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Bronchial asthma ´ëÀå°æ Á¤¸®

1. Bronchial asthma Á¤ÀÇ

bronchial hyperresponsiveness·Î ÀÎÇÑ dyspnea, wheezing, coughµîÀÇ ¹Ýº¹Àû ¹ß»ýÀ»

Ư¡À¸·Î ÇÏ´Â chronic inflammatory disease

* ±â°üÁö °ú¹Î¼º = ºñƯÀÌÀû °ú¹Î¼º(nonspecific hyperreactivity)

2. asthma acute exacerbation½ÃŰ´Â virus

¼ºÀÎ: rhinovirus, influenza virus

¼Ò¾Æ: RSV, parainfluenza virus

3. bronchial asthma °¨º°Áø´Ü

i) upper airway obstruction(tumor, laryngeal edema)

ii) endobronchial disease(foreign body aspiration, neoplasm)

iii) acute LV failure

iv) carcinoid tumor

v) recurrent pulmonary emboli

vi) chronic bronchititis

vii) eosinophilic pneumonia

viii) systemic vasculitis

4. ±¹³»¿¡¼­ °¡Àå Áß¿äÇÑ allergen: Áý¸ÕÁö Áøµå±â

Dermatophagoides farinae, Dermatophagoides pteronyssinus

5. ±â°üÁö õ½Ä À¯¹ß¾à¹°

aspirin, NSAIDs, tartrazine(Ȳ»ö5È£), ¥â-blocker, sulfiting agent(¹æºÎÁ¦)

6. ±â°üÁö õ½ÄÀÇ ¿¹ÈÄ

Èí¿¬ µîÀ¸·Î ºñ°¡¿ªÀû º¯È­¸¦ °¡Á®¿Ã¼ö ÀÖ´Ù.

¼ºÀÎ ±â°üÁö õ½ÄÀÇ ¾à 20%´Â ÀÚ¿¬°üÇØ°¡ ¿Ã¼ö ÀÖ´Ù.

¼ºÀÎ ±â°üÁö õ½ÄÀÇ ¾à 40%´Â ³ªÀ̰¡ µé¸é¼­ È£ÀüµÇ±âµµ ÇÑ´Ù.

¼ºÀÎ ±â°üÁö õ½ÄÀÌ ¼Ò¾Æ¿¡¼­ ¹ßº´ÇÑ °æ¿ìº¸´Ù ¿¹Èİ¡ ³ª»Ú´Ù.

7. ±â°üÁö õ½Ä¿¡¼­ airway inflammation°ú ´õºÒ¾î airway remodellingÀÌ °üÂûµÇ´Âµ¥

Ư¡ÀûÀÎ airway remodelling¼Ò°ß 2°¡Áö?

Basement membrane thickening

bronchial smooth muscle hypertrophy

cf. bronchial asthmaÀÇ Á¶Á÷¼Ò°ß

i) bronchial wall¿¡ eosinophil infiltration

ii) mucosal edema

iii) surface epithelium denudation

iv) BM thickening

v) mucosal and submucosal vessel hyperplasia

vi) bronchial smooth muscle hypertrophy

8. bronchial asthmaÀÇ pathophysiologic hallmark

i) smooth muscle contraction

ii) vascular congestion

iii) bronchial wall edema

iv) thick, tenacious secretion

9. wheezingÀº Èí±â½Ãº¸´Ù È£±â½Ã¿¡ ´õ ¶Ñ·ÇÇØÁø´Ù. ±× ÀÌÀ¯?

Èí±â½Ã¿¡ Èä°­³» À½¾Ð ¶§¹®¿¡ Èí±â½Ã¿¡ ±âµµ ³»°­ÀÌ ³Ð¾îÁö¹Ç·Î

10. bronchial asthmaÀÇ ±âµµ¿°Áõº¯È­¿¡ °ü¿©ÇÏ´Â ¼¼Æ÷?

mast cell, eosinophil, macrophage, neutrophil, lymphocyte, bronchial epitheliumµî..

