CMA: Pulmonary and Systemic Effects of Deployment Related Particulate Matter Exposures

CMA：与部署相关的颗粒物暴露对肺部和全身的影响

• 批准号: 10436775
• 负责人: ERIC GARSHICK
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10436775
• 关键词: Address; Afghanistan; Alveolus; Asia; Biochemical; Biological Markers; Boston; Caliber; Chronic Obstructive Pulmonary Disease; Clinical; Clinical Research; Cluster Analysis; Complement; Coughing; Country; Deposition; Development; Diffusion; Disease; Dose; Dyspnea; Enrollment; Eosinophilia; Epidemiology; Exhalation; Exposure to; Forced expiratory volume function; Future; Gases; Health; Human Resources; Hypersensitivity; IgE; Immune response; Impairment; Industrialization; Iraq; Lead; Location; Lung; Lung diseases; Medical center; Military Personnel; Nitric Oxide; Obstructive Lung Diseases; Participant; Particulate Matter; Patients; Phenotype; Physiological; Prevalence; Pulmonary Emphysema; Pulmonary Function Test/Forced Expiratory Volume 1; Questionnaires; Records; Reporting; Respiratory Signs and Symptoms; Scanning; Services; Shortness of Breath; Site; Smoke; Smoking History; Source; Spirometry; Structural defect; Symptoms; Testing; Time; United States National Aeronautics and Space Administration; Veterans; Vital capacity; Wheezing; X-Ray Computed Tomography; airway inflammation; airway obstruction; attenuation; base; burn pit; chronic respiratory disease; clinical application; cooperative study; design; disorder subtype; dust storms; eosinophilic inflammation; experience; fine particles; former smoker; health assessment; imaging biomarker; immune activation; injured airway; never smoker; particle; programs; pulmonary function; recruit; respiratory health; small airways disease; sound; treatment strategy; wasting

Over 2.7 million military personnel were deployed to Afghanistan, Iraq, and other countries in Southwest Asia and exposed to high levels of particulate matter ≤2.5 µm in diameter (PM2.5, particles small enough to deposit in the small airways and alveoli) from frequent dust storms, burn-pit smoke (waste burning), and poorly regulated industrial and vehicular sources. Previous studies have reported that deployed personnel have experienced symptoms consistent with chronic respiratory disease. However, objective evidence of exposure- related health effects is limited. To address this concern, VA Cooperative Study #595 “Service and Health Among Deployed Veterans (SHADE)” is being conducted to examine the hypothesis that greater cumulative exposure to PM2.5 while deployed is associated with lower lung function assessed by spirometry. A key strength of SHADE is an exposure assessment approach that will use of historical satellite and regional visibility records to reconstruct deployment-related PM2.5 in 5000 Veterans assessed at 6 centers. A limitation of spirometry is that it is insensitive to early lung disease. This proposal is one of three collaborative projects to systematically examine the pulmonary and systemic consequences of exposure during deployment. We will conduct additional assessments in 280 SHADE participants (70 at each of four sites; Boston, Minneapolis, Seattle, Houston) with and without respiratory symptoms (cough, wheeze, dyspnea) as assessed on the CSP #595 respiratory health questionnaire and with little smoking history (former smokers with <10 pack years or never smokers). In the Boston proposal we will use CT imaging to test the hypothesis that Veterans deployed to Southwest Asia and Afghanistan will have evidence of structural lung disease associated with respiratory symptoms, a lower FEV1, and deployment-related PM2.5. In addition to structural assessment by CT scan, as part of each collaborative proposal, participants will also have (a) assessment of systemic biomarkers and immune cell activation (lead by Minneapolis and Houston VA), and (b) additional physiologic characterization using diffusion capacity (gas exchange), exhaled nitric oxide (eosinophilic airway inflammation), and IgE and eosinophilia (allergy) (lead by VA Puget Sound). We will test the hypothesis that greater exposure to deployment-related PM2.5 results in specific airway and lung parenchymal endotypes that could be distinguished by functional, structural, and biochemical mechanisms. Our three coordinated proposals will complement CSP #595 by comprehensively characterizing early deployment-related lung findings related to PM2.5 exposure that may in the future be used to assess disease. The resultant exposure-related disease types identified provide new clinical applications for the recognition, management, and future treatment strategies for Veterans with deployment-related lung disease.

向阿富汗、伊拉克等西南亚国家部署了超过270万军事人员 并暴露于高浓度的直径≤2.5 µm 的颗粒物（PM2.5，小到足以沉积的颗粒） 频繁的沙尘暴、燃烧坑烟雾（废物燃烧）和不良 受监管的工业和车辆来源。此前的研究报告称，部署的人员 出现与慢性呼吸道疾病一致的症状。然而，暴露的客观证据—— 相关的健康影响有限。为了解决这一问题，VA 合作研究#595“服务与健康 正在部署的退伍军人中（SHADE）”正在进行，以检验以下假设：更大的累积 部署期间暴露于 PM2.5 与肺活量测定法评估的肺功能较低有关。一把钥匙 SHADE 的优势是一种暴露评估方法，将使用历史卫星和区域 可见性记录，以重建在 6 个中心评估的 5000 名退伍军人中与部署相关的 PM2.5。 肺活量测定法的局限性在于它对早期肺部疾病不敏感。该提案是三个提案之一 合作项目系统地检查暴露期间的肺部和全身后果 部署。我们将对 280 名 SHADE 参与者进行额外评估（四个地点各 70 名； 波士顿、明尼阿波利斯、西雅图、休斯顿）有或没有呼吸道症状（咳嗽、喘息、呼吸困难） 根据 CSP #595 呼吸健康调查问卷进行评估，几乎没有吸烟史（以前吸烟者） <10包年或从不吸烟者）。在波士顿提案中，我们将使用 CT 成像来检验假设 部署到西南亚和阿富汗的退伍军人将有结构性肺病的证据 与呼吸道症状、较低的 FEV1 以及与部署相关的 PM2.5 相关。 除了通过 CT 扫描进行结构评估之外，作为每个合作提案的一部分，参与者还将 (a) 对全身生物标志物和免疫细胞激活进行评估（由明尼阿波利斯和休斯顿牵头） VA）和（b）使用扩散能力（气体交换）、呼出的硝酸的附加生理特征 氧化物（嗜酸性气道炎症），以及 IgE 和嗜酸性粒细胞增多（过敏）（由 VA Puget Sound 领导）。我们将 检验以下假设：更多地接触与部署相关的 PM2.5 会导致特定气道和肺部损伤 可以通过功能、结构和生化机制来区分的实质内型。 我们的三个协调提案将通过全面描述早期特征来补充 CSP #595 与 PM2.5 暴露相关的部署相关肺部检查结果可能在未来用于评估疾病。 由此确定的与暴露相关的疾病类型为识别提供了新的临床应用， 管理以及患有与部署相关的肺部疾病的退伍军人的未来治疗策略。