg creatinine) of EIA patients before and after exercise were 159+40 and 450+75, respectively. Those of control subjects were 208+ 54 and 275+ 62, respectively. Uninary N-methylhistamine levels of EIA group increased significantly after exercise, while those of control group did not change. Urinary concentrations of LTE,(mean+SE, pg/mg creatinine) of EIA patients before and after exercise were 15.6 k2.6 and 22.2+5.8, respectively. Those of control subjects were 10.4+ 4.0, 18.2 +7.0, respectively. The concentrations of LTE4 in the urine samples collected before exerise revealed no difference between EIA and control subjects (p=0.07). There was no change after exercise in both groups. Percent fall of FEV, was 29.1+8.0% (mean+SD) in EIA group and 3.4 + 4.0% in control group, respectively. There was no correlation between reduction of FEV, and change in urinary concentrations of N-methyl-histmine after exercise. CONCLUSTION: Chemical mediators of activated mast cells may be involved in exercise-induced bronchoconstriction, but there is little evidence for enhanced sulfidopeptide leukotriene generation as assessed by urinary LTE4.

Familial aggregation of bronchial asthma, and genetic role of atopy and bronchial responsiveness in the development of asthma / 천식및알레르기

BACKGROUND: Familial aggregation of the phenotypes can be caused by common environmental and genetic factors, but there has been no family study on familial aggregation of the bronchial asthma, and genetic role of atopy and bronchial responsiveness in the development of asthma in Korean families. OBJECTIVE: We did family study to evaluate the familial aggregation of bronchial asthma, and the genetic role of atopy and bronchial responsiveness in the development of asthma. MATERIALS AND METHODS: Questionnaire, serum total IgE level, skin prick test with 10 common aeroallergens, and bronchial responsiveness to methacholine were performed in 154 parents of atopic asthmatics, 72 parents of atopic control, and 65 parents of non-atopic control. RESULTS: Bronchial asthma was more prevalent in parents of atopic asthmatics(7.1% ) than in parents of non-atopic control(0% ). Geometric mean of serum total IgE level was not different among parents of atopic asthmatics, atopic control, and non-atopic control(2.03+0.06, 2.10 +0.07, and 1.89 +0.09 IU/ml). Positive rates of skin prick test to 10 common aeroallergens were more prevalent in parents of atopic asthmatics(43.0% ) and atopic control(43.0% ) than in parents of non-atopic control(27.8%). Prevalence of bronchial hyperresponsiveness to methacholine was more prevalent in parents of atopic asthmatics(17.0% ) than in parents of atopic control(7.2%) and non-atopic control(1.5%), and slope of dose-response curve was more increased in parents of atopic asthmatics(11.0+ 1.5) than in parents of atopic control and non-atopic control(4.8+ 0.7 and 3.0+ 0.5). CONCLUSION: Bronchial asthma runs in Korean families, and genetic role of atopy and bronchial responsiveness may be important in the development of asthma.

Metered dose inhaler(MDI)-induced bronchocostriction in asthmatic patients: the effects of the incert ingredients and propellants / 천식및알레르기

BACKGROUND: Bronchoconstriction associated with aerosolized agents delivered by a metered dose inhaler (MDI) is relatively uncommon, but has been of particular interest. MATERIAL AND METHOD: In this study, we investigated to what extent the inert ingredients and propellants (freons) influence pulmonary function in 25 asthmatic patients. Forced expiratory volume in one second(FEV,) was measured by spirometry, Autospira HI 498(Chest, Japan) before and 1, 3, 5 and 10 minutes after the inhalation of saline control and MDI-placebo containing freons and inert ingredients. RESULT: Twenty four % (6/25) of asthmatics experienced a decrease in FEV20 by 10% or greater when compared to saline control. Number of positive cases in steroid dependent asthmatics is significantly higher compared to non-steroid dependent asthmatics. (p<0.05) Bronchoconstriction associated with the use of MDI-placebo appeared within 3 to 5 minutes and resolved spontaneouly at 10 minutes after the inhalation. CONCLUSION: The bronchoconstrictive response induced by MDI might be caused by the pro-pellants and/or the other inert ingredients contained in MDIs.