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T69. Acute asthma and status asthmaticus

A. Pathophysiology

(1) ํ‰ํ™œ๊ทผ ์ˆ˜์ถ•, ํ˜ˆ๊ด€ ์šธํ˜ˆ, ๊ธฐ๋„๋ฒฝ์˜ ๋ถ€์ข…, ๊ธฐ๋„๋ถ„๋น„๋ฌผ์— ์˜ํ•œ ๊ธฐ๋„ ๋‚ด๊ฒฝ์˜ ๊ฐ์†Œ
(2) Bronchospasm โ†’ Airway inflammation โ†’ Permanent airway remodeling
(3) Airway remodeling
โ€ข
๊ธฐ๋„ ๊ฒฐํ•ฉ์กฐ์ง์˜ ์นจ์ „๊ณผ ํ‰ํ™œ๊ทผ์˜ ๋น„๋Œ€
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๊ธฐ์ €๋ง‰ ๋น„ํ›„
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์ƒํ”ผ์„ธํฌ์˜ ์ฆ์‹
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์ƒํ”ผํ•˜ ์„ฌ์œ ํ™”
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์ ๋ง‰์ƒ˜์˜ ํ™”์ƒ
(4) Triggers
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Allergen
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Virus (m/c)
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Pharmaceutical agent (Aspirin, ฮฒ-blocker, NSAIDs)
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Exercise
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Environmental conditions (Atmospheric pollutants and indoor antigens)
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Emotional stress
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Exposure to cold air alone
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Endocrine factors (ex. ์ƒ๋ฆฌ์ฃผ๊ธฐ ๋•Œ estradiol, progesterone์˜ ์ƒ๋ฆฌ์  ๋ณ€ํ™”)

B. Clinical Features

โ€ข
Classic triad : Dyspnea, Wheezing, Cough
โ€ข
์ดˆ๊ธฐ์—๋Š” chest constriction, cough๋กœ ์‹œ์ž‘ โ†’ Mild exacerbation ๋•Œ end-expiratory wheezing ๋ฐœ์ƒ โ†’ ๋”์šฑ ์‹ฌํ•ด์ง€๋ฉด paradoxical respiration (inspiration ์‹œ chest deflation, abdominal protrusion) โ†’ ๊ถ๊ทน์—๋Š” mental change, respiratory arrest

B1. Cough

โ€ข
์กฐ๊ธฐ์— ๋ฐœํ˜„ํ•˜๋ฉฐ ๊ธฐ์นจ ์ดํ˜• ์ฒœ์‹(cough-variant asthma)์ด๋‚˜ ๋…ธ์ธ์—์„œ๋Š” ์œ ์ผํ•œ ์ฆ์ƒ์ผ ์ˆ˜ ์žˆ๋‹ค.
โ€ข
์ƒํ”ผ ํ•˜์˜ ๋ฏธ์ฃผ์‹ ๊ฒฝ ์ž๊ทน์— ์˜ํ•ด ๊ฐ๋‹ด๊ณผ ๋™๋ฐ˜๋˜๊ธฐ๋„ ํ•œ๋‹ค
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๋ฐค์— ์•…ํ™”๋œ๋‹ค.
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40% ์ •๋„์˜ ์—ฌ์ž ํ™˜์ž๊ฐ€ ์ƒ๋ฆฌ ์ „ ์ฆ์ƒ์ด ์•…ํ™”๋˜์–ด ์ƒ๋ฆฌ 2~3์ผ ์ „์— ์ตœ๊ณ ์กฐ์— ์ด๋ฅด๋Ÿฌ ์‘๊ธ‰์‹ค์„ ๋ฐฉ๋ฌธ

