Asthmatic patients are generally considered to have an increased risk of mortality compared with subjects without asthma. However, this issue has been less evaluated using nationally representative ...data. Moreover, it is unclear whether respiratory comorbidities other than chronic obstructive pulmonary disease (COPD) are associated with increased mortality in asthmatic patients compared with subjects without. Using a nationally representative sample database, we performed a retrospective cohort study of patients with asthma and age-sex-matched control cohort. We estimated the hazard ratio (HR) and stratified the asthma cohort based on respiratory comorbidities. During a median 8.9-year follow-up, the overall mortality rate was higher in the asthma cohort than in the control cohort (p < 0.001). The hazard ratio (HR) for overall mortality in the asthma cohort compared with the control cohort was 1.13. The effects of asthma on overall mortality were more evident in males, patients under medical aid, and subjects with COPD. Respiratory comorbidities were significantly associated with increased risk of overall mortality in asthmatic patients compared with controls (adjusted HRs; 1.48 for COPD, 1.40 for bronchiectasis, 4.08 for lung cancer, and 1.59 for pneumonia). While asthma and lung cancer showed an additive effect only on overall mortality, asthma and other respiratory comorbidities (COPD, pneumonia, and bronchiectasis) had additive effects only on respiratory mortality. Patients with asthma had a higher overall mortality rate compared with subjects without asthma. Respiratory comorbidities showed an additive effect on overall or respiratory mortality in patients with asthma.
The aim of this study is to examine the impact of tumor necrosis factor inhibitors (TNFI) on nontuberculous mycobacterium (NTM) infection in rheumatoid arthritis (RA) patients in a mycobacterium ...tuberculosis (MTB) endemic area. We selected 1089 TNFI-treated RA patients and 4356 untreated RA patients using propensity-matching analysis according to age, gender, and Charlson comorbidity index using the Korean National Health Insurance Service database from July 2009 to December 2010. Both groups were followed-up until the end of 2016 to measure the incidence of mycobacterial diseases. The incidence rate of NTM in TNFI-treated RA group was similar to those of MTB (328.1 and 340.9 per 100,000 person-years, respectively). The adjusted hazard ratio (aHR) of NTM for TNFI-treated RA compared to untreated RA was 1.751(95% CI 1.105-2.774). The risk of TNFI-associated NTM in RA was 2.108-fold higher among women than men. The age-stratified effects of TNFI on NTM development were significantly high in RA patients aged 50-65 years (aHR 2.018). RA patients without comorbidities had a higher incidence of NTM following TNFI treatment (aHR 1.742). This real-world, observational study highlights the need to increase awareness of NTM in TNFI-treated RA patients in an MTB endemic area.
Response to vaccines generally varies according to individual factors of the vaccinated subjects such as demographics and immune status. While there are various reports of factors associated with ...immunogenicity of mRNA COVID-19 vaccines, little is known about those of adenovirus vector vaccines. We conducted a prospective observational study to assess the relationships of antibody level with age, sex, body mass index (BMI), and adverse reactions (ARs) to an adenovirus vector vaccine, ChAdOx1 nCoV-19. Healthcare workers who planned to receive both the first and second injections of the ChAdOx1 nCoV-19 vaccine at Hanyang University Hospital, Seoul, Korea, were enrolled in the study. Seven days after each injection, participants were asked to complete an online adverse reaction survey. In addition, anti-SARS-CoV-2 spike (S) protein receptor binding domain (RBD) antibody concentration was measured 4 weeks after the second injection. All participants (n = 447, 100%) showed serologic positivity (≥ 0.8 U/mL) 4 weeks after the second injection of ChAdOx1 nCoV-19 vaccine. Furthermore, the anti-SARS-CoV-2 S protein RBD concentration was similar among groups when stratified by age, sex, BMI, or presence and severity of AR; multivariable linear regression found no associations between antibody response to the ChAdOx1 nCoV-19 vaccine and age, BMI, sex, and vaccine-induced ARs. In conclusion, age, sex, obesity, and ARs were not associated with antibody responses after two doses of ChAdOx1 nCoV-19 vaccination.
