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2006⵵ õİ

Է:2007-07-31 / :2007-08-17 / ȸ:44500 / õ:204 / ۼ:Ѹ

2006 ǰл õ ǷԴϴ. ٸ ִ Ȩ ְ Ǿ ű Ǿ. ø ű Ѵ.

  1. õ ˷ ȯ ֱ ϰ ִ.
  2. õ Ǵ پϴ. ⵵ (Airway inflammation)̴.   
  3. õ ⵵ ̸, ⵵ ؾ Ѵ.    
  4. ⵵ Ѵ.  
  5. ⵵ ¸ ˱ پ ǻ ϰ ȴ.  
  6. ϴ ߿ϴ.    
  7. õ ȯ ٽ ̴.  
  8. õ ȯڴ ˻翡 Ư¡ δ.    
  9. ִȣ(Peak expiratory flow) ϰ ϴ.    
  10. μ(Hyperresponsiveness) ߰˻ Ȯ ϴ.   
  11. ڱع ⵵ ϴ 2 ȣ Dosimeter ִ.   
  12. Ư ⵵ ߰˻翡 ⵵ ʱ ı ִ.    
  13. ε õ ϴµ ϳ, ʴ.
  14. Ư ߰˻縦 ˻ ؼ ־ Ѵ.   
  15. õ ߵ , ɰ ๰ 䱸 ǴѴ.    
  16. õ ๰ (Controler) ȭ(Relievers) ִ.   
  17. õ ܰ迡 ȴ.
  18. ġ װ ִ.
  19. Ǵ ๰ ũ 0.5 - 5 um ϴ.
  20. ׺ ΰ ִ. ϳ Jet , ٸ ϳ Ľ  
  21. ġ 뿬ɿ ִ ٸ.  
  22. Կ ׷̵尡 õ ġ ⺻̴.   
  23. Կ ׷̵ 뷮 ϰ ϸ鼭 ؾ Ѵ.  
  24. Կ ׷̵带 뷮 ϸ ۿ ּȭȴ.
  25. Ȯ ȿ ִ. ӻ ٸ.
  26. ñ õ ġ ȯڸ ϰ ִ ̴.
  27. Ƹ Ҿ õ Ư¡ ϱ ٴ ̴.
  28. õ õ ų ħ ؾ Ѵ.  
  29. õ ˷ , κ񵿿 Ǿ ִ.
  30. ħ õ, κ񵿿 Ǵ ĵ ؾ Ѵ.    
  31. ߱ ϰ˻ Ȯ ִ.    
  32. õ ⷮ Ҽ ߻ ´.  
  33. õ ȭ(Relievers) ġѴ.   
  34. õ нǥ .   
  35. ̰ .   

õ ˷ ȯ ֱ ϰ ִ.

Lancet 1998⿡ ǥ 뿡 , õ . ̴ ISAAC(International Study of Asthma and Allergies in Children) ̸ 츮 ̴(Lancet 1998).л ˾ƾ .

  • õ Ҿƿ ȯ̴.
  • õ ֱ 30⵿ ϰ ִ. , ߵ ϰ ִ.
  • 5% ܶ ̴ ܹ ̰ ִ.
  • ϰ ִ Ѵ. Ȱ ȭ, ˷ , ̷, پ ϰ ִ.

õ Ǵ پϴ. ⵵ (Airway inflammation)̴.

, ⵵ õ Ǵ ȭϿ Դ.

GINA 2005(Global Initiative for Asthma)(GINA 2005)

    Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation causes an associated increase in airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.

GINA 2003

    Asthma is a chronic inflammatory disorder of the airways in which many cells play a role, in particular mast cells, eosinophils, and T lymphocytes. In susceptible individuals this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough particularly at night and/or in the early morning. These symptoms are usually associated with widespread but variable airflow limitation that is at least partly reversible either spontaneously or with treatment. The inflammation also causes an associated increase in airway responsiveness to a variety of stimuli.

NHLBI(National Heart Lung and Blood Institute) 1997(NHLBI 1997)

    Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli.

õ .

  • ⵵ ⵵ μ(airway hyperresponsiveness), ȣ (airflow limitation) õ Ư¡ ħ, , õ , ȭ ֿ ̴.
  • ⵵ ޼ , , Plug ⵵ ش. ̴ ⵵ ⸦ Ѵ.

õ ⵵ ̸, ⵵ ؾ Ѵ.

