Search

Background: In South Korea, bacteria in the Mycobacterium abscessus complex (MABC), a group of rapidly growing mycobacteria, are second to those in the Mycobacterium avium complex as a cause of non-tuberculous mycobacterial pulmonary disease. The MABC includes several subspecies, including M. abscessus subsp. abscessus (M. abscessus) and M. abscessus subsp. massiliense (M. massiliense), the former of which is difficult to treat owing to its antibiotic resistance. Current Concepts: M. abscessus encodes a functional erythromycin ribosomal methylase gene, erm(41), that causes inducible macrolide resistance. Contrastingly, M. massiliense lacks a functional erm(41) gene owing to a partial deletion. Accordingly, culture conversion rates using currently recommended macrolide-based antibiotic treatments are considerably higher among patients with M. massiliense infection than in those infected with M. abscessus. Phase therapy (intensive and continuous) is recommended for MABC pulmonary disease and, depending on the subspecies and antimicrobial susceptibility test results, should include an initial treatment of ≥3 to 4 injectable and oral antibiotics, followed by inhaled or intravenous amikacin and ≥1 to 2 oral antibiotics. Recommended injectable antibiotics include amikacin, imipenem or cefoxitin, and tigecycline, and oral antibiotics include macrolides (azithromycin or clarithromycin), clofazimine, linezolid, and rifabutin. For some patients, surgery should be considered as an adjunctive treatment option. Discussion and Conclusion: Given that M. abscessus expresses the inducible resistance gene erm(41) associated with macrolide resistance, the identification of MABC subspecies is important for disease management. However, despite the combined application of several injectable/oral antibiotics, the treatment outcomes for M. abscessus pulmonary disease remain unsatisfactory. [ABSTRACT FROM AUTHOR]

Background: Nontuberculous mycobacteria are mycobacteria other than those that cause tuberculosis and leprosy and can cause infections in various parts of the body, predominantly the lungs. Of approximately 200 species of nontuberculous mycobacteria, only about 10 are linked to pulmonary infections, with Mycobacterium avium complex (MAC) being the most common. Current Concepts: The standard treatment for pulmonary diseases caused by the MAC is combination therapy, including macrolide antibiotics and other antibiotics such as ethambutol and rifampin. Among macrolide antibiotics, azithromycin and clarithromycin are commonly used for managing MAC pulmonary diseases, and in cases with extensive lesions, amikacin injections are administered concurrently during the initial stages of treatment. Ensuring an overall treatment duration of an additional 12 months after negative culture conversion is recommended in affected patients. However, despite an extended treatment period, the cure rate remains at 60~70%. Recently, an inhalable liposomal form of amikacin, marketed as ARIKAYCE, has been developed. It has been approved by the US Food and Drug Administration as an effective treatment for refractory MAC pulmonary diseases. When ARIKAYCE was used for an additional 6 months or more in patients with refractory MAC pulmonary diseases, approximately 29% of patients achieved additional treatment success. However, it has yet to be officially imported into South Korea, and a high monthly cost restricts its practical use in the country. Therefore, the treatment of MAC pulmonary disease in South Korea will remain a challenge, unless a more effective treatment emerges. Discussion and Conclusion: MAC pulmonary disease requires long-term combination antibiotic therapy, usually with macrolides, ethambutol, and rifampin, and amikacin injections are recommended for cases with extensive lesions. The lack of effective drugs hampers treatment, increasing the burden of antibiotic side effects. Therefore, more research is urgently needed for better treatment of MAC pulmonary disease. [ABSTRACT FROM AUTHOR]

