Korean version of the Cough Symptom Score: clinical utility and validity for chronic cough

BACKGROUND/AIMS: The Cough Symptom Score (CSS) is a simple, useful tool for measuring cough severity. However, there is no standard Korean version of the CSS. We developed a Korean version of the CSS and evaluated its clinical utility and validity for assessing chronic cough severity. METHODS: The CSS was adapted for Korean use following a forward-backward translation procedure. Patients with chronic cough enrolled from five university hospitals were graded using the CSS and a 100-mm linear visual analog scale (VAS) of cough severity at each visit. Patients completed the Leicester Cough Questionnaire (LCQ) upon presentation and completed the LCQ and Global Rating of Change at follow-up visits after 2 to 4 weeks. The concurrent validity, repeatability, and responsiveness of the Korean version of the CSS were determined. RESULTS: Correlation coefficients between the CSS and LCQ, and between the CSS and VAS, were –0.66 and 0.52, respectively. There was a weak correlation between the scores for night and day symptoms (r = 0.24, p = 0.0006). The repeatability of the CSS in patients with no change in cough (n = 23) was high (intra-class correlation coefficient, 0.75; 95% confidence interval [CI], 0.51 to 0.88). Patients who reported an improvement in cough (n = 30) at follow-up visits had a significant improvement in the CSS (median, −2; 95% CI, −3 to −1; p = 0.0003). CONCLUSIONS: The Korean version of the CSS correlated well with other tools for accessing cough severity in chronic cough patients. Therefore, it could be a reliable method for measuring chronic cough severity.

Reliability and Validity of a Korean Version of the Leicester Cough Questionnaire

PURPOSE: There are no specific tools for measurement of the severity of chronic cough in Korea. We developed a Korean version of the Leicester Cough Questionnaire (LCQ) and tested its scaling and clinical properties. METHODS: The LCQ was adapted for Korean conditions following a forward-backward translation procedure. All patients referred to chronic cough clinics at 5 university hospitals between May 2011 and October 2013 completed 2 questionnaires, the LCQ and the Short-Form 36 (SF-36), upon presentation and completed the LCQ and the Global Rating of Change (GRC) upon follow-up visits after 2 or 4 weeks. Concurrent validation, internal consistency, repeatability, and responsiveness were determined. RESULTS: For the concurrent validation, the correlation coefficients (n=202 patients) between the LCQ and SF-36 varied between 0.42 and 0.58. The internal consistency of the LCQ (n=207) was high for each of the domains with a Cronbach's alpha coefficient of 0.82-0.94. The repeatability of the LCQ in patients with no change in cough (n=23) was high, with intra-class correlation coefficients of 0.66-0.81. Patients who reported an improvement in cough (n=30) on follow-up visits demonstrated significant improvement in each of the domains of the LCQ. CONCLUSIONS: The Korean version of the LCQ is a valid and reliable questionnaire for measurement of the severity of cough in patients with chronic cough.

Association of insulin resistance with bronchial hyperreactivity

BACKGROUND: Several epidemiologic studies showed the significant association of insulin resistance with asthma. OBJECTIVE: The aim of this study was to evaluate the association of insulin resistance with airway hyperresponsiveness (AHR) in adult population. METHODS: 1,058 subjects who visited to the Seoul National University Hospital Gangnam Center from October 2007 to January 2009 for a routine health check-up were enrolled. All subjects completed a questionnaire, anthropometric measurements such as body mass index (BMI) and waist circumference, blood tests, pulmonary function test, and methacholine bronchial provocation test (MBPT). Insulin resistance was estimated from the homeostasis model of assessment of insulin resistance (HOMA-IR).

