Earticle

본 연구는 남자체육전공 대학생 집단 11명을 대상으로 흉곽 심호흡 스트레칭 적용 유무 간의 폐기능 검사와 운동 부하검사를 통하여 폐기능(노력성호기량, 최대흡기류속, 최대호기류속, 최대수의적환기량)과 유산소성 운동능력(최대 산소섭취량, 호흡교환율, 분당환기량, 운동지속시간)을 비교 분석하여 유산소성 운동 전에 효과적으로 시행할 수 있는 스트레칭 프로그램 개발을 위한 기초자료로 제공하기 위해 실시하였다. 흉곽심호흡 스트레칭에 따른 결과로는 폐기능에 서 최대흡기류속(p=.046), 최대수의적환기량(p=.008)에서 유의한 증가가, 유산소성 운동능력에서는 호흡교환율 (p=.029), 분당환기량(p=.027), 운동지속시간(p=.001)에서 유의한 차이가 있었다. 따라서 흉곽심호흡스트레칭이 폐 기능과 유산소성 운동능력을 향상시킬 수 있는 간편하고도 의미 있는 단기 처치방법이라 할 수 있다.

The aim of study is to identify the effects of thoracic deep breathing stretching on pulmonary function and aerobic exercise capacity of male university student in physical education major. Lung function(FVC, PIF, PEF, MVV) and aerobic exercise capacity(VO2max, RER, VE, Exercise Duration) were measured by pulmonary function test and Graded exercise testing before and after thoracic deep breathing stretching program. All data were compared and analyzed to provided fundamental data for development of stretching program that can be effectively. Thoracic deep breathing stretching improved the result of lung function(PIF(p=.046), MVV(p=.008)) and aerobic capacity(RER(p=.029), VE(p=.027), Endurance Time(p=.001)). Therefore, thoracic deep breathing stretching is a simple and effective treatment method to improve lung function and aerobic capacity.

Objective To determine the abnormal pulmonary function value in Korean Duchenne muscular dystrophy (DMD) patients, we performed a comparative analysis of the patients’ pulmonary function value expressed as % of the overseas reference data and Korean healthy children and adolescent reference data.Methods We performed pulmonary function test (PFT) in a total of 27 DMD patients. We compared the patients’ FVC% and FEV1% of the overseas reference data with those of the Korean children and adolescent reference data. Also, we compared the patients’ MIP% and MEP% of the prediction equation data with those of the Korean children and adolescent reference data. Results Age of the subjects ranged from 8 to 16 years (12.03±2.27 years). The mean maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak cough flow (PCF) were 36.93±9.5 cmH2O, 45.79±17.46 cmH2O, 1.4±0.43 L, 1.45±0.45 L, 1.40±0.41 L, and 206.25±61.21 L/min, respectively. The MIP%, MEP%, and FVC% of the Korean children and adolescent reference data showed statistically significant higher values than those of the prediction equation data.Conclusion We observed a clear numeric difference between Korean DMD patients’ pulmonary function value expressed as % of the overseas data and inland data. To perform a precise assessment of respiratory function and to determine appropriate respiratory therapy, pulmonary function values of Korean DMD patients should be interpreted taking into account the inland normal pulmonary function test data.

폐기능검사는 호흡기 질환을 진단하는 검사방법으로 정확한 검사 결과를 얻기 위해서는 환자의 이해와 협조가 절대적으로 필요하다. 본 연구는 폐활량검사에서 환자의 이해도와 자세의 중요성에 대하여 실험하였다. 2016년 110명의 건강한 사람을 대상으로 1) 검사자의 설명만으로, 2) 동영상 상영과 검사자의 시연 후, 3) 자세에 제한을 주기 위하여 다리 를 꼰 후 어깨를 구부린 상태로 측정하였다. 폐활량 검사기기를 이용하여 FVC, FEV1, FEV1/FVC, FEF25-75%, PEF를 측정 하였다. 대상자가 검사방법을 이해하기 전과 후의 FVC, FEV1, FEV1/FVC, FEF25-75%, PEF가 유의적으로 증가하였다. 잘못 된 자세에서 검사 시 FVC, FEV1, PEF의 유의적으로 차이가 있었다. 재현성은 대상자의 이해도와 자세이상에서, 적합성은 자세이상에서 유의적인 차이를 보였다. 폐기능 검사의 정확한 결과를 도출해 내기 위해서는 검사 시 환자의 정확한 이해와 올바른 자세를 유지하여야 신뢰할 수 있는 결과를 얻을 수 있을 것이다.

Pulmonary function test (PFT) is a test method to determine respiratory disease. In order to obtain accurate PFT results, it is absolutely necessary to induce the inspector and cooperate with the patient. This study was to observe the importance of understanding and posture of the patient in spirometry. In 2016, 110 healthy experimenter performed spirometry; 1) only heard the explanation, 2) watching video and inspector,s demonstration, 3) twisting legs and bending shoulder. FVC, FEV1, FEV1/FVC, FEF25-75%, PEF were measured by spirometry. FVC, FEV1, FEV1/FVC, FEF25-75%, PEF were significantly increased before and after the understanding the test method. There was a significant difference in FVC, FEV1, and PEF in the false posture. Reproducibility was significantly different in the experimenter' comprehension and false posture. This study provides accurate understanding of the patient and correct posture should be maintained during the examination to obtain correct and reproducible results of PFT.

