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

超过270万名军事人员被部署到阿富汗、伊拉克和其他西南亚国家 并暴露在直径为2.5µm的高浓度颗粒物≤(PM2.5，小到足以沉积的颗粒)中 在小气道和肺泡)，由于频繁的沙尘暴、焚烧坑烟雾(垃圾焚烧)和较差 受管制的工业和车辆污染源。以前的研究报告说，部署的人员已经 出现与慢性呼吸道疾病相一致的症状。然而，接触的客观证据- 相关的健康影响是有限的。为了解决这一问题，退伍军人事务部合作研究#595“服务与健康” 在已部署的退伍军人中(SHADE)正在进行“，以检验更大的累积 部署时暴露于PM2.5与肺功能低下有关，通过肺活量测定法进行评估。一把钥匙 遮阳强度是一种暴露评估方法，将使用历史卫星和区域 在6个中心评估的5000名退伍军人中重建与部署相关的PM2.5的可见性记录。 肺活量测定法的一个局限性是它对早期肺部疾病不敏感。这项提议是三项建议之一 合作项目，以系统地检查接触的肺部和全身后果 部署。我们将对280名阴影参与者进行额外评估(四个地点各70个； 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)为 根据CSP#595呼吸健康问卷进行评估，且几乎没有吸烟史(前吸烟者 有10年烟龄或从不吸烟)。在波士顿的提案中，我们将使用CT成像来检验这一假设 被派往西南亚和阿富汗的退伍军人将有结构性肺部疾病的证据 与呼吸道症状相关，FEV1较低，以及与部署相关的PM2.5。 除了通过CT扫描进行结构评估外，作为每个协作提案的一部分，与会者还将 评估系统生物标记物和免疫细胞激活(由明尼阿波利斯和休斯顿牵头 (A)和(B)使用扩散能力(气体交换)的附加生理特征，呼出的硝酸盐 氧化物(嗜酸性气道炎)、IgE和嗜酸性粒细胞增多症(过敏)(由VA Puget Sound牵头)。我们会 测试以下假设：暴露于与部署相关的PM2.5会导致特定的呼吸道和肺 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的特征来补充CSP#595 与PM2.5暴露相关的部署相关肺部表现，未来可能用于评估疾病。 由此识别的暴露相关疾病类型为识别提供了新的临床应用， 对患有部署相关肺部疾病的退伍军人的管理和未来治疗战略。

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.