B2. Wheezing

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ํ‰ํ™œ๊ทผ ์ˆ˜์ถ•์œผ๋กœ ์ธํ•ด ๊ธฐ๋„๊ฐ€ ์ข์•„์ ธ์„œ ๋ฐœ์ƒํ•œ๋‹ค.
โ€ข
์‹ฌํ•œ ๊ธฐ๋„ ํ์‡„์—์„œ๋Š” ๊ณต๊ธฐ ์œ ์†์ด ๊ฐ์†Œํ•˜๋ฉด์„œ ์ฒœ๋ช…์Œ์€ ๊ฐ์†Œํ•˜๋‹ค ์‚ฌ๋ผ์ง„๋‹ค. (Silent chest)
โ€ข
๋ชจ๋“  ์ฒœ๋ช…์Œ์ด ์ฒœ์‹์€ ์•„๋‹ˆ๋‹ค. (Asthma Mimickers : Table 69-4)

B3. Dyspnea

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ํ˜ธํก ๊ณค๋ž€์˜ ์ •๋„์™€ PFT ๊ฒฐ๊ณผ๋กœ ํ•ด์„ํ•œ ๊ธฐ๋„ํ์‡„์˜ ์ •๋„์™€์˜ ์ƒ๊ด€๊ด€๊ณ„๋Š” ๋–จ์–ด์ง„๋‹ค.
โ€ข
์žฌ๋ฐœ์„ฑ ์•…ํ™”๋ฅผ ๊ฑฐ๋“ญํ•˜๋Š” ์‹ฌํ•œ ์ฒœ์‹ ํ™˜์ž๋Š” ํ˜ธํก ๊ณค๋ž€์— ๋Œ€ํ•œ ๊ฐ์ง€ ๋Šฅ๋ ฅ์ด ์ €ํ•˜๋˜์–ด ๋ฐœ์ž‘์˜ ์ค‘์ฆ๋„๋ฅผ ๊ณผ์†Œ ํ‰๊ฐ€ํ•  ์œ„ํ—˜์„ฑ์ด ์ฆ๊ฐ€ํ•œ๋‹ค.

C. Diagnosis and patient monitoring

C1. ํ๊ธฐ๋Šฅ ๊ฒ€์‚ฌ

(1) FEV1 ํ˜น์€ PEFR

โ€ข
FEV1์€ ์ฒœ์‹๊ณผ vocal cord dysfunction, restrictive lung dz. ๋“ฑ๊ณผ ๊ตฌ๋ถ„ ํ•  ์ˆ˜ ์žˆ๊ฒŒ ํ•ด์ค€๋‹ค.
โ€ข
PEFR์€ ๊ธ‰์„ฑ์ฒœ์‹์˜ ์ค‘์ฆ๋„๋ฅผ ์ธก์ •ํ•˜๋Š”๋ฐ ์œ ์šฉํ•˜๋‹ค.

C2. ์‚ฐ์†Œ ํฌํ™”๋„ ๊ฐ์‹œ

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Pulse oxymeter๋Š” ์‚ฐ์†Œ ํˆฌ์—ฌ ํ›„ ์‚ฐ์†Œ ํฌํ™”๋„๊ฐ€ 3~4๋ถ„ ํ›„์— ํ‰ํ˜•์„ ์ด๋ฃจ๊ธฐ ๋•Œ๋ฌธ์— ์‚ฐ์†Œํ™”์— ๋Œ€ํ•œ ํ‰๊ฐ€์— ๋งค์šฐ ์œ ์šฉํ•˜๊ฒŒ ์ด์šฉ๋œ๋‹ค.

C3. ABGA

โ€ข
PaCO2๊ฐ€ ์ •์ƒ ๋˜๋Š” ์•ฝ๊ฐ„ ์ฆ๊ฐ€ (>42mmHg)๋Š” ์‹ฌํ•œ ๊ธฐ๋„ ํ์‡„์™€ ํ˜ธํก๊ทผ ํ”ผ๋กœ๋ฅผ ๋‚˜ํƒ€๋‚ธ๋‹ค

D. Treatment

์ฒœ์‹ ๋‹จ๊ณ„๋ณ„ ์™ธ๋ž˜ ์น˜๋ฃŒ์ง€์นจ

D1. ฮฒ-adrenergic Agents (ex. albuterol and levalbuterol)

โ€ข
Adenyl cyclase๋ฅผ ์ž๊ทนํ•ด intracellular ATP๊ฐ€ cAMP๋กœ ๋ฐ”๋€Œ๊ฒŒ ํ•˜์—ฌ myoplasmic calcium concentration์„ ๋–จ์–ด๋œจ๋ ค bronchial smooth muscle์˜ relaxation์„ ์œ ๋ฐœ

(1) ๋ถ€์ž‘์šฉ (๋ถ€์ •๋งฅ ๋ฐ ์‹ฌ๊ทผ ๊ฒฝ์ƒ‰์€ ๋“œ๋ฌผ๋‹ค.)

