pissn: eissn: Allergy Asthma Respir Dis 1(3): , September ORIGINAL ARTICLE

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1 pissn: eissn: (3): , September ORIGINAL ARTICLE 소아천식환자에서비염과천식과의관계 : 알레르기비염과비알레르기비염비교 권은별 1, 백지현 2, 김형윤 1, 윤정원 3, 신윤호 2, 지혜미 2, 최선희 4, 한만용 2 1 분당제생병원소아청소년과, 2 차의과학대학교소아과학교실, 3 명지병원소아청소년과, 4 경희대학교의과대학소아과학교실 Relationship between the asthma and rhinitis in asthmatic children: comparison of allergic rhinitis and nonallergic rhinitis Eun Byul Kwon 1, Ji Hyeon Baek 2, Hyeong Yun Kim 1, Jung Won Yoon 3, Youn Ho Shin 2, Hye Mi Jee 2, Sun Hee Choi 4, Man Yong Han 2 1 Department of Pediatrics, Bundang Jaesaeng Hospital, Seongnam; 2 Department of Pediatrics, CHA University College of Medicine, Seongnam; 3 Department of Pediatrics, Myuongji Hospital, Goyang; 4 Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea Purpose: We aimed to determine the prevalence of allergic rhinitis and nonallergic rhinitis, difference in symptoms between allergic rhinitis and nonallergic rhinitis, and the association between lung function and the degree of asthma control in children with asthma. Methods: One hundred seventy patients who were followed-up for asthma treatment at the department of pediatrics of CHA Bundang Medical Center were enrolled in this study. We conducted the questionnaire regarding coexistence of rhinitis, childhood asthma control test (C-ACT), and the basic lung function test. The patients were classified as allergic rhinitis group and nonallergic rhinitis group according to the response to 11 common inhalation and food allergens, and assessed the degree of asthma control and the severity of rhinitis. Results: One hundred thirty patients (73%) were found to have rhinitis. Of these, 79 patients (53%) had allergic rhinitis and 34 patients (20%) had nonallergic rhinitis. The allergic rhinitis group was older than the nonallergic rhinitis group or the nonrhinitis group (7.73 ± 2.85 vs ± 2.48 vs ± 2.70, P< 0.001). Nasal itching sense was more prevalent in the allergic-rhinitis group than in the nonallergic rhinitis group (3.23 ± 1.90 vs ± 1.56, P= 0.036). There was an inverse correlation between the