The purposes of this study was to effects of the POWERbreathe training program on pulmonary function and shuttle run test in soccer players. Subjects were aged 20~21 years. There was classified two groups(exercise group 15, control group 15), total 30. Measured items for this study were rest pulmonary function test(VC, FVC, FEV1, PEF, PIF, MVV), during exercise pulmonary function test(VErest, VEpeak, RER, VT, VO2max, TET), and shuttle run test in the 12weeks before and after. Subjects of exercise group were participated an 12week POWERbreathe training program. Data were analyzed by two-way ANOVA with repeated measure method of SPSS accepting level for all significances was above p<0.05. Results of this study were as follows; In the rest pulmonary function test, exercise group were showed significant differences on the FEV1, PEF, PIF, and MVV in the 12week POWERbreathe training program. In the during exercise pulmonary function test, exercise group were showed significant differences on the VEpeak, RER, VT, VO2max, and treadmill exercise time in the 12week POWERbreathe training program. In the shuttle run test, exercise group were showed significant differences in the 12week POWERbreathe training program. This study showed that an 12weeks POWERbreathe training program affected in a positive effects in almost of items in trained soccer players, but not in untrained soccer players. These results support evidence that POWERbreathe training has beneficial effects on pulmonary function, shuttle run test and might be a factor that improve soccer players exercise performance.

본 논문에서는 문자 검출 및 인식 기술을 활용하여 비정형의 폐 기능 검사지 이미지로부터 연구를 위한 관련 정보들을 추출하여 정형화하는 방법을 제안한다. 또한 문자 인식 오차율을 줄이기 위한 후처리 방법 또한 개발하고자 한다. 제안하는 정형화 방법은 폐 기능 검사지 이미지에 대해 문자 검출 모델을 사용해 검사지 내에 존재하는 모든 문자를 검출하고, 검출된 문자 이미지를 문자 인식 모델에 통과시켜 문자열을 얻어낸다. 얻어낸 문자열에 대해 문자열 매칭을 이용한 유효성 검토를 진행하고 정형화를 마무리한다. 제안하는 정형화 시스템의 오차율은 약 1% 이내, 검사지 당 처리속도는 2초 이내로 전문인력의 수작업을 통한 정형화 방법보다 더 효율적이고 안정적인 방식이라는 것을 확인할 수 있다.

In this paper, we propose a method of extracting and recognizing related information for research from images of the unstructured pulmonary function test papers using character detection and recognition techniques. Also, we develop a post-processing method to reduce the character recognition error rate. The proposed structuring method uses a character detection model for the pulmonary function test paper images to detect all characters in the test paper and passes the detected character image through the character recognition model to obtain a string. The obtained string is reviewed for validity using string matching and structuring is completed. We confirm that our proposed structuring system is a more efficient and stable method than the structuring method through manual work of professionals because our system's error rate is within about 1% and the processing speed per pulmonary function test paper is within 2 seconds.

Background/Aims: The pulmonary abnormalities (principally restrictive abnormalities) are characteristic of renal transplant recipients or those with end-stage renal disease. Our aim was to explore whether the prevalence of spirometric abnormalities was influenced by the estimated glomerular filtration rates (GFRs) in a Korean general population. Methods: We used data obtained during the 2010 to 2012 Korean National Health and Nutrition Examination Survey, a national cross-sectional survey. We analyzed data from subjects for whom spirometric assays and estimated GFRs were of acceptable quality. Results: A total of 8,809 subjects (3,868 male and 4,941 female) was included. In both males and females with GFR values < 60 mL/min/1.73 m2, the linear trends toward the presence of obstructive and restrictive patterns were significant. However, the percent predicted forced vital capacity (FVC) decreased with a decline in the estimated GFR, but only in males (p for trend < 0.0031). Multivariate linear regression analysis showed a decline in the estimated GFR was independently associated with falls in the percent predicted FVC and the forced expiratory volume in 1 second/FVC ratio in both males and females. However, the percent predicted FVC was independently predictive only in males (p = 0.002). Conclusions: Impaired pulmonary function was associated with a decline in the estimated GFR. The percent predicted FVC decrease paralleled the decline in estimated GFR in male only. Careful interpretation of pulmonary function test data is required in patients with decreased GFRs or impaired renal function, especially males.

The single intratracheal instillation (ITI) of bleomycin (BLM) is a widely used method for inducing experimental pulmonary fibrosis in rat model. In the present study, pulmonary function tests (PFTs) of tidal volume ($V_T$), minute volume ($V_M$), and respiratory frequency ($F_R$) have been applied to study their possibility as a tool to monitor the progress of BLM-induced lung injury in rat model. Rats were treated with a single ITI of BLM (2.5 mg/kg) or saline (control). Animals were euthanized at 3, 7, 14, 21, and 28 days post-ITI. Lung toxicity effects were evaluated by inflammatory cell count, lactate dehydrogenase (LDH) activity in the bronchoalveolar lavage fluid (BALF), and light microscopic examination of lung injury. The PFT parameters were measured immediately before the animals were sacrificed. BLM treatment induced significant cellular changes in BALF-increase in number of total cells, neutrophils, and lymphocytes along with sustained increase in number of macrophages compared to the controls at days 3, 7, and 14. BALF LDH level was significantly increased compared to that in the controls up to day 14. On day 3, infiltration of neutrophils was observed in the alveolar spaces. These changes developed into marked peribronchiolar and interstitial infiltration by inflammatory cells, and extensive thickening of the interalveolar septa on day 7. At 14, 21, and 28 days, mild peribronchiolar fibrosis was observed along with inflammatory cell infiltration. The results of PFT show significant consistencies compared to the results of other toxicity tests. These data demonstrate that the most suitable time point for assessing lung fibrosis in this model is 14 days post-ITI of BLM based on the observation of fibrosis at 14, 21, and 28 days. Further, the progress of lung injury can be traced by monitoring the PFT parameters of $F_R$, $V_T$, and $V_M$.