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๊ณจ๊ฒฉ๊ทผ ๋–จ๋ฆผ ์ฆ์ƒ (m/c)
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Nervous/anxiety
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๋ถˆ๋ฉด
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๋‘ํ†ต
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์‹ฌ๊ณ„ํ•ญ์ง„, ์‹ฌ๋ฐ•์ˆ˜ ๋ฐ ํ˜ธํก์ˆ˜ ์ฆ๊ฐ€
โ€ข
๊ณ ํ˜ˆ๋‹น

(2) Salmeterol xinafoate and formoterol

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์ง€์†์„ฑ ฮฒ2 ํ•ญ์ง„์ œ๋กœ Albuterol ๋ณด๋‹ค ฮฒ2 adrenoreceptor ๊ฒฐํ•ฉํ•˜๋ ค๋Š” ์นœํ™”๋„๊ฐ€ ๋” ํฌ๋‹ค.
โ€ข
12์‹œ๊ฐ„ ์ด์ƒ ์ง€์†๋˜๋Š” ฮฒ2 ํ•ญ์ง„์ œ๋กœ MDI๋กœ ์œ ์ง€๋ชฉ์ ์œผ๋กœ ํ•˜๋ฃจ ๋‘ ๋ฒˆ ์‚ฌ์šฉ
โ€ข
์ž‘์šฉ ์‹œ์ž‘ ์‹œ๊ฐ„์€ 20๋ถ„์ด ๋„˜์–ด์„œ, ๊ธ‰์„ฑ ๋ฐœ์ž‘์—์„œ๋Š” ์‚ฌ์šฉ๋˜์ง€ ์•Š๋Š”๋‹ค.

D2. Corticosteroids

(1) ํ•ญ์—ผ์ฆ ์ž‘์šฉ ๋ฐœํ˜„ ์‹œ๊ฐ„

โ€ข
IV/PO ์‚ฌ์šฉ ์‹œ ์ ์–ด๋„ 4~8์‹œ๊ฐ„์€ ๊ฑธ๋ฆฐ๋‹ค.
โ€ข
๊ทธ๋Ÿฌ๋‚˜ ED ๋‚ด์› 1์‹œ๊ฐ„ ๋‚ด์— ์‚ฌ์šฉํ•  ๊ฒฝ์šฐ ์ž…์› ํ•„์š”์„ฑ์„ ์ค„์ธ๋‹ค.

(2) ์‹œ์ž‘ ์šฉ๋Ÿ‰

โ€ข
Prednisone 40~60mg PO ๋˜๋Š” Methylprednisolone (Salon) 1mg/kg IV bolus
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์ฃผ๊ด€์ , ๊ฐ๊ด€์ ์œผ๋กœ ์ฆ์ƒ ํ˜ธ์ „ ์žˆ์„ ๋•Œ๊นŒ์ง€ ์ž…์› ํ™˜์ž๋Š” ๋ถ€๊ฐ€ ์šฉ๋Ÿ‰์„ 1~2๋ฒˆ ๋” ์“ด๋‹ค. (9ํŒ์—์„œ ์‚ญ์ œ)
โ€ข
Higher-dose corticosteroid therapy๋Š” ์žฅ์ ์ด ์—†๋‹ค.

(3) ํ‡ด์› ํ™˜์ž์—์„œ

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ED ์น˜๋ฃŒ ํ›„ 5~10์ผ ์ •๋„์˜ non-tapering course of prednisone (40~60mg/day in single daily dose or its equivalent)
โ€ข
ํ˜น์€ 2์ผ ์ •๋„์˜ oral dexamethasone (16mg/day in a single daily dose) ํ•„์š”
(4) ํ™˜์ž์˜ compliance๊ฐ€ ์ข‹์ง€ ์•Š์„ ๊ฒฝ์šฐ depot methylprednisolone 150ใŽŽ IM์„ ์‚ฌ์šฉํ•ด ๋ณผ ์ˆ˜ ์žˆ๋‹ค.