rhinitis and C-ACT (r = 0.329, P< 0.05). Of note, nasal obstruction symptom was highly correlated with C-ACT (r= 0.334, P< 0.001). Conclusion: Allergic rhinitis and nonallergic rhinitis were highly prevalent in the pediatric patients with asthma and both of them had a significantly adverse impact on asthma control by rhinitis-itself. Therefore, regardless of atopic status, clinicians should focus on relieving rhinitis symptoms. ( 2013;1: ) Keywords: Allergic rhinitis, Nonallergic rhinitis, Asthma control 서론비염은매우흔하고삶의질에영향을줄정도로불편한질병중에하나이다. 1) 비염의한형태인알레르기비염은하부기도염증질환인기관지천식과연결되어시간차를두고차례로생기거나동시에생기는경우가많다. 2) 이러한알레르기비염은천식환자의 70 90% 에서동반되고, 3) 알레르기비염의 20 50% 환자에서천식이동반된다. 또한천식발생이비염이없는환자보다알레르기비염환자에서 10배이상높게발생하며 4) 비염증상이심할수록기관지천식증상도심하다. 5) 특히알레르기비염이있는천식환자는중증도도심하고악화도자주재발하며병원입원율, 응급실내원율도높다. 6) 비알레르기비염또한천식의위험요인으로알려져있다. 7) 비알레르기비염증상이없는대조군에비해천식발병률이높고알레르기비염을가진환자들과유사한상관성을보인다. 7) 비알레르기비염의중증도가높으면천명음, 호흡곤란, 운동시숨가쁨, 추위에서의숨참, 추위에서운동시숨가쁨등의증상이두개이상나타 Correspondence to: Man Yong Han Department of Pediatrics, CHA Bundang Medical Center, CHA University College of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam , Korea Tel: , Fax: , drmesh@gmail.com Received: May 7, 2013 Revised: July 30, 2013 Accepted: August 9, The Korean Academy of Pediatric Allergy and Respiratory Disease The Korean Academy of Asthma, Allergy and Clinical Immunology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (

2 Kwon EB, et al. Relationship between the asthma and rhinitis 나는다증상천식 (multi-symptom asthma) 의위험이증가한다. 8) 그러나알레르기비염과달리식품감작, 습진발생, 총 immunoglobulin E (IgE), 혈중호산구수, fractional exhaled nitric oxide, 기관지과민성등과는상관성이없다. 7) 이는알레르기염증반응을뛰어넘는상기도와하기도의연관성에기인하는것으로알려져있다. 7) 이렇게알레르기비염과비알레르기비염이천식과연관되어있다는것은성인에서는잘알려져있지만소아천식환자를중심으로비염동반의유병률, 비염종류에따른천식조절과의상관성에대해서는잘알려져있지않다. 이에본연구는천식을가진소아환자에서알레르기비염과비알레르기비염의유병률과증상, 중증도의차이를확인하고자하였다. 또한비염과천식조절정도의상관성을보고자하였다. 대상및방법 1. 연구대상 2011년 5월부터 2012년 12월까지분당차병원소아청소년과로기관지천식을진단받고치료, 추적관찰을받기위해내원한환자를대상으로하였다. 본연구에서모든환자는폐활량 (spirometry) 과충격진동법 (impulse oscillation system) 폐기능검사를실시하였다. 또한피부단자시험을이용한특이 IgE 검사를시행하였으며, 비염유무에대해조사하였다. 더불어알레르기전반에대한가족력, 과거력과환경요인에대해알아보고자구조화된설문지를사용하여조사하였다. 설문내용에는형제자매수, 알레르기가족력, 출생력, 알레르기질환의의사진단여부, 코골이, 폐렴, 모세기관지염과천식등의질환으로인한입원력, 애완동물소유여부, 가족들의흡연여부, 거주지형태에대해질문한내용이포함되었다. 