목적: 범발성 세기관지염 환자에 대한 저용량 에리스로마이신 (erythromycin)의 임상적 효과를 알아보고, 치료 후 폐기능검사와 연속적 고해상 전산화단층촬영 (HRCT)과의 연관성에 대해서 알아보고자 한다. 대상과 방법: 13명의 환자 (남자 7,여자 6)를 후향적으로 분석하였으며, 연령은 23세에서 68세였다(평균,46.2세). 모든 환자는 폐기능검사와 고해상 전산화단층 촬영을 하였으며, 치료 전에 기관지경 또는 폐 조직검사를 하였다. 모든 환자는 저 용량의 에리스로마이신을 한 번에 250 mg씩 하루에 2회씩 6개월 이상 장기간 복용하였으며, 환자의 추적 기간은 7개월에서 32개월이었다(평균,16.6 $\pm$8.0개월).치료 전과 치료 후의 폐기능의 변화와 고해상 전산화단층촬영의 변화를 비교 분석하였다. 결과: 중심 소엽성 결절 (centrilobular nodule, p=0.006),주변성 세기관기벽의 두께 (peripheral bronchiolar wall thickening,p=0.02),저 음영 부위 (low attenuation area,p=0.011)가 치료 후 추적 고해상 전산화단층촬영에서 통계적으로 의의 있게 감소하였다.FVC와 FEV 1 이 저 용량 에리스로마이신으로 치료 후 통계적으로 의의있게 호전되었다: FVC,from 2.47 $\pm$0.83 to 2.74 $\pm$0.95 (p=0.028);FEV1,from 1.66 $\pm$0.75 to 1.95 $\pm$0.87 (p=0.02). 또한, 추적 전산화단층촬영상 주변성 세기관기벽의 두께 (r=-0.609,p=0.047)와 저음영 부위가 (r=-0.687,p=0.041)감소할수록 폐 기능은 더욱 호전되었다. 결론: 고해상 단층촬영을 통한 장기간 추적 검사상 저용량의 에리스로마이신은 범발성 세기관지염의 치료에 효과가 있다. 또한, 고해상 전산화단층촬영은 에리스로마이신의 치료 반응에 대한 객관적인 평가에 가치가 있다.

Purpose: To determine evaluate the clinical effectiveness of low-dose erythromycin (EM) therapy in patients with diffuse panbronchiolitis (DPB), and to correlate the pulmonary function testing (PFT) changes seen at serial high-resolution CT (HRCT) withthe results of post-treatment. Materials and Methods: We retrospectively evaluated 13 DPB patients [seven men and six women aged 23-68 (mean, 46.2) years] who had undergone PFT, HRCT, and transbronchial or open lung biopsy prior to long-term, low-dose EM therapy (250 mg twice daily for more than six months). The interval between initial and follow-up study ranged from 7 to 32 (mean, 16.6+/-8.0) months, and we compared the changes in HRCT findings and PFT parameters before and after treatment. Results: At HRCT after EM therapy, the extent of centrilobular nodules (p=0.006), peripheral bronchiolar wall thickening (p=0.02), and areas of low attenuation (p=0.011) decreased significantly, while FVC and FEV1 showed significant increases: FVC, from 2.47+/-0.83 to 2.74+/-0.95 (p=0.028); and FEV1, from 1.66+/-0.75 to 1.95+/-0.87 (p=0.02). As the extent of peripheral bronchiolar wall thickening (r=-0.609, p=0.047) and areas of low attenuation (r=-0.687, p=0.041) decreased at serial HRCT, FVC and FEV1 increased significantly. Conclusion: Long-term follow-up HRCT findings showed that for DPB patients, lowdose EM provides effective treatment. In addition, HRCT appears to be valuable for the objective evaluation of responses to EM therapy.

목 적 : 비만아에서 폐기능 검사와 체성분 분석을 시행함으로써 비만이 폐기능과 체성분에 미치는 영향을 밝히고자 하였다. 방 법 : 9세에서 12세의 중등도 이상의 비만 소아 27명과 정상 대조군 20명을 대상으로 체성분(세포내액, 세포외액, 단백질, 무기질, 근육량, 체지방량, 체지방률, 복부지방률)을 분석하였다. 헤모글로빈, 혈당, aspartate aminotransferase(AST), alanine aminotransferase(ALT), 총 콜레스테롤, 혈중 중성지방을 측정하였고 폐기능 검사를 시행하였다. 결 과 : 중등도 이상의 비만 소아에서 peak expiratory flow rate(PEFR)이 정상군에 비해 유의하게 감소하였고, 고도 비만아에서 중등도 비만아보다 세포내액, 단백질, 체지방량, 체지방률, 복부지방률이 유의하게 높았고, peak expiratory flow rate(PEFR)은 고도 비만아에서 유의한 감소를 보였다. peak expiratory flow rate(PEFR)이 비만 소아 중 37.0%에서 감소하였고, forced expiratory flow 25%($FEF_{25}$)와 mid-expiratory flow rate(MEFR)이 14.8%에서, forced expiratory flow 50%($FEF_{50}$)이 11.1%에서, forced expiratory volume in 1st second($FEV_1$)과 FVC가 3.7%에서 감소하였다. 결 론 : 본 연구 대상인 9-12세 소아에서 비만도, 체지방률과 폐기능 측정치와 상관성은 없었지만, 중등도 이상의 비만 소아에서 peak expiratory flow rate(PEFR)이 감소하는 결과를 보이므로 중등도 비만 소아에서 폐기능 검사를 시행하는 것이 좋으며 앞으로 다른 연령군의 비만 소아에서 폐기능 검사에 대한 연구가 필요할 것으로 생각한다.

