Long-Term Lung Health After Exposure to Chlorine Gas

接触氯气后的长期肺部健康

• 批准号: 7987774
• 负责人: Erik Robert Svendsen
• 金额: $ 64.01万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7987774
• 关键词: Accidents; Acute; Acute Lung Injury; Age; Allergic; Body Weight; Bronchodilator Agents; Byssinosis; Chemicals; Chlorine; Chronic; Cohort Studies; Collaborations; Communities; Community Health; Data; Defect; Diffuse; Disasters; Dose; Double-Blind Method; Dust; Enrollment; Environment; Event; Exhalation; Exposure to; Fibrosis; Follow-Up Studies; Gases; Goals; Gossypium; Health; Industry; Inflammation; Inflammatory; Irritants; Link; Longitudinal Studies; Lung; Lung Inflammation; Lung diseases; Measures; Medical Surveillance; Modeling; Monitor; Natural experiment; Nitric Oxide; Obesity; Occupational; Occupational Exposure; Oxidative Stress; Participant; Persons; Population; Post-Traumatic Stress Disorders; Public Health; Pulmonary Function Test/Forced Expiratory Volume 1; Pulmonary function tests; Questionnaires; Race; Recording of previous events; Research; Research Design; Research Personnel; Respiratory physiology; Sampling; Science; Screening procedure; Series; Services; Smell Perception; Smoke; Smoking; South Carolina; Spirometry; Stress; Testing; Time; Training; Transportation; Work; airway inflammation; atopy; chlorination; chlorine gas; cigarette smoking; cohort; design; experience; functional decline; innovation; prospective; public health relevance; public health research; respiratory; response; sex; weapons of mass destruction

DESCRIPTION (provided by applicant): Chlorine gas is a potential weapon of mass destruction and is one of the most commonly used chemicals [1-5]. Chlorination accidents are common, exposing thousands of people collectively each year [1, 2, 5-16]. A large accident releasing chlorine gas could result in a public health disaster [6, 17]. The acute health effects on the lungs are well documented [1, 7, 9, 18-22], but there has been no large systematic long-term longitudinal cohort study of a population exposed to a single high-concentration chlorine gas event. New science has provided evidence for potential long-term health effects [24], and called for long-term longitudinal study of irritant gas exposed persons for at least 5 years [27]. On January 6, 2005 a train derailment and subsequent 54,422 kg chlorine gas spill occurred in the cotton mill town of Graniteville, South Carolina [28-33]. Several hundred people became immediately sick and thousands were potentially exposed, including millworkers. Millworkers had their lung health monitored for byssinosis from 1980 to 2006. We have a cohort of 8,234 millworkers with at least 3 years of pre-event spirometry data. Millworkers who returned to work after the accident had lung function loss (FEV1) in both 2005 and 2006 that was twice the rate observed in the years immediately before the accident. We will assess differential pre/post-event lung function decline in a sample of millworkers with 3 years of new lung function tests contrasted with data from 3 years pre-event in a natural experiment, using a double-blinded interrupted time-series design nested within a prospective longitudinal cohort study. Hypothesis are: (H1) Lung function decline increases with increasing chlorine gas exposure (H2) Airway responsiveness increases with increasing chlorine gas exposure (H3) Age, sex, race, smoking, post traumatic stress disorder (PTSD), atopy, occupational history of lung-irritant exposures, pre-existing lung disease, and obesity modify the association of exposure to chlorine gas with lung function decline (H4) Increased lung function decline is associated with increased fibrosis (restrictive lung defects) and airway inflammation (obstructive lung defects). Assuming a 5 percent annual attrition, we will enroll 670 millworkers to study 600, including 150 millworkers from each of the 3 validated plume model exposure estimate groups (peak sustained 30-minute concentrations of 0.5 ppm, 2.8 ppm, and 28 ppm chlorine gas outdoors) and 150 unexposed millworkers. We will measure lung function, airway inflammation, indicators of airway fibrosis, atopy, PTSD, and airway responsiveness at 6-10 years post- event. This study is significant because it is the largest general US population ever exposed to a chlorine gas event. Our investigators are strong and capable, having succeeded with public health screening, validated plume modeling, and experience with other disasters. This study has the unique opportunity for strong scientific influence due to the innovative and robust study design, having personal exposure group double blinded, each participant serving as their own control, and confounder data available from before the exposure. PUBLIC HEALTH RELEVANCE: Chlorine gas is a potential weapon of mass destruction and is one of the most commonly used chemicals in industry [1-5]. In a natural experiment, using a double-blinded interrupted time-series design nested within a prospective longitudinal cohort study, we will assess differential pre/post-event lung function decline with 3 years of new post-event lung function test data contrasted with data from 3 years pre-event in a sample of 600 millworkers from our cohort of 8,234 with at least 3 years of pre-event data who were potentially exposed to chlorine gas from the January 6, 2005 chlorine gas accident in Graniteville, South Carolina. This study of the largest general US population ever exposed to a chlorine gas event has the unique opportunity for significant scientific influence due to the innovative and robust study design, having personal exposure group double blinded, each participant serving as their own control, and confounder data available from before the exposure.

