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BACKGROUND: Home oxygen therapy is well known to improve survival among patients with severe chronic obstructive pulmonary disease (COPD). In Korea, home oxygen therapy has been reimbursed by national health care insurance since 2006. However, an adequate management strategy for home oxygen therapy is not yet established in Korea. This pilot study aimed to develop a new management strategy for home oxygen therapy. METHODS: We developed a new home oxygen service strategy for COPD patients. The new strategy consists of patient education materials, “oxygen notes” for oxygen use self-monitoring, and provision of ambulatory oxygen. Using a structured questionnaire, we explored the usefulness of the new strategy and health status changes among patients before and after the study period. RESULTS: Among 29 participants, the mean age was 69.6 years, and 62.1% were male. At the end of the study, the proportion of patients with severe dyspnea [modified Medical Research Council (mMRC) grade 4] decreased from 62.1% to 41.4%. The mean COPD assessment test score improved from 30.3 to 24.7, and 68.9% of patients scored above the minimum clinically important difference. The mean time and amount of ambulatory oxygen administration changed significantly by the end of the study. More than three-quarters of patients were satisfied with the educational material and oxygen note. CONCLUSIONS: We showed that the new home oxygen service strategy improved the health status of COPD patients. Larger-scale and longer-term research to validate these results is warranted.

Cough is the most common respiratory symptom that can have various causes. It is a major clinical problem that can reduce a patient’s quality of life. Thus, clinical guidelines for the treatment of cough were established in 2014 by the cough guideline committee under the Korean Academy of Tuberculosis and Respiratory Diseases. From October 2018 to July 2020, cough guidelines were revised by members of the committee based on the first guidelines. The purpose of these guidelines is to help clinicians efficiently diagnose and treat patients with cough. This article highlights the recommendations and summary of the revised Korean cough guidelines. It includes a revised algorithm for the evaluation of acute, subacute, and chronic cough. For a chronic cough, upper airway cough syndrome (UACS), cough variant asthma (CVA), and gastroesophageal reflux disease (GERD) should be considered in differential diagnoses. If UACS is suspected, first-generation antihistamines and nasal decongestants can be used empirically. In cases with CVA, inhaled corticosteroids are recommended to improve cough. In patients with suspected chronic cough due to symptomatic GERD, proton pump inhibitors are recommended. Chronic bronchitis, bronchiectasis, bronchiolitis, lung cancer, aspiration, intake of angiotensin-converting enzyme inhibitor, intake of dipeptidyl peptidase-4 inhibitor, habitual cough, psychogenic cough, interstitial lung disease, environmental and occupational factors, tuberculosis, obstructive sleep apnea, peritoneal dialysis, and unexplained cough can also be considered as causes of a chronic cough. Chronic cough due to laryngeal dysfunction syndrome has been newly added to the guidelines.

Purpose The prevalence of chronic obstructive pulmonary disease (COPD) in females has increased, changing the concept of COPD as a disease mostly limited to males. In this study, the clinical characteristics of COPD in females were investigated. Patients and methods The study was based on a multicenter cohort of COPD patients recruited from 54 medical centers in South Korea. Sex-based differences in general characteristics, exposure risk factors, depression scores, results of pulmonary function tests, COPD exacerbation, symptom scores, and radiologic findings were evaluated. Sex-related differences in the annual FEV1 change over 5 years were analyzed in a linear mixed model. Results Of the 2515 patients enrolled in this study, 8.1% were female. Female patients who had a higher BMI and a lower level of education were less likely to be smokers, were more exposed to passive smoking/biomass, and were more depressed compared to males. The rates of bronchiectasis, previous childhood respiratory infection, and asthma were higher in females. Female patients also had more symptoms and a poorer exercise capacity than males, but no significant differences were observed in terms of exacerbations. Radiologic findings revealed that male patients had worse emphysema, and female patients had worse bronchiectasis, as determined based on chest X-ray and computed tomography findings. On pulmonary function tests, female patients had less obstruction and less annual FEV1 loss over 5 years. Conclusion This study revealed differences in the clinical parameters between male and female patients with COPD, including general characteristics, disease characteristics, and clinical outcomes.

Delpazolid, an oxazolidinone, has been studied in non-clinical studies of efficacy and toxicity and Phase 1 clinical studies. Delpazolid has in vitro activity against Gram-positive bacteria, including Mycobacterium tuberculosis .

