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

超过270万军事人员被部署到阿富汗，伊拉克和其他西南亚国家 并暴露于高水平的直径≤2.5 µm的颗粒物（PM2.5，小到足以存款的颗粒 在小气道和肺泡），从频繁的沙尘暴，焚烧坑烟雾（废物燃烧）， 受管制的工业和车辆来源。以前的研究报告说，部署的人员 出现了与慢性呼吸道疾病相符的症状但是，客观的暴露证据- 相关的健康影响有限。为了解决这一问题，VA合作研究#595“服务和健康” 在部署的退伍军人（阴影）”正在进行检查的假设，更大的累积 在展开时暴露于PM2.5与通过肺活量测定法评估的较低肺功能相关。一个关键 SHADE强度是一种暴露评估方法，将利用历史卫星和区域 可见性记录，以重建在6个中心评估的5000名退伍军人的部署相关PM2.5。 肺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 开展合作项目，系统地检查在接触放射性物质期间对肺部和全身造成的后果， 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）伴和不伴呼吸道症状（咳嗽、喘息、呼吸困难）， 根据CSP#595呼吸健康问卷进行评估，并且几乎没有吸烟史（既往吸烟者 <10包年或从不吸烟者）。在波士顿的提案中，我们将使用CT成像来验证假设 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FEV 1和部署相关的PM2.5相关。 除了通过CT扫描进行结构评估外，作为每个合作提案的一部分，参与者还将 （a）评估全身生物标志物和免疫细胞活化（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）、呼出的氮的附加生理表征 氧化物（嗜酸性气道炎症），IgE和嗜酸性粒细胞增多（过敏）（由VA普吉特湾牵头）。我们将 测试假设，即更多地暴露于与部署相关的PM2.5会导致特定的气道和肺 实质内型，可以区分的功能，结构和生化机制。 我们的三个协调提案将通过全面表征早期 与PM2.5暴露相关的部署相关肺部发现，未来可能用于评估疾病。 所鉴定的与糖尿病相关的疾病类型为识别提供了新的临床应用， 管理和未来的退伍军人与部署相关的肺部疾病的治疗策略。

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.