Background: Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic respiratory condition with significant morbidity and mortality. Globally, the disease burden of NTM-PD is growing. This study reviews the current state of NTM-PD in Korea and worldwide, followed by a discussion of known risk factors. Current Concepts: In most countries, NTM-PD is not specified as a notifiable disease; thus, determining the actual incidence and prevalence has been challenging. When NTM-PD is defined using microbiological and diagnostic coding criteria, data consistently show a dramatic increase in the worldwide incidence and prevalence of NTM-PD. Although the cause of this increase is not completely understood, it is believed to result from a complex interplay of environmental and host-related factors that facilitates increased interactions between patients and the bacterium, as well as promoting mycobacterial survival within the hosts. Discussion and Conclusion: The global incidence, prevalence, and socioeconomic burden of NTM-PD is increasing, necessitating a comprehensive approach to understand this phenomenon. As a first step, the establishment of a coordinated system for identifying and managing patients with NTM-PD is imperative. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to predict the functional performance of patients with chronic obstructive pulmonary disease by clarifying the relationship among disease severity, uncertainty, social support, symptom experience, coping, and functional performance. Design: A model‐testing design was used. Methods: The subjects of this study were outpatients with chronic obstructive pulmonary disease who visited the respiratory clinic of a general hospital in Seoul, Korea. The data were collected using validated instruments from July 2018 to April 2019, of which 202 questionnaires in total were used for data analysis. Collected data were analysed by using IBM SPSS v27.0 and Mplus 8.0. Results: The severity of the disease, uncertainty, and symptom experience should be reduced to improve the functional performance of chronic obstructive pulmonary disease patients. Furthermore, reduced uncertainty can improve functional performance by reducing symptom experience. Nursing interventions for the improvement of pulmonary function and reduction of symptom experience should be developed. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the validity and reliability of the Korean version of the Self-Care in Chronic Obstructive Pulmonary Disease Inventory (SC-COPDI) and the Chronic Obstructive Pulmonary Disease Self-Care Self-Efficacy Scale (SCES-COPD). The SC-COPDI consists of the Self-Care Maintenance Scale (SCMES), Self-Care Monitoring Scale (SCMOS), and Self-Care Management Scale (SCMAS). Methods: The original tool was translated using a back-translation process. Participants were 241 patients with COPD at the Chonnam National University Hospital in Korea. The construct validity was verified through confirmatory factor analysis, and reliability was verified using Cronbach's α. Results: The SCMES consisted of 10 items of three factors--one of four factors was deleted from the original tool. In the SCMOS, there were six items of two factors after two items were deleted from the original tool. The SCMAS consisted of the original 10 items of three factors. The SCES-COPD consisted of six items of two factors, with one item removed from the original tool. The model fit indices of all tools were good, and the construct validity was confirmed. Cronbach's α of SCMES was .72, SCMOS was .90, SCMAS was .81, and SCES-COPD was .85. Conclusion: The Korean version of SC-COPDI and SCES-COPD are valid and reliable instruments for measuring selfcare in people with COPD. These instruments can be used in self-care studies of COPD patients in Korea. [ABSTRACT FROM AUTHOR]

Purpose: We examined risk factors that may have contributed to Cytomegalovirus (CMV) reactivation among patients who underwent lung transplantation (LTx). Methods: We reviewed medical records of patients who underwent LTx at a tertiary healthcare hospital in South Korea between January 2013 and May 2017. We excluded patients who died within the first year after LTx and those lost to follow-up. CMV reactivation was defined as the detection of CMV titers above 3000 copies/ml regardless of specific symptoms after prophylaxis cessation. Results: Of 89 patients included, 39 (43.8%) developed CMV reactivation. Of those 39 patients, 16 (41.0%) experienced additional CMV reactivation. Multivariate analysis identified lymphocyte counts below 1.0 × 103/μl (hazard ratio [HR] 49.33, p < 0.001) and use of steroids at more than twice the standard dose (HR 8.07, p < 0.001) as risk factors for CMV reactivation. The multivariate model also identified chronic kidney disease (CKD; HR 5.19, p = 0.016) and pneumonia (HR 17.22, p = 0.013) as risk factors for repetitive CMV reactivation. Conclusion: This study suggests that lymphopenia and high doses of steroids may be important risk factors for CMV reactivation in LTx patients. Our results also suggest that repetitive CMV reactivation may be associated with CKD and pneumonia. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify the characteristics of nutritional status and its risk factors in patients with Chronic Obstructive Pulmonary Disease (COPD). Methods: Participants included 136 patients with COPD in Donga University hospital and Haeundae paik hospital in Busan city. The data, collected by a trained research assistant from January 10 to July 18, 2017, were analyzed using Fisher's exact test, the Mann-Whitney U test, and logistic regression analysis with SPSS/WIN 21.0. Results: Among the 136 patients with COPD, 31 (22.8%) had abnormal nutritional status. According to the results of the logistic regression analysis, gender (Odds Ratio [OR]=5.27, 95% Confidence Interval [CI]=1.18-23.49, p=.029), percent predicted forced expiratory volume in one second [FEV1%] (OR=1.04, 95% CI=0.92-0.99, p=.012), symptom experience (OR=16.19, 95% CI=3.08-85.00, p=.001), carbohydrate intake (OR=1.01, 95% CI=1.00-1.02, p=.037), protein intake (OR=1.06, 95% CI=0.90-0.99, p=.012), and fat intake (OR=1.04, 95% CI=1.01-1.08, p=.015) were associated with nutritional status in patients with COPD. Conclusion: In order to improve the nutrutional status of COPD patients, nursing education is needed with intensive screen on female patients and patients with low lung function, managing symptoms and increasing protein intake. [ABSTRACT FROM AUTHOR]

