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不同类型的慢性下呼吸道 在世贸中心(WTC)工作人员和志愿者中观察到的疾病(LAD)，揭示他们的危险因素和 合并症，确定具有不利和有利的肺功能轨迹和结果的亚组，以及 开发和部署新的成像方法，以调查其下的肺损伤。是这样的 目标将反过来转化为对疾病病理生理学的更好理解，更有针对性， 个人化，也许还可以改变疾病的治疗方法，以及改进的监测和 预防策略。 我们之前的研究建立了有效的临床诊断，并显示出明显的分歧。 最大和最多样化的WTC职业队列中的纵向肺功能轨迹。除了我们的 在纵向肺功能分析方面的专业知识，我们能够独一无二地证明 定量胸部计算机断层扫描(QCT)指标，帮助验证和表征 与WTC职业暴露相关的疾病过程。QCT已经带来了革命性的变化 呼吸系统研究，并在间质、近端和 远端呼吸道，以及炎症重塑和疾病过程中的血管变化 进步。我们在这个队列中的观察也发现了一个子组，他们经历了 成人生活中意想不到且显著的肺功能增加，表明需要解决问题的过程 提高了理解能力。我们的研究一直走在职业性呼吸研究的前沿。 我们提出了三个具体目标来部署新的QCT和肺活量测定标记物来早期研究 经历肺功能加速的受试者的间质和呼吸道损伤和重塑 在纵向和临床监测期间减少或发展为慢性阻塞性肺疾病。

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.