Respiratory Effects of the Hebei Spirit Oil Spill on Children in Taean, Korea

PURPOSE: The oil spill from the Heibei Spirit in December 2007 contaminated the Yellow Coast of South Korea. We evaluated the respiratory effects of that spill on children who lived along the Yellow Coast. METHODS: Of 662 children living in the area exposed to the oil spill, 436 (65.9%) were enrolled as subjects. All subjects completed a modified International Study of Asthma and Allergies in Childhood questionnaire. A health examination, including a skin prick test, pulmonary function test, and methacholine bronchial provocation test (MBPT), was administered. The children were assigned to two groups: those who lived close to the oil spill area and those who lived far from the oil spill area. RESULTS: The children who lived close to the oil spill area showed a significantly lower forced expiratory volume in one second (FEV1), an increased prevalence of 'asthma ever' (based on a questionnaire), and 'airway hyperresponsiveness' (based on the MBPT) than those who lived far from the oil spill area (FEV1; P=0.011, prevalence of 'asthma ever' based on a questionnaire; P=0.005, prevalence of 'airway hyperresponsiveness' based on the MBPT; P=0.001). The onset of wheezing after the oil spill was significantly higher in children who lived close to the oil spill area than in those who lived far from the oil spill area among the 'wheeze ever' group (P=0.002). In a multiple logistic regression analysis, male sex, family history of asthma, and residence near the oil spill area were significant risk factors for asthma (sex [male/female]: odds ratio [OR], 2.54; 95% confidence interval [CI], 1.31-4.91; family history of asthma [No/Yes]: OR, 3.77; 95% CI, 1.83-7.75; exposure group [low/high]; OR, 2.43; 95% CI, 1.27-4.65). CONCLUSIONS: This study suggests that exposure to an oil spill is a risk factor for asthma in children.

Respiratory Effects of the Hebei Spirit Oil Spill on Children in Taean, Korea

PURPOSE: The oil spill from the Heibei Spirit in December 2007 contaminated the Yellow Coast of South Korea. We evaluated the respiratory effects of that spill on children who lived along the Yellow Coast. METHODS: Of 662 children living in the area exposed to the oil spill, 436 (65.9%) were enrolled as subjects. All subjects completed a modified International Study of Asthma and Allergies in Childhood questionnaire. A health examination, including a skin prick test, pulmonary function test, and methacholine bronchial provocation test (MBPT), was administered. The children were assigned to two groups: those who lived close to the oil spill area and those who lived far from the oil spill area. RESULTS: The children who lived close to the oil spill area showed a significantly lower forced expiratory volume in one second (FEV1), an increased prevalence of 'asthma ever' (based on a questionnaire), and 'airway hyperresponsiveness' (based on the MBPT) than those who lived far from the oil spill area (FEV1; P=0.011, prevalence of 'asthma ever' based on a questionnaire; P=0.005, prevalence of 'airway hyperresponsiveness' based on the MBPT; P=0.001). The onset of wheezing after the oil spill was significantly higher in children who lived close to the oil spill area than in those who lived far from the oil spill area among the 'wheeze ever' group (P=0.002). In a multiple logistic regression analysis, male sex, family history of asthma, and residence near the oil spill area were significant risk factors for asthma (sex [male/female]: odds ratio [OR], 2.54; 95% confidence interval [CI], 1.31-4.91; family history of asthma [No/Yes]: OR, 3.77; 95% CI, 1.83-7.75; exposure group [low/high]; OR, 2.43; 95% CI, 1.27-4.65). CONCLUSIONS: This study suggests that exposure to an oil spill is a risk factor for asthma in children.

Differences in airway inflammation according to atopic status in patients with chronic rhinitis

BACKGROUND: Chronic rhinitis is a heterogeneous group of diseases that cause nasal inflammation. And the nose may be a window into the lung in the concept of "one airway one disease." OBJECTIVE: This study was conducted to evaluate differences between the different forms of chronic rhinitis in terms of lower airway inflammation. METHODS: Patients that attended the allergy clinic and presented with moderate/severe persistent rhinitis symptoms for more than 1 year were enrolled. The patients with chronic rhinitis were classified into two groups (house dust mites [HDM]-sensitive allergic rhinitis [AR] or non-allergic rhinitis [NAR]) according to the presence of atopy, and additionally according to nasal polyposis and airway hyperresponsiveness, respectively. Medical records were reviewed and the mRNA expression levels of IL-5, IFN-γ, TGF-β1, IL-17A, and IL-25 were evaluated in induced sputum samples in each group. RESULTS: Induced sputum samples of 53 patients were evaluated. Patients with NAR were significantly older than patients with HDM-sensitive AR (p < 0.05). Nasal polyposis was more prevalent in NAR patients than in HDM-sensitive AR patients (10.2% vs. 62.5%, p < 0.001). The expression levels of IL-17A mRNA were higher in NAR patients, regardless of the presence of airway hyperresponsiveness (p = 0.005). CONCLUSION: These results suggest that patients with different forms of chronic rhinitis could have different inflammatory environments in their lower airway and NAR patients might have bronchial inflammation related to the elevated levels of IL-17A compared to HDM-sensitive AR patients.