ֱٱ õ Ұ õ ȯ ΰ˰ . 1980 ˻簡 ϸ鼭 » ذ о. ̿ Ұ Եȴ.

  • ⵵ , к(Mucus plug)
  • ⵵ Ǽ Ż(Desquamation of epithelium)
  • (Subbasement membrane thickening)
  • Ȱ (Hypertrophy of smooth muscle)
  • к (Submucus gland hyperplasia)
  • Ȯ(Vasodilation)
  • , (Edema of mucosa and submucosa)
  • پ ħ(Infiltration with eosinophils, neutrophils, mast cells, and T cells)
  • õ ⵵ 2 mm ұ⵵, (Parenchyma) ⵵ ̴. ̴ ޼, ο ⵵ ݵȴ.
  • ȣ걸 ̿ܿ ȣ߱ ϸ õõȯ, ۽ õ ȯڿ Ǿ ִ. õ ȯ ⵵ ȣ߱ ֿ ̴.
  • (Structural cell)μ (fibroblast), Ǽ(endothelial cell) Ǽ(epithelial cell) кϴ ī ɿ ϰ ִ.

⵵ Ѵ.

  • õ ִ ȯ ⵵ ȣ ȸ ʱ⵵ Ѵ. ̴ ⵵ ȭ Ͼ ̴. ̷ ȭ ִ ȯڴ ӵ ְ ġῡ ִ. ̸ ⵵ (Airway remodeling)̶ Ѵ.
  • ȭ, ⵵ Ȱ , ׼ ⵵ β ̴.
  • ⵵ ϱ ġ ǰ ſ Ǿ ִ.

⵵ ¸ ˱ پ ǻ ϰ ȴ.

̿ ⵵ ¸ Ȯϴ ִ.

1. ⵵ Ȯϴ .

  • ô ˻ : Bronchoalveolar lavage(BAL), Bx
  • ˻( ˻)
  • Nitric oxide Ǵ ȣⰡ м

2. ⵵ ι ϴ

  • ߰˻(Provocation Test)

3. ⵵ ⸦ ϴ

  • Ȱ˻(Spirometer)

4. ϴ

  • ڼ ŷ

ϴ ߿ϴ.

  • õİ õǾ , ⿩, , ȭ پ ο ִ. ̸ Ȯ кϱ . ̰ õ Ǵ õ ȭŰ Ͽ Ѵ. ̸ Ʋ ̶ Ͽ Ѵ.
  • з ִ.
  1. dz ׿
    1. ֿϵ ; , , ġ, ҿ , ⸣ )
    2. ()
    3. dz ȭп ȭ ȭ(ɰ)
    4. (RS ̷, Chlamydia sp., ö ű )
    5. ȭй ; ˵, , 迬, NO2, Nox, , , ̼, , VOCs(volatile organic compounds)
  2. ǿ ׿
    1. ȭ(ɰ)
    2. ()
    3. ; ̼, Ȳ갡, , ϻȭ
  3. ׿
    1. ƽǸ NSAID ๰
    2. beta2
  4. Ĺ
  • ȭа dz, ǿ ׿ ο Եȴ. dz ִ.
  •  ȸ ΰ ˷ ġ ٽ ̸ ̴ '˷ ġĢ' ŷеǾ. 1 , 2 , 3 ο ߿ ̴.
  • ๰ õ ȭ ο ϸ Ĺ ȭ 幰 Ҿƿ ϴ.

õ ȯ ٽ ̴.

  • õ ϱ ؼ ڼ , ӻ Ұ پ ˻縦 ؼ Ȯ ִ. ٽ̴.
  • õ ϱ Ȯؾ ׵
    • õ ǽɵǴ
    • ( ˷Ⱑ ִ )
    • ŷ( Ǻο ˷ 󿩺, Կ, ȣ ȯ , )
    • ȭŰ ǽɽ ε, ȭ
    • ȯ(˷ , κ񵿿, ⵵ , ĵ )
  • õȯڴ ȣѴ.
    • õ 鸰.
    • ħ Ѵ.
    • (ȣ )
  • ̷ ο Ǹ ȭȴ.
  • õ ħ ϴ ȯڵ ִ. ̸  ڵ Cough variant Asthma(ħõ)̶ Ѵ.
  • õ ų ִ ٸ ε Ѿ Ѵ.
  • ħ ȯڵ鿡 '˷⼺ ħ' '˷⼺ ' ' ' Ǵ 'õ ' ̶ ܸ ٱ⵵ Ѵ. ̷ ȯ õĿθ Ȯ ִ ߿ϴ.