Monoclonal antibodies against type 2 inflammatory pathways are currently promising therapeutics for severe asthma. The aim of this study was to determine how well type 2 (T2) inflammation-specific agents targeting interleukins reduce the rate of asthma exacerbations (AE) in patients with severe asthma.We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. A systematic literature search was conducted in PubMed, Embase, and the Cochrane Central Register. The primary outcome was the reduction rate of annualized AEs.We analyzed 17 studies comprising 11800 subjects. A total of 6197 patients received T2-specific agents (benralizumab, dupilumab, lebrikizumab, mepolizumab, reslizumab, and tralokinumab). Overall, T2-specific agents were significantly associated with a lower risk of AE, compared with placebo [rate ratio (RR) 0.58, 95% confidence interval (CI) 0.51 to 0.66]. Among all studied agents, only tralokinumab did not demonstrate a reduction in AE. The efficacy of T2-specific agents in reducing AE was maintained regardless of the pathway used. A subgroup analysis indicated that T2-specific agents further reduced the risk of AE in patients with eosinophil counts of ≥300 cells/µL (RR 0.41, 95% CI 0.32 to 0.53).Our findings suggest that T2-specific agents are significantly associated with a reduced rate of AE, compared with placebo. Their efficacy appears to be enhanced in patients with eosinophil counts of ≥300 cells/µL.

Objective: HL301 is a combination product of seven medicinal plants that has been proven effective in acute bronchitis by two phase II studies. In the present study, its efficacy and safety compare...

Purpose To determine the diagnostic accuracy of the Xpert MTB/RIF assay in patients with smear-negative pulmonary tuberculosis (TB) and to assess clinical and CT characteristics of Xpert-negative pulmonary TB. Material and methods We retrospectively reviewed the records of 1,400 patients with suspected pulmonary TB for whom the sputum Xpert MTB/RIF assay was performed between September 1, 2014 and February 28, 2020. Clinical and CT characteristics of smear-negative pulmonary TB patients with negative Xpert MTB/RIF results were compared with positive results. Results Of 1,400 patients, 365 (26.1%) were diagnosed with pulmonary TB and 190 of 365 patients (52.1%) were negative for sputum acid-fast bacilli. The diagnosis of pulmonary TB was based on a positive culture, positive Xpert MTB/RIF or the clinical diagnoses of patients treated with an anti-TB medication. The sensitivity, specificity, positive predictive and negative predictive values of sputum Xpert MTB/RIF for smear-negative pulmonary TB were 41.1%, 100%, 100%, and 90.1%, respectively. Finally, 172 patients with smear-negative pulmonary TB who underwent chest CT within 2 weeks of diagnosis were included to compare Xpert-positive (n = 66) and Xpert- negative (n = 106) groups. Patients with sputum Xpert-negative TB showed lower positive rates for sputum culture (33.0% vs. 81.8%, p Conclusion The detection rate of sputum Xpert MTB/RIF assay was relatively low for smear negative pulmonary TB. Chest CT image interpretation may play an important role in early diagnosis and treatment of Xpert MTB/RIF-negative pulmonary TB.

Rationale: In recent decades, diagnosis and treatment recommendations for idiopathic pulmonary fibrosis (IPF) have changed. In Korea, the average life expectancy has increased, unmet healthcare nee...

Purpose The prevalence of chronic obstructive pulmonary disease (COPD) in females has increased, changing the concept of COPD as a disease mostly limited to males. In this study, the clinical characteristics of COPD in females were investigated. Patients and Methods The study was based on a multicenter cohort of COPD patients recruited from 54 medical centers in South Korea. Sex-based differences in general characteristics, exposure risk factors, depression scores, results of pulmonary function tests, COPD exacerbation, symptom scores, and radiologic findings were evaluated. Sex-related differences in the annual FEV1 change over 5 years were analyzed in a linear mixed model. Results Of the 2515 patients enrolled in this study, 8.1% were female. Female patients who had a higher BMI and a lower level of education were less likely to be smokers, were more exposed to passive smoking/biomass, and were more depressed compared to males. The rates of bronchiectasis, previous childhood respiratory infection, and asthma were higher in females. Female patients also had more symptoms and a poorer exercise capacity than males, but no significant differences were observed in terms of exacerbations. Radiologic findings revealed that male patients had worse emphysema, and female patients had worse bronchiectasis, as determined based on chest X-ray and computed tomography findings. On pulmonary function tests, female patients had less obstruction and less annual FEV1 loss over 5 years. Conclusion This study revealed differences in the clinical parameters between male and female patients with COPD, including general characteristics, disease characteristics, and clinical outcomes.