Purpose : Obesity is associated with disturbances of ventilatory functions in adults. But few studies have evaluated the pulmonary complications of obesity in the pediatric population. The purpose of this study is to clarify the effects of obesity on pulmonary function and body composition in obese children. Methods : Forty seven obese children whose ages ranged from nine to twelve years were evaluated for their body composition(intracellular fluid, extracellular fluid, protein mass, mineral mass, soft lean mass, fat mass, percent body fat, fat distribution) by bioelectrical impedance analysis. Hemoglobin, serum glucose, aspartate aminotransferase(AST), alanine aminotransferase(ALT), total cholesterol and triglycerides were measured. Pulmonary function test was performed by spirometer. Results : Intracellular fluid, protein mass, fat mass, percent body fat and fat distribution were significantly higher in severely obese children with an obesity index of more than 150 percent compared with those with an index of less than 150 percent. Peak expiratory flow rate(PEFR) was significantly lower in severely obese children with obesity index of more than 150 percent compared with those with less than 150 percent($241.7{\pm}14.6L/sec$ vs $276.8{\pm}64.3L/sec$). PEFR, forced expiratory flow 25 percent($FEF_{25}$), mid expiratory flow rate(MEFR), forced expiratory flow 50 percent($FEF_{50}$), forced expiratory volume in 1st second($FEV_1$) and forced vital capacity(FVC) were decreased in 37.0 percent, 14.8 percent, 14.8 percent, 11.1 percent, 3.7 percent and 3.7 percent of obese children, respectively. Conclusion : PEFR was significantly decreased in obese children. Pulmonary function test must be performed in severely obese children and more extended study is needed in other age groups.

Pulmonary function test is a group of tests which are composed of measurement for lung function. Thy are spirometry, blood-gas analysis, lung volumes, exercise test, diffusion capacity, and bronchial challenge test. In this article, I will review the pulmonary function test and it's application in terms of clinical aspect and insurance medicine. The standard spirometric indicies are forced vital capacity(FVC), forced expiratory volume at 1 second(FEV1), and the ratio of FEV1 over FVC(FEV1/FVC). If the value of FEV1/FVC less than 70%, the examinee has obstructive ventilatory dysfunction.

연구배경 : 흡입화상은 폐렴, 호흡부전 등의 폐합병증으로 인해 이환율 및 사망률 증가에 기인하는 것으로 알려져 있다. 화기 흡입에 의한 기도 손상이 폐기능에 영향을 줄 것으로 예상되나 이에 대한 연구는 빈약한 실정이다. 흡입화상으로 인한 폐기능 검사소견의 변화를 알아보고자 하였다. 방 법 : 2002년 8월부터 2005년 8월까지 기관지내시경검사에 의해 흡입 폐 손상이 확인된 환자들을 대상으로 급성기 및 회복기에 폐기능 검사를 시행하여 비교 및 분석하였다. 초기 폐기능 검사에서 FVC, FEV1, FEV25-75% 및 PEF의 정상 추정치는 흡입화상에 대한 내시경적 중증도와의 상관성을 알아보았다. 사망환자, 연기 흡입으로 뇌손상을 입은 환자 및 선행 만성 호흡기질환자는 제외하였다. 결 과 : 화상체표면적이 0-18%의 범위에 있는 총 37명(남 28, 여 9)의 환자를 대상으로 하였다. 내원 당시의 $PaO_2/FiO_2$ 비는 $286.4{\pm}129.6mmHg$, COHb은 $7.8{\pm}6.6%$ 였으며, 기관내 삽관은 9예(24.3%), 기계호흡은 3예(8.1%)에서 이루어졌다. 초기 방사선 소견에서 이상 소견을 보인 18예(48.6%) 중 15예(83.3%)는 정상화되었으나 3예(16.7%)는 잔흔을 남기고 치유되었다. 초기 폐기능 검사에서 19예(51.4%)가 정상 소견이었다. 폐쇄성 장애가 9예(24.3%) 있었으며 이 중 4예(44.4%)는 기관지 확장제에 양성반응을 보였다. 제한성 장애도 9예(24.3%) 관찰되었다. DLco를 시행한 23예 중 4예(17.4%)만이 감소된 소견을 보여 주었다. 추적 폐기능 검사에서 초기에 이상 폐기능 소견을 보인 대부분이 정상으로 회복되었으며, 폐쇄성 및 제한성 장애가 각각 1예(2.7%)씩 관찰되었다. DLco는 전부 정상화 되었다. 결 론 : 흡입화상 이후 생존한 환자를 대상으로 급성 호흡기 증상이 안정된 상태에서 시행한 초기 폐기능 검사상 정상, 폐쇄성 및 제한성 장애로 나타나 특이적인 환기장애 양상은 관찰되지 않았다. 또한 초기에 이상소견을 보여주었다 하더라도 추적검사에서 대부분 정상으로 회복되는 것을 관찰할 수 있었다. 그리고, 기관지확장제 양성을 보이는 일부 환자는 기관지 확장제 치료를 적극적으로 시도해 볼 수 있을 것으로 사료된다.

Background: The changes in the pulmonary function observed in burn patients with an inhalation injury are probably the result of a combination of airway inflammation, chest wall and muscular abnormalities, and scar formation. In addition, it appears that prolonged ventilatory support and an episode of pneumonia contribute to the findings. This study investigated the changes in the pulmonary function in patients with inhalation injury at the early and late post-burn periods. Methods: From August 1, 2002, to August 30, 2005, surviving burn patients who had an inhalation injury were enrolled prospectively. An inhalation injury was identified by bronchoscopy within 48hours after admission. Spirometry was performed at the early phase during admission and the recovery phase after discharge, and the changes in the pulmonary function were compared. Results: 37 patients (M=28, F=9) with a total burn surface area (% TBSA), ranging from 0 to 18%, were included. The initial $PaO_2/$FiO_2$ratio and COHb were $286.4{\pm}129.6mmHg$ and $7.8{\pm}6.6%$. Nine cases (24.3%) underwent endotracheal intubation and 3 cases (8.1%) underwent mechanical ventilation. The initial X-ray findings revealed abnormalities in, 18 cases (48.6%) with 15 (83.3%) of these being completely resolved. However, 3 (16.7%) of these had residual sequela. The initial pulmonary function test, showed an obstructive pattern in 9 (24.3%) with 4 (44.4%) of these showing a positive bronchodilator response, A restrictive pattern was also observed in 9 (24.3%) patients. A lower DLco was observed in only 4 (17.4%) patients of which 23 had undergone DLco. In the follow-up study, an obstructive and restrictive pattern was observed in only one (2.7%) case each. All the decreased DLco returned to mormal. Conclusions: Most surviving burn patients with an inhalation injury but with a small burn size showed initial derangements in the pulmonary function test that was restored to a normal lung function during the follow up period.