õ ȯڴ ˻翡 Ư¡ δ.

  • - õ ȯڿ ˻縦 ϸ Ư¡ δ.
  • Ȱ
    • RV >> FRC > TLC
    • VC
    • Inspiratory flow preserved, Expiratory flow rate decreased

  • Flow-Volume Curve
    • Low FEV1
    • FEV1/FVC < 0.8
    • Post bronchodilator FEV1 > 12%

  • VC ϸ Inspiratory flow Expiratory flow ϰ ȴ.
  • 5 ̸ Ҿƿ ˻縦 ϱ .

ִȣ(Peak expiratory flow) ϰ ϴ.

  • ִȣ̶ ִ ִȣ(Forced maximal flow) Ÿ Ѵ. Liter/min(L/m)̴.
  • ̴ Spirometer MEFR(forced expiratory flow maximum or maximum expiratory flow) ҷ⵵ Ѵ.
  • ̿ܿ Flow rate Ȯϴ
    • MEFV curve(Maximal expiratory flow-volume curve)
    • FEF25-75(Force expiratory flow 25-75%)
  • ִȣӱ(Peak flow meter) Ʒ ׸ PEF ϴµ Ѵ.
  • α⿡ õ ȯڸ ϴµ ϰ ִ.
  • ο Ϸ ġ 10% ̸̳, õ ȯڿ ߵ , Ϸ ġ , õ  Ȱ ִ.

                           

׸ 1) ִȣ ӱ                 ׸ 2) Ϸ ġ

  • ȣ ȣڵ鿡 Ǵ ̴. Ϸ ġ 20% ̸ , Ϸ ġ 20-50% , 50% ̻ Ѵ. Ȯ ٴ ๰ 䱸 ؾ Ѵٴ ǹѴ.
  • ȯڿ ʿ ƴϴ. 5 ̸̻ Կ Ͽų ڰ ϴ ̵鿡 ʿ ִ.
  • Ͽ , ߿ , ȣ ġ ޶ ִ. ׷Ƿ ġ ſ ũ. ڸ ̰ ٴ ˾ƾ Ѵ.
  • ǰ ġ ̰ . ׷Ƿ ǰ ؾ Ѵ.
  • FEV1 ū Ͱ ߰ ũ ݿ PEF ū ݿѴ. FEV1 Ͽ ġ ǥ д.
  • Ϲ PEF ⵵ FEV1 ΰ ʰ Ȯ ȸ FEV1 ΰ ʴ.
  • ᱹ PEF FEV1 .

μ(Hyperresponsiveness) ߰˻ Ȯ ϴ.

  • ⵵ μ̶ ܺ Ǵ ڱع Ѵ. ǰ ߿ Ҵ ⵵ ̴. ⵵ μ õ ߿ ̴. ε õĿ Ư õ ִ κ ȯڿ ⵵ μ δ.
  • ⵵ μ ˷ Ͽ ϴ Ư ߰˻硯 Ÿ Ǵ Ÿݸ, 3% Ŀ Ư ڱع ϴ Ư ߰˻硯 ִ.
  • ̷ ڱ з ڱ(Direct Stimuli) ڱ(Indirect Stimuli) ⵵ Ѵ. ڱ̶ ⵵Ȱٿ ڱصǾ ⵵ ߱ϴ ϸ, ̿ Cholinergic agonist Methacholine, acethylcholine, Carbachol Ÿ, νŸ׶ D2, Ʈ ڱ ִ Ѵ. ̿ʹ޸ ڱ ⵵ Ǽ, Ű ڱ ־ ϴ Ѵ. ̿ , NonIsotionic aerosol(hyper-, hypo, distilled water, manitol) ๰ Ƶ, ˷հ ƽǸ ڱ Ѵ. ڱغٴ ڱ ˷ȸǿ ⵵ ȭ ݿѴ.
  • ⵵ ߰˻ ⵵ ڱ ־ FEV1 ľϴ ̴. 20% ̻ Ÿݸ 󵵸 Ͽ PC20(Provocative concentration) Ǵ PD20 ϰ ȴ.
  • 30ʿ 3̳ ϴµ ̶ ⵵ ϴ δ FEV1, Raw, sRaw, PEFR ִ. FEV1 ˻, ܼ, Ͽ ȴ.

 

׸ ) Ư ڱع 󵵸 ø Ǹ FEV1 ġ 20%̻ ʴ´. ׷ ε ִ FEV1 20%̻ ̶ ڱع Ǵ Ե ѷ Ͽ PC20 Ǵ PD20 Ѵ.