설문지는환자보호자가작성하도록하였다. 비염의조절정도는시각적비율척도 (visual analog scale, VAS) 9) 로, 천식조절정도는소아천식조절점수 (childhood asthma control test, C-ACT) 설문지 10) 를활용하여평가하였다. 이모든검사와설문조사에응한환자들만을대상으로연구를진행하였다. 연구시행전 4주이내에상기도나하기도의호흡기감염의증상을보이거나최근 6개월내에천식의급성악화로전신스테로이드를투여받았던경우는연구대상에서제외하였다. 2. 특이 IgE 검사알레르겐양성여부는피부단자시험을활용하였다. 총 11종 (Allergo Pharma, Steinbeck, Germany) 의주요흡입또는식품항원을사용하였다. 이에는집먼지진드기두종류 (Dermatophagoides pteronyssinus, Dermatophagoides farina), 동물털 mix (cat, dog, hamster, guinea pig, rabbit), 나무류 I (alder, hazel, poplar, elm, willow), 나무류 II (birch, beech, oak, plane), 곰팡이 mix (Alternaria tenuis, Botrytis cinerea, Cladosporium herbarum, Curvularia lunata, Fusarium moniliforme, Helminthosporium halodes), 잔디류 (velvet, orchard, rye, timothy, kentucky blue, meadow fescue), 잡초류 (mugwort, nettle, dandelion, plantain), 우유, 달걀, 땅콩이포함되었다. 알레르겐으로단자검사시행한 15분후팽진의크기가 3 mm 이상이면양성으로판정하였다. 11) 3. 용어정의천식의진단은만성기침, 호흡곤란, 천명의전형적인증상을반복적으로보인경우로하였다. 아토피천식은비염유무와상관없이특이 IgE가양성인경우로하였고, 특이 IgE가음성인경우에는비아토피천식으로하였다. 비염은감기없이평상시콧물, 코막힘, 재채기또는코간지러움을호소하는경우로하였다. 알레르기비염은비염증상이있으면서항원특이 IgE검사에양성일때, 비알레르기비염은비염증상은있으나특이 IgE가음성일때로하였다. 12) 그러므로대상군을알레르기비염, 비알레르기비염과비염음성군으로나누어연구하였다. 4. 비염중증도비염환자에서비염증상의지속기간, 수면방해, 일상생활이나운동의방해, 기타성가신증상과전반적인증상의중증도등에대한항목을조사하였으며이를토대로 allergic rhinitis and its impact on asthma (ARIA) 가이드라인에따라비염중증도를분류하였다. 13) 5. 비염과천식조절정도비염환자에서재채기, 콧물, 코간지러움과코막힘의조절정도를조사하였다. 각항목에대해경증 1점부터중증 7점까지점수를주고이에대한점수를합산하여 VAS 점수를구하였다. 9) 소아천식조절정도는 Liu 등 10) 이검증한 C-ACT의한국어번역본을저작권소유자인 GlaxoSmithKline (GSK) 로부터허락을받아사용하였다. C-ACT 는소아가직접선택하는 4개의항목과부모가선택하는 3개의항목으로구성되어있으며, 각각의항목들은천식증상, 기침, 천명, 야간및주간증상에대한질문으로이루어져있다. 소아가선택하는 4개의항목은중증 1점부터경증 4점까지의점수를주었으며, 부모가선택하는 3개의항목은중증 1점부터경증 5점까지의점수를주어 7개항목의점수를합산하여총점수를구하였다. 6. 폐기능검사폐활량과충격진동법은 MS-IOS Digital instrument (Erich Jaeger AG, Würzburg, Germany) 를사용하였다. 먼저충격진동법에의한기도저항 (resistance at 5 Hz, Rrs 5) 과유도저항 (reactance at