목 적:건강한 미숙아에서 기관지폐이형성증을 가진 미숙아에 이르기까지 미숙아의 폐기능은 다양한 정도로 감소되어 있다고 알려져 있다. 영아에서 폐기능을 평가하는 방법은 오랜 노력 끝에 표준화되기에 이르렀으나 국내에서 아직까지 연구된 바 없다. 본 연구에서는 만성 폐질환을 가진 미숙아에서 폐기능을 객관적인 평가방법을 통하여 측정하고 폐기능 감소에 영향을 미치는 위험 요인들을 분석하여 그 유용성을 알아보고자 하였다. 방 법:세브란스 어린이병원에서 출생한 54명을 대상으로 하였다. 전체 대상아 중 남자는 31명, 여자는 23명이었고, 평균연령은 5.6±3.7개월이었다. 대상자에서 영아폐기능 측정기구(Exhalyser; EcoMedics, Dürnten, Switzerland)를 이용하여 일회호흡량(tidal volume, TV) 및 기능적잔기량(functional Residual Capacity, FRC)을 측정하였고, 기관지확장제 흡입 후 같은 방법으로 측정하여 변화를 관찰하였다. 전체 대상아에서 검사와 관련된 부작용은 없었다. 결 과:대상 환아 54명 중 22명은 재태주령 28주 미만 출생아, 25명은 28주 이상 33주 미만 출생아, 7명은 33주 이상 37주 미만의 출생아였다. 또한 초극소 저체중출생아 23명, 극소 저체중출생아 23명, 저체중출생아는 8명이었다. 기관지확장제 흡입 전후 기능적잔기량 변화(delta FRC, dFRC)는 재태주령이 어릴수록(P＜0.05), 출생체중이 작을수록(P＜0.05) 의미있게 증가하였다. 기능적잔기량 변화는 재태주령(r=-0.35; P=0.013), 출생체중(r=-0.32; P=0.026)과 유의한 음의 상관관계를, 기계호흡일수(r= 0.42; P=0.0028), 산소치료일수(r=0.43; P=0.0024)와는 양의 상관관계를 보였다. 기관지확장제 흡입 전 기능적잔기량은 출생체중이 작을수록 유의하게 작았으며,(r=0.43; P=0.0013) 기관지확장제 흡입 전 일회호흡량은 기계호흡일수와 음의 상관관계를 나타내었다.(r=-0.39; P= 0.0048)결 론:미숙아에서 출생체중이 작을수록, 재태주령이 어릴수록, 기계호흡일수와 산소치료일수가 길수록 기관지확장제에 의한 기능적잔기량의 가역성이 증가하였다. 기능적잔기량 가역성은 만성 폐질환 미숙아에서 안전하게 측정할 수 있는 유용한 폐기능 지표로 생각된다.

Purpose:Pulmonary function is decreased in varying degrees in healthy premature infants as well as those with bronchopulmonary dysplasia. The evaluation of pulmonary function in infants is finally standardized after strenuous efforts, but it has not yet been in Korea. In this study, we aimed at the evaluation of the utility of pulmonary function tests in premature infants with chronic lung disease by objectively measuring pulmonary function and by analyzing the risk factors that may decrease lung function. Methods:Fifty-four premature infants born in Severance Hospital were selected. Among the 54 infants, 31 were male and 23 were female, and their mean age was 5.6±3.7 years. Exhalyser was used to measure tidal volume and functional residual capacity, and then their change after the inhalation of bronchodilators was evaluated. There was no test related complication in all subjects. Results:Among the 54 subjects, 22 were at the gestational age of ＜28 weeks, 25 were at the gestational age between 28 and 33 weeks, and 7 were at the gestational age between 33 and 37 weeks. As for birth weight, 23 had extreme low birth weight, 23 had very low birth weight, and 8 had low birth weight. The delta functional residual capacities (FRCs) before and after the inhalation of bronchodilator were significantly increased in infants with younger gestational age (P＜0.05) and lower birth weight (P＜0.05). There was a significant negative correlation between gestational age and birth weight, and a significant positive correlation with the duration of ventilator care and that of oxygen therapy. The delta FRC before the inhalation of bronchodilator was significantly lower in infants with lower birth weight, and the tidal volume before the inhalation of bronchodilator correlated negatively with the duration of ventilator care. Conclusion:The reversibility of FRC is increased in premature infants with lower birth weight, younger gestational age, and longer duration of ventilator care and oxygen therapy. The reversibility of FRC may be a useful parameter of pulmonary function that can be safely measured in premature infants with chronic lung disease.