The guidelines for chronic obstructive pulmonary disease (COPD) treatment are important for the management of the disease. However, studies regarding the treatment adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have been scarce in Korea. Therefore, to examine the adherence to the GOLD guidelines, we examined the patterns of prescribed medication in COPD patients from 2011 to 2018. Patients were classified as having been appropriately and inappropriately treated (overtreatment or undertreatment) for the GOLD group. Appropriate medical therapy was defined as using the first choice or alternative choice drug recommended in the GOLD guidelines. Inappropriate therapy was classified as overtreatment or undertreatment in accordance with the categorization in the GOLD guidelines. According to treatment of 2011 GOLD guidelines, there was inappropriate treatment in 52.3% in group A, 47.3% in group B, 56.3% in group C, and 17.8% in group D. According to treatment of 2017 GOLD guidelines, there was inappropriate treatment in 66.7% in group A, 45.3% in group B, 14.3% in group C, and 24.0% in group D. The common type of inappropriate COPD treatment is overtreatment, with inhaled corticosteroid (ICS) containing regimens. In conclusions, adherence to the GOLD guideline by the pulmonologist in clinical practice is still low in Korea. Therefore, we need better strategies to both optimize the use of the guidelines and adhere to the guidelines as well. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the effect of smoking duration, smoked cigarettes per day and smoking cessation period on pulmonary function among ex-smokers: based on the 6th Korea National Health and Nutrition Examination Survey (KNHANES). Methods: This study was analyzed using the 6th KNHANES data. Pulmonary function tests were performed on a total of 4,214 adults (>40 years old). A total of 770 adults ex-smokers were eligible for inclusion in the final analysis. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FEV were measured to evaluate pulmonary function. Results: This study showed that there were significant differences in both FEV1 and FVC values based on gender, age and height, among ex-smokers. FEV1/FVC significantly differed by age, height and the smoking duration prior to smoking cessation. Multiple regression analysis revealed that, FEV1/FVC accounted for 26.0% of the variance by age, height and smoking duration. There was a difference in the mean value of FEV1/FVC with or without smoking for more than 10 years. Conclusion: This study’s findings show that smoking for over 10 years in an ex-smoker can lead to problems with the respiratory system. The long-term cigarette has progressive ill effects on the respiratory system. [ABSTRACT FROM AUTHOR]

Acute exacerbation of chronic obstructive pulmonary disease (COPD) is defined as an acute aggravation of the patient's respiratory symptoms, particularly cough, sputum production, and dyspnea, which requires a change of medication. COPD exacerbation leads to an accelerated decline in lung function, poorer health status, and is the main cause of hospital admission and death in patients with COPD. A majority of COPD exacerbations are triggered by respiratory infection. The Management of acute exacerbation of COPD consists of systemic corticosteroids, antibiotics, and inhaled short-acting bronchodilators. Oxygen supplementation is an essential component of treatment to improve hypoxemia. Noninvasive or invasive ventilator support is necessary for COPD patients with severe exacerbation, particularly associated with hypercapnic respiratory failure. The Korean clinical practice guideline for COPD was revised in 2018 by the members of the Korean Academy of Tuberculosis and Respiratory Diseases as well as participating members of the Health Insurance Review and Assessment Service. The purpose of this review is to provide an overview of the treatment and prevention strategies recommended in the 2018 Korean Academy of Tuberculosis and Respiratory Diseases for patient with acute exacerbation of COPD. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) should be considered in any patient who has dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease, such as cigarette smoking, biomass exposure, and occupational dust. Spirometry is required to make the diagnosis, and a post-bronchodilator forced expiratory volume in one second/forced vital capacity ratio <0.7 confirms the presence of persistent airflow limitation. The goal of COPD assessment is to determine the severity of the disease, including the severity of airflow limitation, the impact of the disease on the patient's health status, the risk of future events (such as exacerbations, hospital admission, or death), and comorbidities in order to guide therapy. Concomitant chronic diseases occur frequently in COPD patients, including cardiovascular disease, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, depression, anxiety, and lung cancer. These comorbidities should be actively surveilled and treated appropriately when present, as they can independently influence mortality and hospitalization. Above all, further efforts are required to increase the diagnosis rate of COPD in Korea. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by persistent respiratory symptoms and irreversible airflow obstruction. It is caused by smoking, occupational exposure, and air pollution. It shows a high prevalence, both in South Korea and worldwide. The global COPD prevalence is 11.7%, and a similar prevalence has been reported in South Korea. In the Korea National Health and Nutrition Examination Survey 2010-2016, the prevalence of COPD was found to be between 13.1% to 14.6%. The prevalence of COPD is increasing continuously. Aging, male sex, smoking, and air pollution are risk factors of COPD. However, COPD is strikingly underrecognized given its prevalence. Three million people die annually due to COPD, and the mortality burden of COPD is increasing along with population aging. The socioeconomic burden of COPD is becoming enormous. [ABSTRACT FROM AUTHOR]