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.

超过270万军事人员被部署到阿富汗，伊拉克和西南亚的其他国家 并暴露于高水平的颗粒物物质≤2.5µm直径（PM2.5，颗粒小到足以沉积的颗粒 在小型气道和肺泡中），经常发生沙尘暴，燃烧的烟雾（废物燃烧）和不良 受管制的工业和车辆来源。先前的研究报告说，部署的人员有 经历了与慢性呼吸系统疾病一致的症状。但是，暴露的客观证据 - 相关的健康效果是有限的。为了解决这个问题，VA合作研究＃595“服务与健康 在部署的退伍军人（阴影）中，正在进行以下假设：累积性更大 部署时暴露于PM2.5与通过肺活量测定法评估的较低肺功能有关。钥匙 阴影的力量是一种曝光评估方法，它将使用历史卫星和区域性 可见性记录以6个中心评估的5000名退伍军人中与部署相关的PM2.5重建。 肺活量测定法的局限性是它对早期肺部疾病不敏感。该提议是三个 协作项目，以系统地检查暴露期间的肺和系统后果 部署。我们将对280名参与者进行其他评估（在四个地点中的每个参与者中有70个； 波士顿，明尼阿波利斯，西雅图，休斯顿），有和没有呼吸道症状（咳嗽，喘息，呼吸困难） 在CSP＃595呼吸健康问卷中进行评估，吸烟史很少（前吸烟者 <10包或从未吸烟）。在波士顿的提案中，我们将使用CT成像检验假设 部署到西南亚和阿富汗的退伍军人将有结构性肺部疾病的证据 与呼吸道症状，较低的FEV1和与部署有关的PM2.5相关。 除了通过CT扫描进行结构评估之外，作为每个协作建议的一部分，参与者还将 具有（a）评估系统性生物标志物和免疫池激活（明尼阿波利斯和休斯顿领导 VA）和（b）使用扩散能力（气体交换），呼出的一氮的其他生理表征 氧化物（嗜酸性气道注射）以及IgE和嗜酸性粒细胞（过敏）（由VA Puget Sound领导）。我们将 检验以下假设，即更多接触与部署相关的PM2.5导致特定气道和肺 实质内型可以通过功能，结构和生化机制来区分。 我们的三个协调提案将通过全面表征早期来完成CSP＃595 与部署相关的肺发现与PM2.5暴露有关的肺发现将来可能用于评估疾病。 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， 管理与部署相关的肺部疾病的退伍军人的管理和未来治疗策略。