Pulmonary Diseases in WTC Workers: Symptoms, Function, and Chest CT Correlates

项目摘要 我们的长期目标是描述慢性下气道疾病的异质性组， 在世界贸易中心（WTC）工作人员和志愿者中观察到的疾病（LAD），揭示其风险因素， 合并症，识别具有不良和有利肺功能轨迹和结局的亚组，以及 开发和部署新的成像方法，以调查潜在的肺损伤。等 目标将反过来转化为更好地理解疾病的病理生理学，更有针对性， 个性化的，也许是改变疾病的治疗方法，以及改善的监测和 预防战略。 我们以前的研究建立了有效的临床诊断，并证明了明显的分歧 最大和最多样化的WTC职业队列中的纵向肺功能轨迹。除了我们 通过纵向肺功能分析的专业知识，我们唯一能够证明相关的 定量胸部计算机断层扫描（QCT）指标，有助于验证和表征 与WTC职业暴露相关的疾病过程。QCT彻底改变了 呼吸研究，并提供了重要的和新的信息，间质，近端和 远端气道以及炎症重塑和疾病过程基础的血管变化 进展我们对这一队列的观察还发现了一个亚组， 在成年生活中意外和显著的肺功能增加，表明需要解决的过程 增进理解。我们的研究一直处于职业呼吸研究的前沿。 我们提出了三个具体的目标，部署新的QCT和肺功能测定标志物，以调查早期 肺功能加速受试者的间质和气道损伤及重塑 在纵向和临床监测期间减少或发展慢性阻塞性肺疾病。

Project Summary Our long-term goal has been to characterize the heterogeneous group of chronic lower airway diseases (LAD) observed in World Trade Center (WTC) workers and volunteers, uncover their risk factors and comorbidities, identify subgroups with adverse and favorable lung function trajectories and outcomes, and develop and deploy novel imaging approaches to the investigation of the lung injury underlying them. Such goal will in turn translate into better understanding of disease pathophysiology, more targeted, personalized, and perhaps disease modifying treatment approaches, and improved surveillance and prevention strategies. Our previous studies established valid clinical diagnoses and have demonstrated markedly diverging longitudinal lung function trajectories in the largest and most diverse WTC occupational cohort. Besides our expertise with longitudinal lung function analyses, we were uniquely able to demonstrate associated quantitative chest computer tomography (QCT) metrics that have helped validate and characterize the disease processes that have been associated with WTC occupational exposures. QCT has revolutionized respiratory research, and has contributed important and novel information on interstitial, proximal and distal airway, and vascular changes that underlie the process of inflammatory remodeling and disease progression. Our observations in this cohort have also identified a subgroup who has experienced unexpected and significant lung function gain in adult life, suggesting a process of resolution in need of improved understanding. Our studies have been on the forefront of occupational respiratory research. We propose three specific aims to deploy novel QCT and spirometric markers to investigate early interstitial and airway injury and remodeling in subjects who have experienced accelerated lung function decline or developed chronic obstructive pulmonary disease while on longitudinal and clinical surveillance.