Background and objective A cough-specific quality-of-life questionnaire is recommended to assess the impact of cough; however, a simple instrument to quantify cough is required for everyday clinical practice. This study was aimed to develop a short patient-completed questionnaire (COugh Assessment Test, COAT). Methods The COAT was developed and validated by comparison with the Korean version of Leicester Cough Questionnaire (K-LCQ) and cough numeric rating scale (NRS, 0-10, 11-point scale) for chronic cough patients. Results Item selection identified five items regarding cough frequency, daily activity, sleep disturbance, fatigue and cough hypersensitivity (0-4 scaling of items, 0-20 score range) through reliability test cohort (n = 78). Test-retest reliability was strong (intra-class correlation coefficient = 0.88). The final COAT was compared with K-LCQ and cough NRS in a validation cohort (n = 323). In Rasch analysis, COAT fitted well to a unidimensional model. Pearson correlations of COAT versus K-LCQ (i) before treatment, (ii) after treatment; COAT versus cough NRS (iii) before treatment, (iv) after treatment; (v) delta-COAT versus delta-cough NRS, (vi) delta-COAT versus delta-K-LCQ were (i) -0.71, (ii) -0.81, (iii) 0.69, (iv) 0.82, (v) -0.66 and (vi) 0.72, respectively. Conclusion The COAT is a useful, simple questionnaire for assessing and monitoring cough.

The efficacy and safety of Chinese herbs for symptomatic treatment of bronchitis is not well established. We evaluated the efficacy and safety of a combination product of seven herbs (HL301) for the treatment of acute bronchitis (AB) and acute exacerbation of chronic bronchitis (AECB) using a randomized, double-blind, placebo-controlled, multicenter trial design.A total of 160 patients with AB or with AECB were randomized to receive placebo or one of three doses of HL301 (0.6 g/day, 1.2 g/day, or 1.8 g/day) for a total of 7 days. The primary study endpoint was the change in bronchitis severity score (BSS) from the baseline visit (visit 2) to the end of treatment visit (visit 3). Other efficacy variables were percentage BSS systemic sign efficacy after treatment and change in individual BSS parameters after treatment.Changes in BSS from visit 2 to visit 3 in the three treatment groups (4.63 ± 2.24, 4.08 ± 1.63, and 4.15 ± 1.74 in the HL301 0.6 g/day, 1.2 g/day, and 1.8 g/day groups, respectively) were higher than that of the placebo group (2.88 ± 2.57) in the per protocol set (PPS) (P .05), and it was also valid in the full analysis set (FAS). The number of participants whose symptoms (measured by BSS) improved at least 30% after treatment was higher in all three treatment groups compared to the placebo group in both the FAS and the PPS (P .05, for all).Three different doses of HL301 (0.6 g/day, 1.2 g/day, and 1.8 g/day) were effective in decreasing the BSS index compared to placebo. HL301 may be effective for symptomatic treatment of both AB and AECB.Essential components of HL301 have not been delineated in the study and patients with AB and AECB were indiscriminately enrolled in the present study. Respective evaluation of the efficacy of HL301 for AB and AECB will be necessary in the future.

Background Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by arterial and venous thrombosis or pregnancy morbidity in patients with persistent antiphospholipid antibodies. However, nationwide population-based epidemiology studies regarding APS are still unavailable. Methods We analyzed claims data extracted from the Korean Health Insurance and Review Agency (HIRA) covering more than 52 million Koreans, between January 1, 2008, and December 31, 2017. Patients diagnosed with APS, as determined by the Korean Classification of Disease, 7th edition (D68.6), and a rare intractable disease program (V253), were identified in HIRA. Results A total of 3,088 newly diagnosed incident cases of 1,215 men and 1,873 women were identified during 2009–2016. The mean age was 44.6 ± 16.6 (men, 47.4 ± 16.3; women, 42.8 ± 16.6) years. The incidence was 0.75 per 105 person-year (95% confidence interval, 0.73–0.78). The prevalence in 2016 was 6.19 per 105 people. For incident cases, women showed incidence peak at ages of 30–39 years and 70–79 years, whereas for men, it was highest at ages of 70–79 years only. Of all patients, 1,766 (57%, 810 men and 956 women) had primary APS, 1,322 (43%, 405 men and 917 women) had secondary APS, and 845 (27%, 216 men and 629 women) were associated with systemic lupus erythematosus (SLE). Conclusion The incidence of APS differs according to age groups and gender. The incidence of primary APS was higher than that of secondary APS in both gender. Furthermore, as already reported, secondary APS is highly associated with SLE; however, we observed that rheumatoid arthritis is also highly related., Graphical Abstract

