92.03.01 95.5.24
...4..5... 6...... 7.....8.....11......... 11....... 12.. 17. 21..23. 25.. 28. 30...... 33.. 33 ISAAC 34 35 36 46 47. 48. 49.50 2
3
10% 85 8.6% 18.8%( 1996 SMART (School Management of Asthma Research Team 4
Fillmore (1997 NAEP (1991 1. 2. 3. 4. 1. 2. 3. 80% 4. 80% 5. 6. 80% 7. 95% 5
ISAAC IgE 1. 2. 3. 80% 4. 80% 5. 6. 80% 7. 95% BMI 20±2% ( 6 PEF
ISAAC, 6-7 38 91 13-14 56 155 (International Study of Asthma Allergies in Childhood ISAAC 40 1995-1996 (Asher 1995 ISAAC ISAAC 1~5 ( 7
( ( % 1 / 2 / 80% <20% >1 />2 / 80% 20-30% >1 /, 60-80% >30% 60% >30% 8
0 1 2 3 0~3 9
A B C D E F : ( : A.B. C.D. E.F. A B C D E F : ( : A.B. C.D. E. F. 10
: ( :American of Allerergy, Asthma and Immunology 11
12 ( -46 1.
(Budesonide (Fluticasone propionate, FP (Beclomethasone dipropionate, BDP : A. B. C. 2. ( 3. (Cromones (intal-5 ( 4 6 13
4. 1 2 1 2 2 Zileuton Churg-Strauss Syndrome (CSC 5. (Formoterol (Salmenterol 12 ( 4 6 2 ( 14
15 (Fluticasone propionate (Salmenterol (Seretide (Budesonide (Formoterol (Symbicort : A. ( B. ( 6. (Bricanyl (
16 7. ( 10mg/kg/day ( ( (Relievers (Anticholinergics 1. 4~6
17 2. 4~6 3 10 30-60mg 1-2mg/kg/ 60mg ( 7 3. (30 60 4. 5
18 ( 1 2 3 4 5 6 15 7
( ( 6 18 ( ( 42 46 50 54 57 60 64 68 72 ( 107 117 127 137 145 152 163 173 183 6 134 164 193 223 245 268 297 327 357 8 153 182 212 242 264 287 316 346 376 10 171 201 231 261 283 305 335 365 395 12 190 220 250 280 302 324 354 384 414 14 209 239 269 298 321 343 373 403 432 16 228 258 288 317 340 362 392 421 451 18 247 277 306 336 358 381 411 440 470 6 18 ( ( 44 48 52 56 60 64 68 72 76 ( 112 122 132 142 152 163 173 183 193 6 99 146 194 241 289 336 384 431 479 8 119 166 214 261 309 356 404 451 499 10 139 186 234 281 329 376 424 471 519 12 159 206 254 301 349 396 444 491 539 14 178 226 274 321 369 416 464 511 559 16 198 246 293 341 389 436 484 531 579 18 218 266 313 361 408 456 503 551 599 ( PEF PEF = 100% 1/2PEF + PEF PEF 300 400 Ans 400-300 = 100% 28.57 1/2(400+300 19
20 ( ( ( 80% 20% ( ( 60~80% 20~30% ( 60 30% 2~4 20 1
21 ( ( 2. ( 2. (1
10 15 3 5 (2 2-4 15 4 6 2-4 15 2 3 2 30 12 2 24 (3 3. 6075 4. 15 20 5 10 22
23 5. 10 20 ( ( (
tartrazin benzoate monosodium glutamate ( 1. 2. 3. 4. E 50 C C 20 E C 24
25 ( ( ( 1. 55,
55, 50% HEPA benzoate, pyretoids, pirimiphos methyl, Benzyl benzoate tannic acid 3%, 2. 3. 4. 50% 26
27 5. 6. 7. (1 (2 (3 (4 (5
28 6-12 1. 2. /
29 3. 4. / 8 5.