D3. Anticholinergics

(1) Ipratropium bromide (Atrovent)

(2) ํ•ญ์ฝœ๋ฆฐ์ œ๋Š” ๋Œ€/์ค‘์‹ฌ๊ธฐ๋„์—, ฮฒ2 ํ•ญ์ง„์ œ๋Š” ์†Œ๊ธฐ๋„์— ์ž‘์šฉ

(3) ์ตœ๋Œ€ ํšจ๊ณผ๋Š” 30~120๋ถ„ ํ›„์— ๋‚˜ํƒ€๋‚˜์„œ 6์‹œ๊ฐ„ ๋™์•ˆ ์ง€์†๋œ๋‹ค.

โ€ข
๊ธฐ๊ด€์ง€ ์ด์™„ ํšจ๊ณผ๋Š” ฮฒ2 ํ•ญ์ง„์ œ๋ณด๋‹ค ๋‚ฎ๊ณ  ์ž‘์šฉ ์‹œ์ž‘ ์‹œ๊ฐ„์€ ๋Šฆ๊ธฐ ๋•Œ๋ฌธ์— ๊ธ‰์„ฑ ๋ฐœ์ž‘ ์‹œ์— ๋‹จ๋…์œผ๋กœ ์‚ฌ์šฉํ•ด์„œ๋Š” ์•ˆ๋œ๋‹ค.

(4) Moderate-severe acute asthma

โ€ข
Multiple doses of ipratropuim bromide + SABA : ๊ธฐ๊ด€์ง€ ์ด์™„์„ ํ˜ธ์ „์‹œํ‚ค๊ณ  ์ž…์›์„ ์ค„์ž„

D4. Magnesium

โ€ข
๊ธฐ๊ด€์ง€ ํ‰ํ™œ๊ทผ์— ์ง์ ‘ ์ž‘์šฉํ•˜๊ณ , ํ‰ํ™œ๊ทผ์„ ์ด์™„์‹œ์ผœ ๊ธฐ๊ด€์ง€ ์ด์™„ ํšจ๊ณผ๋ฅผ ๋‚˜ํƒ€๋‚ธ๋‹ค.
โ€ข
๊ธ‰์„ฑ ์ค‘์ฆ ์ฒœ์‹์—์„œ๋งŒ ์ ์‘์ด ๋˜๋ฉฐ ๊ฒฝ์ฆ/์ค‘๋“ฑ๋„์—์„œ๋Š” ์†Œ์šฉ์ด ์—†๋‹ค.
โ€ข
๋ถ€์ž‘์šฉ์€ ์˜จ์—ด๊ฐ, ํ™์กฐ, ๋ฐœํ•œ, ์˜ค์‹ฌ, ๊ตฌํ† , ๊ทผ๋ ฅ ์ €ํ•˜, DTR ๊ฐ์†Œ, ์ €ํ˜ˆ์••, ํ˜ธํก ์ €ํ•˜ ๋“ฑ์ด ์žˆ๊ณ  ์ด๊ฒƒ์€ ์šฉ๋Ÿ‰์— ๋น„๋ก€ํ•ด์„œ ๋‚˜ํƒ€๋‚œ๋‹ค.

D5. Heliox

โ€ข
๋งค์šฐ ์‹ฌํ•œ ์ฒœ์‹ ์•…ํ™”์— ๊ณ ๋ ค
โ€ข
PEFR 30% ๋ฏธ๋งŒ์ด ์˜ˆ์ƒ๋˜๋ฉด์„œ ์ฆ์ƒ์ด 24์‹œ๊ฐ„ ์ด๋‚ด๋กœ ๋ฐœ์ƒํ–ˆ์„ ๋•Œ