  • PD20(Provocative dose) Ÿݸ(Ÿ) ۺ ԵǾ 뷮 ǥ ̴.
  • ߰˻ ׿ ãų ľϰ ġ θ Ȯϴµ ϴ.

ڱع ⵵ ϴ 2 ȣ Dosimeter ִ.

  •   ϴ 2 ȣ ϴ '2 ȣ'(tidal breathing method) 20 psi з й⿡ ߻ϴ ü (Dosimeter) ̿Ͽ 0.6 뷮 5ȸ ϵ ϴ ' Թ'(Dosimeter method) ִ

.

  • ԵǴ 뷮 ̰ ˷ ִ.
  • ׸ ˻ 踦 Ȱ Թ̴.

Ư ⵵ ߰˻翡 ⵵ ʱ ı ִ.

  • ׿ г Ÿ ʱ(early asthmatic response, EAR) ̶ ϰ ð Ŀ Ÿ ı(late asthmatic response, LAR) ̶ Ѵ.
  • ȯڿ ʱ, ı Ÿ ƴ϶, ̴ ȯڰ ְ ʱ ̴ ȯڿ ı ̴ ȯڰ ִ.

.

  • ʱ 񸸼 Ǵ ȭй ؼ Ͼ ̰, ı ȣ걸 ǥǴ ħϿ Ÿ ⵵̴. ̸ ǥ ָ .

ε õ ϴµ ϳ, ʴ.

  • 忡 PC20 󵵰 25 mg/dL ̸ ε ְ 8 mg/dL ̸ õ ִٰ ̴ ʴ. ߰˻翡 Ÿ õȯ( õȯ) 100% 缺 δ. ׷ PC20 8 mg/mL 缺 50% ȵȴ. Cutoff value ߸ Ư̵ 缺 100% ö󰡳 ΰ ſ . ׷Ƿ 8-16 mg/mL ġ ſ ΰϱ⿡ õ ƴ϶ ְ ſ ġ PC20 õ̶ ϴ.
  • ⵵(COPD)ȯڿ ⵵ ε δ. ᱹ Ÿݸ(Ÿ) ⵵ ߰˻ õ ãƳµ ſ ΰ ٸ ȣ ȯ ϴµ Ѱ谡 ִ.
  • ε ϴ ϴ. ׷ 迡 å ؼ ؼؾ ̴.

  • ⵵߰˻ 뼺 Ư̵ ٴµ ִ. õ ƴϸ鼭 ⵵ Ÿ ִ. ̷ δ ˷ , ȣ , , , ִ.
  • PC20 뼺 õ ܿ ȴٴµ ִ.  

׸ ) ⵵߰˻縦 ϱ õ ɼ 10%(࿡ 0.1) ̶ Ҵµ ߰˻翡 PC20 1 mg/dL Դٸ õ ɼ 83% ȴ. ˻ ɼ ְ ˻ ɼ ش.

  • ̷ ̸ ̴ ⵵ ⵵ ִٰ Ͽ ⵵ ִٴ ǹ ʱ ̴.

Ư ߰˻縦 ˻ ؼ ־ Ѵ.

- ȯ ̴. ̸ ؼ ־ Ѵ. ȯڴ 9 ڷ Ű 148 cm, ü 39 kg ̾.

  • ˻ Ȯ
    • ⵵ ; FEV1 % pred., FEV1/FVC, FEF25-75
    • ⵵ μ : PC20̴.
  • FEF25-75 MFEF ұ⵵ ΰϳ ϴٴ ִ.
  • Ȯ FEV1 ȸ 12 ~ 15% ̻ Ǹ μ ִ.

õ ߵ , ɰ ๰ 䱸 ǴѴ.

  • õ ġϱ ؼ õ ߵ ľϰ ȴ. ̶ ߵ ľϴ ݾ ٸ ִ. ̰ NAEPP ̵ο зѴ.
  • õ ߵ 漺(mild intermittent) Ӽ(mild persistent) ߵ Ӽ(moderate persistent) Ӽ(severe persistent) .
  • ߵ Ǵϴ , , FEV1 Ǵ PEFR ġ %, FEV1 Ǵ PEFR , κ зϰ ȴ. ̴ Ʒ ǥ Ÿ´.

  • ȯڰ ๰ ġ ̶ ๰ ġ μ õ ߵ ϰ ȴ.