A Case of Recurrent Kimura Disease in the Groin Area / 대한내과학회지

Kimura disease is a rare chronic inflammatory disorder of unknown etiology, suggestive of an allergic or autoimmune mechanism, which presents mainly as soft tissue masses in the head and neck area in young Asian males. Blood tests show eosinophilia and an elevated immunoglobulin E; the typical pathologic findings are lymphoid follicular hyperplasia, interfollicular eosinophilic infiltration, and vascular hyperplasia. There is no standard treatment; surgical resection is preferred and systemic steroid or radiotherapy is used to treat disease relapses. Kimura disease in unusual sites has been reported, but there are few cases with long-term observations because of its benign nature. Here, we present the case of a female with recurrent Kimura disease; we follow her progress for about 5 years after surgical resection of masses in the right groin area, an unusual site, with a brief review of the literature.

A Case of Interstitial Pneumonitis and Pancytopenia Following the Combination Therapy of Pegylated Interferon and Ribavirin / 결핵및호흡기질환

The combination therapy of pegylated interferon and ribavirin is the mainstay of treatment for chronic hepatitis C patients. Anti-viral therapy is commonly associated with side effects such as headache, fever, myalgia, and arthralgia. However, anti-viral therapy can continue because these side effects are mostly mild and can be improved with supportive management. Anti-viral therapy should be stopped promptly if serious side effects, such as interstitial pneumonitis or hemolytic anemia occur, although those serious side effects are rare. There were a few case reports of interferon-related interstitial pneumonitis worldwide. In Korea, one atypical case report of interstitial pneumonitis has been reported, which followed the combination therapy of interferon-alpha and ribavirin in a patient with chronic hepatitis C. We present a case of interstitial pneumonitis and pancytopenia following the combination therapy of pegylated interferon and ribavirin in a patient with chronic hepatitis C.

A Case of Interstitial Pneumonitis and Pancytopenia Following the Combination Therapy of Pegylated Interferon and Ribavirin / 결핵및호흡기질환

The combination therapy of pegylated interferon and ribavirin is the mainstay of treatment for chronic hepatitis C patients. Anti-viral therapy is commonly associated with side effects such as headache, fever, myalgia, and arthralgia. However, anti-viral therapy can continue because these side effects are mostly mild and can be improved with supportive management. Anti-viral therapy should be stopped promptly if serious side effects, such as interstitial pneumonitis or hemolytic anemia occur, although those serious side effects are rare. There were a few case reports of interferon-related interstitial pneumonitis worldwide. In Korea, one atypical case report of interstitial pneumonitis has been reported, which followed the combination therapy of interferon-alpha and ribavirin in a patient with chronic hepatitis C. We present a case of interstitial pneumonitis and pancytopenia following the combination therapy of pegylated interferon and ribavirin in a patient with chronic hepatitis C.