Programmed death ligand 1 (PD-L1) expression has been associated with clinical outcome of programmed death 1 (PD-1) pathway blockade in non-small cell lung cancer (NSCLC). PD-L1 is highly expressed in approximately 30% of patients without EGFR mutation or ALK rearrangement in previous trials. The objective of this study was to determine the frequency of PD-L1 expression and the clinical outcome according to PD-L1 expression in lung adenocarcinomas harboring EGFR mutation and treated with tyrosine kinase inhibitors (TKIs). We retrospectively evaluated PD-L1 expression using 22C3 pharmDx assay in lung adenocarcinoma patients with EGFR mutations at two referral hospitals between January 2017 and June 2018. Samples were obtained from surgically resected tumors, small biopsy, or cytologic cell blocks. Of all 71 patients analyzed, 44 (58.7%) had PD-L1 tumor proportion score (TPS) of

Aims: The aim of this study was to examine the difference of medical costs between antibiotics prescription and no antibiotics prescription in patients with acute exacerbations of mild to moderate COPD. Methods: This was a retrospective observational study. Data were obtained from the Korean National Health and Nutrition Examination Survey (KNHANES) (2007 ~ 2012) database. Mild to moderate COPD patients were defined as 50 % ≤ FEV1 Acute exacerbation of COPD was defined as emergency room visit or hospital admission with prescription of antibiotics and/or systemic corticosteroid within 3 days. We compared the medical cost between the patients with antibiotics prescription (antibiotics group) and the patients without antibiotics (no-antibiotics group). Results: A total of 374 exacerbations (10.1%) were developed in 2363 mild to moderate COPD patients during 6 years. Among the exacerbations event 85.2% were prescribed antibiotics and 14.7% were not prescribed antibiotcs. Antibiotics group showed lower FEV1 (0.61 L VS. 0.65L, P=0.010). Antibiotics group showed long hospital stay than no-antibiotics group (12.9 days vs. 9.5 days, p=0.022). Antibiotics group showed higher medical costs compared to no-antibiotics group (2439$ vs. 1314$, p Conclusion: More severe airflow limitation increased antibiotics prescriptions. Medical costs for COPD exacerbations were higher in antibiotics group compared to no-antibiotics group.

Acute lung injury(ALI) induction upregulates tumor necrosis factor-α(TNF-α) that activates NF-κB and mitogen-activated protein kinases(MAPK) to induce pro-inflammatory mediators. Polydexyribonucleotide(PDRN) is an adenosine A2A receptor agonist, and it exerts anti-inflammatory effect by suppressing the production of pro-inflammatory cytokines, and suppressing apoptosis. We investigated the therapeutic efficiency of PDRN on ALI induced by lipopolysaccharide(LPS) in rats. Rats were randomly divided into 4 groups(n=8 each group): control, ALI-induced, ALI-induced and PDRN treated, ALI-induced and PDRN+3,7-dimethyl-1-propargylxanthine(adenosine A2A receptor antagonist; DMPX) treated. ALI was induced by intratracheal instillation of LPS(5mg/kg) in 200μL saline. Rats in drugs(PDRN, DMPX) treated groups received a single intraperitoneal injection of 500μL saline including PDRN(8mg/kg) and DMPX(8mg/kg), 1 h after lung injury induction. Rats were sacrificed 6h after PDRN and DMPX administrations, according to each group. Administration of LPS caused lung tissue damages, increased lung injury score and pro-inflammatory cytokines. Both NFκB and MAPK signaling factors were increased by LPS. However, PDRN therapy potently suppressed expressions of NFκB and MAPK signaling factors compared PDRN+DMPX treated group. These alterations led to a reduction of pro-inflammatory cytokines and NFκB and MAPK signaling, which promote recovery of damage pulmonary tissue. PDRN therapy showed more potent therapeutic effect on LPS-induced ALI compared to the non-treated and DMPX-treated group. Therefore, the PDRN may provide new therapeutic guideline for initial treatment in ALI.