3 권은별외 소아천식환자에서비염과천식과의관계 Hz, Xrs 5) 측정은인위적인신호없이, 최소한 15초이상적절한신호가지속될때적합한것으로간주하였다. 적정한결과를얻기위해최소한 3번측정을반복하였다. 14) 제조사의매뉴얼에따라매일기계보정을하였다. 폐활량기에의한 1초간강제호기량 (forced expiratory volume in 1 second) 측정은아이들이좀더쉽고오래숨을내쉴수있도록기계화면상에보이는촛불을불어끄는행위혹은풍선을부는행위등의장려프로그램 (incentive program) 을이용하였다. 학동전기연령의소아에서폐활량측정법의적합성과반복성을만족시키기위해 1) 검사시작기준, 2) 두번결과의반복성, 3) 인위성 (artifact) 이없는세조건을충족할때로하였다. 14) 각폐기능검사의결과는 z score로표기하였고 z score는 IOS 제조사에서 Dencker 등 15) 이제시한 ( 측정값 평균값 )/( 표준편차 ) 를이용하였다. 7. 통계알레르기비염, 비알레르기비염과비염음성군으로분류하여세집단간의차이 ( 나이, 성별, C-ACT, 폐기능검사소견 ) 를분산분석 (analysis of variance) 을이용하여확인하였으며, 사후분석은 Scheffe 검정을이용하였다. 알레르기비염과비알레르기비염환자의증상과중증도비교는대응표본 t 검정을이용하여분석하였다. 비염증상에대한점수 (VAS score) 와천식조절검사사이의상관성은 Pearson correlation을이용하였다. 이모든분석은 IBM SPSS ver (IBM Co., Armonk, NY, USA) 을이용하여실시하였다. 결과 1. 연구대상자의특징연구대상자 170명 ( 남자 105명 ) 의평균나이는 6.84±2.84세 (95% confidence interval [CI], ) 였다. 특이 IgE 양성은 110 명 (64.7%) 이었다. 천식조절점수는 20.95±4.44 (95% CI, ), 1초간강제호기량의예측치는 93.10%±17.76% (95% CI, ) 였다. 그리고충격진동법을이용하여측정한 Rrs 5 와 Xrs 5 의 z score는각각 0.96±1.63 (95% CI, ) 와 0.50± 0.82 (95% CI, 0.63 to 0.37) 였다 (Table 1). 2. 비염에따른분류알레르기비염환자의평균나이는 7.73±2.85세, 비알레르기비염환자는5.97±2.48세로비알레르기비염환자군이더어렸다 (P = 0.008). 비염음성군의평균나이또한 6.12±2.70세로알레르기비염군보다통계적으로유의하게어렸다 (P = 0.004). 비염이없는천식환자57명 (33.5%) 중감작만을보이는환자는총 31명 (54.4%) 으로평균나이는 7.26±2.73세, 감작이없는군은 5.5±2.3세로감작군에서나이가더많았다. 그러나알레르기비염과비알레르기비염군에서성별, 소아천식조절점수, 부모의알레르기질환력, 예측 1초간강제호기량, Rrs 5, Xrs 5 에는통계적의미있는차이가없었다 (Table 2). Table 1. Clinical characteristics of the patients Characteristic Value 95% CI Age (yr) 6.84± Male gender 105 (61.8) Height (cm) ± Sensitization 110 (64.7) Rhinitis symptom 113 (66.5) C-ACT 20.95± Family history Parental asthma 12 (7.1) Parental allergic rhinitis 61 (35.9) Parental atopic dermatitis 8 (4.7) FEV1 (L) 1.38± Predicted (%) 93.10± FEV1/FVC 86.88± Resistance at 5 Hz (kpa/l/sec) 0.88± z score 0.96± to 0.71 Reactance at 5 Hz (kpa/l/sec) 0.35± to 0.33 z score 0.50± to 0.37 Values are presented as mean± standard deviation or number (%). CI, confidence interval; C-ACT, childhood asthma control test; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity. Table 2. Comparison of subjects with allergic rhinitis, nonallergic rhinitis, and nonrhinitis (n= 170) Variable Allergic rhinitis Nonallergic rhinitis Nonrhinitis Patient 79 (46.5) 34 (20.0) 57 (33.5) P-value Age (yr) 7.73± ± 2.48* 6.12± 2.70 < Male gender 55 (69.6) 21 (61.8) 14 (24.5) C-ACT 21.01± ± ± Lung function test FEV1 (pred. %) 91.35± ± ± FEV1/FVC (%) 86.07± ± ± MMEF (pred. %) 82.12± ± ± Xrs5 (z score) 0.44± ± ± Rrs5 (z score) 0.82± ± ± Values are presented as number (%) or mean± standard deviation. Analysis of variance testing with post hoc Scheffe analysis was used to assess differences between groups. C-ACT, childhood asthma control test; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; MMEF, maximum mid expiratory flow; Xrs5, reactance at 5 Hz; Rrs5, resistance at 5 Hz. *Nonallergic rhinitis group versus allergic rhinitis group, P= Nonrhinitis group versus allergic rhinitis group, P=

4 Kwon EB, et al. Relationship between the asthma and rhinitis Table 3. Comparison of severity of rhinitis symptoms in subjects with allergic and nonallergic rhinitis Variable Allergic rhinitis Nonallergic rhinitis P-value Patient 79 (46.5) 34 (20.0) Rhinitis symptom Sneezing 2.62± ± Rhinorrhea 3.03± ± Obstruction 3.94± ± Itching 3.23± ± General 4.00± ± Nasal Severity Mild intermittent 24 (30.4) 11 (32.4) Mild persistent 8 (10.1) 5 (14.7) Mod-severe intermittent 27 (34.2) 13 (38.2) Mod-severe persistent 20 (25.3) 5 (14.7) Values are presented as number (%) or mean± standard deviation. Total VAS score Sum of C-ACT Fig. 1. The relationship between nasal severity scores (total visual analog scale [VAS] score) and childhood asthma control test (C-ACT) (r= and P<0.001). 3. 비염중증도와증상 ARIA 가이드라인에따른비염중증도는알레르기비염환자군에서경증-간헐성비염이 30.4%, 경증-지속성비염이 10.1%, 중등도 / 중증-간헐성비염이 34.2%, 중등도 / 중증-지속성비염이 25.3% 였다. 같은분류방법으로비알레르기비염환자군에서는각각 32.4%, 14.7%, 38.2% 과 14.7% 였다 (Table 3). 소아천식환자에서중등도 / 중증간헐성알레르기비염이 34.2% 로가장높은동반이환빈도를보였고, 이는동반이환된비알레르기비염의중증도 (38.2%) 도유사하였다. 비염증상중코간지러움이알레르기비염에서유의하게높았다 ( 알레르기비염 3.23±1.90 vs. 비알레르기비염 2.44 ±1.56, P = 0.036). 비염의다른증상인재채기, 콧물과코막힘증상은두군간의통계적차이가없었고, 전반적인증상점수또한차이가없었다 (Table 3). 두군간의비염중증도에서의미있는차이는없었다. 또한비염의중증도에따른천식조절점수는차이가없었다 (P = 0.141). 4. 천식조절과비염증상비염조절점수와 C-ACT의상관성은음의상관관계를보였다 (r = 0.329, P<0.001) (Fig. 1). 알레르기비염환자군의상관계수는 (P = 0.048) 로비알레르기비염군의상관계수 (P<0.001) 보다낮았다. 특히비염증상에따른상관관계는재채기 r= (P = 0.172), 콧물 r= (P = 0.002), 코간지러움 r= (P = 0.084) 와코막힘 r = (P < 0.001) 으로코막힘정도와천식조절정도의상관성이가장높았다. 고찰저자들은학동기전후소아천식환자에서알레르기비염과비알 레르기비염의동반이환을비교하였다. 본연구결과알레르기비염은 53%, 비알레르기비염은 20% 로성인천식에비해비알레르기비염은소아천식의주요한동반이환질환임을확인하였다. 