D6. Theophylline

โ€ข
1st, 2nd line ์น˜๋ฃŒ๋กœ ๋” ์ด์ƒ ์“ฐ์ง€ ์•Š๋Š”๋‹ค. โ†’ ฮฒ2-ํ•ญ์ง„์ œ์™€ ๊ฐ™์ด ์“ฐ๋ฉด ๋…์„ฑ๋งŒ ์ฆ๊ฐ€, ํšจ๊ณผ๋Š” ๋ณ„ ์ฐจ์ด ์—†์Œ
โ€ข
ํšก๊ฒฉ๋ง‰์˜ ์ˆ˜์ถ•์„ฑ ๋ฐ ์œ„์‚ฐ ๋ถ„๋น„๋„ ์ฆ๊ฐ€์‹œํ‚จ๋‹ค.
โ€ข
์˜ค์‹ฌ, ๊ตฌํ† , ์‹์š•๋ถ€์ง„, ๋‘ํ†ต, ํ˜ผ๋ฏธ ๋“ฑ์ด ์ƒ๊ธธ ์ˆ˜ ์žˆ์Œ.
โ€ข
ํ˜ˆ์ฒญ ๋†๋„ 30ใŽŽ/ใŽ– ์ด์ƒ์—์„œ ๊ฒฝ๋ จ/๋ถ€์ •๋งฅ ๊ฐ€๋Šฅ

D7. Ketamine and Halothane

โ€ข
๊ธฐ๊ด€์ง€ ์ด์™„ ํšจ๊ณผ๊ฐ€ ์žˆ์ง€๋งŒ ๊ธฐ๋„ ๋ถ„๋น„๋ฅผ ์ฆ๊ฐ€์‹œํ‚ค๋Š” ํšจ๊ณผ๊ฐ€ ์žˆ๋‹ค.

D8. Mast cell modifier

โ€ข
Cromolyn, Nedocromil
โ€ข
๊ธ‰์„ฑ ๊ธฐ๊ด€์ง€ ์ˆ˜์ถ•์—์„œ๋Š” ์ ์‘์ฆ์ด ๋˜์ง€ ์•Š์Œ

D9. Leukotriene modifier

(1) ์‘๊ธ‰์‹ค์—์„œ ์“ธ ์ผ์€ ์—†๋‹ค.

D10. NIPPV

โ€ข
๊ธ‰์„ฑ ์ค‘์ฆ ์ฒœ์‹์—์„œ๋Š” ์—ญํ•  ์• ๋งคํ•˜๋‹ค.
โ€ข
๊ธฐํ‰์ด ์˜์‹ฌ๋˜๊ฑฐ๋‚˜ intubation ์ ์‘์ฆ ์‹œ ์‚ฌ์šฉํ•ด์„œ๋Š” ์•ˆ ๋œ๋‹ค.

D11. Mechanical ventilation

โ€ข
๊ธฐ๊ณ„ํ™˜๊ธฐ๋ฅผ ์ ์šฉํ•œ๋‹ค๊ณ  ๊ณต๊ธฐ ํ๋ฆ„์˜ ํ์‡„๋ฅผ ํ•ด๊ฒฐํ•ด์ฃผ์ง€๋Š” ์•Š๋Š”๋‹ค. ๋‹จ์ง€ airflow obstruction์ด ํ˜ธ์ „๋  ๋•Œ๊นŒ์ง€ ํ™˜์ž์˜ work of breathing์„ ์ค„์ด๋Š” ์—ญํ• 
โ€ข
์‹ฌํ•œ ์ฒœ์‹์—์„œ๋Š” ์ผํšŒํ˜ธํก๋Ÿ‰์„ ์ „๋‹ฌํ•˜๊ธฐ ์œ„ํ•œ ํก๊ธฐ ์œ ๋ฐœ์••์ด ๋งค์šฐ ํฌ๋ฏ€๋กœ ์šฉ์  ์ œํ•œ (Volume controlled) ์–‘์•• ํ™˜๊ธฐ๋ฅผ ์‹œํ–‰