Adding either macrolide or fluoroquinolone (FQ) to β-lactam has been recommended for patients with severe community-acquired pneumonia (CAP). However, due to the limited evidence available, there is a question as to the superiority of the two combination therapies. The MEDLINE, EMBASE, Cochrane Central Register, Scopus, and Web of Science databases were searched for systematic review and meta-analysis. A total of eight trials were analyzed. The total number of patients in the β-lactam plus macrolide (BL-M) and β-lactam plus fluoroquinolone (BL-F) groups was 2,273 and 1,600, respectively. Overall mortality of the BL-M group was lower than that of the BL-F group (19.4% vs. 26.8%), which showed statistical significance (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.49 to 0.94; P = 0.02). Length of hospital stay was reduced in the BL-M group compared to the BL-F group (mean difference, -3.05 days; 95% CI, -6.01 to -0.09; P = 0.04). However, there was no significant difference in length of intensive care unit (ICU) stay between the two groups. Among patients with severe CAP, BL-M therapy may better reduce overall mortality and length of hospital stay than BL-F therapy. However, we could not elicit strong conclusions from the available trials due to high risk of bias and methodological limitations.

Uncontrolled diabetes, unlike controlled diabetes, is associated with an impaired immune response. However, little is known about the impact of the status of diabetes control on clinical features and treatment outcomes in patients with pulmonary TB (PTB). We conducted this study to evaluate whether the status of diabetes control influences clinical manifestations and treatment responses in PTB.A multicentre prospective study was performed between September 2012 and September 2014. The patients were categorised into three groups according to the glycated haemoglobin (HbA1C) level: PTB without diabetes mellitus (non-DM), PTB with controlled diabetes (controlled-DM) and PTB with uncontrolled diabetes (uncontrolled-DM). The primary outcome was the sputum culture conversion rate after 2 months of intensive treatment.Among 661 patients with PTB, 157 (23.8%) had diabetes and 108 (68.8%) had uncontrolled diabetes (HbA1C≥7.0%). The uncontrolled-DM group exhibited more symptoms, positive sputum smears (p0.001) and presence of cavities (p0.001) than the non-DM group. Regarding treatment responses, patients with uncontrolled-DM were more likely to have a positive culture after 2 months (p=0.009) and either treatment failure (p=0.015) or death (p=0.027) compared with the non-DM group. In contrast, those with controlled-DM showed similar treatment responses to the non-DM group. In multivariable analysis, uncontrolled diabetes was an independent risk factor for a positive sputum culture after 2 months of treatment (adjusted OR, 2.11; p=0.042) and either treatment failure or death (adjusted OR, 4.11; p=0.022).Uncontrolled diabetes is an independent risk factor for poor treatment response in PTB.

We previously showed that the choice of levofloxacin or moxifloxacin for the treatment of patients with fluoroquinolone-sensitive multidrug-resistant tuberculosis (MDR-TB) did not affect sputum culture conversion at 3 months of treatment.To compare final treatment outcomes between patients with MDR-TB randomized to levofloxacin or moxifloxacin.A total of 151 participants with MDR-TB who were included for the final analysis in our previous trial were followed through the end of treatment. Treatment outcomes were compared between 77 patients in the levofloxacin group and 74 in the moxifloxacin group, based on the 2008 World Health Organization definitions as well as 2013 revised definitions of treatment outcomes. In addition, the time to culture conversion was compared between the two groups.Treatment outcomes were not different between the two groups, based on 2008 World Health Organization definitions as well as 2013 definitions. With 2008 definitions, cure was achieved in 54 patients (70.1%) in the levofloxacin group and 54 (73.0%) in the moxifloxacin group (P = 0.72). Treatment success rates, including cure and treatment completed, were not different between the two groups (87.0 vs. 81.1%, P = 0.38). With 2013 definitions, cure rates (83.1 vs. 78.4%, P = 0.54) and treatment success rates (84.4 vs. 79.7%, P = 0.53) were also similar between the levofloxacin and moxifloxacin groups. Time to culture conversion was also not different between the two groups (27.0 vs. 45.0 d, P = 0.11 on liquid media; 17.0 vs. 42.0 d, P = 0.14 on solid media). Patients in the levofloxacin group had more adverse events than those in the moxifloxacin group (79.2 vs. 63.5%, P = 0.03), especially musculoskeletal ones (37.7 vs. 14.9%, P = 0.001).The choice of levofloxacin or moxifloxacin made no difference to the final treatment outcome among patients with fluoroquinolone-sensitive MDR-TB. Clinical trial registered with www.clinicalrials.gov (NCT01055145).