11. eosinophil: ±âµµ¿°Áõ¹ÝÀÀ¿¡¼­ °¡Àå Áß¿äÇÑ ¼¼Æ÷

electron-dense core¿Í electron-lucent matrix µÎºÎºÐÀ¸·Î ±¸¼º

i) electron-dense core: MBP(major basic protein)

ii) electron-lucent matrix: ECP(eosinophilic cationic protein)

EDN(eosinophil-derived neurotoxin)

EP(eosinophilic peroxidase)

12. eosinophilÀÇ Áõ½Ä, ºÐÈ­, Ȱ¼ºÈ­¿¡ °ü¿©ÇÏ´Â cytokines: IL-3, 5, GM-CSF

cf. IL-5: °¡Àå Áß¿ä, eosinophilÀÇ chemotactic effect, basophilÀÇ granule release

ÃÖ±Ù anti-IL-5 Ab¸¦ Åõ¿©ÇÑ µ¿¹°½ÇÇè¿¡¼­ È£»ê±¸¼º ¿°Áõ ¾ïÁ¦È¿°ú¸¦ º¸ÀÓ.

13. chemotactic effect¸¦ °¡Áö°í ÀÖ´Â cytokineÀ» ÅëĪÇÏ¿© chemokineÀ̶ó ÇÑ´Ù.

14. eosinophilÀÌ ±âµµÁ¶Á÷³»·Î À̵¿Çϴµ¥ °ü¿©ÇÏ´Â eosinophil Ç¥¸é ¹°Áú ¹× endothelial

surface adhesion molecule?

eosinophil surface: VLA-4(very late antigen-4)

endothelial cell surface: VCAM-1(vascular cell adhesion molecule 1)

15. bronchial asthma¿¡¼­ ¹éÇ÷±¸¸¦ ±âµµÁ¶Á÷³»·Î À̵¿½Ã۴µ¥ °ü¿©ÇÏ´Â adhesion

molecule?

1) selectin: L-selectin, P-selectin, E-selectin

2) integrin: ¥â1 integrin(VLA-4), ¥â2 subfamily

3) immunoglobulin gene superfamily: ICAM-1, ICAM-2, VCAM-1

16. IgE binding receptor: 2 types

1) high affinity IgE receptors: mast cell, basophil

2) low affinity IgE receptors: lymphocyte, eosinophil, platelet, macrophage

17. IgE »ý¼º ¹× eosinophilºÐÈ­¿¡ °¡Àå Áß¿äÇÑ ¿ªÇÒÀ» ÇÏ´Â ¼¼Æ÷: Th2 cell(type II helper T

cell)

cf. ¾Ë·¹¸£±â ¿°Áõ¹ÝÀÀÀº ÁÖ·Î Th2 cell¿¡ ÀÇÇØ ÀϾ´Ù.

18. Th0(IL-12) -> Th1 cell: IL-2, IFN-¥ã, TNF-¥â, IL-3, GM-CSF - delayed hypersensitivity

Th0(IL-4) -> Th2 cell: IL-4, 5, 6, 10, IL-3, GM-CSF - allergic inflammation

19. IgE»ý¼º À¯µµ: IL-4, 13 CD40

IgE»ý¼º ¾ïÁ¦: IFN-¥á,¥ã, TNF-¥â, TGF-¥â, IL-8

20. APC´Â MHC class II¸¦ ÅëÇØ T lymphocyteÀÇ TCR(T cell receptor)¿¡ °áÇÕÇÑ´Ù.

21. õ½Ä ¹ß»ý¿¡ À־ airway disease¸¦ ÀÏÀ¸Å°±â À§Çؼ­´Â eosinophilia À̿ܿ¡µµ allergen

ÀÌ ÇÊ¿äÇÏ´Ù.

22. ±â°üÁö õ½Ä¿¡¼­ nitric oxide´Â °í³óµµ·Î Á¸ÀçÇϴµ¥ iNOS expressionÁõ°¡·Î ÀÎÇØ

ÀϾ´Ù.

°í³óµµ¿¡¼­´Â Áö¼ÓÀûÀÎ Á¶Á÷¼Õ»ó°ú ¸¸¼ºÃµ½Ä¿°ÁõÀ» ¾ß±âÇÑ´Ù.

õ½ÄȯÀÚÀÇ È£±â°¡½º¿¡´Â NO°¡ ³ô°í, glucocorticoid Ä¡·á·Î ³·¾ÆÁø´Ù.

23. IL-1: ´Ù¾çÇÑ ¼¼Æ÷¿¡¼­ »ý»êµÇ¾î fibrosis¿¡ °ü¿©ÇÑ´Ù.

IL-10: vitro¿¡¼­ T cell cytokineºÐºñ¸¦ ¾ïÁ¦ÇÏÁö¸¸, vivo¿¡¼­´Â dendritic cellÀ» ÅëÇÏ¿©

allergic response¸¦ ÃËÁøÇÑ´Ù.