Association of Exercise-Induced Asthma with Atopy in Adult Patients with Asthma-Like Symptoms / 대한내과학회지

BACKGROUND/AIMS: Atopy is closely related to asthma and is a risk factor for the development and exacerbation of asthma. The aim of this study was to evaluate the association between exercise-induced asthma (EIA) and atopy in adult patients with asthma-like symptoms. METHODS: Forty young male patients with asthma-like symptoms were enrolled. Skin prick, methacholine bronchial provocation, and exercise provocation tests were performed. Current and ex-smokers were excluded. RESULTS: Exercise provocation tests were positive in 21 patients (52.5%). Airway hyperresponsiveness (AHR) to methacholine (85.7% vs. 42.1%, p = 0.007) and atopy (85.7% vs. 47.4, p = 0.017) was found more frequently in patients with EIA than in those without EIA. EIA was significantly associated with atopy score (16.5 +/- 3.0 vs. 6.5 +/- 2.0, p = 0.011), atopy index (2.1 +/- 0.3 vs. 1.0 +/- 0.3, p = 0.004), and positive responses to Dermatophagoides pteronyssinus (76.2% vs. 42.1%, p = 0.028) and Dermatophagoides farinae (76.2% vs. 36.8%, p = 0.012), but not with positive responses to pollen allergens. AHR to methacholine (odds ratio [OR]: 14.3, 95% confidence interval [CI]: 1.86-109.4) and atopy (OR: 16.9, 95% CI: 2.04-140.74) were significant risk factors for EIA. CONCLUSIONS: Atopy was a risk factor for EIA in young adult men, and sensitization to house dust mites was associated with EIA.

Association of Exercise-Induced Asthma with Atopy in Adult Patients with Asthma-Like Symptoms / 대한내과학회지

BACKGROUND/AIMS: Atopy is closely related to asthma and is a risk factor for the development and exacerbation of asthma. The aim of this study was to evaluate the association between exercise-induced asthma (EIA) and atopy in adult patients with asthma-like symptoms. METHODS: Forty young male patients with asthma-like symptoms were enrolled. Skin prick, methacholine bronchial provocation, and exercise provocation tests were performed. Current and ex-smokers were excluded. RESULTS: Exercise provocation tests were positive in 21 patients (52.5%). Airway hyperresponsiveness (AHR) to methacholine (85.7% vs. 42.1%, p = 0.007) and atopy (85.7% vs. 47.4, p = 0.017) was found more frequently in patients with EIA than in those without EIA. EIA was significantly associated with atopy score (16.5 +/- 3.0 vs. 6.5 +/- 2.0, p = 0.011), atopy index (2.1 +/- 0.3 vs. 1.0 +/- 0.3, p = 0.004), and positive responses to Dermatophagoides pteronyssinus (76.2% vs. 42.1%, p = 0.028) and Dermatophagoides farinae (76.2% vs. 36.8%, p = 0.012), but not with positive responses to pollen allergens. AHR to methacholine (odds ratio [OR]: 14.3, 95% confidence interval [CI]: 1.86-109.4) and atopy (OR: 16.9, 95% CI: 2.04-140.74) were significant risk factors for EIA. CONCLUSIONS: Atopy was a risk factor for EIA in young adult men, and sensitization to house dust mites was associated with EIA.

The Speed of Eating and Functional Dyspepsia in Young Women

BACKGROUND/AIMS: Little information is available on whether the speed of eating differs between individuals with and without dyspepsia, mainly because controlled studies are usually not feasible. METHODS: A survey was applied to 89 individuals with relatively controlled eating patterns, using questionnaires that assessed eating time and functional dyspepsia (FD) based on the Rome III criteria. RESULTS: The prevalence of FD was 12% (11 of 89 participants), and 7% (6 of 89) were diagnosed with gastroesophageal reflux disease (GERD). The proportion of individuals reporting that they ate their meals rapidly was higher for those with FD than for those without FD or GERD (control) (46% vs 17%, p=0.043), as was the reported eating speed (7.1+/-1.5 vs 5.8+/-2.0 [mean+/-SD], p=0.045; visual analog scale on which a higher score indicated faster eating). However, the measured eating time did not differ significantly between FD and controls (11.0+/-2.8 vs 12.8+/-3.3 minutes, p=0.098). The proportion of individuals who ate their meals within 13 minutes was significantly higher for those with FD than for controls (91% vs 51%, p=0.020). CONCLUSIONS: The results of this study suggest that eating speed affects dyspepsia. Further studies are warranted.