Yong Suk Jo,1 Yee Hyung Kim,2 Jung Yeon Lee,3 Kyungjoo Kim,4 Ki-Suck Jung,5 Kwang Ha Yoo,6 Chin Kook Rhee4 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea; 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; 3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea; 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea; 5Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea; 6Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea Background and objective: The rate of obesity is increasing in Asia, but the clinical impact of body mass index (BMI) on the outcome of chronic obstructive pulmonary disease (COPD) remains unknown. We aimed to assess this impact while focusing on the risk of exacerbation, health-care utilization, and medical costs. Methods: We examined 43,864 subjects registered in the Korean National Health and Nutrition Examination Survey (KNHANES) database from 2007 to 2012, and linked the data of COPD patients who had mild to moderate airflow obstruction (n = 1,320) to National Health Insurance (NHI) data. COPD was confirmed by spirometry. BMI was used to stratify patients into four categories: underweight (BMI

Min-Hye Kim,1 Chin Kook Rhee,2 Kyungjoo Kim,2 Sang Hyun Kim,3 Jung Yeon Lee,4 Yee Hyung Kim,5 Kwang Ha Yoo,6 Young-Joo Cho,1 Ki-Suck Jung,7 Jin Hwa Lee1 1Department of Internal Medicine, College of Medicine, Ewha Womans University, 2Department of Internal Medicine, Seoul St Mary’s Hospital, The Catholic University of Korea, Seoul, 3Big Data Division, Health Insurance Review and Assessment Service, Wonju, 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, 5Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 6Department of Internal Medicine, Konkuk University College of Medicine, Seoul, 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Republic of Korea Background: Asthma and COPD are heterogeneous diseases. Patients with both disease features (asthma–COPD overlap [ACO]) are common. However, clinical characteristics and socio-economic burden of ACO are still controversial. The aim of this study was to identify the heterogeneity of ACO and to find out the subtypes with clinical impact among ACO subtypes. Methods: In the Korean National Health and Nutrition Examination Survey (KNHANES) conducted between 2007 and 2012, subjects who were ≥40years and had prebronchodilator FEV1/FVC

Anti-leukotriene (anti-LT) agents have been not yet established for effectiveness in patients with chronic obstructive pulmonary disease (COPD). We performed a systematic review and meta-analysis to assess whether anti-LT agents have the responsiveness for COPD patients.MEDLINE, EMBASE, Cochrane Central Register, and Korea Med were searched for relevant clinical trials to review.Seven studies involving 342 patients were finally analyzed. Pooled estimation from three randomized controlled studies did not demonstrate that anti-LT agents increased forced expiratory volume in 1 s [overall effect: 0.09 L, 95 % confidence interval (CI) -0.04 to 0.21; P = 0.17; I (2) = 41.0 %] or forced vital capacity (overall effect: 0.04 L, 95 % CI -0.04 to 0.11; P = 0.64; I (2) = 0.0 %). As for inflammatory markers, anti-LT agents did not affect the level of myeloperoxidase (standardized mean difference, -0.15; 95 % CI -0.65 to 0.36) or LTB4 (standardized mean difference, -0.41; 95 % CI -0.96 to 0.13). They reduced the frequency of dyspnea [relative risk (RR) 0.43; 95 % CI 0.29 to 0.64] and sputum (RR 0.37; 95 % CI 0.22 to 0.63), based on overall estimation from two non-randomized studies. However, our review revealed that there are few well-designed, randomized controlled studies with large sample sizes and long treatment durations.Although symptomatic improvements were demonstrated in some studies, there is a lack of evidence to support the therapeutic efficacy of anti-LT agents in patients with COPD. Further large-scale, long-term studies are needed to identify predictive factors for COPD patients who may benefit from anti-LT agents.

Background Although prior hospitalization (PH) has been considered as a risk factor for infection with potentially drug-resistant (PDR) pathogens in patients admitted with pneumonia, the evidence is limited. We aimed to elucidate the clinical impact of PH on these patients. Methods PH was defined as hospitalization for two or more days in the preceding 90 days. Patients with PH-associated pneumonia (PHAP) or community-acquired pneumonia (CAP) were matched using the propensity score matching method, and the clinical outcomes were compared. We also conducted subgroup analyses based on intravenous antibiotic use during PH, duration of PH, and time to re-admission. Results A total of 704 patients were identified; the PHAP group included 97 patients (13.7%). After matching according to propensity scores, the baseline characteristics of the PHAP group were similar to those of the CAP group. The isolation rate of PDR pathogens as well as the 30-day and total in-hospital mortality did not differ between propensity score-matched PHAP and CAP patients (13.6% vs. 10.2%, P = 0.485; 10.2% vs. 14.8%, P = 0.362; and 13.6% vs. 15.9%, P = 0.671, respectively). In subgroup analyses, only intravenous antibiotic use during PH was associated with the isolation rate of PDR pathogens (adjusted OR: 5.066; 95% CI: 1.231–20.845). Conclusions PH itself might not be related with higher isolation rates of PDR pathogens or mortality in patients admitted with pneumonia. Therefore, it seems reasonable that broad spectrum antibiotic therapy for PDR pathogens should be selectively applied to PHAP patients with intravenous antibiotic use during PH.