(1) Intrinsic PEEP

โ€ข
์น˜๋ฃŒ ์ดˆ๊ธฐ์— ์ƒ๊ธฐ๋Š” ๊ธฐ๋„ ํ์‡„ ๋•Œ๋ฌธ์— TV์ด ๋Œ์•„์˜ค๋Š” ์šฉ์ ๋ณด๋‹ค ์ปค์ ธ์„œ air trapping ๋ฐ ์ž”๋ฅ˜ ์šฉ์ ์ด ์ฆ๊ฐ€ํ•œ๋‹ค.
โ€ข
ํก์ž… ์œ ์†(Inspiratory flow rate)์„ ๋น ๋ฅด๊ฒŒ, ํ˜ธํก์ˆ˜๋Š” ๋‚ฎ์ถ”๊ณ  (12~14ํšŒ/min), ํ˜ธ๊ธฐ ์‹œ๊ฐ„์€ ์ถฉ๋ถ„ํžˆ ์ค€๋‹ค.

(2) MV apply Indication

โ€ข
Alterted consciousness
โ€ข
Cardiac or respiratory arrest
โ€ข
Paradoxical breathing pattern
โ€ข
Refractory hypoxemia
โ€ข
Failure of NIPPV

E. Disposition and Follow-up

E1. ํ‡ด์› ๊ฐ€๋Šฅ ์—ฌ๋ถ€์˜ Parameter

โ€ข
Wheezing ํ˜ธ์ „
โ€ข
๊ฐ€์Šค ๊ตํ™˜์˜ ๊ฐœ์„  (์ฒญ์ง„ ๋ฐ ํ™˜์ž์˜ ์˜๊ฒฌ)
โ€ข
FEV1/PEF์˜ ์ •์ƒํ™”
โ€ข
์ด์ „ ์น˜๋ฃŒ์—์˜ compliance
โ€ข
ED ๋ฐฉ๋ฌธ/์ž…์› ๋ณ‘๋ ฅ

E2. ํ‡ด์› ์ฒ˜๋ฐฉ

โ€ข
SABA๋ฅผ ์ˆ˜ ์ผ๊ฐ„ scheduled basis๋กœ ์‚ฌ์šฉ
โ€ข
์‘๊ธ‰์‹ค์—์„œ ์ „์‹  ์Šคํ…Œ๋กœ์ด๋“œ๋ฅผ ์‚ฌ์šฉํ–ˆ์œผ๋ฉด ๊ฒฝ๊ตฌ ์Šคํ…Œ๋กœ์ด๋“œ 5~10์ผ ๊ฐ€๋Ÿ‰ ์‚ฌ์šฉํ•˜๊ฑฐ๋‚˜, depot methylprednisolone 150ใŽŽ IM์„ ์‚ฌ์šฉํ•˜๋„๋ก ํ•œ๋‹ค.
โ€ข
์•„์ง ํก์ž…์šฉ ์Šคํ…Œ๋กœ์ด๋“œ๋ฅผ ์‚ฌ์šฉํ•˜์ง€ ์•Š์•˜๊ณ  ์ง€์†์„ฑ ์ฒœ์‹ ๋ณ‘๋ ฅ ์žˆ๋Š” ํ™˜์ž์—์„œ ํก์ž…์šฉ ์Šคํ…Œ๋กœ์ด๋“œ ์‚ฌ์šฉ์„ ์‹œ์ž‘ํ•  ๊ฒƒ์„ ๊ณ ๋ ค

E3. ์น˜๋ฃŒ์— ๋Œ€ํ•œ ๋ฐ˜์‘

(1) ์ข‹์€ ๋ฐ˜์‘ (Good response) : ์ฆ์ƒ ํ˜ธ์ „, PEFR/FEV1 >70% โ†’ ์•ˆ์ „ํ•˜๊ฒŒ ๊ท€๊ฐ€ ๊ฐ€๋Šฅ
(2) ๋‚˜์œ ๋ฐ˜์‘ (Poor response) : ์ฆ์ƒ ์ง€์†, PEFR/FEV1 <40% โ†’ ์ž…์› ๊ณ ๋ ค
(3) ๋ถˆ์™„์ „ํ•œ ๋ฐ˜์‘ : PEFR/FEV1 40~69%. ์ด๊ฒƒ์€ ๊ฐœ๊ฐœ์ธ์— ๋”ฐ๋ผ์„œ ๋งž์ถ˜๋‹ค.
(4) ์Šคํ…Œ๋กœ์ด๋“œ๊นŒ์ง€ ์‚ฌ์šฉํ•˜๊ณ ๋„ ์ž์ฃผ ์žฌ๋ฐœํ•˜๋ฉด ์‘๊ธ‰์‹ค ๋ฐฉ๋ฌธ 1~4์ฃผ ๋‚ด ์™ธ๋ž˜ ์ถ”์  ๊ด€์ฐฐ์„ ํ•ด์•ผ ํ•จ