Vaccination Rate and Seroepidemiology of Hepatitis A in Chronic-Hepatitis-B-Infected Individuals in the Korean Army

BACKGROUND/AIMS: Vaccination against hepatitis A virus (HAV) is recommended for patients with chronic hepatitis B (CHB), since they are potentially at an increased risk of HAV-related morbidity and mortality. However, little is known about the adherence to these recommendations in the community. This study evaluated the current vaccination status and immunity against HAV among Korean military soldiers with CHB. METHODS: We performed a prospective study of Korean military soldiers from August 2008 to January 2009. We enrolled 96 soldiers with CHB on a consecutive basis. We assessed their vaccination history and the presence of anti-HAV immunoglobulin G (IgG). RESULTS: The HAV vaccination rate of the soldiers enrolled in our study was 2% (2 of the 96 soldiers). The seroprevalence rates of anti-HAV IgG among military soldiers without a vaccination history were 0%, 50%, and 100% for those aged 19-29 years (n=71), 30-39 years (n=8), and 40 years or older (n=15), respectively (p<0.001). CONCLUSIONS: The HAV vaccination rate is very low among military soldiers. Public health efforts aimed at raising awareness about HAV vaccination in patients with CHB should be strongly encouraged.

Update on the management of bronchial asthma / 대한내과학회지

No abstract available.

An atypical case of Churg-Strauss syndrome without asthma / 대한내과학회지

Churg-Strauss syndrome is a rare systemic necrotizing vasculitis that is characterized by asthma, peripheral eosinophilia, non-fixed pulmonary infiltrates, neuropathy and histopathologic features of extravascular eosinophilic infiltration and granuloma formation. Churg-Strauss syndrome is accompanied by asthma in nearly all cases. However, a few atypical cases of Churg-Strauss syndrome without asthma or eosinophilia have been reported. An 18-year-old male was referred for discoloration of right second finger, and right foot drop. He developed peripheral eosinophilia, bilateral pulmonary infiltrates, mononeuritis multiplex, extravascular eosinophilic infiltration on lung biopsy, and vasculitis on medium to small sized arteries of upper and lower extremities without asthma. We report an atypical case of an 18-year-old male patient diagnosed as Churg-Strauss syndrome without preexisting asthma.

Korean Ginseng-Induced Occupational Asthma and Determination of IgE Binding Components

A number of case reports on occupational asthma caused by herbal medicines have been issued, for example, on Sanyak, Chunkung, Banha, and Brazilian ginseng. Recently, cases of occupational asthma induced by Sanyak and Korean ginseng have been reported, but the pathogenic mechanisms involved are unknown. This study was carried out to evaluate the immunologic mechanism underlying Korean ginseng-induced occupational asthma. A patient engaged in Korean ginseng wholesale was referred for recurrent dyspnea, wheezing, and nasal symptoms, which were aggravated at work. Allergen bronchial provocation testing to Korean ginseng extract showed a typical immediate response, and skin prick testing to Korean ginseng extract also showed a strong positive response. Moreover, serum-specific IgE levels to Korean ginseng extract were significantly higher than in controls. Enzymelinked immunosorbent assay (ELISA) inhibition tests showed a dose-dependent inhibition by Korean ginseng, but not by Dermatophagoides farinae, wheat flour, or Chinese balloon flower. Sodium dodecylsulfate-poly-acrylamide gel electrophoresis (SDS-PAGE) and immunoblotting revealed four specific Immunoglobulin E (IgE) binding components at 26, 30, 47, and 60 kDa, which were not bound by control sera. These results strongly suggest that occupation asthma induced by Korean ginseng is induced via an IgE-mediated mechanism.