24. ±â°üÁö õ½ÄÀÇ inflammatory mediators

acetylcholine, histamine, bradykinin, leukotriene, neuropeptides(substance P,

neurokinin A) nitric oxide, PAF µî..

cf. VIP(vasoactive intestinal peptide)´Â ±â°üÁö È®Àå ÀÛ¿ë

25. * ±â°üÁö õ½ÄÀº ´ë°³´Â early airway response¿Í late airway response°¡ ¸ðµÎ ÀÖ´Â

dual response°¡ ´ëºÎºÐÀÌÁö¸¸ EAR¾øÀÌ LAR¸¸ ³ªÅ¸³ª´Â isolated LAR, ¶Ç´Â isolated

EARÀÌ Á¸ÀçÇÑ´Ù.

* dual response¸¦ º¸À̴ ȯÀÚ¿Í isolated EAR¸¸ º¸À̴ ȯÀÚ»çÀÌ¿¡ Å« ÀÓ»óÀû Â÷À̰¡

¾ø´Ù.

* LARÀ» º¸ÀΠȯÀÚ´Â isolated EAR¸¸ Àִ ȯÀÚ¿¡ ºñÇØ specific IgE °ªÀÌ ³ô´Ù.

* exercise´Â ÀüÇüÀûÀ¸·Î early response¸¸ ÀÏÀ¸Å²´Ù.

26. EAR°ú LAR¸¦ ¸ðµÎ ¿¹¹æÇÏ´Â ¾àÁ¦

cromolyin sodium, nedocromil, long-acting ¥â2-agonist

27. APC°¡ T cellÀ» Ȱ¼ºÈ­ ½ÃŰ´Â ±âÀü

i) signal 1: TCR/CD3 complex·Î AgÀ» deliver

ii) signal 2: APCÀÇ B7(B7-1, B7-2)°ú Th cellÀÇ CD28ÀÌ °áÇÕ

cf. signal 2´Â antigen-nonspecific co-stimulatory signal

B7-1(CD80), B7-2(CD86)

28. severe bronchospasmÀÇ ÀÌÇÐÀû ¼Ò°ß

accessory muscle use, paradoxical pulse, wheezing¼Ò½Ç

29. °¡¿ªÀû ±âµµÆó¼â¶õ short-acting bronchodilatorÅõ¿©ÈÄ FEV1ÀÌ 15%, 200mlÀÌ»ó

Áõ°¡Çϰųª PEFRÀÌ 15%ÀÌ»ó Áõ°¡ÇÏ´Â °ÍÀ» ¸»ÇÑ´Ù.

30. methacholine challenge test¿¡¼­ Á¤»óÀÎÀÇ 6-20%¿¡¼­ ¾ç¼ºÀÇ °á°ú¸¦ º¸À̸ç õ½ÄȯÀÚ

¿Í´Â ´Þ¸® ³óµµ¸¦ ³ôÀÌ´õ¶óµµ ±â°üÁö¼öÃàÀÇ Á¤µµ°¡ ´õ ½ÉÇØÁöÁö ¾Ê°í plateau response¸¦

º¸ÀδÙ.

31. õ½Ä Ä¡·áÈÄ PEFR, FEV1ÀÌ ¸ÕÀú È£ÀüµÇ°í RVÀº °¡Àå ³ªÁß¿¡ ÁÁ¾ÆÁø´Ù.

32. ±â°üÁö õ½Ä¶§ÀÇ PFTº¯È­

Áõ°¡: TLC, RV, V/Q mismatch, work of breathing, airway resistance

°¨¼Ò: FEV1, PEFR, MMEFR

elastic recoil º¯È­

33. methacholine challenge test¶§ steroid inhaler¸¦ ÁßÁöÇÒ ÇÊ¿ä´Â ¾ø´Ù.

