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: 8486601
• 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/8486601
• 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：有明确证据表明，部署到“持久行动”、“伊拉克自由行动”和“新黎明行动”(OEF/OIF/OND) 的退伍军人暴露于高浓度的颗粒物 (PM)，超出了环境、职业和军事暴露准则。 PM 暴露被认为是心血管疾病发病和死亡的危险因素，并且会增加气道疾病的风险并加剧气道疾病。审查的流行病学表明，OEF/OIF/OND 退伍军人中新报告的呼吸道症状的患病率很高，这严重影响了他们的部署职责，包括他们的体力消耗能力。 尽管有这些回顾性数据和有限的空气采样报告，但仍缺乏前瞻性研究。我们的试点研究将采用综合方法来评估 OEF/OIF/OND 退伍军人与从未部署到该地区的退伍军人的心肺和自主功能。 为了评估心肺功能，每位退伍军人将接受运动挑战，其中包括运动前和运动后（运动后 5、10、15、20 和 30 分钟）的肺活量测定。锻炼将在跑步机上进行，参与者将尝试在目标通气量和心率下维持 6 - 8 分钟的锻炼。对于肺活量测试， 退伍军人将被要求在每个时间点进行最大用力呼气动作。肺活量测定也将在不同的日子重复进行，包括相同的最大用力呼气操作，但将在支气管扩张剂之前和之后进行评估。 当我们预期交感迷走平衡会改变时，我们将评估定速呼吸期间心率变异性的几个指标。此外，我们还将量化脑血流量、血压、心率和通气量，以响应瓦氏动作和姿势变化（即从坐到站）。这种综合评估将表明自主系统调节心血管功能的程度，这取决于精确的反射调节。这些评估可以提供对认可症状背后的病理生理机制的见解，并可以为减轻肺部和心血管疾病等长期不良后果提供干预点。 从这个试点项目中获得的数据将产生关于心肺损伤的程度和严重程度的重要见解——这些数据随后可用于指导康复。此外，自主神经测试的结果在以下方面也具有类似的功效： 检测亚临床或明显的生理变化的存在。通过早期识别，可以采取治疗方案（例如运动疗法、药物治疗）来增强自主神经功能，从而帮助缓解症状并降低慢性病风险。 公共卫生相关性： 项目叙述：在部署到持久行动、伊拉克自由行动和新黎明行动 (OEF/OIF/OND) 后，退伍军人报告出现呼吸问题、运动困难和其他症状。这些症状可能与部署暴露有关，例如区域灰尘和沙子、燃烧垃圾产生的烟雾以及当地工业。研究报告称空气质量很差，但人们对接触这种污染空气可能对退伍军人的短期和长期健康产生的影响知之甚少。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和神经系统功能——这些数据随后可用于指导康复。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 退伍军人患上慢性呼吸系统疾病。