õ ๰ (Controler) ȭ(Relievers) ִ.

  • õġḦ Ǵ ๰,
    • Ÿ2 (beta2 agonist) ; Salbutamol(albutamol), Terbutaline, Formoterol, Salmeterol, Procaterol, Clenbuterol ִ.
    • ƿƾ(Methylxanthine) ; ʸ(Theophylline, ׿ʸ), ƹ̳ʸ(aminophylline)
    • ݸ(anti-cholinergic) ; Ipratropium bromide
    • ν ׷̵(Corticosteroid)
    • ũθ ׵ũι(Cromolyn, Nedocromyl)
    • ׷Ʈ(Anti leukotriene) ; Pranlukast, Montelukast, Zafirlukast 5-LP(Lipoxygenase) Zileuton
    • 鿪 : Methotrexate, Cyclosporin, Gold ִ.
  • ̸ õ ġῡ ΰ ๰ . ϳ ޼ Ȯ ִ ๰ ȭ ٸ ϳ ⵵ ϱ ̴.
  • ,
    • ׷̵(Կ, ),
    • ũθ ׵ũι,
    • ʸ,
    • Ȯ(Կ, 汸)
    • ׷Ʈ Եȴ. Կ ׷̵ ȿ̸ ߿ ġ̴.
  • ȭ,
    • ȿ Ÿ2 (rapid acting beta2 agonist, 汸, Կ),
    • ȿ ʸ,
    • Կ ݸ,
    • ׷̵(Systemic glucocorticosteroid) ִ.
  • θ ϸ ȵǰ õ ȭ ؼ ȵȴ.

õ ܰ迡 ȴ.

  • õ ⵵̹Ƿ Կ ׷̵尡 ⺻ ġ̴.
  • Ǹ ȭ ġϸ ġ õ ܰ迡 Ʒ ϰ ȴ.

  • ǥ 5 ̻ Ҿ ο ġ Ģ̴.
  • ġ ߿ Ǹ ȭ( Ȯ) ġḦ ־ Ѵ.
  • 漺 õȯ õ ִ ȯڴ ߵ Ӽ õȯڿ ġḦ ִ.
  • IgE ġ 12 ̻󿡼 ް ִ.
  • 5 ̸ ġ ħ  ٸ.
  • 5 ̸ Կ Ÿ2 . ׷ ȵ ϰ ȴ.
  • IgE ġ ʴ´.
  • 뷮 3 ˻ 鼭 Step Up/Down ִ.

ġ װ ִ.

  • й (Metered dose inhaler, MDI)
  • ̼ й (MDI with Spacer)
  • и (Dry powder inhaler, DPI)
  • ׺ (Nebulizer)

ġḦ õĿ ϴ ⵵ ๰ ȿ ϴ ϰ ִ. װ  ϴ ˰ ־ Ѵ.

       

- ǰ ִ MDI              - ̼ MDI                              

                            

- ǰ ִ DPI                     - ׺              - MDI л

Ǵ ๰ ũ 0.5 - 5 um ϴ.

  • Ե ๰ 浹(Impaction), ħ(Sedimentation) Ȯ(Diffusion) ؼ ޵ȴ.

׺ ΰ ִ. ϳ Jet , ٸ ϳ Ľ

  • Ľ ׷̵尡 ޵ ʴ´. ׷Ƿ Jet Ǿ Ѵ.

  • Ľ

ġ 뿬ɿ ִ ٸ.

  •  ġ ⱸ ΰ ̿ ȯ ȣ Ȱ Ͽ ޸ Ͽ Ѵ.

  • MDI with spacer
    • 5-10 ϵ Ѵ.
    • õõ ׸ Ѵ.
    • й ̰ 30 ǰ Ѵ.
    • 18 ̵ ڷ Ƿ Ϻα Է 50% Ѵ.
    • ๰ Ե ʴ´.
    • ߿ ũ 󱼿 ̴.
  • MDI
    • Ա Ѳ 3ȸ
    • õõ .
    • õõ ø鼭 Ա⸦ 鼭 Ŵ.
    • Ա⸦ Կ 10 ´.
    • - , ġ Ư¡ ; ڷ , ⵵ , Tidal volume ۰ ȣ .
  • ̼ ; ʰ, ๰ ȿ̸, Ծ๰ ۿ ּȭ Ѵ.

Կ ׷̵尡 õ ġ ⺻̴.

Կ ׷̵ 뷮 ϰ ϸ鼭 ؾ Ѵ.