¥â-agonist, theophylline, antihistamine, cromolyin sodium µîÀº Áß´Ü

±× ¿Ü, ´ã¹è, Ä«ÆäÀÎ, Äݶó, ÃÊÄݸ´, ¿îµ¿, °øÇØ µî Áß´Ü

34. bronchoprovocation test¿¡ ÀÌ¿ëµÇ´Â ¾àÁ¦: histamine, methacholine

35. ÈíÀÔÇ׿ø ¹ÝÀÀ °Ë»çÈÄÀÇ ºñƯÀÌÀû ±â°üÁö °ú¹Î¼ºÀº 1ÁÖ ÀÌ»ó Áö¼ÓµÇ¹Ç·Î Ç׿øÀ¯¹ß ½ÃÇè

À» ¹Ýº¹ÇÒ¶§´Â ÃÖ¼Ò 1ÁÖÀÏ ÀÌ»óÀÇ °£°ÝÀÌ ÇÊ¿äÇÏ´Ù.

36. ±â°üÁö õ½Ä ȯÀÚÀÇ Ä¡·áÁß¿¡ Áúº´ÀÇ °æ°ú ¹× Ä¡·áÈ¿°ú ÆÇÁ¤À» À§ÇØ ÁÖ±âÀûÀ¸·Î °Ë»çÇØ¾ß

ÇÒ°Í

°¡Á¤: PEFR °Ë»ç½Ç: FEV1

37. ½Äǰ ÷°¡Á¦ À¯¹ß ¾Ë·¹¸£±â: sulfite(¾ÆÈ²»ê¿°)

38. Atopy: ¿ÜºÎ allergen¿¡ ´ëÇÑ IgE-mediated alllergic response

<°Ë»ç> total serum IgE, allergen-specific IgE, allergic skin test

39. skin test

- prick test´Â intradermal test¿¡ ºñÇØ ´ú ¹Î°¨ÇÏÁö¸¸ º¸´Ù ƯÀÌÀûÀÌ´Ù.

- Áõ»ó°ú correlationÀÌ ´õ ÁÁ°í ±¹¼Ò¹ÝÀÀµµ Àû´Ù.

- skin test´Â RAST¿¡ ºñÇØ ȯÀÚ¿¡ ´ëÇÑ À§ÇèÀÌ ³ô´Ù.

- 15-30ºÐÈÄ wheal size¸¦ ÃøÁ¤ÇÑ´Ù.

- allergen¿¡ ÀÇÇÑ wheal size°¡ histamine¿¡ ÀÇÇÑ wheal size¿Í °°À¸¸é ¾ç¼ºÀÌ´Ù.

40. bronchial asthma¿¡¼­ ¿øÀι°ÁúÀ» Áõ¸íÇÏ´Â ¹æ¹ý 5°¡Áö

i) skin test

ii) specific IgE Ab(RASTµî)

iii) Basophil histamine release test

iv) allergen bronchial provocation test(nasal or bronchial)

v) P-K test

41. RAST´Â skin testÀÇ °á°ú¿¡ Àß ºÎÇÕÇÑ´Ù. µû¶ó¼­ RAST´Â Àü½ÅÀûÀÎ ÇǺο°À̳ª

dermographismÀ¸·Î ÀÎÇØ skin test°¡ ¾î·Á¿î °æ¿ì À¯¿ëÇÏ´Ù.

42. ¸¸¼ºÃµ½ÄÀÇ ºÐ·ù(ÁßÁõµµ¿¡ µû¸¥)

1) mild intermittent: ÁÖ2ȸÀÌÇÏ, ¾ß°£Áõ»ó ¿ù 2ȸ ÀÌÇÏ => short-acting ¥â agonistÇÊ¿ä½Ã

2) mild persistent: ÁÖ2ȸ¡è, ¾ß°£Áõ»ó ¿ù2ȸ¡è => steroid inhaler(800 ug/d¡é),

short-acting ¥â agonistÇÊ¿ä½Ã

3) moderate persistent: ¸ÅÀÏ Áõ»ó ¹ß»ý, ÁÖ2ȸÀÌ»ó Áõ»ó ¾ÇÈ­, ¾ß°£Áõ»ó>1ȸ/day

=> steroid inhaler(800-2000 ug/d), long-acting ¥â2 agonist,

short-acting ¥â agonistÇÊ¿ä½Ã

4) severe persistent: 3) + steroid PO

ÁÖÀÇ> ÇÊ¿ä½Ã short-acting ¥â-agonist¸¦ ¾µ ¶§ ÇÏ·ç 4ȸ ÀÌÇÏ·Î ¾´´Ù.

43. ¸ÕÁö Áøµå±â´Â ¸öüº¸´Ù´Â ¹è¼³¹°ÀÌ Ç׿ø¼ºÀÌ °­ÇÏ´Ù.