연구배경: 1초량은 폐기능의 지표로 측정된다. 또한 흡연은 폐기능의 잘 알려진 위험요인이다. 본 연구에서는 한국인 남성에서 폐기능과 흡연의 관련성을 체질량지수와 나이를 고려하여 분석하였다. 방법: 연구 대상자는 2016년 국민건강영양조사에 참여한3,411명의 성인이다. 남성 1,411명이 분석에 포함되었다. 통계 분석은 1요인 분산분석을 하여 집단 간의 평균을 비교하였다. 비만 여부에 따라서 대상자를 나누어 분석하였다. 또한 대상자를 연령의 중앙값인 55세로 나누어서 분석하였다. 결과: 1초량 예측 %는 흡연자에서 비흡연자와 비교하여통계적으로 낮은 값을 보였다(P=0.024). 이러한 관련성은나이가 55세 이상인 대상자만 분석하였을 때 더 차이가 컸다(P=0.008). 또한 BMI가 25 이상인 대상자에서는 흡연 여부에 따른 1초량 예측 %에 차이가 없었으나, BMI가 25 미만인 대상자에서는 흡연 여부에 따라서 1초량 예측 %에 통계적으로 유의한 차이가 있었다(P=0.019). 결론: 본 연구에서 흡연은 55세 이상인 남성과 BMI가 25 미만인 남성에서 예측 1초량 %와 관련이 있었다. 인과관계를 더 정확히 알기 위해서는 추후 전향적인 코호트연구가필요하겠다.

Background: Smoking is a known risk factor for decreasing pulmonary function. The objective of this study was to investigate the relationship between smoking and lung function considering obesity and age group. Methods: This study was based on the data collected during the 2016 Korean National Health and Nutrition Examination Surveys (KNHANES VII). A total of 3,411 adults were retrieved from KNHANES VII. Among 3,411 adults, we studied 1,411 male subjects. Impaired lung function was measured by spirometry at least twice. Data were analyzed using one way analysis of variance. Results: In this study, forced expiratory volume in the first second was associated with smoking status (P=0.024). The association was stronger in old subjects (P=0.008). Also, in the obese group, the association of lung function with smoking status was not significant, but the association was significant in the non-obese group (P=0.019). Conclusions: In this study, Smoking was significantly associated with impaired lung function. The association was stronger in old men and obese men. In order to obtain an accurate assessment of the association between smoking and pulmonary function values, further prospective cohort study in the future is necessary.

목 적 : 천식의 특징은 기도염증의 결과인 가역적인 기류제한과 기관지과반응성이다. 최근에 호기산화질소(exhaled nitric oxide; FeNO)이 비침습적으로 기도염증을 알 수 있는 지표로서 이에 대한 많은 연구가 있었다. 또한 FeNO는 천식의 중증도를 나타내는 데 이용되는 객담내 호산구수나 메타콜린 기도유발시험과 관련이 있다고 보고되었다. 이에 저자들은 간헐성 천식환자에서 폐기능검사와 호기산화질소와의 관계를 알아보고자 본 연구를 시행하였다. 방 법 : 2005년 4월부터 8월까지 경희의대부속병원 소아과에서 천식으로 진단되어 폐기능검사와 호기산화질소 측정이 가능하였던 5세부터 15세의 80명의 환자를 대상으로 하였다. 최근 4주내에 상기도 감염이 없었고, 부신피질스테로이드를 포함한 조절약물을 사용하지 않은 경우에 연구 대상에 포함하였다. 폐기능검사는 Microspirometer를 사용하였다. Eco Medics사의 Chemiluminescence NO-analyzer(CLD 88 sp, Duernten, Switzerland)를 사용하여 FeNO를 측정하였으며 폐기능 검사와 FeNO와의 상관관계 분석은 Spearman correlation coefficient를 사용 하였다. 결 과 : 1초간 강제호기량(forced expiratory volume in 1 second, $FEV_1$)의 평균은 $0.890{\pm}0.455L$이었으며 강제폐활량 (forced vital capacity; FVC)의 평균은 $1.071{\pm}0.630L$이었다. $FEV_1%pred$의 평균은 $98.39{\pm}34.27%$였으며 $FEV_1/FVC$의 평균은 $88.53{\pm}19.49$이었다. FeNO의 평균치는 16.88 parts per billion(ppb)이었다. FeNO 측정치는 $FEV_1$(r=0.345, P<0.01), FVC(r=0.244, P<0.05)와 유의한 상관관계를 보였으나 $FEV_1%pred$와 $FEV_1/FVC$는 FeNO와 유의한 상관관계를 나타내지 않았다. 결 론 : FeNO의 측정은 폐기능 검사와 함께 소아천식 환자의 관리에 유용하게 사용될 수 있는 신빙성있는 검사로 생각되며 측정 방법이나 측정치의 참고치 설정에 앞으로 많은 연구가 필요할 것으로 생각된다.

Purpose : Asthma is characterized by reversible airway obstruction and bronchial hyperresponsiveness result from airway inflammation. Fraction of nitric oxide in expired air (FeNO) has recently been investigated as a noninvasive measure of airway inflammation. FeNO has been reported to correlate with induced sputum eosinophilia and methacholine challenge test that it is represent severity of asthma. The purpose of this study was to analyze the relationship of FeNO with pulmonary function tests in patients with intermittent asthma. Methods : Eighty children included in this study were diagnosed as asthma from April through August, 2005 in Department of Pediatrics, College of Medicine, Kyunghee University. They aged from 4 to 15 years who were able to conduct spirometry and FeNO monitoring. They did not have upper respiratory tract infection and did not use an asthma controller which contain corticosteroids within 4 weeks. Pulmonary function test was done and FeNO was measured with online tidal breathing method using a chemiluminescence NO analyzer (CLD 88 sp, Eco Medics, Duernten, Switzerland). The correlations between pulmonary function test and FeNO were analyzed using Spearman correlation coefficient method. Results : The mean of FeNO of subject was 16.88 parts per billion (ppb). The mean of forced expiratory volume in 1 second ($FEV_1$) was $0.890{\pm}0.455L$ and forced vital capacity (FVC) was $1.071{\pm}0.630L$. The mean of predicted $FEV_1%$ ($FEV_1%pred$) was $98.39{\pm}34.27%$ and $FEV_1/FVC$ was $88.53{\pm}19.49$. FeNO was significantly correlate with $FEV_1$ (r=0.345, P<0.01) and FVC (r=0.244, P<0.05). FeNO did not correlate with $FEV_1%pred$ or $FEV_1/FVC$. Conclusion : The measurement of FeNO could be a useful marker in the management of childhood asthma and it is evolving to provide a complementary role alongside existing pulmonary function test. We propose that measuring technique and establishment of normal reference range are important area for future research.