Poor adherence to medication can lead to treatment failure in healthcare workers (HWCs) with latent tuberculosis infection (LTBI) who are at high risk of developing active tuberculosis. However, the ...factors associated with non-completion of nine-month LTBI treatment with isoniazid (9 H) have not been well studied. We investigated the completion rate and factors affecting adherence to LTBI treatment with 9 H among HCWs. A prospective cohort study of 114 HCWs who were diagnosed with LTBI by QuantiFERON-TB Gold In-Tube tests were performed in a single university hospital between June 2016 and December 2017. All patients received the 9 H LTBI treatment. At each visit, treatment adherence and development of adverse reactions to isoniazid were evaluated via a standard questionnaire. To evaluate the impact of the severity of hepatotoxicity on non-completion of LTBI treatment, we classified hepatotoxicity into two groups: severe hepatotoxicity was defined as alanine aminotransferase >3.0 times the upper normal limit (UNL) with symptoms or = 5.0 times the UNL. Mild hepatotoxicity was defined as alanine aminotransferase>UNL, but not meet the definition of severe hepatotoxicity. Overall, 71 HCWs (62.3%) completed LTBI treatment with 9 H while 43 HCWs (37.7%) discontinued their treatment. Most discontinuation (81.4%, 35/43) occurred during the first three months of treatment. There were no significant differences in age, sex, occupation, or comorbidities between the HCWs who completed and those who discontinued LTBI treatment. However, HCWs who discontinued LTBI treatment had more hepatotoxicity than those who completed treatment (44.2% vs. 11.3%, P < 0.001). Cox proportional hazard analysis revealed that hepatotoxicity is the only factor significantly associated with discontinuation of 9 H LTBI treatment (unadjusted HR = 2.89, 95% CI = 1.62-5.46). In multivariable analysis, not only severe hepatotoxicity (adjusted HR = 7.99, 95% CI = 3.05-20.94) but also mild hepatotoxicity was significantly associated with discontinuation of LTBI treatment (adjusted HR = 2.34, 95% CI = 1.05-5.21). The completion rate of 9 H LTBI treatment was 62.3% among HCWs. While age, sex, occupation, and pretreatment comorbidities were not associated with treatment completion, isoniazid-induced hepatotoxicity significantly affected adherence.
Background The impact of long-term chronic periodontal conditions on the risk of lung cancer could not be accurately evaluated. Our aim was to provide more evidence on the connection between chronic ...periodontitis (CP) and lung cancer using a nationwide dataset. Methods This study used data from the Korean National Health Insurance Service National Sample Cohort. We enrolled 72,658 individuals with CP (CP cohort) between 2005 and 2019 and 1:1 age- and sex-matched controls without CP (non-CP cohort). Results During the median follow-up period of 5.1 (interquartile range, 2.8–8.0) years, 0.56% (n = 405/72,658) of the CP cohort and 0.29% (n = 212/72,658) of the matched non-CP cohort developed lung cancer, with incidence rates of 8.3 and 4.5 per 10,000 person-years. The risk of incident lung cancer was significantly higher in the CP cohort than in the matched non-CP cohort (adjusted hazard ratio = 2.27, 95% confidence interval = 1.94–2.65). The risk of incident lung cancer was 2.45-fold and 2.10-fold higher in mild and moderate-to-severe CP cohorts than in the matched non-CP control. The risk of incident lung cancer was especially higher in the 40–59 age group, females, and never-smokers than their counterparts. Conclusion We demonstrate that the risk of incident lung cancer is higher in individuals with CP than in those without. The risk of lung cancer was especially high in individuals with more severe CP, females, never-smokers, and obese populations.