»ç¶÷ÇǺο¡¼­ ³ª¿À´Â ºñµëÀ» ¸Ô°í »ýÀåÇÑ´Ù.

¸ÕÁö 1 gram´ç 100¸¶¸® ÀÌ»óÀÖ°í, ½ÉÇÑ Áõ»ó¹ßÀÛÀº 500¸¶¸®À̻󿡼­ »ý±ä´Ù.

8¿ù¿¡ ¸¹°í 5¿ù¿¡ °¡Àå Àû´Ù.

»ó´ë½Àµµ°¡ 60%ÀÌÇϽà ¹ø½ÄÀÌ ÁßÁöµÇ¹Ç·Î »ó´ë½Àµµ¸¦ 50%ÀÌÇÏ·Î À¯ÁöÇÑ´Ù.

Àç¹ø½ÄÀÇ ¿øÃµÀº À¯ÃæÀÌ´Ù.

44. ±â°üÁö õ½Ä Ä¡·á¾àÁ¦ ºÐ·ù

1) Áõ»ó¿ÏÈ­Á¦(smooth muscle contraction¾ïÁ¦)

¥â-agonist, anticholinergics, methylxanthines

2) Áúº´Á¶ÀýÁ¦(antiinflammatory agent)

glucocorticoid, mast-cell stabilizer(cromolyn sodium, nedocromil sodium)

45. Leukotrine antagonist

- õ½Ä¿¹¹æÈ¿°ú°¡ ÀÖ°í ¾Æ½ºÇǸ° °ú¹Î¼º ȯÀÚ¿¡¼­ È¿°úÀûÀÌ´Ù.

- Á¶±â¹ÝÀÀÀ» °¨¼Ò½Ã۰í, Èıâ¹ÝÀÀÀÇ ÀϺθ¦ °¨¼Ò½ÃŲ´Ù.

- steroid°¨·®È¿°ú°¡ ÀÖ´Ù.

- Æó±â´ÉÀÇ È£Àüµµ ±â´ëÇÒ¼ö ÀÖ´Ù.

- mild persistent asthmaÀÇ 1Â÷ ÀûÀÀÀÌ µÇ³ª, moderate to severe persistent asthma¿¡¼±

1Â÷ ÀûÀÀÀÌ ¾ÈµÈ´Ù.

46. 5-lipoxygenase ¼±ÅÃÀû ¾ïÁ¦: Zileuton

leukotriene antagonist: pranlukast(onon), montelukast, Zafirlukast

47. Mast cell stabilizer: Cromolyin, nedocromil

Æó±â´É ¹× °ú¹Î¼ºÀ» È£Àü½ÃŲ´Ù.

¾ÆÅäÇÇ È¯ÀÚ¿¡¼­ ´õ È¿°úÀûÀÌ´Ù.

¿¹¹æÀûÀ¸·Î Åõ¿©ÇßÀ» ¶§ ¿îµ¿ ¹× Ç׿ø ³ëÃâ¿¡ ÀÇÇÑ Áõ»ó¾ÇÈ­¸¦ ¸·À»¼ö ÀÖ´Ù.

Ç׿ø³ëÃâ 20ºÐÀü¿¡ Åõ¿©ÇÑ´Ù.

48. Corticosteroid-dependent & corticosteroid-resistant asthmaÀÇ Á¤ÀÇ

ÇÏ·ç Pd 30-40mgÀ» 10-14Àϰ£ Åõ¿©Çصµ FEV1 »ó½ÂÀÌ 15%ÀÌÇÏÀÏ ¶§

Ä¡·á> cyclosporine A, methotrexateµî ¸é¿ª¾ïÁ¦Á¦

long-acting ¥â2-agnost or theophyllineÅõ¿©

49. theophylline clearance¡é

hepatic dysfunction, CHF, severe acute illness, viral infection, febrile illness

COPD with severe hypoxemia, high CHO diet, old age, neonate

drug> macrolide, quinolone, propranolol, cimetidine....

50. theophylline clearance¡è

smoking, hyperthyroidism, cystic fibrosis, high protein diet

children, adolescent

drug> phenytoin, barbiturate, rifampin, carbamazepine

51. long-acting ¥â2-agonist inhaler : salmeterol(seretide), formoterol(Atock)

52.

