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¿¡ ÀÖ¾î¼ 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»ó¾Çȸ¦ ¸·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
ģȷÂÀÌ °¨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 ºÐȰ¡ 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¸¦ monitoringÇÏ¸é¼ 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