Hypereosinophilia Presenting as Eosinophilic Vasculitis and Multiple Peripheral Artery Occlusions without Organ Involvement

We report here a case with hypereosinophilia and peripheral artery occlusion. A 32-yr-old Korean woman presented to us with lower extremity swelling and pain. Angiography revealed that multiple lower extremity arteries were occlusive. The biopsy specimen showed perivascular and periadnexal dense eosinophilic infiltration in dermis and subcutaneous adipose tissue. Laboratory investigations revealed a persistent hypereosinophilia. She was prescribed prednisolone 60 mg daily. Her skin lesion and pain were improved and the eosinophil count was dramatically decreased. After discharge, eosinophil count gradually increased again. Cyanosis and pain of her fingers recurred. She had been treated with cyclophosphamide pulse therapy. Her eosinophilia was decreased, but the cyanosis and tingling sense were progressive. The extremity arterial stenoses were slightly progressed. Skin biopsy showed perivascular eosinophilic infiltration in the dermis and CD40 ligand (CD40L) positive eosinophilic infiltration. The serum TNF-alpha was markedly increased. These results suggest that CD40L (a member of TNF-alpha superfamily) could play a role in the inflammatory processes when eosinophil infiltration and activation are observed. We prescribed prednisolone, cyclophosphamide, clopidogrel, cilostazol, beraprost and nifedipine, and she was discharged.

Sensitization rates for inhalant allergens in Korea; a multi-center study / 천식및알레르기

BACKGROUND AND OBJECTIVE: There are many differences in common inhalant allergens between countries and regions. We need to determine the major inhalant allergens in this country with geographical characteristics. To observe the major inhalant allergens and establish essential ones for the skin prick test in Korea, a nation-wide multicenter study was performed. METHOD: The skin prick tests were performed with the same kits of 43 allergens on 2,554 allergy patients who visited their regional hospitals for one year. RESULT: There are significant differences in the sensitization rate to common inhalant allergens among the centers. Twenty three allergens showed > or=5% sensitization rate: D. pteronyssinus, D. farinae, Tyrophagus putrescentiae, Tetranychus urticae, Panonychus citri, Alternaria alternata, Cladosporium tenuis, cat fur, dog hair, American and German cockroach, tree pollen mixture I, alder, hazel, tree pollen mixture II, birch, beech, oak, plane tree, ragweed, mugwort, hop Japanese and chrysanthemum. CONCLUSION: We suggest the major allergens such as D. pteronyssinus, D. farinae, T. putrescentiae, T. urticae, P. citri, outdoor molds, indoor molds, cat fur, dog hair, German and American cockroaches, tree pollens, mugwort, and hop Japanese pollen should be included in skin test battery in Korea.

The sensitization rates of food allergens in a Korean population: a multi-center study / 천식및알레르기

BACKGROUND: Sensitization to food allergens is associated with development of food allergy. Although rates of sensitization to food allergens are different according to countries, there has not been surveyed on the sensitization rate to each food allergen in Korean population. The aim of this study was to evaluate the food allergen sensitization rate among patients who visited allergy clinics at several university hospitals in Korea. METHODS: This study was carried out on 1,425 patients who visited allergy clinics with various allergic symptoms. They had skin prick test for 62 items to evaluate sensitization to food allergens. RESULT: The food allergens of which sensitization rate was above 1% were pupa of a silkworm, shrimp, chestnut, curry, potato, soybean, rice flour, buckwheat, cabbage, mackerel, abalone, lobster, turban shell, arrowroot in decreasing order. The sensitization rate of pupa was highest among them by 9.4% and that of shrimp followed by 5.8%. The sensitization rates of food allergens were generally higher in males and young adults than in those of females and old people. Atopic patients for inhalant allergens showed higher sensitization rates of food allergens than non-atopic patients for inhalant allergens. CONCLUSION: Common food allergens sensitized in a Korean population were different from those in other countries. Pupa of a silkworm, shrimp, chestnut, curry, potato, soybean, rice flourbuckwheat, cabbage, mackerel were the 10 most common food allergens sensitized in Korean population above 10 years old.

A Case of Acute Mediastinitis Associated with Fish Bone with Successful Conservative Treatment / 결핵

Acute mediastinitis is a life threatening disorder that causes severe morbidity in affected patient. We experienced a case of acute mediastinitis in a 56 year-old man as a result of swallowing a fish bone (Order Perciformes, Family Pomacentridae). Conservative treatment, including starvation therapy and the injection of antibiotic drugs, were successful in treating this patient. Although the optimal treatment for acute mediastinitis remains controversial, it is important to choose the appropriate strategies when encountering cases of acute mediastinitis.