描述（由申请人提供）：氯气是一种潜在的大规模杀伤性武器，是最常用的化学品之一[1-5]。氯化事故很常见，每年有数千人集体暴露[1，2，5-16]。一个大的事故释放氯气可能会导致公共卫生灾难[6，17]。对肺部的急性健康影响有充分的记录[1，7，9，18-22]，但尚未对暴露于单一高浓度氯气事件的人群进行大型系统性长期纵向队列研究。新的科学已经为潜在的长期健康影响提供了证据[24]，并呼吁对刺激性气体暴露人员进行至少5年的长期纵向研究[27]。2005年1月6日，南卡罗来纳州的一个棉纺厂小镇Graniteville发生火车出轨事故，随后发生了54，422公斤氯气泄漏事故[28-33]。数百人立即患病，数千人可能受到影响，包括工厂工人。从1980年到2006年，磨坊工人的肺部健康受到了监测。我们有一个8,234名工厂工人的队列，至少有3年的事件前肺量测定数据。在事故发生后重返工作岗位的磨坊工人在2005年和2006年的肺功能损失（FEV 1）是事故发生前几年观察到的比率的两倍。我们将使用嵌套在一项前瞻性纵向队列研究中的双盲中断时间序列设计，通过3年新肺功能检查与自然实验中事件前3年的数据对比，评估工厂工人样本中事件前/事件后肺功能下降的差异。假设是：（H1）肺功能下降随着氯气暴露的增加而增加（H2）气道反应性随着氯气暴露的增加而增加（H3）年龄、性别、种族、吸烟、创伤后应激障碍（PTSD）、特应性、肺刺激物暴露的职业史、先前存在的肺病、和肥胖改变了暴露于氯气与肺功能下降的相关性（H4）肺功能下降增加与纤维化增加相关（限制性肺缺陷）和气道炎症（阻塞性肺缺陷）。假设每年有5%的人员流失，我们将招募670名工厂工人研究600名工人，其中包括来自3个经验证的羽流模型暴露估计组（户外持续30分钟的峰值浓度为0.5 ppm，2.8 ppm和28 ppm氯气）的150名工厂工人和150名未暴露的工厂工人。我们将在事件后6-10年测量肺功能、气道炎症、气道纤维化指标、特应性、创伤后应激障碍和气道反应性。这项研究意义重大，因为它是有史以来暴露于氯气事件的最大的美国普通人群。我们的调查人员强大而有能力，成功地进行了公共卫生筛查，验证了羽流建模，并具有其他灾害的经验。由于创新和稳健的研究设计，本研究具有独特的机会产生强大的科学影响，具有个人暴露组双盲，每名参与者作为自己的对照，以及暴露前可用的混杂数据。 氯气是一种潜在的大规模杀伤性武器，是工业中最常用的化学品之一[1-5]。在一项自然实验中，使用嵌套在前瞻性纵向队列研究中的双盲中断时间序列设计，我们将评估事件前/事件后肺功能下降的差异，3年新的事件后肺功能测试数据与事件前3年的数据进行对比，样本为来自我们的8人队列的600名工厂工人，234名具有至少3年的事件前数据的人，他们可能暴露于2005年1月6日南卡罗来纳州Graniteville氯气事故中的氯气。由于创新和稳健的研究设计、个人暴露组双盲、每名参与者作为自己的对照以及暴露前可用的混杂数据，这项针对美国有史以来最大规模的氯气事件暴露人群的研究具有产生重大科学影响的独特机会。