- ³ëÀÎõ½ÄȯÀÚ´Â COPD°¡ µ¿¹ÝµÇ±â ½¬¿ì¸ç °¡¿ªÀû ±âµµÆó¼â ¿©ºÎ¸¦ º¸±â À§ÇØ Pd¸¦ ÇÏ·ç

30-40mg¾¿ 2-3ÁÖ°£ Åõ¿©ÇØ º¸¾Æ¾ß ÇÑ´Ù.

- ½ºÅ×·ÎÀ̵å ÀúÇ×¼º õ½ÄÀÇ ½ºÅ×·ÎÀ̵å ÀúÇ×¼º À¯µµ¹°Áú Çü¼ºÀ¸·Î ÀÎÇÑ 2Â÷¼º ȯÀÚ°¡

´ëºÎºÐÀÌ´Ù.

- ½ºÅ×·ÎÀ̵å ÀúÇ×¼º õ½ÄȯÀÚ´Â 2 typeÀ¸·Î ³ª´­¼ö Àִµ¥ Á¦ 1ÇüÀº steroid receptor

ģȭ·ÂÀÌ °¨¼ÒµÈ °ÍÀ̰í, Á¦ 2ÇüÀº steroid receptorÀÇ Àý´ëÀû ¼öÀÇ °¨¼Ò·Î ÀÎÇØ »ý±ä´Ù.

53. ¸é¿ªÄ¡·á°¡ È¿°úÀûÀÎ Áúȯ ¼¼°¡Áö(¸é¿ªÄ¡·á´Â Ç« ½¬´Â °ÍÀÌ´Ù=ABR)

allergic asthma, bee venom allergy, allergic rhinitis

cf. È¿°ú°¡ ¾ø´Â ¾Ë·¹¸£±â Áúȯ

: food allergy, chronic urticaria, angioedema, ABPA

54. ¾Ë·¹¸£°Õ ¸é¿ª¿ä¹ýÀÇ ÀûÀÀÁõ

i) ¿øÀÎÇ׿ø¿¡ ´ëÇÑ IgE ¸Å°³¹ÝÀÀ°ú õ½ÄÁõ»ó°úÀÇ ¿¬°ü¼ºÀÌ È®½ÇÇÑ °æ¿ì

ii) Ç׿øÈ¸Çǰ¡ ºÒ°¡´ÉÇÑ °æ¿ì

iii) ¾àÁ¦»ç¿ë¿¡ ºÎÀÛ¿ëÀÌ Àְųª ¾à¹°¿ë¹ýÀ¸·Î Áõ»óÀÌ Á¶ÀýµÇÁö ¾Ê´Â °æ¿ì

iv) ÇØ´çÇ׿øÀÌ Áý¸ÕÁöÁøµå±âÀ̰ųª ²É°¡·ç(¼ö¸ñ, ¸ñÃÊ, ÀâÃÊ)À϶§

v) ȯÀÚÀÇ ¼øÀÀµµ°¡ ÁÁÀ» ¶§

55. Immunotherapy½Ã ƯÀÌIgE Ç×ü´Â °¨¼ÒÇÏ°í Æ¯ÀÌ IgG ¶Ç´Â IgG4´Â Áõ°¡ÇÑ´Ù.

Ç׿øÀڱؿ¡ ´ëÇÑ T cellÁõ½ÄÀÌ °¨¼ÒÇϰí Ç׿ø ƯÀÌÀû ¾ïÁ¦ T cellÀÌ Áõ°¡ÇÑ´Ù.

Ä¡·á±â°£Àº Àû¾îµµ 3-5³âÀÌ ÇÊ¿äÇϰí 3³âÀ̳»¿¡ ÁßÁöÇϸé Àç¹ßÀÌ ¸¹À¸¹Ç·Î ÃÖ¼Ò 3³âÀÌ»ó

Àº Ä¡·áÇØ¾ß ÇÑ´Ù.

½ÉÇÑ °íÇ÷¾Ð ¶Ç´Â °ü»óµ¿¸ÆÁúȯÀÌ ÀÖÀ» ¶§ ¸é¿ªÄ¡·á´Â ±Ý±âÀÌ´Ù.

