Effects of Deployment Exposures on Cardiopulmonary and Autonomic Function

部署暴露对心肺和自主神经功能的影响

• 批准号: 8984837
• 负责人: Michael J. Falvo
• 金额: --
• 依托单位: VA NEW JERSEY HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8984837
• 关键词: Address; Affect; Afghanistan; Age; Air; Air Pollutants; Air Pollution; Attenuated; Blood Pressure; Breathing; Bronchoconstriction; Bronchodilator Agents; Burn injury; Cardiopulmonary; Cardiovascular Diseases; Cardiovascular Physiology; Cardiovascular system; Caring; Cerebrovascular Circulation; Chronic; Chronic Disease; Comorbidity; Controlled Study; Critical Illness; Data; Depressed mood; Development; Diagnosis; Diesel Exhaust; Disease; Dust; Early identification; Environmental air flow; Epidemiology; Equilibrium; Exercise; Exertion; Exposure to; Foundations; Freedom; Functional disorder; Future; Gender; Goals; Guidelines; Health; Healthcare; Heart Rate; High Prevalence; Hospitals; Impairment; Industry; Institute of Medicine (U.S.); Intervention; Iraq; Knowledge; Left; Lung diseases; Military Personnel; Morbidity - disease rate; Nervous System Physiology; Observational Study; Occupational; Odds Ratio; Participant; Particulate Matter; Pathway interactions; Pharmacologic Substance; Physical therapy exercises; Physiological; Pilot Projects; Posture; Prospective Studies; Reflex action; Regulation; Rehabilitation therapy; Reporting; Respiratory System; Risk; Risk Factors; Science; Sea; Secondary to; Services; Severities; Silicon Dioxide; Smoke; Spirometry; Symptoms; System; Testing; Time; United States Agency for Healthcare Research and Quality; Valsalva Maneuver; Vasomotor; Veterans; abstracting; adverse outcome; air sampling; base; cardiovascular risk factor; disorder risk; evidence base; heart rate variability; improved; indexing; insight; lung volume; mortality; operation; outcome forecast; particle; prevent; problems and exercises; prospective; public health relevance; respiratory; respiratory health; response

DESCRIPTION (provided by applicant): Project Summary/Abstract: Evidence is clear that Veterans deployed to Operations Enduring and Iraqi Freedom and Operation New Dawn (OEF/OIF/OND) have been exposed to high levels of particulate matter (PM) that exceeded environmental, occupational and military exposure guidelines. PM exposure is acknowledged as a risk factor for cardiovascular morbidity and mortality, and can increase the risk of and exacerbate airway disease. The reviewed epidemiology indicates a high prevalence of newly reported respiratory symptoms in OEF/OIF/OND Veterans that has significantly affected their deployment duties, including their physical exertion capability. Despite these retrospective data and limited air sampling reports, prospective studies are absent. Our pilot study will take an integrative approach to evaluate cardiorespiratory and autonomic function in OEF/OIF/OND Veterans as compared to Veterans never deployed to the region. To evaluate cardiopulmonary function, each Veteran will undergo an exercise challenge which consists of spirometry before and then serially after exercise (5, 10, 15, 20, and 30 min post-exercise). Exercise will be treadmill-based and participants will try to maintain 6 - 8 minutes of exercise at a target ventilation and heart rate. For spirometric testing, Veterans will be asked to perform a maximal forced expiratory maneuver at each time point. Spirometry will also be repeated on separate day to include the same maximal forced expiratory maneuver, but will be assessed before and after a bronchodilator. As we anticipate altered sympathovagal balance, we will evaluate several indices of heart rate variability during paced breathing. In addition, we will quantify cerebral blood flow, blood pressure, heart rate and ventilation in response to a Valsalva maneuver and postural change (i.e. sit-to-stand). This integrative assessment will provide an indication of how well the autonomic system regulates cardiovascular function, which is dependent on precise reflex regulation. These assessments may provide insight on the pathophysiological mechanisms that underlie endorsed symptoms, and may provide intervention points for attenuating long-term adverse outcomes such as pulmonary and cardiovascular disease. Data derived from this pilot project will yield important insight on the extent and severity of cardiorespiratory impairment - data that may then be used to guide rehabilitation. In addition, results from autonomic testing will be of similar efficacy in detecting the presence of subclinical or overt physiological changes. Through early identification, treatment options (e.g. exercise therapy, pharmaceutical) may be implemented to enhance autonomic function, with the goal of helping to alleviate symptoms and reduce chronic disease risk. PUBLIC HEALTH RELEVANCE: Project Narrative: Following deployment to Operations Enduring and Iraqi Freedom and Operation New Dawn (OEF/OIF/OND), Veterans report breathing problems, difficulty exercising and other symptoms. These symptoms are likely related to deployment exposures, such as regional dust and sand, smoke from burning trash, and local industry. Studies have reported poor air quality, but very little is known about the effect that exposure to this polluted air may have on Veterans' short- and long-term health. We will determine whether deployment-related exposures have affected respiratory and nervous system function in these Veterans - data that may then be used to guide rehabilitation. Ultimately, our long-term goal is early identification and evidence-based therapy to prevent the development of chronic respiratory conditions in this group of OEF/OIF/OND Veterans.

