Lauren M Zell-Baran1, Silpa D Krefft2, Camille M Moore3, Jenna Wolff4, Richard Meehan5, Cecile S Rose5. 1. National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, CO, USA. Electronic address: Zell-BaranL@njhealth.org. 2. National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, CO, USA; Veterans Administration Eastern Colorado Health Care System, Division of Pulmonary and Critical Care Medicine, Aurora, CO, USA; University of Colorado, School of Medicine, Aurora, CO, USA. 3. National Jewish Health, Center for Genes, Environment and Health, Denver, CO, USA; University of Colorado, Department of Biostatistics and Informatics, Aurora, CO, USA. 4. National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, CO, USA. 5. National Jewish Health, Division of Environmental and Occupational Health Sciences, Denver, CO, USA; University of Colorado, School of Medicine, Aurora, CO, USA.
Abstract
RATIONALE: Military deployments to austere environments since November 9, 2001 may put "deployers" at risk for respiratory disease. Sensitive, noninvasive tools for detecting large and small airways injury are needed to identify early disease and help inform management for this at-risk population. OBJECTIVES: We examined multiple breath washout (MBW) as a tool for identifying deployment-related airways disease and assessed host and exposure risk factors compared to healthy controls. METHODS: Between March 2015 and March 2020, 103 healthy controls and 71 symptomatic deployers with asthma and/or distal lung disease completed a questionnaire, spirometry and MBW testing. SAS v. 9.4 was used to compare MBW parameters between deployers and controls via univariate analyses and adjusted for demographic factors using multiple linear regression. MEASUREMENTS AND MAIN RESULTS: Deployers were significantly more likely than controls to have an abnormal lung clearance index (LCI) score indicating global ventilation inhomogeneity. Adjusting for sex, smoking status, smoking pack-years and body mass index, LCI scores were significantly more abnormal among those with deployment-related asthma and distal lung disease compared to controls. The unadjusted variable Sacin (a marker of ventilation inhomogeneity in the acinar airways) was higher and thus more abnormal in those with both proximal and distal airways disease. Deployers who reported more frequent exposure to explosive blasts had significantly higher LCI scores. CONCLUSIONS: This study demonstrates the utility of MBW in evaluating exposure-related airways disease in symptomatic military personnel following deployment to austere environments, and is the first to link exposure to explosive blasts to measurable small airways injury.
RATIONALE: Military deployments to austere environments since November 9, 2001 may put "deployers" at risk for respiratory disease. Sensitive, noninvasive tools for detecting large and small airways injury are needed to identify early disease and help inform management for this at-risk population. OBJECTIVES: We examined multiple breath washout (MBW) as a tool for identifying deployment-related airways disease and assessed host and exposure risk factors compared to healthy controls. METHODS: Between March 2015 and March 2020, 103 healthy controls and 71 symptomatic deployers with asthma and/or distal lung disease completed a questionnaire, spirometry and MBW testing. SAS v. 9.4 was used to compare MBW parameters between deployers and controls via univariate analyses and adjusted for demographic factors using multiple linear regression. MEASUREMENTS AND MAIN RESULTS: Deployers were significantly more likely than controls to have an abnormal lung clearance index (LCI) score indicating global ventilation inhomogeneity. Adjusting for sex, smoking status, smoking pack-years and body mass index, LCI scores were significantly more abnormal among those with deployment-related asthma and distal lung disease compared to controls. The unadjusted variable Sacin (a marker of ventilation inhomogeneity in the acinar airways) was higher and thus more abnormal in those with both proximal and distal airways disease. Deployers who reported more frequent exposure to explosive blasts had significantly higher LCI scores. CONCLUSIONS: This study demonstrates the utility of MBW in evaluating exposure-related airways disease in symptomatic military personnel following deployment to austere environments, and is the first to link exposure to explosive blasts to measurable small airways injury.
Authors: Besa Smith; Charlene A Wong; Edward J Boyko; Christopher J Phillips; Gary D Gackstetter; Margaret A K Ryan; Tyler C Smith Journal: J Occup Environ Med Date: 2012-06 Impact factor: 2.162
Authors: M R Miller; J Hankinson; V Brusasco; F Burgos; R Casaburi; A Coates; R Crapo; P Enright; C P M van der Grinten; P Gustafsson; R Jensen; D C Johnson; N MacIntyre; R McKay; D Navajas; O F Pedersen; R Pellegrino; G Viegi; J Wanger Journal: Eur Respir J Date: 2005-08 Impact factor: 16.671
Authors: Francesca S M Tang; Sandra Rutting; Catherine E Farrow; Katrina O Tonga; Joanna Watts; Jessica R Dame-Carrol; Amy Bertolin; Gregory G King; Cindy Thamrin; David G Chapman Journal: Respirology Date: 2020-02-05 Impact factor: 6.424
Authors: Michael J Morris; Robert J Walter; Edward T McCann; John H Sherner; Christina G Murillo; Brian S Barber; John C Hunninghake; Aaron B Holley Journal: Chest Date: 2020-02-01 Impact factor: 9.410
Authors: Paul A Harris; Robert Taylor; Brenda L Minor; Veida Elliott; Michelle Fernandez; Lindsay O'Neal; Laura McLeod; Giovanni Delacqua; Francesco Delacqua; Jacqueline Kirby; Stephany N Duda Journal: J Biomed Inform Date: 2019-05-09 Impact factor: 6.317
Authors: Bruce R Thompson; Jo A Douglass; Matthew J Ellis; Vanessa J Kelly; Robyn E O'Hehir; Gregory G King; Sylvia Verbanck Journal: J Allergy Clin Immunol Date: 2013-04-02 Impact factor: 10.793
Authors: Brian L Graham; Vito Brusasco; Felip Burgos; Brendan G Cooper; Robert Jensen; Adrian Kendrick; Neil R MacIntyre; Bruce R Thompson; Jack Wanger Journal: Eur Respir J Date: 2017-01-03 Impact factor: 16.671
Authors: Stephen A Rowan; Judy M Bradley; Ian Bradbury; John Lawson; Tom Lynch; Per Gustafsson; Alex Horsley; Katherine O'Neill; Madeleine Ennis; J Stuart Elborn Journal: Am J Respir Crit Care Med Date: 2014-03-01 Impact factor: 21.405
Authors: Renee Jensen; Sanja Stanojevic; Michelle Klingel; Maria Ester Pizarro; Graham L Hall; Kathryn Ramsey; Rachel Foong; Clare Saunders; Paul D Robinson; Hailey Webster; Kate Hardaker; Mica Kane; Felix Ratjen Journal: PLoS One Date: 2016-06-15 Impact factor: 3.240
Authors: Drew A Helmer; Michael J Falvo; Jennifer H Therkorn; Sean Hu; Anays M Sotolongo; Israel C Christie; Tianshi David Wu; William W Van Doren; Venkata Siva Sai Sujith Sajja; Nisha Jani; Jacquelyn C Klein-Adams Journal: Respir Res Date: 2022-06-10
Authors: Lauren M Zell-Baran; Stephen M Humphries; Camille M Moore; David A Lynch; Jean-Paul Charbonnier; Andrea S Oh; Cecile S Rose Journal: BMC Pulm Med Date: 2022-04-27 Impact factor: 3.320