  • Կ ׷̵ 뷮 Ʒ . ǥõ ȵǰ ִ ̴.

  • 뷮 ǥ ݾ ٸ.
  • Կδ DPI, MDI, Nebulizer ִ.
  • 뷮 Ҿ 뷮 ̰ ִ.
  • õ ߵ ϴ 뷮 ̸ ξ Ѵ.

Կ ׷̵带 뷮 ϸ ۿ ּȭȴ.

  • Կ ׷̵ 뿡 ۿ ŷеǴ .
  • Local side effects
    • Ҹ 㽺Ű.(Hoarseness, dysphonia)
    • Ʊâ .(Oral candidiasis)
    • å) 뷮 ̸鼭 ü ๰ ϰų, ̼ Ȱϰų, 󱺴.
  • Systemic side effects
    • е
    • HPA
  • 뷮 Կ ׷̵带 ( ΰ)Ͽ
    • ʱ 1Ⱓ Ͼ Ͻ̸ Catch Up . Ű ̰ ų ̴.
    • е Ұ Ͼ ʴ´. Ǵ (minimal) ̴.
    • HPA Ͼ ʴ´. Ǵ (minimal) ̴.
    • 鳻 Ű ϴ.
  • 뷮 Կ ׷̵带 ϸ systemic side effects Ͼ ִ.

Ȯ ȿ ִ. ӻ ٸ.

  • ȿ(Short acting beta2 agonist) ȭ ȴ.
    • Salbutamol(Albuterol) ; VentolinTM
    • Terbutaline ; BrycanylTM ( ȵ)
    • Pirbuterol
    • Bitolterol
  • (Long acting beta2 agonist) ȴ.
    • Salmeterol ; SereventTM ( ȵ)
    • Formoterol ; OxisTM
  • Կ ׷̵ Ȯθ õ ġϸ ȵȴ.
  • ΰ ִ.
    • Seretide evohalerTM ; Fluticasone + Salmeterol
    • Seretide diskusTM ; Fluticasone + Salmeterol
    • SymbicortTM ; Budesonide + Formoterol

ñ õ ġ ȯڸ ϰ ִ ̴.

  • õ ġϿ ġ Ŵ ȯڵ鿡 õ ̰, ۿ , õ Ͽ ϵ ϴ ġ ǥ̴.
  • ̸ ü õ ġ ǥ ϸ,
    • ּȭ
    • õ ּȭ
    • ޽ǿ ʵ Ѵ.
    • beta2 ۿ Ȯ ּȭ
    •  ϻȰ
    • PEF Ϸ ġ 20% ̳ ǵ
    • ๰ ۿ ּȭ
  • ȯ ġ ٽ̴.
  • ˷ ġ ȸǿ, ๰, 鿪 ġ ٽ̴.

Ƹ Ҿ õ Ư¡ ϱ ٴ ̴.

  • ƽñ⿡ õ 鸮 õ ǽϰ ȴ. ̸ ϱ . õĿ Ȯ ȵǴ 찡 ̴ õ ̱ ̴.
  • ƽñ⿡ õ ȴ ̵ Ͽ .
    • A. ñ⿡ õ 鸮 ̰ (Transient Wheezer )
    • B. ñ õ ̰ ӵ (Persistent Wheezer )
    • C. ñ⿡ õ ̰ Ÿ (Late Wheezer )

  • õ 鸱 ִ δ .
    • õ
    • 2 ̻
    • న ۽ ߺ
    • ȣ걸
    • Ȯ
  • ̸ ϴ ǥ  ̸ Asthma Predictive Index(API)  Ҿ õ ̵鿡 ġḦ ϰ ִ.
  • õ ٸ . ׷Ƿ ġḦ ⿡ ϰ õǴ ȴ.

õ õ ų ħ ؾ Ѵ.

  • Ҿƿ ȯ ؾ Ѵ.
    • Bronchiolitis obliterans ; ؼ ұ⵵ Scarring Ѵ. ġῡ ϴ Ư¡̴.
    • Interstitial lung disease ; FEV1 FEV1/FVC ̴.
    • Vocal cord dysfunction(VCD) ; ߿ 밡 paradoxic ϰ Ѵ. ɰ˻ ǽ ְ laryngoscopy ȮѴ.
    • Foreign bodies
    • ̿ܿ ĵ κ񵿿 Ǿ Ѵ.