Pneumonia is one of the most common causes of hospital admissions and mortality, and it is responsible for significant socioeconomic burden worldwide. Neutrophil gelatinase-associated lipocalin ...(NGAL) is a 25-kDa protein, which is involved in iron trafficking and has chemostatic and bacteriostatic effects. NGAL is also known as an early marker of many inflammatory diseases. However, little is known about the role of NGAL in the management of pneumonia. Thus, this study aimed to investigate whether plasma NGAL levels can predict intensive care unit (ICU) admission and in-hospital mortality in patients with pneumonia. This retrospective observational study included 241 adults hospitalized with pneumonia who underwent NGAL measurement. We compared the prognostic values of plasma NGAL with pneumonia severity index (PSI) for prediction of ICU admission and in-hospital mortality. Of 241 patients, 47 (19.5%) died during hospital admission. There was no significant difference between NGAL and PSI for predicting ICU admission (area under the receiver operating characteristic curve AUC of log NGAL vs. PSI, P > 0.999). Although log NGAL was useful in predicting in-hospital mortality, its ability was inferior to that of PSI (AUC of log NGAL vs. PSI, P = 0.008). Multivariable analysis revealed that log NGAL was significantly associated with ICU admission (adjusted odds ratio = 10.76, P < 0.001) and in-hospital mortality (adjusted odds ratio = 5.04, P = 0.004). These results suggest that plasma NGAL level is a useful biomarker for predicting ICU admission and mortality in hospitalized patients with pneumonia.
Short-acting β2-agonist (SABA) use is known to be lower in Korean patients with asthma than in those from other countries, while the rate of asthma exacerbations in Korea is higher than in other ...countries. Thus, an epidemiologic study on SABA use and the relationship between SABA overuse and treatment outcomes in asthma is needed in Korea. We performed a crosssectional study using the National Health Insurance Service-National Sample Cohort 2002– 2012 database. We evaluated the trend of annual SABA use and overuse (prescription of 3 or more SABA canisters/year) and the impact of SABA overuse on mortality. During the study period, the proportion of asthmatic patients who used SABA was approximately 8%–11%, with no significant change in trend. The mean annual SABA use in asthmatic patients was 0.15–0.22 canisters/patient/year and 1.93–2.05 canisters/patient/year in those who used SABA in 12 months. SABA overuse was observed in about 2%–4% of asthmatic patients during the study period. SABA overuse generally tended to increase as the age of patients increased, with triple peaks in the late 20s (3.3%), late 40s (3.1%), and late 70s (3.6%). SABA overuse was associated with mortality (adjusted odds ratio, 1.72; 95% confidence interval, 1.61–1.84). The rate of SABA use was very low in Korean asthmatic patients between 2002–2012. SABA overuse was found in 2%–4% of patients in Korea. SABA overuse was associated with an increased risk of mortality.
Besides obesity, there are limited studies regarding the relationship between the individual components of metabolic syndrome and wheezing. It is largely unknown whether the co-existence of other ...metabolic syndrome components has additive effects on wheezing in the adult population. The association between the individual components of metabolic syndrome and current wheezing was evaluated in adults using data from the Korea National Health and Nutrition Examination Survey from 2008 to 2012. Subjects with metabolic syndrome more frequently had wheezing during the past 12 months (current wheezing) (adjusted odds ratio aOR = 1.56; 95% confidence interval CI = 1.37–1.77) and wheezing during exercise in the past 12 months (aOR = 1.59; 95% CI = 1.37–1.84). Of the individual metabolic syndrome components, central obesity (aOR = 1.48; 95% CI = 1.31–1.66) and low high-density lipoprotein (HDL) cholesterol (aOR = 1.18; 95% CI = 1.05–1.34) were significantly associated with current wheezing. There were no significant associations between the other components of metabolic syndrome (high triglyceride level, blood pressure, and fasting plasma glucose level) and the presence of current wheezing. In addition, the association was much higher when both central obesity and low HDL cholesterol were present together compared to when either of the conditions was present alone (aOR = 1.67; 95% CI = 1.44–1.94). There is a significant association between metabolic syndrome and current wheezing in Korean adults. Of the components of metabolic syndrome, low HDL cholesterol and central obesity are independently and additively associated with the increased rate of current wheezing.
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