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목 적 : 폐기능 검사는 폐질환의 평가에 매우 중요하여 반복해서 검사를 시행하여 질병의 경과와 치료에 대한 반응을 객관적으로 평가할 수 있다. 소아에서는 협조와 이해 정도에 따라 수치의 변동이 크므로 풍선을 이용한 연습과 검사에 대한 이해가 결과에 어떤 영향을 미치는지 분석하고자 한다. 방 법 : 2006년 6월부터 10월까지 천식으로 순천향대학교병원 소아과 알레르기호흡기센터를 방문하여 폐기능 검사를 실시한 106명을 대상으로 하였다. 첫 검사 시행 후 풍선불기 연습을 시킨 후 다시 검사한 군, 연습과 검사의 필요성에 대한 교육을 시킨 후 다시 검사한 군, 교육만 시킨 후 다시 검사한 군, 그대로 다시 검사를 시행한 군 등 4군으로 나누어 검사 수치를 비교하였다. 결 과 : 연습 전후의 검사 결과는 통계학적으로 유의한 차이는 없었다. 연습과 교육을 시행하여 전후의 검사 결과를 비교했을 시에도 유의한 차이는 없었다. 교육만 시행하였을 경우 $FEV_1$, $FEV_1/FVC$, $FEF_{25-75%}$, PEFR의 평균치가 전반적으로 상승하였으며 $FEV_1$, $FEF_{25-75%}$, PEFR은 통계학적으로 의미가 있는 상승을 보였다. 교육이나 연습을 시행하지 않고 2회 검사 시행시 유의한 차이는 없었다. 결 론 : 폐기능 검사 시행시 풍선 등을 이용하여 연습을 시키거나 여러차례 반복하여 검사를 시행하게 될 경우 오히려 검사 결과에 나쁜 영향을 줄 수 있고 검사의 필요성에 대해 잘 이해를 시킨 후 검사를 하는 것이 정확한 결과에 더 큰 영향을 미치는 것으로 보여지며 이를 바탕으로 향후 폐기능 검사 시행시 체계적으로 검사에 대한 설명을 하여 환아가 충분한 이해를 하도록 하는 것이 필요하다고 할 수 있겠다.

Purpose : The results of pulmonary function test (PFT) in children are variable according to the patient's cooperation and comprehensiveness. This study has intended to figure out the effectiveness of pre-education and training with balloons on PFT in children. Methods : One hundred six children mean aged $9.35{\pm}2.92\;years$ were tested. All participants performed PFT twice in 30 minutes intervals. First PFT were performed after usual instruction and second PFT were performed according to randomly classified grouping; Group 1 : repeat PFT after training with balloons, Group 2 : repeat PFT after training and education, both, Group 3 : repeat PFT after education about objects and necessities of pulmonary function test, Group 4 : repeat PFT without any education and training. Results : There were no difference statistically on the results of percent of predicted $FEV_1$, $FEV_1/FVC$, $FEF_{25-75%}$ and PEFR in Group 1, 2 and 4 patients. In some cases, the average is decreased with repeated PFT. At the case of repeated PFT after education, the average of percent of predicted $FEV_1$, $FEV_1/FVC$, $FEF_{25-75%}$ and PEFR is increased. There was statistically significant difference on the value of $FEV_1$, $FEF_{25-75%}$ and PEFR between first and second PFT in Group 3. Conclusion : Training with balloons before PFT causes fatigueness and lowers concentration. Understanding of PFT makes results better than training. Therefore, enough explanation and education about PFT before examination is most effective for appropriate PFT in children.

폐 환기 검사는 직접 방사성 기체를 흡입한 후 이를 영상화 한다. 그러나 실제 폐 환기 검사 시 활용할 수 있는 흡입과 관련한 지표는 널리 알려진 바가 없다. 따라서 본 연구를 통해 흡입과 관련한 객관적인 지표로써 폐 환기 검사 계수율과 폐 기능검사 결과 값의 상관관계를 확인하고 그 유용성을 알아보고자 한다. 2010년 10월부터 2018년 9월까지 본원에서 폐 환기 검사와 폐 기능 검사를 모두 시행한 만성폐쇄성 폐질환 환자 36명을 대상으로 중증도(Mild, Moderate, Severe)별로 분류하였다. 폐 환기 검사는 Technegas Generator (Vita Medical Ltd, Australia)로 Technegas를 생성하여, 환자에게 흡입하게 하였다. 영상은 Forte (Philips Medical Systems, Netherlands) 장비를 사용하였으며, 폐 기능 검사는 Vmax Encore 22 (Carefusion Corporation, USA)를 사용하였다. 폐 환기 검사에서는 양측 폐에 관심 영역을 설정하여 계수율을 측정하였고, 이와 함께 폐 기능 검사의 결과 값 중 노력 폐활량(FVC), 1초 노력 호기량($FEV_1$), 일초율($FEV_1/FVC$) 사이의 상관관계를 비교 분석하였다. 만성폐쇄성폐질환 환자의 폐 환기 검사 계수율과 폐 기능 검사 결과 값의 상관관계를 분석한 결과, 중증도별 $FEV_1/FVC$와 계수율 사이의 상관계수는 Severe에서 -0.773, Moderate에서 -0.750, Mild에서 -0.437이였다. Severe, Moderate 결과 값은 통계적으로 유의하였으며(P<0.05), Mild는 유의하지 않았다(P=0.155). 반면에 FVC와 계수율 사이의 상관계수는 Mild에서만 0.882로 통계적으로 유의한 것을 확인하였다(P<0.05). 만성폐쇄성폐질환 환자를 대상으로 시행한 폐 환기 검사 시 계수율과 폐 기능 검사 결과 값의 상관관계를 확인할 수 있었다. 이를 통해 폐 환기 검사 시 호흡력에 대한 지표로써 폐 기능 검사 결과 값을 활용할 수 있을 것으로 생각된다.