描述（由申请人提供）： 项目摘要/摘要：证据很明显，部署在持久运营的退伍军人以及伊拉克自由与行动新黎明（OEF/OIF/OND）已暴露于超过环境，职业和军事曝光指南的高水平颗粒物（PM）。 PM暴露被认为是心血管发病率和死亡率的危险因素，并可能增加患气道疾病的风险和加剧。审查的流行病学表明，在OEF/OIF/OND退伍军人中，新报告的呼吸道症状的流行率很高，这些症状严重影响了其部署职责，包括其身体劳累能力。 尽管这些回顾性数据和空气采样报告有限，但仍未进行前瞻性研究。与从未部署到该地区的退伍军人相比，我们的试点研究将采用一种综合方法来评估OEF/OIF/OND退伍军人的心肺和自主功能。 为了评估心肺功能，每位退伍军人将经历一项运动挑战，该运动挑战包括运动前后的肺活量测定法（运动后5、10、15、20和30分钟）。锻炼将以跑步机为基础，参与者将尝试以目标通风和心率维持6-8分钟的运动。对于肺活量测试， 将要求退伍军人在每个时间点执行最大的强迫呼气操作。肺活量测定法也将在不同的一天重复，以包括相同的最大强制呼气操作，但将在支气管扩张剂之前和之后进行评估。 正如我们预期的交感神经平衡发生了变化一样，我们将评估节奏呼吸期间心率变异性的几个指数。此外，我们将对瓦尔萨尔瓦（Valsalva）的动作和姿势变化（即坐姿）量化脑血流，血压，心率和通风。该综合评估将提供表明自主系统调节心血管功能的效果，这取决于精确的反射调节。这些评估可能会提供有关认可症状的基础的病理生理机制，并可能为减弱长期不良结局（例如肺和心血管疾病）提供干预点。 从该试验项目得出的数据将对心肺障碍的程度和严重程度产生重要的见解 - 然后可以使用这些数据来指导康复。此外，自主性测试的结果将具有相似的功效 检测亚临床或明显生理变化的存在。通过早期识别，可以实施治疗选择（例如运动疗法，药物）来增强自主神经功能，目的是帮助减轻症状并降低慢性疾病风险。 公共卫生相关性： 项目叙述：部署到持久的行动和伊拉克自由与操作新黎明（OEF/OIF/OND）之后，退伍军人报告呼吸问题，锻炼难度和其他症状。这些症状可能与部署暴露有关，例如区域尘埃和沙子，燃烧垃圾的烟雾以及当地工业。研究报告说，空气质量差，但对这种污染空气的影响可能对退伍军人的短期健康状况很少了解。我们将确定与部署相关的暴露是否影响了这些退伍军人的呼吸道和神经系统功能 - 然后可以用来指导康复。最终，我们的长期目标是早期识别和循证治疗，以防止这组OEF/OIF/OND退伍军人的慢性呼吸条件发展。