  • ο Ҿư  ؾ ȯ ִ.
    • Localized carcinoma ; laryngeal carcinoma, Tracheal carcinoma, Bronchial carcinoma
    • Generalized obstructive disease ; COPD, Bronchiectasis
    • ׽ õ ȣ ؾ Ѵ. Common colds, Bronchiolitis, Pneumonia, Tuberculosis, HIV/AIDS infection.

õ ˷ , κ񵿿 Ǿ ִ.

  • ڿ κ ſ ִ. ù° ڿ κ Ǿ ִ. °, ڿ κ񵿿 ſ Ͽ аϱ ƴ. °, κ񵿿 Ÿ. °, κ񵿿 ִ. ̷ ڿ κ ʰ Rhinosinusitis Ѵ.- ڿ õİ 赵 ִ. 翡, õ ִ 80-90% ִ ˷ ִ. ִ κ 15% õ ִ ˷ ִ. ̹ flitering ϴ ϰ Ǵµ ̷ ϸ ˷ ڱ ִ.
  • ̷ 񿰰 õİ 踦 ؼϴ ֽϴ.
    • ⵵ Ѿ.
    • reflex . Naso-sino-bronchia reflex
    • Cell migration
  • κ񵿿 õĵ ִ. κ񵿿 ġϸ õ ȭǸ κ񵿿 ִ ȯ 50% õ ִ.
  • ׷Ƿ ̷ , ȣ, κ Ǿ ְ ġ ϱ⿡ 'One airway One disease' Ǵ 'United airway disease' Ѵ.

ħ õ, κ񵿿 Ǵ ĵ ؾ Ѵ.

- Ҿƿ ħ Ʒ ǽؾ Ѵ.

- ο ħ õ, κ񵿿, ĵ ǽؾ Ѵ.

߱ ϰ˻ Ȯ ִ.

  • ϰ˻ Ư ڱع̸ ڱ ̱⵵ ϴ. ϰ˻ õ ѵ Ÿݸ Ͽ ׽ ġ ߴ. ϰ˻ õ ϴµ Ÿݸ ߰˻纸 ΰ Ư̵ . Ҿƿ õİ Ȯ, PCD BO ϴµ Ÿݸ ϰ˻簡 . ΰ/Ư̵ ϰ˻ Ÿݸ(Ÿ) PC20 1 - 2 mg/ML ´. Ư̵ ̷ ڱ õİ ִ پ ־ Ÿ ̸, ΰ ڱ ̷µ ߱ ̶ Ѵ.
  • ϰ˻ 12 Ҿƴ 6е, 8е (25 , 50% ) ִ ȣ 60% 4е ϴ  ؾ Ѵ. ̴ д ȣ 14迡 21迡 ̸. ȣ ִ ⱸ ٸ ƹڼ Ѵ. Ǵ ִ ƹڼ 90% ̸  4б ǵ ؾ Ѵ. ˻ FEV1 10% (10~20%) ٸ 缺̶ Ѵ.
  • ߼ õ(Exercise induced asthma, EIA) Ǵ ߼ (Exercise induced bronchospasm, EIB) ϸ ̴  ϰ Ͼ õ Ÿ Ѵ.
  • ϰ˻ ϰ Ǹ  15 Ŀ Ͼ.
  •  FEV1 15% ̻ ϸ ִ.
  •  ߼ õ õ ׽ ʴ.
  • ߼ õ ġϱ ؼ  Ģ ؾ Ѵ.

õ ⷮ Ҽ ߻ ´.

  •  Ư Ͽ ̳ , ,  Ǿ ħ , ȣ õ ߻ Ȥ ȭǴٰ ų ׸θ ҽǵǰų ̴ ̴.
  • Ǵ Ҽ ߻ Ѵ.
  • Sensitizing potency ߿ϴ.
  • ι 300 Ǿ. .
    • ()

        ( ), ( ), а(), ( ), Ѿ(Ѿ ), ī(īٷ), ؽ(Ƿ), ̴(ǰ), Ұ(Ұ) .

    • ()

      TDI(, ǾƳ DZ), MDI(Ʈ ), (), ( ), (), (ȸ, Ƿ), ̵ ݼ(ݰ) .

  • ġ ݸ̴.
  • õ ⵵ ε õ ̸ μ 忰 ̴.

õ ȭ(Relievers) ġѴ.