Purpose Lung Ventilation Scan(LVS) images directly inhaled radiation gas to evaluate lung ventilation ability. Therefore, it is influenced by various factors related to inhalation, including number of breaths, respiratory duration, respiration rate, and breathing method. In actual LVS examinations, it is difficult for objectify the patient's ability to inhale, and there is currently no known index related to inhalation. Therefore, this study confirms the correlation between counts per second(cps) in LVS and the results of pulmonary function test(PFT) and evaluate its usefulness as an objective indicator of inhalation. Materials and Methods From October 2010 to September 2018, 36 Chronic Obstructive Pulmonary Disease(COPD) patients who had both LVS and PFT were classified by severity(Mild, Moderate, Severe). LVS was performed by creating Technegas with Vita Medical's Technegas Generator and inhaling it to the patient. LVS images were acquired with Philips's Forte equipment., and PFT used Carefusion's Vmax Encore 22. The correlation between the cps measured by setting the region of interest(ROI) of both lungs on the LVS and the forced vital capacity(FVC), forced expiratory volume in one second($FEV_1$), $FEV_1/FVC$ of the results of PFT was compared and analyzed. Results We analyzed the correlation between cps of LVS using Technegas and the results of PFT by classifying COPD patients according to severity. Correlation coefficient between $FEV_1/FVC$ and cps was Severe -0.773, Moderate -0.750, and Mild -0.437. The Severe and Modulate result values were statistically significant(P<0.05) and Mild was not significant(P=0.155). On the other hand, the correlation coefficient between FVC and cps was statistically significant only in Mild and it was 0.882(P<0.05). Conclusion According to the study, we were able to analyze correlation between cps of LVS using Technegas and the results of PFT in COPD Patients. Using this result, when performing a LVS, the results of PFT can be used as an index of inhaling capacity. In addition, it is thought that it will be more effective for the operation of the exam rooms.

연구배경: 호기말에 흉부 촬영을 시행하면 폐 내의 공기의 부피가 감소되어 폐 감쇄도가 증가한다. 이런 폐 감쇄도의 변화가 국소적으로 저하되는 공기 가둠 현상에 대해서는 일부 연구들이 있었으나 전체 폐의 전반적인 감쇄도 변화에 대한 연구는 거의 없고, 특히 정상인을 대상으로 한 연구는 거의 없다. 저자들은 호흡기 질환이 없으며 폐기능 및 흡기 전산화단층촬영이 정상 소견이고 호기 영상에서 국소적인 공기 가둠 현상이 없는 100명을 대상으로 연구를 수행하였다. 방 법: 흉부 전산화단층촬영 영상에서 24개의 지점을 정하고, 흡기 및 호기 시 각 지점에서 폐 음영도를 측정한 후 호기말 폐 감쇄도 증가와 흡연량, 연령 사이의 상관 관계를 알아보았다. 결 과: 연구 대상 100명의 연령은 중앙값 49.0세(범위 25~71세)였고, 평균 흡연량은 $22.5{\pm}17.0$갑년이었다. 연령과 폐 감쇄도의 증가 사이에는 유의한 음의 상관관계가 있었으며 이는 흡연의 효과를 보정하였을 때에도 유지되었고, 연령을 기준으로 세 군으로 나누어 폐 감쇄도의 증가 정도를 비교하였을 때에도 유의한 차이가 있었다. 흡연량과 호기말 폐 감쇄도의 증가 사이에는 유의한 음의 상관관계가 관찰되었으나 연령을 보정하였을 때에는 유의성이 감소하였다. 결 론: 흡기-호기 시의 폐의 전반적인 감쇄도 변화 정도는 연령과 상관관계가 있으며, 노화를 반영할 가능성이 있다.

Background: The attenuation of the lung parenchyma increases on expiration as a consequence of decreased air in the lung. Expiratory CT scans have been used to show air trapping in patients with chronic airway disease and diffuse parenchymal disease and also in asymptomatic smokers. Although there have been several reports investigating the regional air trapping on a expiratory CT scan, there have been only a few reports evaluating the changes of whole lung attenuation with considering its clinical significance, and especially in healthy subjects. The purpose of this study was to evaluate the correlation of an expiratory increase of lung attenuation with age and smoking in healthy subjects. Methods: Asymptomatic subjects who underwent a low dose chest CT scan as part of a routine check-up and who showed normal spirometry and a normal inspiratory CT scan were recruited for this study. We excluded the subjects with significant regional air trapping seen on their expiratory CT scan. Lung attenuation was measured at 24 points of both the inspiratory and expiratory CT scans, respectively, for 100 subjects. The correlations between an expiratory increase of the lung attenuation and the amount of smoking, the patient's age and the results of spirometric test were assessed. Results: There were 87 men and 13 women included in this study. Their median age was 49.0 years old (range:25~71). Sixty current smokers, 24 ex-smokers and 16 non-smokers were included. As age increased, the expiratory increase of lung attenuation was reduced at every measuring points (r=-0.297~-0.487, Pearson correlation). The statistical significance was maintained after controlling for the effect of smoking. Smoking was associated with a reduction of the expiratory increase of lung attenuation. But the significance was reduced after controlling for the patient's age. The $FEV_1$, FVC, $FEV_1/FVC$ and $FEF_{25{\sim}75%}$ were not associated with an expiratory increase of lung attenuation. Conclusion: The expiratory increase of lung attenuation in subjects with a normal inspiratory CT scan was negatively correlated with age. It was also reduced in heavy smokers. It may reflect aging and the smoking related changes.