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1 35 24 9 21 TLC 50~70% outgrow 2 10% QOL COPD QOL COPD) COPD) QOL COPD) COPD) FEV1 FEV1 (James, et al.

2 Am J Respir Crit Care Med;2005;171:109)FEV1 FEV1 (James, et al. Am J Respir Crit Care Med;2005;171:109) FEV1 FEV1 FEV1 FEV1 ARCOPDt etc. COPD COPD LTRA COMPACT Effectofmontelukastonlungfunctioninasthm apatientswithallergicrhinitis:analysisfr omthe Effect of montelukast on lung function in asthma patients with allergic rhinitis: analysis from the COMPACT trial (Allergy 2006) MONICA A subgroup analysis of the MONICA study.

3 A 12 month, open label study of add on montelukast treatment in asthma patients (J Asthma2010) RADAR RADAR Montelukast as add on therapy with ICS or ICS+LABA in the management of patients diagnosed with asthma and concurrent allergic rhinitis (Can Respir J2009) ASTAR Treatment and Outcomes in Patients with Asthma and Allergic Rhinitis in the United Kingdom (Int Arch Allergy Immunol2007) PRAACTICAL Asthma control in patients with asthma and allergic rhinitis receiving add on montelukast thf12thttibtiltd(CMdROi2007)therapy for 12 months: a retrospective observational study (Curr Med Res Opin2007)PRAACTICAL PRAACTICALPRAACTICAL 696 15 55 2 12 SABA 12 12 2 (Borderias L et al.)

4 Curr Med Res Opin 2007;23:721-30.) (1 PRAACTICAL 60 55 32 4050 N=69635 * **32 19 2030 18 35 * **10 4 5 010* *1 6 *0 *p= * * p= vs. (Borderias L et al. Curr Med Res Opin. 2007;23:721-30.) PRAACTICAL 85 3 100 N=696* 80 58 9 **24 9 4060 * *0 SABA LABA *p= vs. Borderias L et al. Curr Med Res Opin. 2007;23:721-30. 8 00060 000 8,0007,00060,00050,000 6,0005,00040,000 3,0004,00020,00030,000 1,0002,00010,0002,348 JGLJGLJGLJGLJGL 00 85 88 90 93 95 97 00 01 03 05 08 86 87 89 91 92 94 96 98 99 02 04 06 07 : Mebio. 27: 27 33, 2010 JGL 93 JGL 95 JGL 98 JPGL 00 JPGL 02 JGL 03 JPGL 05 JGL 06 2007 2007 500400440423399 2172/2523 400300 345200 143217175100 1531 333947689314330095 9910015 1920 2425 2930 3435 3940 4445 4950 5455 5960 6465 6970 7475 7980 8485 8990 94 651415 2007 9919242934394449545964697479848994 15 COPD COPD COPD 15 COPD COPD 10 COPD 25 10 10 5040 45 50 55 60 65 70 75 80 QOL 2005 (COPD)

5 85% (COPD) BP Th2 SasakiOetal Sasaki O, et al.

6 (TLC)() (Self) life care Total Health Care (THC)73 PSL, CAM, Theophylline, 2 (Self) life care 60 60 60 60 ATP ATP RCM R CO2 O2 R CO2 CO2 O2 CO2 O2 C O2 M C O O2 O2 O2 < >TCA ATP = R C M R

7 R CO2 CO2 O2 C O2 CO2 M C O2 R C M RCM TLC TLC / / / / centerofgravity:COG) center of gravity: COG) A B C COG Plazter Plazter Plazter 9 12 O2 250 300 m CO2 m MAS

8 / 4 6000 4 3 9000 3 7500 3 7500 3 7000 3 6750 3 6750~6250 3 6750 6250 6-4 4-2 4 Gakken) Gakken)

9 IgA T RA ACPA(anti citrullinated peptide antibody)Smoking + PAD14 ACPAP hiili(PAD)ACPAP orphyromonas gingivalis (PAD)(Klareskog L, et al. Lancet 373:659-72, 2009) ( (NO / / 132132 1321328997+ 97mmHg 8989+ (A) (B)))

10 Yhtt You are what you eat / 300 400m2 75~80% GALT GALT T Treg 1) GALT(gut-associated lympoid tissue) 2) 2) 20/20/60 20/20/60 109 11 (106 9) (106 9) (1069) (105 7)