30 * 1~2 2 * (20kg 5mg prednisolone2 2-4 (30 1~2 4~6 2-4 4~6 20 4-6 (20kg 5mg prednisolone2 2 ( * * 60%80% * * 80% * * 60%
31 ( ( ( ( ( ( ( ( 2-4 ( ( 80% 4 4 (
(1 (2 (3 ; ( / > 80 60-80% <60% ( 2 32
33 p.43
34 ISAAC ISAAC
1. (PEF 2. 3. 4. 5. 6. 7. 35
(kg cm ( ( 1 ( ( A. B. C. D. E. F. G (1 (2 (3 (4 36
37
38
39
40
% 1 / 2 / 80% <20% >1 / >2 / 80% 20-30% >1 / 60-80% >30%, 60% >30% 1 2 3 4 5 6 7 8 ( 1 2 3 4 5 6 7 8 41
( 1 2 3 4 5 6 7 8 9 Theophylline 10 11 42
1 2 3 4 5 6 7 8 9 10 ( 43
( 1 2 3 4 44
45
46 ( Becotide ( Aldecin ( Beclomet (Orion Clenil (Chiesi Beclomethasone Dipropironate Becodisk ( Budesonide Pulmicort ( Duasthma ( Fluticasone Propionate Flixotide ( Sodium Cromoglycate Intal-5 ( Salmeterol Xinafoate Serevent ( Formoterol Fumavate Oxis ( Salmeterol/Fluticason e Seretide ( Formoterol/Budesoni de Symbicort ( Ventoline Ventodisc ( Bricanyl ( Glin ( Terbutaline Sulfate Soter ( Berotec ( Fenoterol ( Deasthma ( Sunchisu ( Beroasma ( Fenoterol Fenol ( Procaterol HCL Meptin Air ( ( 2002
47 / / / mmhg ( l/min
48 / / / mmhg?? l/min * PEF at PEF at PEF at PEF at PEF at PEF at *
49
50 93
93 51
(1 (1996., (2 (1996. -.,EPA-85-1404-09-06 (3 (1994..Acta Paed Sin, 35(1,4 (4 (1997., (5 (1994..,34,195~205 (6 2000., (7 (1999..,7(4, In Press. (8 (2001. -..NSC89-2314-H-003-111 (9, (2001. -ISAAC.,15,23-43 (10 (1999.., 20(3, 18~19 (11 (1995.., 36( B, 9~20 (12 Asher, M I., Keil, U., Anderson, H R., Beasley, R., Crane, J., Martinez, F., Mitchell, E A., Pearce, N., Sibbald, B. Stewart, A W., Strachan, D., Weiland, S K., & Williams, H C. (1995. International study of asthma and allergies in childhood (ISAAC : rationale and methods. European Respiratory Journal, 8(3, 483-491. (13 Christiansen SC, Zuraw BL. Serving the underserved: school-based asthma intervention programs. J Asthma. 2002;39(6:463-472. (14 Harris L. Asthma education for middle school students and staff. J Sch Nurs. 2002;18(2:117-121. (15 Hogan MB, Wilson NW. Asthma in the school-aged child. Pediatr Ann. 2003;32(1:20-25. (16 Golshan M, Mohamad-Zadeh Z, Zahedi-Nejad N, Rostam-Poor B. Prevalence of asthma and related symptoms in primary school children of Isfahan, Iran, in 1998. Asian Pac J Allergy Immunol. 2001;19(3:163-170. (17 Roder I, Kroonenberg PM, Boekaerts M. Psychosocial functioning and stress-processing of children with asthma in the school context: differences and similarities with children without 52
asthma. J Asthma. 2003;40(7:777-787. (18 Webber MP, Carpiniello KE, Oruwariye T et al. Burden of asthma in inner-city elementary schoolchildren: do school-based health centers make a difference? Arch Pediatr Adolesc Med. 2003;157(2:125-129. (19 Yawn BP, Wollan P, Scanlon PD, Kurland M. Outcome results of a school-based screening program for undertreated asthma. Ann Allergy Asthma Immunol. 2003;90(5:508-515. (20 Young NL, Foster AM, Parkin PC et al. Assessing the efficacy of a school-based asthma education program for children: a pilot study. Can J Public Health. 2001;92(1:30-34. (21 Zejda JE, Kowalska M. Risk factors for asthma in school children--results of a seven-year follow-up. Cent Eur J Public Health. 2003;11(3:149-154. 53