E4. ์ฒœ์‹์— ์˜ํ•œ ์‚ฌ๋ง์˜ ์œ„ํ—˜ ์ธ์ž

(1) ์‹ฌํ•œ ์ฒœ์‹ ์•…ํ™”์˜ ๊ณผ๊ฑฐ๋ ฅ (2) ์ง€๋‚œ 1๋…„๊ฐ„ ์ฒœ์‹์œผ๋กœ 2ํšŒ ์ด์ƒ ์ž…์› (3) ์ง€๋‚œ 1๋…„๊ฐ„ ์ฒœ์‹์œผ๋กœ 3ํšŒ ์ดˆ๊ณผ ์‘๊ธ‰์‹ค ๋‚ด์› (4) 1๊ฐœ์›” ์ด๋‚ด์— ์ž…์›ํ–ˆ๊ฑฐ๋‚˜ ์‘๊ธ‰์‹ค ๋‚ด์› (5) ๋ฒ ํƒ€ ํก์ž…์ œ 1๋‹ฌ์— 2ํ†ต ์ดˆ๊ณผ ํก์ž… (6) ๊ณต๊ธฐ ํ๋ฆ„์˜ ํ์ƒ‰์ด๋‚˜ ๊ทธ ์‹ฌ๊ฐ์„ฑ์„ ์ธ์ง€ํ•˜๊ธฐ ์–ด๋ ค์›Œํ•˜๋Š” ๊ฒฝ์šฐ (7) ๋ช…์‹œ๋œ ์ฒœ์‹์— ๋Œ€ํ•œ ๋Œ€์‘์ด ๋ถ€์กฑํ•˜๊ฑฐ๋‚˜ Alternaria์— ๊ณผ๋ฏผ์„ฑ์„ ๔€Ÿฟ์ด๋Š” ๊ฒฝ์šฐ (8) ๋„์‹œ ๊ฑฐ์ฃผ์ž๋กœ ์‚ฌํšŒ๊ฒฝ์ œ์ ์ธ ์ง€์œ„๊ฐ€ ๋‚ฎ์€ ๊ฒฝ์šฐ (9) ๋ถˆ๋ฒ• ์•ฝ๋ฌผ ์‚ฌ์šฉ์ž (10) ์‹ฌ๊ฐํ•œ ์ •์‹ ์  ๋ฌธ์ œ๋ฅผ ๋™๋ฐ˜ํ•œ ๊ฒฝ์šฐ

E5. ์ฒœ์‹์— ์˜ํ•œ ์‹ฌ์ •์ง€์˜ ์›์ธ

(1) ์‹ฌํ•œ ๊ธฐ๊ด€์ง€ ์ˆ˜์ถ• ๋ฐ Mucus plug๋กœ ์ธํ•œ ์งˆ์‹(asphyxia)
(2) ์ €์‚ฐ์†Œ์ฆ ๋ฐ ฮฒ-ํ•ญ์ง„์ œ, ์ „ํ•ด์งˆ ์žฅ์•  ๋“ฑ์œผ๋กœ ์˜ํ•œ ์‹ฌ๋ถ€์ •๋งฅ
(3) Auto PEEP ๋“ฑ์˜ Dynamic hyperinflation์— ์˜ํ•œ ์ •๋งฅํ™˜๋ฅ˜ ๊ฐ์†Œ๋กœ ์ธํ•œ ์‹ฌํ˜ˆ๊ด€๊ณ„ ํ—ˆํƒˆ
(4) ๊ธด์žฅ์„ฑ ๊ธฐํ‰ (๋ณดํ†ต ์–‘์ธก์„ฑ)