56. allergen immunotherapy½Ã

i) Ç÷Áß Æ¯ÀÌ IgEÇ×ü °¨¼Ò

ii) Ç÷Áß Æ¯ÀÌ IgG ¶Ç´Â IgG4Áõ°¡

iii) basophil µî ÀÛµ¿¼¼Æ÷ÀÇ ¹ÝÀÀµµ °¨¼Ò

iv) Ç׿ø¿¡ ´ëÇÑ T cellÀÇ ºÐÈ­°¡ Th2 cell¿¡¼­ Th1 cell·Î º¯È¯

57. ¸é¿ªÄ¡·áÈÄ ÀÓ»óÀû È£ÀüÀ» °¡Àå Àß ¹Ý¿µÇÏ´Â parameter?

ƯÀÌ IgGÇ×üÀÇ Áõ°¡(IgG4ÀÇ Áõ°¡)

58. allergen immunotherapy¿¡¼­ ¿ë·®Á¶Àý

1) Áֻ翬±â

1ÁÖ³» È£Èí±â °¨¿°, Åë»ó¿ë·®¿¡¼­ PEFR 20%ÀÌ»ó °¨¼Ò

Ãֱ٠õ½ÄÁõ»ó ¾ÇÈ­

2) ¿ë·®À» ´Ã¸®Áö ¾Ê´Â °æ¿ì

immediate large local reaction(adult>5cm, children>3cm)

delayed large local reaction > 8cm

Áß°£¿¡ intervalÀÌ ±ä °æ¿ì

3) °¨·®

systemic reaction: anaphylaxis, asthma attack

Áß°£¿¡ intervalÀÌ ±ä °æ¿ì(4ÁÖÀÌ»óÀ϶© ¹ÝÀ¸·Î, 8ÁÖÀÌ»óÀ϶© 1/10ÀÌÇÏ ¶Ç´Â restart)

59. ÀӽŸ»±âÀΠõ½ÄȯÀÚ¿¡¼­ ¥â2 agonist(terbutaline)´Â ºÐ¸¸Àå¾Ö¸¦ ÀÏÀ¸Å³¼ö ÀÖÀ¸¹Ç·Î

ÇÇÇÏ´Â °ÍÀÌ ÁÁ´Ù.

cf. ÀÓ½ÅÁß ¥â2 agonist inhaler´Â »ç¿ëÇÒ¼ö ÀÖ´Ù.

±× ¿Ü õ½Ä¾à ¸ðµÎ »ç¿ë°¡´É

60. ¼ö¼ú½Ã õ½ÄÄ¡·á

Àü½Å¸¶Ã븦 ÇÏ´Â °æ¿ì¿¡´Â ±â°üÁö ºÐºñ¹°ÀÌ Àû°í ±â°üÁö ÆòȰ±ÙÀ» À̿ϽÃŰ´Â ÀÛ¿ëÀÌ ÀÖ´Â

halothaneÀÌ ¾ÈÀüÇÏ´Ù.

61. exercise-induced asthma

long-term sequalae¸¦ ³²±âÁö ¾Ê°í, airway reactivity¸¦ º¯È­½ÃŰÁö ¾Ê´Â´Ù.

smooth muscle contraction°ú´Â °ü°è¾ø°í, ¿îµ¿¿¡ ÀÇÇØ bronchial wall microvasculatureÀÇ

engorgement¿¡ ÀÇÇÑ´Ù.