또한, 비염중증도와폐기능은두군간의차이가없었지만, 천식과비염조절정도는알레르기비염과비알레르기비염모두에서상관성이있었고, 코막힘정도가천식조절정도와가장관련있는증상임을알수있었다. 그러므로소아천식환자에서알레르기비염뿐만아니라비알레르기비염의동반이환을확인하고, 코막힘같은비염증상을천식증상과같이조절하면증상의호전과삶의질의개선을기대할수있을것으로여겨진다. 1. 천식환자에서비염의유병률성인천식환자에서알레르기비염의유병률은 60 80% 이른다는보고는잘알려져있다 ) 이전의소아천식환자연구에서는성인과마찬가지로비염동반율은 60 80% 에이른다고보고되고있으며 17) 3세전후소아를대상으로한연구 19) 또한비염동반율도 78% 에이른다하였다. 그러나 60 80% 의알레르기비염의동반이환을보인성인천식환자와달리소아천식환자에서알레르기비염의동반율은높지않을것으로여겨진다. 10세소아를대상으로감작유무에따라아토피천식과비아토피성천식으로나누어비교한한연구 20) 에서아토피천식유병률이 10.9%, 비아토피성천식은 9.7% 로유사하였다. 비아토피천식에서알레르기비염을갖고있을가능성이적고, 감작률이나이가들며증가하며역동적으로일어나는일련의과정이므로 21) 아토피천식과비아토피천식의비슷한유병률을보이는소아천식은 60 80% 의알레르기비염의동반이환을보이는성인천식에비하여다소낮은알레르기비염의동반이환을보일것으로여겨진다. 본연구에서도학동기전후천식환자의 73% 에서비염이있었고, 이중알레르기비염은 53% 였다. 기존 244

5 권은별외 소아천식환자에서비염과천식과의관계 의소아천식의비염동반율은 60 80% 라고보고한연구는 19) 피부단자시험없이코간지러움, 재채기, 코분비물의증가, 코막힘등의증상으로알레르기비염을진단하였으며, 3세전후소아천식환자를대상으로한연구에서도 18) 비강내점막상태와비염증상의지속여부로알레르기비염을진단하여흡입항원에대한감작도를진단기준에포함시키지않았다. 22) 이는통상적인알레르기비염의정의 19) 와다르며비알레르기비염이알레르기비염으로진단되었을가능성을배제할수없다. 이와달리 Hamouda 등 23) 의연구에서는 237명의소아천식환자에서 3 5세는알레르기비염이 39%, 6 11 세는 63%, 12 18세는 67% 였다. 흡입항원에감작된환자비율이 6 세이후에통계적으로의미있게증가하였는데, 이는평균연령이 6.8세의환아들을대상으로조사한본연구의알레르기성비염의 53% 와유사한결과이다. 본연구에서비염증세가없으며감작만있는군과감작이없는군의나이가통계적으로의미있는차이를보인것은감작이나이와함께역동적으로변화하며이로인해알레르기비염진단율에차이가난것이라여겨진다. 다만, 본연구에서비경검사나비즙세포검사 (nasal cytology) 를시행하지않았기에비염이있지만현재증상이없는환자들이포함되지않아진단율이낮아졌을가능성이있다. 2세에서 10세천식이있는 130명의소아를대상으로한연구 18) 에서비경검사로전형적인알레르기비염의코점막소견을보이나코증상이없다고대답한환자의비율은 11.9% 였다. 이와반대로보호자가지속적인코증상을호소한환자중 22.3% 는비경검사에서알레르기비염의증거가보이지않았다. 이는비염의유병기간이짧고알레르기항원노출이없는기간에비강이정상소견으로보일수있기에나타난결과이다. 24) 또한보호자가작성한설문지에기초한알레르기비염진단의양성예측도는 81.7%, 음성예측도는 42.9% 였다. 18) 이런점을고려한다면, 향후알레르기성비염진단에특이 IgE 검사와함께비경이나비즙세포검사를시행하여진단의정확도를높인연구가필요하다. 2. 알레르기비염과비알레르기비염의증상차이성인에서알레르기비염과비알레르기비염의증상차이에대한보고는많이있어왔다. 25) 한연구자는알레르기비염에서코간지러움, 재채기와다른알레르기증상이동반하는경우가흔하고, 후비루는비알레르기비염에서더흔하다고보고하였다. 26) 다른연구자는, 27) 알레르기비염에서증상이더심하고알레르기결막염이동반되는경우가많으나, 비알레르기비염의경우두통등의증상이동반되는경우가더많다고기술하였다. 14세미만의소아를대상으로한연구에서성인과마찬가지로코간지러움, 재채기, 눈증상은알레르기성비염에서더흔하고, 부비동염과상기도폐쇄는비알레르기성비염에서더흔하였다. 28) 이런연구결과는알레르기비염환자에서코간지러움증상이더뚜렷한것으로나타난본연구와유사하다. 코간지러움증상의차이는연구대상군이흡입항원감작 률이증가하는시기 29) 와유사하기에만성비염의염증형태인코막힘증상 30) 보다간지러움이특징적으로나타난것이아닌가한다. 천식조절점수, 1초간강제호기량, 충격진동검사기로측정한 Rrs 5, Xrs 5 에서두군간의유의한차이가없었는데, 이는천식환자들을대상으로하였기때문에나타난결과라고여겨진다. 