F. Specific issues that affect diagnosis, evaluation, and treatment

F1. AGE

(1) ๊ณ ๋ น์˜ ์น˜๋ฃŒ = ์ Š์€ ์‚ฌ๋žŒ์˜ ์น˜๋ฃŒ, ๋‚˜์ด์— ๋”ฐ๋ฅธ ํ๊ธฐ๋Šฅ์˜ ๋ณ€ํ™”๋Š” ๊ณ ๋ คํ•ด์•ผ ํ•จ
(2) ์šธํ˜ˆ์„ฑ ์‹ฌ๋ถ€์ „, ํ์˜ ์•…์„ฑ ์ข…์–‘, ํ์‡„์„ฑ ๊ธฐ๋„ ์งˆํ™˜ ๋“ฑ๊ณผ ๊ฐ๋ณ„ ํ•„์š”

F2. Gender

(1) ์—ฌ์„ฑ์ด ๋†’์€ PEF์—์„œ๋„ ํ˜ธํก๊ณค๋ž€์„ ๋” ๋งŽ์ด ๋Š๋ผ๊ณ , ED ๋ฐฉ๋ฌธ ํ›„ ์žฌ๋ฐœ๋„ ๋” ๋งŽ์Œ
(2) ์ฃผ๊ธฐ์„ฑ ํ˜ธ๋ฅด๋ชฌ ๋ณ€ํ™” ๋˜ํ•œ ์˜ํ–ฅ์„ ์ค€๋‹ค.

F3. Pregnancy (9ํŒ p626 ์ฐธ์กฐ)

(1) ์ฒœ์‹์œผ๋กœ ์ธํ•œ ๋ชจ์„ฑ๊ณผ ํƒœ์•„ ์‚ฌ๋ง๋ฅ ์ด ๋†’๊ธฐ ๋•Œ๋ฌธ์— ๊ธ‰์„ฑ ๋ฐœ์ž‘์€ ์ตœ๋Œ€ํ•œ์œผ๋กœ ์น˜๋ฃŒํ•˜์—ฌ์•ผ ํ•œ๋‹ค. ์น˜๋ฃŒ๋Š” ๋น„์ž„์‹  ํ™˜์ž์˜ ์น˜๋ฃŒ์™€ ๋น„์Šทํ•˜๋‹ค. โ‘  Oxygen saturation >95% โ‘ก Inhaled ฮฒ2-agonist(albuterol/salbutamol) โ‘ข Inhlaed ipratropium โ‘ฃ Systemic cortocosteroids โ‘ค IV magnesium โ‘ฅ Terbutaline sulfate SC - 0,25mg 20๋ถ„๋งˆ๋‹ค โ‘ฆ Epinephrine์€ uteroplacental circulation์˜ vasoconstriction ๋ถ€์ž‘์šฉ์œผ๋กœ ํ”ผํ•œ๋‹ค
(2) ์ž„์‹ ์—์„œ PaO2๊ฐ€ ๋” ๋†’์€ ๊ฒฝํ–ฅ (โˆต ์ •์ƒ์ ์ธ ๊ณผํ˜ธํก ๋•Œ๋ฌธ์—)
(3) PaO2 < 70ใŽœHg๋‚˜ PaCO2 > 35ใŽœHg๋Š” ์‹ฌํ•œ ํ˜ธํก ๋ถ€์ „์„ ์˜๋ฏธํ•œ๋‹ค.
(4) ์ €์‚ฐ์†Œ์ฆ์˜ ์˜ํ–ฅ์€ ์‚ฐ๋ชจ๔€Ÿฟ๋‹ค ํƒœ์•„์— ๋” ์‹ฌํ•˜๋‹ค.
(5) ฮฒ2 ํ•ญ์ง„์ œ์™€ ํก์ž…์šฉ ์Šคํ…Œ๋กœ์ด๋“œ๋Š” ์ž„์‹  ์ค‘์— ์‚ฌ์šฉ ์•ˆ์ „
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