Background: Cough specific quality of life questionnaire such as Leicester Cough Questionnaire (LCQ) is recommended to assess the impact of cough. A short, simple instrument to quantify cough will be useful like as CAT for COPD. Aims: Develop a short patient-completed questionnaire ( CO ugh A ssessment T est, COAT ), assessing the impact of cough on health status. Methods: The COAT was developed though reliability test and then validated by comparing with Korean version of LCQ (K-LCQ), cough numeric rating scale (NRS, 0-10, 11-point scale) for chronic coughers. Candidate items were surveyed from 19 pulmonologists. Results: Item selection process identified 5 items about cough frequency, daily activity, sleep disturbance, fatigue, and cough hypersensivitity. The COAT composed of 5 items (0-4 scaling of the items, 0-20 score range) was finally developed. Reliability of COAT was tested in reliability test cohort (n=78). Internal consistency was excellent (Cronbach’s a=0.84). Test re-test repeatability was also very good (intra-class correlation coefficient=0.88). Validation of COAT is ongoing in validation cohort (until now n=83, target n=200). Pearson’s correlations of 1) COAT vs. K-LCQ, 2) COAT vs. cough NRS, and 3) K-LCQ vs. cough NRS before treatment were r=-0.61, 0.72, and -0.51, respectively (p Conclusion: The COAT is a useful simple questionnaire for assessing and monitoring cough.

Background: Chronic cough is defined as a cough lasting more than 8 weeks and socio-economic burden of chronic cough is enormous. The characteristics of chronic cough in Korea are not well understood. The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) published guidelines on cough management in 2014. The current study evaluated the clinical characteristics of chronic cough in Korea and the efficacy of the KATRD guidelines. Methods: This was a multi-center, retrospective observational study conducted in Korea. The participants were over 18 years of age. They had coughs lasting more than 8 weeks. Subjects with current pulmonary diseases, smokers, ex-smokers with more than 10 pack-years or who quit within the past 1 year, pregnant women, and users of cough-inducing medications were excluded. Evaluation and management of cough followed the KATRD cough-management guidelines. Results: Participants with chronic cough in Korea showed age in the late forties and cough duration of more than 1 year. Upper airway cough syndrome was the most common cause of cough, followed by cough-variant asthma (CVA). Gastro-esophageal reflux diseases and eosinophilic bronchitis were less frequently observed. Following the KATRD cough-management guidelines, 91.2% of the subjects improved after 4 weeks of treatment. Responders were younger, had a longer duration of cough, and an initial impression of CVA. In univariate and multivariate analyses, an initial impression of CVA was the only factor related to better treatment response. Conclusion: The causes of chronic cough in Korea differed from those reported in other countries. The current Korean guidelines proved efficient for treating Korean patients with chronic cough.

Pleomorphic adenoma is the most common type of salivary gland tumor. Although it rarely affects the trachea and bronchus, it usually grows in the airway and presents as an endobronchial mass. We recently experienced a case of pleomorphic adenoma originating in the bronchus and growing outward into the mediastinum. We present this case with review of the computed tomography (CT) scan of the patient's chest, the endoscopic ultrasound (EUS), and the histopathology report.

Endotracheal metastasis of primary lung cancer is extremely rare. We report the case of a 51-year-old male patient who had undergone right pneumonectomy for squamous cell carcinoma one year earlier. The post-operative chest computed tomography (CT) image revealed a very small endotracheal nodule with contrast enhancement. This finding was erroneously regarded as endotracheal phlegm because of the nodular size and the rarity of endotracheal metastases from primary lung cancer. This case indicates that a thorough evaluation should be performed with a high level of suspicion for malignancy when a nodule-like lesion with contrast enhancement or tracheal thickening is detected on follow-up CT scan, in patients who undergo surgery for lung cancer.