아토피천식과비아토피천식의기본폐기능에서차이가없었다는보고 31,32) 는본연구결과와일치하는소견이다. 천식이알레르기비염과비알레르기비염모두와비슷한연관성을가지며천식과비염의상관성은감작여부보다는상하부호흡기관의염증반응의연관성이더중요하게작용하여나타난결과 7) 로보여지며이때문에기본폐기능또한감작처럼두군에서차이가나타나지않는것이라해석할수있다. 32) 3. 비염중증도와천식조절 ARIA 가이드라인에따른비염중증도를알레르기비염과비알레르기비염에서분류를하였을때두군간에의미있는차이는없었다. 기존의연구에서는 33) 천식환자에서동반하는알레르기비염중가장비율이높은것은경증간헐적비염이라하였고, 3 18세소아환자들을대상으로한연구 23) 에서도경증간헐적비염비율이높았다. 이는중등도-중증간헐적비염이알레르기비염과비알레르기비염에서가장높은빈도를차지한본연구와차이가있다. 그러나경증간헐적비염빈도도비슷한유병률을보였는데이는연구대상군의차이에의한결과로생각된다. 비염의중증도에따른천식조절점수는차이가없었으나이는 18세에서 60세의성인을대상으로한연구 34) 에서비염중증도가높을수록천식조절이어려웠다는연구결과와일치하지않는다. 4. 비염과천식의조절상관도알레르기비염뿐만아니라비알레르기비염모두에서비염조절점수가높을수록천식조절점수가낮아지는경향성을보였다 (r = 0.329, P<0.05). 이는동반된비염증상을조절해야천식의조절이잘되는것을의미한다. 7) 알레르기비염과천식의연관성에대한기전으로전신염증반응과더불어구강호흡에의한알레르겐의흡입의증가가제시되고있다. 35) 그러므로비염증상중코막힘에의한구강호흡이비염과천식의연관성에중요한기전이될것으로여겨진다. 본연구에서도비염증상중코막힘이다른비염증상보다천식조절정도와더높은상관성을보였다 (r = 0.334, P<0.001). 따라서소아천식환자에서알레르기비염과비알레르기비염의증상을모두조절해야하며, 특히코막힘에의한구강호흡의조절이중요하다. 5. 한계와연구의장점본연구의제한점으로단일병원내천식으로치료받은소아환 245

6 Kwon EB, et al. Relationship between the asthma and rhinitis 자를대상으로한단면적인연구로비염과천식의인과관계를확 인할수없었다는점이다. 또한상대적으로연구대상의숫자가적 었고비염의진단시환자본인이호소한증상에기초하거나보호 자가작성한설문지내용에근거하여진단하였기에코점막의상태 등에대한객관적인평가가이루어지지못했다. 또한소아의비알레 르기비염의주요한요인인감염성비염, 비부비동염의동반여부 등, 좀더세분화된비알레르기비염의구분과분석이이루어지지 않았다. 그러나저자들은소아천식환자에서폐활량과충격진동 법의폐기능검사를모두시행하였고, 소아에서알레르기비염과비 알레르기비염의중증도를비교하여그차이점과유사점을밝혀내 려고한것에의미가있다하겠다. 결론적으로, 알레르기비염과같이비알레르기비염도상부호흡 기염증반응과더불어코폐쇄에의한하부호흡기도에영향으로 천식조절에영향을주는것을알게되었다. 그러나두질환에서기 본폐기능차이가없었고이는아토피유무가천식의중증도에영 향을주지않는것으로여겨진다. 하지만비염조절이안될수록천 식조절에어려움이있고, 이는장기적인관점에서환자의천식단 계를악화시키는것은아니나, 환자의주관적인증상및삶의질, 치료의순응도에는영향을미칠수있다. 따라서, 천식과의밀접한 상관성이논의되어왔던알레르기비염뿐만아니라비알레르기비 염도천식의조절에영향을주기에소아천식환아에서도비알레 르기비염도적극적으로치료하여비염증상을조절및개선해야 한다는점을시사한다. REFERENCES 1. Miraglia Del Giudice M, Marseglia A, Leonardi S, La Rosa M, Salpietro C, Brunese FP, et al. Allergic rhinitis and quality of life in children. Int J Immunopathol Pharmacol 2011;24(4 Suppl): Westman M, Stjarne P, Asarnoj A, Kull I, van Hage M, Wickman M, et al. 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1.. Volume 12, Number 1, 6~16, Factors influencing consultation time and waiting time of ambulatory patients in a tertiary teaching hospital Jee-In Hwang College of Nursing Science, Kyung Hee University :