62. ¿îµ¿ À¯¹ß¼º õ½Ä ¿¹¹æ¹ý

¥â2 agonist¸¦ ¿îµ¿Çϱâ 5-10ºÐÀü ÈíÀÔ ¶Ç´Â

cromolyn sodiumÀ» ¿îµ¿Çϱâ 30ºÐÀü¿¡ ÈíÀÔ

63. aspirin-induced asthmaÀÇ À¯¹ß°Ë»ç

i) lysine aspirin bronchoprovocation test: °¡Àå ¸¹ÀÌ ÀÌ¿ë

ii) oral aspirin provocation test: °¡Àå sensitive

iii) nasal aspirin provocation test: sensitivity¡é

64. aspirin-induced asthma¶§ cross reactivity¾øÀÌ ¾ÈÀüÇÏ°Ô Åõ¿©ÇÒ ¼ö ÀÖ´Â ¾à

sodium salicylate, choline salicylate, acetaminophen, salicylamide, propoxyphene

65. aspirin-induced asthma¿¡¼­ aspirin desensitizationÀÇ ÀûÀÀÁõ

i) ÃÖ´ë¿ë·®ÀÇ topical steroid ¹× Àú¿ë·®ÀÇ IV steroid °ÝÀÏÅõ¿©·Î Á¶Àý¾ÈµÉ ¶§

ii) repeated polypectomy°¡ ÇÊ¿äÇÑ °æ¿ì

iii) ´Ù¸¥ ¸¸¼ºÁúȯÀ¸·Î NSAIDÅõ¿©°¡ ÇÊ¿äÇÑ °æ¿ì

66. aspirin desensitization ¹æ¹ý

2½Ã°£ °£°ÝÀ¸·Î Áõ»ó°ú PFT¸¦ monitoringÇϸ鼭 ¾Æ½ºÇǸ° Áõ·®

50mg -> 100mg(200mg) -> 300mg -> 550mg(650mg)

67. Á÷¾÷¼º õ½ÄÀ» ÀÏÀ¸Å°´Â ¿øÀι°Áú

high molecule: laboratory animals, grain dust, enzymes

low molecule: metal, TDI, formalin

68. Á÷¾÷¼º õ½Ä À§ÇèÀÎÀÚ

i) asthma Hx(+)

ii) atopy: °íºÐÀÚ ¹°Áú°ú °ü·Ã, ÀúºÐÀÚ¹°Áú¿¡ ´ëÇÑ °¨ÀÛÀº ¾ÆÅäÇÇ¿Í °ü·Ã¾ø´Ù.

iii) smoking: ¹é±Ý, ¿°·á µîÀº Èí¿¬ÀÚ¿¡¼­ ´õ ¸¹ÀÌ »ý±â³ª, TDI´Â Èí¿¬°ú °ü·Ã¾ø´Ù.

69. Á÷¾÷¼º õ½ÄÀÇ ±âº»Àû º´¸®´Â ÀÏ¹Ý Ãµ½Ä°ú °°´Ù.

±âÀüÀº ¸é¿ªÇÐÀû ±âÀü(IgE mediated)°ú ºñ¸é¿ªÇÐÀû ±âÀüÀÌ °ü¿©ÇÑ´Ù.

70. Á÷¾÷¼º õ½ÄÀÇ ºñ¸é¿ªÇÐÀû ±âÀü

i) reflex : Àڱؼº °¡½º ¹× Áõ±âÀÇ ÈíÀÔÀ¸·Î ±â°üÁöÀÇ ¹Ý»çÀû ¼öÃà

ii) ¿°Áõ¼º ±âÀü: °í³óµµÀÇ Àڱع°Áú¿¡ ´Ù·® ³ëÃâµð¾î Á÷Á¢ ±â°üÁö »óÇǼ¼Æ÷ÀÇ ¼Õ»ó°ú

±Þ¼º ¿°Áõ ¹ÝÀÀÀÌ ÀϾ. ¼ö½Ã°£³»¿¡ ³ªÅ¸³ª 1ÁÖÀÏÂë ÃÖ°íÁ¶¿¡ ´ÞÇϰí

3-4°³¿ù°¿¡ ¾ÈÁ¤µÇ°Å³ª ȸº¹

iii) ¾à¸®Àû ±âÀü: byssinosis, À¯±âÀÎ »ìÃæÁ¦¿¡ ³ëÃâµÈ ¸ðµç »ç¶÷ÀÌ °¡¿ªÀû ±âµµ¼öÃàÁõ»óÀ»

º¸ÀδÙ.

71. Á÷¾÷¼º õ½ÄÀÇ ¿øÀÎ ¹°ÁúÁß °¡Àå ´ëÇ¥ÀûÀÎ °ÍÀº isocyanateÀÌ´Ù.

cf. isocyanate(TDIµî)- Á¢ÂøÁ¦, ÆäÀÎÆ® °ü·Ã¾÷Á¾, ƯÈ÷ µµÀå ºÎ¼­¿¡ ¸¹´Ù.

ÀúºÐÀÚ·® ¹°Áú

72. ±Ö°ú¼ö¿øÀÌ ¸¹Àº Á¦ÁÖµµ õ½ÄȯÀÚ¿¡¼­ÀÇ ÁÖµÈ Ç׿ø: ±ÖÀÀ¾Ö(Citrus red mite)

73. ±ÖÀÀ¾Ö¿Í ±¤¹üÀ§ÇÑ ±³Â÷¹ÝÀÀÀ» Áö´Ñ ÈíÀÔ ¾Ë·¹¸£°Õ: Áý¸ÕÁö Áøµå±â