  • - Critically ill asthma attack Tx
    • Oxygen
    • Short acting beta agonist every 20 min for 1 hr
    • Ipratropium bromide
    • Systemic corticosteroid(PO or IV)
    • SQ epinephrine, beta 2 agonist.
    • Continuous nebulization with monitoring of EKG and oxymetry
      • tremor, irritability, tachycardia, hypokalemia
      • Hypoxia, V/Q mismatch
    • Slightly below maintenance fluid d/t ADH secretion
    • Theophylline IV
    • Heliox(70:30 helium:oxygen mixture)
    • Magnesium sulfate IV
    • Mechanical ventilation
      • Low barotrauma
      • Short inspiratory long expiratory times
      • 10-15 ml/kg tidal volume
      • 8-15 breaths/min
      • <60 cmH20 peak pressure
      • Without PEEP
    • Rarely occur in medical center, asthma death

õ нǥ

  • õ ǿ ⺻ » Ѵ.
  • õ Ư¡ ӻ Ұ߰ Ұ Ѵ.
  • õ ȯڸ Ѵ.
  • õ Ǵ ȭ Ѵ.
  • õ ûϴ ˻Ұ Ѵ.
  • ũƾ(xanthine) ๰ װ ۿ Ѵ.
  • Ư Ѵ.
  • νȣ Ѵ.
  • ϴ ϰ Ѵ.
  • õ ȯڿ ƾ Ѵ.
  • õİ ؾߵǴ ȯ Ѵ.
  • õ Ѵ.
  • õ ġῡ Ǵ ๰ зϰ ۿ ۿ Ѵ.
  • ⵵ ˻ Ѵ.
  • õ ȯ ˻ Ұ ؼѴ.
  • õ ȯ о Ұ ؼѴ.
  • õ зѴ.
  • õ ġ ǥ Ѵ.
  • õ ġ Ģ Ѵ.
  • ޼ õ ġ Ģ Ѵ.
  • õ ġ ۿ ۿ Ѵ.
  • Ѵ.
  • õ ȯڿ ؾ Ѵ.
  •  ߼ õ ܰ Ѵ.
  • õ Ѵ.

- нǥ ߿伺 ߿ Ѵٴ ̿ܿ ̸ ߽ 迡 ȴٴ ̴. ׷Ƿ ߿ θ ϰ ؾ Ѵ.

- ̰,

  • – ũƾ(xanthine) ๰ װ ۿ Ѵ.
  • – νȣ Ѵ.
  • – ϴ ϰ Ѵ.

- ׸ ˷ ๰ġ Ģ ߺDZ⿡ ⺻ ͸ Ѵ.

̰ .

  • AIDS; acquired immune deficiency syndrome
  • BAL ; Bronchoalveolar lavage
  • Bx ; Biopsy
  • COPD ; Chronic obstructive pulmonary disease
  • DPI ; Dry powder inhaler
  • EAR ; early asthmatic response
  • EIA ; Exercise induced asthma
  • EIB ; Exercise induced bronchospasm
  • ERV ; Expiratory residual volume
  • FEV1 : Forced expiratory volume
  • FRC ; Functional residual capacity
  • FVC ; Forced vital capacity
  • GINA : Global Initiative for Asthma
  • HPA ; Hypothalamic-pituitary-adrenal
  • IRV ; Inspiratory residual volume
  • ISAAC ; International Study of Asthma and Allergies in Children
  • LAR ; late asthmatic response
  • MDI : Metered dose inhaler
  • MEF ; Maximal expiratory flow-volume
  • NHLBI : National Heart Lung and Blood Institute
  • NSAID ; non steroidal anti inflammatory drugs
  • PC ; Provocative concentration
  • PD ; Provocative dose
  • PEFR ; Peak expiratory flow rate
  • Raw ; Resistance of airway
  • RS ; Respiratory syncytial
  • RV ; Residual volume
  • sRaw ; specific airway resistance
  • TLC ; Total lung capacity
  • VC ; Vital capacity
  • VOCs ; Volatile organic compounds
  • VCD ; Vocal cord dysfunction
  • HIV; Human immunodeficiency virus

  • Lancet. 1998 Apr 25;351(9111):1225-32. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. (Medline)
  • GINA 2005 Pocket Guide for Asthma Management and Prevention(Site)
  • NHLBI 1997 Guidelines for the Diagnosis and Management of Asthma(Site)

 

 

 
100   ̸: Է:2024-03-29 
 
ۼ : Mark Pierson
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ۼ : Albert Neistat
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ۼ : Steve Talker
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ۼ : David Quillson
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ۼ : John Wellson
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ۼ : Chase Richards
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