Although blood cultures (BCs) are an important component of diagnostic practice for antibiotic management in patients with pneumonia, several studies have questioned whether they should be performed. The objective of this study was to evaluate the predictive factors of bacteremia and the role of BCs in patients with community-onset pneumonia (community-acquired pneumonia and healthcare-associated pneumonia). This study was retrospectively conducted in patients with community-onset pneumonia who were hospitalized at Jeju National University Hospital between January 2012 and December 2014. A true bacteremia (TB) group and a contaminants or negative bacteremia (CNB) group were classified according to the bacterial growth on the BC media and were investigated for the clinical relevance of the BCs. We enrolled 785 patients; the TB group and the CNB group contained 36 patients (4.5%) and 749 (95.4%) patients, respectively. Only 10 patients (1.2%) required a change in antibiotic therapy based on the BC results (3 patients with an escalation, 7 with a de-escalation). There was no significant difference between the community-acquired pneumonia and the healthcare-associated pneumonia groups with regard to the rate of antibiotic change due to the BC results (1.1% vs 1.4%; P = 0.751). Chronic liver disease (odds ratio [OR] 2.973, 95% confidence interval [CI] 1.099–8.037), a confusion, urea, respiratory rate, blood pressure, age ≥65 (CURB-65) score of 4 to 5 points (OR 3.484, 95% CI 1.304–9.307), and Pneumonia Severity Index (PSI) class V (OR 2.405, 95% CI 1.007–5.743) were independently associated with TB. In patients with PSI class V and a CURB-65 score of 4 to 5 points, the TB group tended to show a higher inhospital mortality rate than the CNB group (50.0% vs 29.4%; P = 0.060, 60.0% vs 42.5%; P = 0.480). The areas under the curve for PSI score and CURB-65 score for predicting TB revealed an increased tendency compared with that of C-reactive protein (0.72, 95% CI 0.630–0.809; and 0.72, 95% CI 0.622–0.819 vs 0.629, 95% CI 0.522–0.735, respectively). It seemed reasonable to selectively conduct BC in patients hospitalized with severe community-onset pneumonia based upon its low overall positive rate, its effects on antimicrobial modification, and the associations of TB with the severity indices of pneumonia.

Background: Although blood cultures (BCs) are important diagnostic practice for antibiotic management in patients with pneumonia, several studies have questioned whether this practice should perform or not. Methods: This study was retrospectively conducted in adult patients with community-onset pneumonia. True bacteremia (TB) group, and contaminants or negative bacteremia (CNB) group were classified through bacterial growth on BC media and were investigated its clinical relevance. Results: A total of 785 patients were enrolled, the TB group and CNB group were 36 patients (4.5%) and 749 (95.4%), respectively. Only 10 patients (1.2%) altered antibiotic therapy based on BC results. The TB group had worse clinical outcomes, and showed higher in-hospital mortality rates than the CNB group (30.5% vs. 10.6%; p = 0.001). Chronic liver disease (odds ratio [OR] 2.973; 95% confidence interval [CI], 1.099-8.037; p = 0.032), CURB-65 score 4 and 5 points (OR 3.484; 95% CI, 1.304-9.307; p = 0.013) and PSI class V (OR 2.405; 95% CI, 1.007-5.743; p = 0.048) were independently associated with TB. In patients having high severity pneumonia with PSI class V and CURB-65 score 4 to 5 points, the TB group tended to show high in-hospital mortality rate than the CNB group (50.0% vs. 29.4%, p = 0.060; 60.0% vs. 42.5%, p = 0.480). Conclusions: Although the identification of TB may be regard as a prognostic factor for in-hospital mortality, BCs were positive for a true pathogen in only 4.5% of cases and the impact on antibiotic management of BCs was limited. Therefore, BCs seemed to be selectively considered in patients having high severity of community-onset pneumonia.

Supplemental Digital Content is available in the text, Although chronic cough is very common, its prevalence and causes have been rarely reported in the large general population including smokers. This study aimed to identify the prevalence of possible causes of chronic cough and their clinical impact. From Korean National Health and Nutrition Examination Survey (KNHANES) data including 119,280 adults aged over 40 years, 302 individuals with chronic cough were recruited irrespective of smoking status. Data from questionnaire, laboratory tests including spirometry, chest radiographs, and otorhinolaryngologic examination were analyzed. The prevalence of chronic cough in adults was 2.5% ± 0.2%. Current smokers occupied 47.7% ± 3.8% of study population and 46.8% ± 3.9% of the subjects showed upper airway cough syndrome (UACS). Based on spirometry, chronic obstructive pulmonary disease (COPD) was identified in 26.4% ± 3.5%. Asthma explained for 14.5% ± 2.8% of chronic cough. Only 4.1% ± 1.6% showed chronic laryngitis suggesting gastro-esophageal reflux-related cough. Abnormalities on chest radiography were found in 4.0% ± 1.2%. Interestingly, 50.3% ± 4.5% of study subjects had coexisting causes. In multivariate analysis, only current smoking (odds ratio [OR] 3.16, P